Achieving Remission in Depression: Raising the Standard of Care
Article in Medscape Psychiatry & Mental Health - "...Despite the widespread use of the SSRIs, it has become increasingly evident that these agents are often less effective in treating depression compared with some dual-acting agents that affect serotonergic and noradrenergic systems. Early studies that reported similar efficacy rates of all the antidepressant classes tended to use response rather than remission rates as the criterion for improvement. Response is generally defined as a 50% decrease in scores on depression scales, such as the Hamilton Depression Rating Scale (HAMD) or the Montgomery Asberg Depression Rating Scale. Yet significant depressive symptoms are often present after a 50% improvement rate is attained. The patient may therefore have symptomatically improved but still not feel well by the response criterion. Alternatively, remission is an indicator of wellness. When remission is achieved, the patient experiences few, if any, symptoms of depression." [Viewing Medscape resources requires registration, which is free].  
comment []    

Insured Americans Drive Surge in Emergency Department Visits
An Issue Brief from the Center for Studying Health System Change - "isits to hospital emergency departments (EDs) have increased greatly in recent years, contributing to crowded conditions and ambulance diversions. Contrary to the popular belief that uninsured people are the major cause of increased emergency department use, insured Americans accounted for most of the 16 percent increase in visits between 1996-97 and 2000-01, according to a study by the Center for Studying Health System Change (HSC). This Issue Brief examines trends in emergency department and other ambulatory care use, focusing on differences among insurance groups. Although insured people accounted for most of the increase in emergency department visits, uninsured Americans increasingly rely on emergency departments because of decreased access to other sources of primary medical care. Emergency department waiting times also have increased substantially, which may lower both insured and uninsured patients’ perceptions of the quality of their care." See also the related press release.  
comment []    

Prisons as Mental Institutions: The Mass Incarceration of the Mentally Ill
Feature article at FindLaw by Joanne Mariner, a lawyer with Human Rights Watch - "...Despite good reasons to limit the incarceration of the mentally ill, the number of mentally ill people behind bars continues to grow. Over the past few decades, the country's prisons and jails have become its default mental health system. Somewhere between two and four hundred thousand mentally ill people are incarcerated, several times more than the number of people living in mental institutions. The results, from a therapeutic, humanitarian, and human rights perspective, are appalling." See also the item posted here last week on the related report by the Human Rights Watch.  
comment []