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Prescribing antidepressants to treat alcohol use disorder can cause cravings: CMAJ

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New guidance to help family doctors detect and manage high-risk drinking addresses a crucial gap in knowledge among both patients and doctors, say its authors, who warn that a common practice to prescribe antidepressants can actually induce cravings for alcohol.

The advice is comprised of 15 recommendations on early detection of alcohol use disorder, withdrawal management, psychological interventions and community-based programs.

It urges routine screening for alcohol use and includes tips on what to avoid, such as prescribing antidepressants without ruling out problematic alcohol use first because selective serotonin reuptake inhibitors (SSRIs) can worsen alcoholism symptoms.

“Unfortunately, all the literature is pretty clear that this is not good practice, whereas those medications that are specifically made for the treatment of alcohol use disorder are almost not used.”

Antipsychotic medications should also not be prescribed off-label to treat alcohol addiction and can exacerbate symptoms, Rehm said.

The guideline was published Monday in the Canadian Medical Association Journal, or CMAJ.

It was developed by the Canadian Research Initiative on Substance Misuse (CRISM) and the BC Centre on Substance Use (BCCSU), with input from a committee of 36 members across the country, including clinicians, academics and people who have experienced alcoholism or are struggling with it.


Click to play video: 'Alcohol poses health risks even in small amounts: report'
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Alcohol poses health risks even in small amounts: report

 


Rehm said committee members hope the guideline will be endorsed by medical associations across the country.

Rehm said screening would only take “half a minute.” Doctors are urged to ask patients how often in the past year they’ve had more than four drinks on one occasion if they’re female, or five drinks if they’re male.

Depending on alcohol use, physicians could advise patients on health risks, suggest ways to cut back or prescribe specific medications for alcohol use disorder. Patients may also be referred to treatment programs in or outside of hospital, based on whether they are at high or low risk of complications such as seizures.

Long-term treatment could also include cognitive behavioural or family-based therapy, peer groups or recovery programs.

Rehm said the treatment rate for alcohol use disorder in Canada is less than 10 per cent compared to an estimated 18 per cent in Britain, where a guideline for doctors was adopted in 2012. He’s not aware of any study that assesses whether more people have since been treated for alcohol use disorder.

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In some provinces, less than two per cent of patients are prescribed medications, such as naltrexone or acamprosate, intended for use with alcohol use disorder and recommended in the guideline, said Rehm, also a senior scientist at the Centre for Addiction and Mental Health and a professor at the University of Toronto’s Dalla Lana School of Public Health.

Patients who report symptoms including depression or insomnia without disclosing alcohol overuse or being asked about it are often prescribed SSRIs, such as Prozac, said Rehm. He said doctors should screen for any connections to alcohol use because 18 per cent of Canadians aged 15 and older will meet the clinical criteria for an alcohol use disorder at some point in their lifetime.

Amanda Hintzen of Toronto said she went to a family doctor when she was “in a spiral” from drinking excessively every day.

“I said, ‘I’m an alcoholic. What can you do to help me?’ I left there with three different prescriptions,” she said, listing one for anxiety, another for insomnia and a third for high blood pressure.

Alcohol affects multiple organs, including the heart and is associated with raised blood pressure. It can also affect sleep, mood and anxiety.

When Hintzen asked for naltrexone by name, she was initially “deterred” from that option, she said of the drug commonly prescribed for patients with moderate to severe alcohol use disorder.

“At that point, I was more dependent on it to function,” she said of alcohol. “The shakes started in the morning.”

Hintzen said she paid for two private rehabilitation programs, the second time in January 2022 where she met many others who had been prescribed medication not intended to treat alcohol addiction.

“Everybody’s on antidepressants. Everyone’s on anti-anxiety medication,” she said.

Dr. Evan Wood, co-chair of the guideline writing committee and an addiction medicine specialist in Vancouver, said most people seeking support for excessive alcohol use do not get evidence-based treatment.

“The guideline really does speak to the failure of institutions to really effectively address the high level of morbidity and mortality in Canada from alcohol use disorder,” said Wood, adding there’s also a need to train more health-care providers.

Alcoholism could be the underlying cause of conditions such as depression, insomnia, anxiety and high blood pressure, but doctors must talk to their patients to find out, Wood said.

“If you don’t stop and talk to people about alcohol, you’ll end up treating their blood pressure with antihypertensive medicine when all they really need to do is cut back on their alcohol use.”

The guidance comes nine months after the Canadian Centre on Substance Use and Addiction (CCSA) released updated guidance that warns of escalating health risks associated with more than two standard drinks per week. Potential health harms include heart disease and cancer, including breast cancer in women.

Wood said the new guideline, funded by Health Canada, will be posted online and webinars will be offered to doctors.

 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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