What the 3 best JAMA Psychiatry articles of 2021 can tell us

With the exception of the stock market, it’s hard to describe 2021 without a lot of red numbers. The COVID-19 pandemic has raged. Economic, social and physical tolls have piled up around the world. Among the myriad effects of the pandemic, a slowdown in mental health around the world has emerged as particularly widespread and severe. It has been called a pandemic in itself, characterized by high rates of stress, depression, anxiety and loneliness.

Mental health is achieved in a unique way for each person. However, large datasets like those of the CDC provide much needed information on the scope and specifics of what changed in 2021. Trends from search engines like Google provide further understanding of the value and approaches of mental health solutions (for example, in 2021 , researching “how to maintain mental health” dramatically increases worldwide).

Additionally, some medical journals explicitly categorize their annual articles by level of public interest. These lists can provide important information on themes of emerging scientific interest around specific medical topics.

End December, “Most discussed articles of 2021“have been classified by the JAMA Psychiatry using Altmetric, a rating program based on mentions of articles published in traditional and social media. As a leading journal in the world of peer-reviewed mental health research, JAMA Psychiatry covers a wide variety of scientific topics. Yet this list of the most discussed articles gives particularly important information on interesting and significant mental health topics in 2021.

Here’s a countdown to the top three items on the list, along with information on what their popularity may reveal.

# 3. Trends in U.S. Emergency Department Visits for Mental Health, Overdose and Violence Outcomes Before and During the COVID-19 Pandemic

At the start of the COVID-19 pandemic, the links between infection and health outcomes focused primarily on respiratory function. In the following years, the medical literature supported a much wider range of health effects associated with the virus.

These disparate physiological findings can be seen as the direct results of infection as well as the indirect effects of political, economic and social changes. Of these associations, worsening mental health appears to be of particular importance.

Posted on February 21 JAMAThe third most discussed article of 2021 reviewed nearly 190 million emergency room visits for mental health issues, drug overdoses, attempted suicides, domestic violence, and suspected child abuse and neglect. children. The researchers compared a period of around 7 months in 2020 with a similar period in 2019 (before the pandemic), and found that compared to 2019, there were many more emergency room visits for mental health issues, suicide attempts and drug overdoses in 2020.

The results of this article agree too well with subsequent research. This includes a recent post estimate by the CDC of an almost 30% increase in drug overdose deaths in the United States (to over 100,000) during the period April 2020 to April 2021 compared to the previous year, and paints a disturbing picture of a population struggling to manage their mental health complications from the pandemic.

# 2. How COVID-19 affects the brain

Years after the start of the COVID-19 pandemic, and several deep variations, the “typical” symptoms of COVID-19 infection remain elusive. With symptoms and associated results ranging from anosmia – meaning loss of smell – to stroke, depression, seizures and brain fog, many have proposed that the virus must affect the central nervous system. Exploration of the neurological pathways exploited by the SARS-CoV-2 virus has been the subject of the second most popular JAMA Psychiatry article in 2021.

With nearly 170,000 views and second place on this list, “How COVID-19 Affects the Brain” was released on March 21 and looked at tough questions related to COVID-19 and the brain. The short article explored the pathways by which the virus could directly infect brain tissue as well as the more indirect role of inflammatory cascades that could influence brain function. This article alludes to some of the biological foundations linking COVID-19 to mental health issues.

It should be noted that several of the brain molecular pathways described in this article can be affected not only by direct infection, but also by lifestyle changes that occurred during the pandemic.

The subject of this article has been questioned in a number of articles since this JAMA Psychiatry publication. This stay a little blurry exactly which pathways are exploited by the virus to influence brain function, and to what extent direct infection of the brain contributes to symptoms. This becomes even more pressing with the millions of people currently potentially at risk for neurological symptoms post-acute COVID or “long COVID”.

# 1. Effects of Psilocybin Assisted Therapy on Major Depressive Disorder

The COVID-19 pandemic is now believed to have directly increased the global burden of mental health problems, including anxiety and depression. Yet even before the pandemic, mental health treatments were often ineffective, along with conventional antidepressants. to fail achieve remission in about a third of patients. This reality has been a driving force behind the study of new therapies for mental health, including psychedelics.

With over 302,000 views, “Effects of Psilocybin Assisted Therapy on Major Depressive Disorder” is at the top of the list. JAMA PsychiatryThe list of the most discussed articles of 2021. Unlike the previous two articles, which mainly focus on diagnosis and pathology, this post directly addresses a potential solution in mental health.

This randomized, controlled waiting-list trial involved 24 adults diagnosed with major depression at Johns Hopkins University. Participants received psychedelic psilocybin (the active ingredient in “magic mushrooms”) over two sessions plus supportive psychotherapy.

The researchers found that this therapeutic intervention was associated with rapid improvements in depressive symptoms within 1 day of treatment. The team also saw significant reductions in depression scores in most participants within a week of treatment, as well as scores indicating remission from depression in more than half of participants 4 weeks after the intervention.

Although this is a smaller study, it expanded the existing research on psychedelics (especially psilocybin) for the management of depression. It should be noted that in April 2021, the New England Journal of Medicine published another high profile article on the subject, “Trial of psilocybin versus escitalopram for depression“, a randomized, double-blind, controlled trial comparing the effects of psilocybin alone to psilocybin plus the antidepressant escitalopram, finding no difference in the effects of antidepressants.

Although the data is preliminary, it further opens the door to examining psychedelics as effective mental health interventions. This potential expands even further when we consider recent research on therapeutic such as methylenedioxymethamphetamine (MDMA) for post-traumatic stress disorder.

Put together

JAMA PsychiatryLeading articles from 2021 demonstrate a strong interest in the mental health effects visible inside and outside of the COVID-19 pandemic as well as psychedelic medicine as a potential mental health solution. While much has changed over the course of 2021, all indications are that the surge in mental health issues linked to the pandemic will remain a major concern over the coming year.

The focus on both the brain biology influenced by the pandemic and how unconventional therapies like psilocybin might target these pathways is expected to persist as major public and academic themes into 2022.

Austin Perlmutter, MD, is a certified internal medicine physician and New York Times bestselling author. He received his medical degree from the University of Miami and completed his internal medicine residency at Oregon Health and Science University in Portland. Its goal is to help others improve decision making and quality of life. He is co-author of Brainwashing: Detoxify Your Mind for Clearer Thinking, Deeper Relationships, and Lasting Happiness; written for Psychology today on his blog, The modern brain; and contributes to several health and wellness websites.


Austin Perlmutter is Senior Director of Science and Clinical Innovation at Big Bold Health and owns shares of Empowering Nutrients, LLC and Breathwork Plus, Inc.

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