“Just Water” – What Happens When You Can’t Drink Thanks to Your Anti-Depressants

The other day I made an obnoxious crack about having never entered a Wine Cave (see the Democratic primary debate for more info, or better yet…don’t):

That tweet inspired this thread:

So, let me expand on this, because I think it’s an important topic – particularly if you are wondering if and how to drink when you take anti-depressants.

I didn’t start drinking until after I started anti-depressants, which was the start of my 2nd semester, Freshman year. Even in college, I wasn’t much of a drinker, but seriously, half a beer, and WEEEEEEEEEEEEEE. As I grew up that changed a little bit, but never much. On my best day, it was never more than two drinks before I got a decent buzz going. I didn’t mind all that much, since alcohol was never much of a part of my life.

As I grew older I came to appreciate drinking for the taste . I’d go out, have a glass of wine and enjoy my night. Unfortunately, at some point in my early 30s, that went out the window: I had one drink AND FELT LIKE SUPER DEATH.

There was no cause for it: One drink, and massive hangover. I guess that’s what happens when you get older. As a result, I cut alcohol out of my life completely. I haven’t had a drink in two years.

Am I alone in this experience? Hardly. Most SSRIs (the type of anti-depressants I have always taken) are known for causing issues when it comes to alcohol. According to the Mayo Clinic, alcohol can cause problems for people on anti-depressants and may result in an enhancement of symptoms or a greater than expected intoxication. I was never more depressed when I drank, but I absolutely had a lower tolerance.

Furthermore, I always felt like different parts of me would get drunk at different levels. There would be times where my hand-eye coordination was clearly off, but my mind felt sharp as ever, and other times where the reverse was true. It always felt like different parts of me got drunk at different rates, and I always wondered if that was just me or a result of the interaction between the booze and the anti-depressants.

All of this has led to a bit of an “other” experience for me, and me saying “Just water” at more banquets and dinners than I care to think about. Yes, I do feel a bit apart from others at social events. I won’t lie about that, and it is a bit isolating. Thankfully for me, my wife doesn’t drink at all (no reason – she just doesn’t have a taste for alcohol), so we hang out together, stone cold sober.

Do I wish it wasn’t like this? Yeah, I do. I wish I could go to the bar and have drink. I wish I could have  glass of wine with dinner. But, that’s the price you pay for taking medication which saves your life. Sure, I wish it was otherwise, but it’s basically a question of this: Would I rather drink, or would I rather not want to die?

I’ll add that my experience is not necessarily going to be yours, or even likely. You should absolutely talk with a doctor before mixing alcohol and anti-depressants – mine told me that everyone’s experience was different and I should use caution. I never had any experience with alcohol until after I started my anti-depressants, so maybe I would have had a different experience if it had been otherwise. I also never drank much as I got older, so perhaps my experience would have been different if I had.

It’s a shame, but it is what it is. No question – it’s worth it.

Any similar experiences to share? I’d love to hear them – let us know in the comments!

 

A new nasal spray for depression

There’s a new anti-depressant treatment now available: Spravato. It’s related to Ketamine, and if it sounds familiar, there’s good reason for it: It’s biologically related to the party drug “Special K.”

Obviously there are major differences. This drug is a nasal spray and actually given in doctors offices – in other words, you won’t be taking this one home and having it in the morning like a standard anti-depressant. That is because, per this Vox article:

….because it can sedate patients and bring on out-of-body experiences, the FDA is only making it available through certified clinics, where patients are to be monitored for at least two hours after taking the drug.

This drug is meant for “treatment-resistant depression” – meaning those who have tried at least two other major depressant treatments and not had their depression ameliorated.

Operators of these clinics – no surprise – were overwhelmingly supportive of the FDA approval. From a USA Today article:

“This is an enormous deal in terms of access to care,” Levine said. “And the degree of advancement can’t be overstated. This is truly the best new option in over 60 years. And more will be coming down the pike.”

Treatment doesn’t work like standard medication. The same USA Today article told the story of Jonathan Herbst, who credited the drug with saving his life:

A financial services manager in Philadelphia, he began ketamine treatments in August – five or six treatments in the first two weeks, then one maintenance treatment every three or four weeks.

Are there side effects? You bet, and they sounds like a very fun time! They include: feeling disconnected from mind and body, dizziness, nausea, sedation, vertigo, decreased feeling or sensitivity, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk. Additionally:

The FDA warned that esketamine distribution will be tightly controlled due to the potential for abuse, suicidal thoughts and sedation along with possible problems with attention, judgment and thinking.

It’s also worth noting that this drug’s approval did not come without real controversy over its effectiveness. This drug was approved after four clinical trials – three of which lasted only four weeks – and two of those short-term studies “did not meet the pre-specified statistical tests for demonstrating effectiveness.”

What do I think? I honestly have no idea. As usual: I’m not a Doctor. Go talk to your Doctor if you are interested. All I’m trying to do here is update my readers about this new drug. If you have treatment-resistant depression (high five, fellow sad people!), it is certainly worth exploring this option. Just be aware, however, that it’s still a relatively new drug with real side effects and some questions about its effectiveness. At the same time, however, there is clearly enough evidence to warrant its approval by the FDA, and there are absolutely people who credit this drug with making major improvements to their life.

