If you've heard of the medication gabapentin before, you'll recall that it is most often used in the treatment of seizures as well as neuropathic pain.

However, addiction medicine specialists have been beginning to use the medication in the management of patients with alcohol use disorder, due to growing evidence that gabapentin, when used at moderate-high doses and compared to placebo, increases abstinence rate and days free of heavy drinking. In addition, studies also demonstrate that gabapentin can reduce withdrawal symptoms and aid in long-term recovery by reducing anxiety, insomnia, and cravings. 

The most common side effect of the medication is sedation and drowsiness. Doses tend to commonly range from 900-1800mg per day in TID divided dosing, but can be as high as 3600mg a day.
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To find out more, check out one of the RCTs that examined the utility of gabapentin for alcohol use disorder:
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1764009

Alcohol withdrawal is not an uncommon presentation in our healthcare system. From patients making ER visits to get help for withdrawal symptoms to patients with a history of heavy or chronic alcohol use being admitted to medical and surgical units where they experience abrupt cessation of their alcohol consumption, it is important that physicians of all specialties be able to determine an individual's drinking history and risk of alcohol withdrawal, as well as be able to manage the withdrawal syndrome accordingly.

While the CIWA protocol is the tool we are most familiar with in terms of assessing a patient's withdrawal symptoms and guiding treatment with medications, in the last few years a new assessment tool has been developed as a way to help providers distinguish between those who are at risk of developing more "complicated" forms of withdrawal that require more intensive monitoring and management, and which are more highly associated with morbidity, mortality, and healthcare resources.

The tool is known as PAWSS "Prediction of Alcohol Withdrawal Severity Scale", and provides physicians with guidelines of both clinical investigations to order and questions to ask patients, to determine one's risk of experiencing severe withdrawal including seizures and delirium tremens. Based on current literature, it is thought that the scale is both highly sensitive and specific, when a score threshold of 4 is used.
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To read more about the PAWSS tool, click here: 
http://alcalc.oxfordjournals.org/content/50/5/509.long

#depression redefined in Dr. Kelly Brogan's new novel ' A Mind of Your Own' where she cites lifestyle imbalances and inflammation as potential causes. She urges her patients to see:
'depression as an opportunity, a sign for us to stop and figure out what’s causing our imbalance rather than just masking, suppressing, or rerouting the symptoms. It’s a chance to choose a new story, to engage in radical transformation, to say yes to a different life experience.'

​http://goop.com/the-roots-of-mental-health-maybe-theyre-not-in-our-heads/?utm_source=bronto&utm_medium=email&utm_term=The+Roots+of+Mental+Health

Depression redefined in Dr. Kelly Brogan's new novel ' A Mind of Your Own' where she cites lifestyle imbalances and inflammation as potential causes. She urges her patients to see: 
​
"Depression as an opportunity, a sign for us to stop and figure out what’s causing our imbalance rather than just masking, suppressing, or rerouting the symptoms. It’s a chance to choose a new story, to engage in radical transformation, to say yes to a different life experience."

For more information, check out:
http://goop.com/the-roots-of-mental-health-maybe-theyre-not-in-our-heads/?utm_source=bronto&utm_medium=email&utm_term=The+Roots+of+Mental+Health

With increasing evidence shedding light on the high rates of burn-out, depression, and suicide among medical students, residents, and new physicians, there has been a new focus on better training our new generation of physicians for dealing with the emotional and psychological strain and stress of medical training. 

Recently, an article was published by Macleans, which reviews some of the new resiliency programs being offered to medical students and residents at programs across the country.

To find out more, click here: ​http://www.macleans.ca/education/new-curriculum-addresses-mental-health-for-young-doctors/

Marine corp veteran and suicide survivor, Timothy Lawson, shares some powerful insights into how we can improve suicide prevention efforts in our communities based on his own experiences as well as his observations from an 18 month study of suicide among the veteran population. 

Specifically, Lawson challenges us to adopt a proactive approach to mental health, and one that incorporates 4 simple components: empathy, a sense of purpose, mentorship, and knowledge that we matter. 
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"If I went to a doctor to show concern about heart disease, he or she would probably recommend nutrition, fitness, and overall care for my cardiovascular system. My doctor would not need to see me at risk for heart disease to recommend these preventative measures. I do not need to show symptoms for my doctor to be proactive about my physical health. Yet the culture around mental health, specifically suicide prevention is reactive. We wait until we see the signs ... then we act. Is the person talking about death often? Are they giving their belongings away? Did they seem distant or detached? I'm here to challenge us all to be proactive about suicidal behaviour and suicide prevention."

In honour of #WSPD and TWLOHA's theme "And I Kept Living' this year, suicide survivors were asked why they kept living. Their answers are beautifully honest, and serve as a real and raw expression of hope, love, and drive for life. 

“I kept living because I realized no matter how I saw myself, there were people who loved me and believed in me. I learned pain wasn’t all there was and that pain meant I was still alive. I still struggle today, but no matter what, I will continue to keep on living.”

“I kept living because a guy I loved couldn’t be in this world anymore. He died by suicide two weeks ago. I’m living for both of us now.”

“I keep living because I am not done breaking the stigma of mental illness by openly, unabashedly telling the story of my struggles with depression and anxiety. I keep living because I know I’m not alone in this fight and I want others to know they aren’t alone either.”

“I kept living because I was meant to. And so are you.”

For the full article, click here: https://themighty.com/2016/09/suicide-prevention-reasons-to-keep-living-ikeptliving/

Did you know that as part of #WSPD, you can get involved by wearing an orange/yellow ribbon which helps to raise awareness for suicide prevention, as well as, show support to those who are suicide survivors or have lost a loved one to suicide.

2016 marks the inaugural year of the universal suicide prevention awareness ribbon.  "Yellow and orange were shown to be the two most frequently used colours in suicide prevention awareness around the world. The Canadian Association for Suicide Prevention (CASP) also believes orange and yellow colours illicit feelings of hope, like the dawning of a sunrise on a new day." The IASP also uses these colours as it reflects the burning flame of a candle, reflecting hope and offering a light in the darkness.

As part of National Suicide Awareness Week, suicide survivors were asked what they wished others understood about their experiences with suicide and suicidal ideation. 

For those of us who have not contemplated suicide ourselves it can be incredibly difficult to understand the mindset of someone who has. Thus, the hope of this article is to shed light on individuals' experiences with #suicide to help eradicate judgment and stigma of suicide, and learn instead how we can help our loved ones who have been through or are going through these troubling times. 

“I don’t really want to die. I just want to kill the way I feel, shut up the incessant chatter in my brain, have a break from feeling like the worst most unworthy and unlovable creature on earth. It is not selfish nor cowardly. It is not to hurt you. It is pure unadulterated desperation.”

“Attempting suicide is not weakness. It can be a cry for help, which takes much strength to ask for when your mind does not want you to. It is a lack of understanding within yourself and from others. It is confusion when you constantly feel like a failure. It is a permanent solution to a temporary feeling that doesn’t feel temporary at all. It is so much more than a mere escape from suffering, and it is sometimes the only conclusion our brains with illnesses can make for ourselves when we don’t know what else to do.”

“I wish my friends and family could understand that it’s not their fault. It wasn’t that I didn’t know they loved me; it was because I was buried so deep. It was too dark for me to see or feel their love. It’s a totally different reality. I just wanted all my struggles and their feelings of helplessness to end. I didn’t want to leave them. I just didn’t have it in me to keep fighting my monsters.”

For the full article, click here: https://themighty.com/2016/09/what-its-like-to-try-to-kill-yourself/