I am very interested in finding better models for representing depressive disorders. Epidemiological models can be very helpful for predicting trends (as with the ways in which climate models are used in climate-change research) and planning policies (they provide a virtual world in which policy options can be explored quickly and inexpensively).  I also think that such models can be useful clinically because they formalize a way of understanding these disorders - whereas currently, clinicians have various informal models that shape their ideas and clinical decisions (e.g. see this p ..read more

Canadian Psychiatry has recently lost one of its leaders, Dr. Roger Bland. One of its emerging leaders, Dr. David Gratzer (also an author of several books as well as a widely read blog) has recently included a feature on Dr. Bland's life - which includes some recollections and reflections by myself. I went Medical School at U of A, where Dr. Bland studied psychiatry and later led the Department. The blog entry may be found here ..read more

Depression is known to be associated with increased mortality. This has little to do with the well-known impact of depression on suicide risk. The risk of suicide, usually in the range of 10-15 per 100,000 person-years, it not enough to make have a big impact on life-expectancy. The bigger effect is due to an elevated frequency of deaths due to the most common causes: cardiovascular disease in particular. However, the treatment of depression has not been shown to diminish cardiovascular mortality in most studies that have looked at this. We've recently explored this association in an epidemiol ..read more

This is an especially controversial topic in psychiatry and in the area of depression, where a wish to die may be a symptom of the illness (thoughts of death or suicide are one of the nine symptoms that comprise the A criteria for major depressive episode in DSM-5) or a response, particularly in treatment resistant depression, to the suffering that is associated with this condition. An interesting discussion of this issue was published in the Canadian Journal of Psychiatry - click HERE to read the piece ..read more

University of Calgary Professor Peter Toohey has produced a fascinating collection images of depression and melancholy in art, which is available to see at his blog, which you can see by clicking here. He is also interested in other emotions, such as boredom and has collections of images for those too. This gallery presents many themes connected to depression through art, including geometry, which is interesting, but there are also religious and musical themes. It is a very interesting experience to scroll through these images. There are several other interesting collections on this same them ..read more

Traditionally, information about psychiatric epidemiology (including the patterns of major depression in Canada) has come from national surveys, such as the two major surveys conducted by Statistics Canada on mental health. One of these was conducted in 2002 and another in 2012. However, a lot of information is available from general health surveys too - and of course from other data sources. The challenge when there are bits and pieces of information available from different sources is to be able to synthesize this information in a meaningful way. Fortunately, there are good statistical tools ..read more

Epidemiologically, the association between smoking and common mental disorders is well characterized, it has been consistently observed in population-based studies. I don't think that the association has been taken very seriously. This is a shame because the settings in which the common mood and anxiety disorders are managed are well situated to help people quit smoking. A recent meta-analysis of studies of smoking cessation that included mental health outcome measures indicated that improvements that follow smoking cessation resemble those of antidepressant medications (when quantified as eff ..read more

For years decision support tools have been available for certain diseases, but not usually for mental health. However, there has recently been an emergence of some on-line calculators for supporting important clinical decisions such as "should I take an antidepressant" and "should I stop my antidepressant." The extent of evidence underpinning the decision support is difficult to discern, but these tools are interesting because they walk a person though a decision making process, soliciting ratings from the decision-maker to inform the final decision ..read more

When I was training (many years ago) in Psychiatry, all of the textbooks used to have long lists of medical conditions that could "cause" depression. The idea was that such lists would serve as a reminder that physical causes should be considered when assessing patients. For example, if there was a reason to suspect hypothyroidism, then that patient's thyroid should be checked. However, in current times this way of thinking - that depression would be distinguished as being "caused" by a physical OR a psychological cause seems very simplistic. Certainly, there are physical mechanisms that could ..read more

Major depression is thought to be more common in the winter than the summer months in Canada (e.g. follow this link), and changing circadian patterns are believed to have a role in this. It has sometimes been suspected that there would be a north-south latitude gradient as well. However, the small number of studies that have looked at this have failed to find an association, see Partonen et al. and Grimaldi et al.  Using data from many large scale Canadian surveys, were able to examine this association with a much larger sample size than was previously possible. These surveys include ..read more