And, as always: If you’ve had any experience with ketamine (good or bad!) or any thoughts to share, please write them in the comments below!

Why the idea of a “pill for loneliness” has me nervous

I came across this article in The Guardian: Scientists are apparently working on a pill for loneliness.

The article does a great job of noting a fundamental truth about humans: We are social creatures. When we are denied social interaction with others, we become depressed and lose our ability to function. As a result of societal changes, a changing family and work structure, the increasing business of human life (and more!), humans are spending less and less time with others. We’re spending more and more time by ourselves. This has frightening implications for our ability to function as a society and as individuals.

Loneliness is bad for you. This is something which The Depression Cure concentrates on, and the Guardian article correctly notes:

Loneliness elevates our risk of developing a range of disorders, including cardiovascular disease, neurodegenerative diseases, cognitive decline, and metastatic cancer. It also weakens the immune system, making us more susceptible to infections. Left untended, even situational loneliness can ossify into a fixed state that changes brain structures and processes…

The cure, in my opinion, has to start on the individual level. We have to prioritize getting off the damn phone and spending time with others. It is very much within our ability to change our lifestyles and re-prioritize how we use our valuable time. The change won’t be easy, but it will come.

That being said, there’s a “promising” line of research creating medication which would “interfere with the ways loneliness affects the brain and body.” Initial studies have shown that the medication reduces perceptions of loneliness among those who take them.

This has me really, really itchy and uncomfortable.

Look, let me just clarify something: I am very pro-medication for treating depression. I’ve been on anti-depressants for almost half my life and I know that they have saved my life. They’ve given me an ability to function which I never would have had otherwise. Medication, combined with therapy, can give someone their life back.

But, that doesn’t mean that we should default to medication when other options are available.

I’ve taken medication for depression – along with millions of others – because traditional therapy wasn’t enough. I viewed it not as a first resort, but as a second/third one (I wouldn’t even say last because there are more intensive forms of therapy, like ECT). But the notion of someone being lonely and turning to a pill has me uncomfortable because there are less radical options which are relatively easily available. 

People who are lonely can undergo a slew of social efforts in order to meet people. Sometimes, this means making yourself attend classes or events. Other times, this means picking up the phone and calling someone in your social network and redeveloping a preexisting connection. But, more often than not, there are ways to deal with loneliness. That’s why I’m nervous here. We can’t just turn to pills to fix something when there are other solutions available.

I suspect I am not completely understanding this. There is something in the article about how taking the medication can actually help people reconnect with others – loneliness can work like depression in that it can create a “cycle” of loneliness – you get lonely and feel too “stuck” to fix it, so you don’t connect with anyone and you withdraw further from your social circle, and then you get more lonely, etc. I get that. But I fear that a pill to cure loneliness will, in the long run, just make us all more lonely.

This is one of the more controversial things I think I’ve said lately about depression and medication, so I’d be curious to hear what you have to say. Am I right or wrong? Let me know in the comments below!

The danger of Benzodiazepians

If you’ve suffered from any sort of mental health disorder, odds are good you are familiar with Benzodiazepians (aka Benzos). Benzos are a class of drugs which are used to treat anxiety and a slew of other conditions, including insomnia, seizures and more. In the short-term, they can be very helpful in getting people through panic attacks. Personally, I’ve used them in the past for rip-roaring anxiety attacks, and they can be helpful in getting through the worst of these condition. When taken in conjunction with therapy or other long-term medication strategies, they are a useful tool in treating mental illness.

Use of benzos has dramatically increased. From 1996-2013, the amount of adults prescribed benzos increased 67%, going from 8.1 million to 13.5 million. Those increases are also seen among individuals who have been prescribed opioids – and that has led to overdose issues.

According to government research, over 30% of opioid overdoses also involve benzos:

Line graph showing causes of death from opioids, benzodiazepines and opioids, and opioids without benzodiazepines between 1999 and 2015

 

Meanwhile, overdose deaths from Benzos have shown frightening increases of late:

Number of Deaths Involving Benzodiazepines

There is also evidence of late that shows that Benzo prescriptions for those with PTSD may increase suicide risk, and that use of Benzos may be tied to an increased risk of Alzheimer’s.

So, am I telling you to throw away your Benzos? No, no, and hell no. When used under a doctors care, and responsibly, Benzo medication can be an important part of any therapeutic regimen. Candidly, when my anxiety was at it’s peak, I walked around with tranquilizers as a “just in case.” Knowing I had those to fall back on gave me the confidence to continue my daily routine in terms of my school, work and social life. If I hadn’t had those, I would have had major difficulties functioning. Eventually, modifications to my regular medication and therapy helped me address my anxiety issues, ones which (thankfully) have not come back.

Benzos can be helpful – you just need to be careful in how you use them!

PS: GO VOTE TOMORROW!