Over 200,000 preventable deaths by overdose occur each year worldwide. The goals then of International Overdose Awareness Day are to honour those lost, educate to prevent further death & injury, and take action for change.

In Ottawa, Ontario earlier this week, a rally was held to help reduce the stigma surrounding drug overdose and push for a better and more readily available overdose prevention and reversing strategy. "Attendees said more of these deaths can be avoided by being more compassionate to people addicted to drugs" in addition to making the drug naloxone more widely available.

Find out more by checking out the article, "Drug overdose deaths can be curbed by compassion, ralliers say" by CBC News.

Did you know that today, August 31, is International Overdose Awareness Day?

Take some time today to learn more about drug overdose including the signs and symptoms to watch out for. More information and a variety of resources can be found at http://www.overdoseday.com/. You can also follow all the conversations on Twitter by checking out @overdoseday or #OD14! Don't forget to show your support by wearing a silver ribbon or sharing the poster below!

In follow up to the previous post on physician suicide, Dr. Pamela Wible, moved by the fact that most physicians have lost a colleague to suicide or have considered suicide themselves, asked med students, residents and doctors about their own mental health and why they thought doctors turned to suicide.

The letters and comments she received were both moving and powerful, and most importantly they serve as a chilling reminder that we need to give more attention to the physical and emotional well-being of medical students and doctors, in addition to providing better supports and mental health services for those in the medical profession.

While all the letters can be found at KevinMD.com, below is just one example to think about ...

“I am a third-year medical student. I have done very well in both my coursework and national boards. I have publications, research. On paper, I am successful. Yet I find myself thinking about killing myself frequently. Walking into traffic, jumping through the window, just dying in the course of a normal day. Miserable thoughts. I went to the school psychologist to be fixed; I was referred to the school psychiatrist, who looked just as broken as I felt. He offered me antidepressants, if I ‘wanted to take them.’ It doesn’t make sense. I never felt this way before medical school. I loved, I thought, I reflected. I enjoyed being creative, yet now I’m chained by procedure, bureaucracy, and paperwork. There are no creative solutions to problems, there is no effective effort to improve the system except from big top-down initiatives of whatever hierarchy you’re subject to. It’s maddening. I used to watch the stars and smile. I volunteered. I ate well and exercised. I enjoyed playing with children. Now I’m finding a sort of perverse pleasure in patients’ pain; I recognize this as sadistic. I’m shocked. I’m revolted at how far my soul has degraded. It’s insane. I’m chronically sleep deprived. I can’t think or learn when I don’t sleep. I can’t smile without ulterior motive. I’ve confided in my family, who don’t understand the demands or the situation and have told me that ‘it’s my decision to feel sad.’ The [professors] don’t teach; half of them treat us as annoyances. Learning and healing both got lost somewhere. The good teachers leave or are ground down. I’m full of hate and sadness. I’m not sure why I’m still here, but I am. I feel like an echo of myself.”

26 year old NYU School of Medicine Class of 2014 graduate Sean O'Rourke's tragic death two weeks ago brought to light an issue which is rarely spoken of in med school classrooms, between physicians, or more generally in society ... physician ‪suicide‬.

It's important to remember that physicians are not immune to mental illness or suicidal ideation. In fact, as the article below points out "studies have found that doctors suffer from ‪depression‬, post-traumatic stress disorder and the highest suicide rate of any profession."

In her must-read article "When doctors commit suicide, it’s often hushed up" for the Washington Post, family physician Pamela Wible MD, explains the "triple taboo" surrounding physician suicide, explores why so many doctors and ‪‎med students‬ are burnt out which can lead to ‪mental health‬ concerns, and what she's doing (and what others can do) to help stir the conversation and provide support to those in the medical profession who are struggling in silence. Check it out now!

"I pointed out why so many doctors and medical students are burning out: We see far too much pain; to ask for help is considered a weakness; to visit a psychiatrist can be professional suicide, meaning that we risk loss of license and hospital privileges, not to mention wariness from patients if our emotional distress becomes known."

Put your knowledge and skills to the test with the case of a 68 year old man who was brought in to an ED by the police who found him in his car, nearly naked, and quite confused.  The man's wife reports that he has experienced marked personality and behaviour changes over the last three months including going on large spending sprees, becoming threatening to his spouse who had to get a restraining order, and exhibiting delusions and auditory hallucinations.

He has had a significant criminal history, a history of alcohol abuse, and was hospitalized in a psychiatric institution three years ago.  The healthcare team notice signs of mania, psychosis and delirium, and his MoCA on admission scores a 5/30 ...

Can you determine the diagnosis or come up with a treatment plan?

"Confused, and nearly naked after going on spending sprees" by Matthew J Davis, Alexander de Nesnera and David G Folks (Current Psychiatry)

Quite often, individuals diagnosed with a mood disorder like depression or bipolar disorder, are often asked by their healthcare team questions like "How have you been feeling since the last visit?", "When was the last time you remember feeling yourself?", among countless other more specific questions about their moods and how they've waxed and waned over time.

While many try and simply remember their mood patterns and shifts, it can be challenging to accurately keep track of one's feelings and emotions, which are important for healthcare professionals to be aware of as such information can influence medications and therapy strategies.

Fortunately, there are a variety of new apps entering the market that are specifically designed to better assist those with mental health conditions monitor their emotional highs and lows.  Not only do they allow users to quickly and easily keep track of their feelings and how they change over time, but the hope is that one comes to better understand their disorder.   "Over time, the user may discover patterns or certain triggers that always precede a negative or positive episode. Becoming aware of mood patterns allows a person to learn more about their illness and begin to take positive steps to steer their emotions toward a stable and happier life."

To find out more about some of these new apps, check out the article, "Mood Tracking Applications for People with Bipolar Disorder" or find them on iTunes:

• Moody Me - https://itunes.apple.com/ca/app/moody-me-mood-diary-tracker/id411567371?mt=8
• T2 Mood Tracker - https://itunes.apple.com/ca/app/t2-mood-tracker/id428373825?mt=8
• Moodtrack.com - https://itunes.apple.com/us/app/moodtrack-diary-private-mood/id545536364?mt=8

Canadian writer Alison Pick addresses some of the commonly held fears and concerns that surround the use of antidepressants by sharing her own experiences with depression and medication, as well as commentary of mental health advocates and experts, in this great Globe and Mail article "Why we're afraid of antidepressants - even when we take them".

"There’s been a backlash against antidepressants since Prozac Nation came out in 1994. Part of our skepticism is about whether Big Pharma has our health at stake or just their profit. Part of our skepticism is about whether antidepressants actually work. These are valid concerns: According to a report in 2012, 42.6 million prescriptions for antidepressants were filled in Canada that year (our population is not quite 35 million). But there’s a deeper fear, too, that pills are a kind of cheating, a lazy way to deal with a problem, and that they will muffle our true or “essential” selves".