The nation's addiction to prescription opioid painkillers dominated headlines in psychiatry once again.
In July, President Obama signed into law the Comprehensive Addiction and Recovery Act (CARA), which expanded medication-assisted treatment and access to treatment programs.
Other agencies developed their own plans aimed at stemming the crisis. For example, in March, the CDC issued guidelines that strongly recommended against using opioids for chronic pain. The U.S. Department of Health and Human Services increased the number of addiction patients that a physician can treat with buprenorphine from 100 to 275.
The FDA took up the gauntlet by advancing its own opioid "action plan," focusing on support for development of abuse-deterrent opioids and increased access to the overdose reversal agent naloxone.
Finally, the U.S. Surgeon General weighed in with a landmark report on addiction that calls for an evidence-based public health response.
While public health officials have been focusing on the nation's opioid addiction problems, some have expressed concerns about increased use of medications that treat attention deficit-hyperactivity disorder (ADHD) in adults.
Since 2013, the FDA has received 19,000 reports of complications from ADHD drugs, most of which are stimulants like Adderall (amphetamine and dextroamphetamine), Concerta (methylphenidate), Ritalin (methylphenidate), and Vyvanse (lisdexamfetamine), according to a MedPage Today/Milwaukee Journal Sentinel analysis.
Federal statistics are showing that recreational use of Adderall in particular is increasing among those ages 26 or older, rising nearly four-fold from 2006 t0 2014. National emergency department data showed that cases involving Adderall and Ritalin quintupled over 7 years.
"Amphetamines are grossly overused," Nicolas Rasmussen, PhD, MPH, a medical historian who has studied the history of amphetamines in the U.S., told reporters.
Depression Screen for Teens
The U.S. Preventive Services Task Force called for routine screening of major depressive disorder (MDD) in adolescents.
Overall, the task force found "adequate" evidence that screening can identify depression in adolescents, and that treatment of MDD in adolescents is linked to "moderate" benefit, such as improved depression severity, depression symptoms, or global functioning scores. There were no studies that directly evaluated whether this screening led to improved health outcomes.
The panel noted that there's still insufficient evidence to recommend routine screening for younger children.
Pot and Psychosis Relapse
Two big studies tied marijuana use to psychosis recurrence. A meta-analysis reported in January found that continued use of cannabis after being diagnosed with psychosis was associated with more relapses compared with both discontinued use and never having used cannabis at all. The study also found an association between extended hospital stays and continued cannabis use.
"What it essentially shows us is that if you continue to use cannabis, it's definitely bad for your psychosis because you continue to have relapses and get admitted to the hospital," lead author Sagnik Bhattacharyya, MBBS, MD, PhD, of King's College in London, told MedPage Today. "If you stop using cannabis, then it's not as bad."
Meanwhile, a quasi-experimental investigation within an observational study showed a higher risk of psychosis relapse while using marijuana. The researchers wrote that these results suggest "that it is more likely than not that continued cannabis use after onset of psychosis is causally associated with increased risk of relapse of psychosis, resulting in psychiatric hospitalization."
Alzheimer's Roller Coaster
The investigational anti-amyloid drug solanezumab failed to meet its primary endpoint in the EXPEDITION3 trial, raising questions for some about the soundness of the amyloid hypothesis in Alzheimer's disease.
But lead investigator Paul Aisen, MD, of the University of Southern California in Los Angeles, said the negative results are the "strongest confirmation to date" of the theory, given that the drug appeared to slow cognitive decline even though the findings weren't significant, and many other secondary endpoints favored the drug.
Indeed, a different anti-amyloid drug, Biogen's aducanumab, showed positive results in an early phase Ib study. The drug's mechanism is different from solanezumab's, which may account for the difference.
Much can change between phase I and phase III, but researchers aren't ready to give up on the amyloid hypothesis just yet.
Boost for CBT
Long-term findings from the COBALT trial showed that cognitive behavioral therapy offered both clinical benefit and bang-for-the-buck in treatment-resistant depression in the long haul. CBT improved quality of life to a greater extent than usual care over nearly 4 years, and that benefit came at an annual cost of about $500, researchers found.
"In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value for money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective," the investigators wrote.
Initial results from that trial provided the first evidence of the sustained effectiveness of CBT.
Here are more of this year's top headlines: