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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by gman22 on September 15, 2012, at 17:55:57
I love the effects of alcohol. It relaxes me and it sure feels like it removes anxiety and depression. I feel like the only time it has a negative effect is after consuming really large amounts..(like more than 8 drinks). I know the literature prohibits concomitant use of alcohol with ADs, but my original Pdoc said moderate usage was fine and he would rather see someone go out and drink a few while socializing than sitting at home and doing nothing. I would like some real world opinions on responsible use of alcohol with ADs. I currently take sertaline 25 + nortriptyline 50.
Posted by Raisinb on September 15, 2012, at 23:30:27
In reply to alcohol, meds, posted by gman22 on September 15, 2012, at 17:55:57
I ponder the same question a lot. I've had many doctors tell me not to drink because it makes depression worse and may interfere with the action of antidepressants, but nobody seems to know for sure how it does that, or even if it's been proven that alcohol is so detrimental.
Posted by jono_in_adelaide on September 16, 2012, at 6:29:14
In reply to Re: alcohol, meds, posted by Raisinb on September 15, 2012, at 23:30:27
I dont think a couple of drinks a night would have any dangerous effects with your meds, though nortriptyline can enhance the effects of alcohol, so that you might get drunk on less alcohol than usual.
BTW, 25mg of sertaline is subtheraputic, the minimum effective dose is 50mg...... its like taking half an advil when you have a headache
Posted by phidippus on September 16, 2012, at 22:33:33
In reply to alcohol, meds, posted by gman22 on September 15, 2012, at 17:55:57
What alcohol can and does do to your brain is affect the way your neurons get their firing triggers from glutamate. It infiltrates the glutamate receptors in your synapses, hurting their ability to send off their normal "fire" messages. Alcohol has this impact all across your brainthe parts that control muscles, speech, coordination, judgment, and so on. Keep that in mind the next time you or someone else claims that they drive, golf, or otherwise perform some task better with alcohol's help.
A recent theory, supported by several researchers, pins alcohol's effect on voltage and ligand-gated ion channels that control neuronal activity. Two distinct ligand-gated channels have been identified, inhibitory ones (GABA receptors and strychnine-sensitive glycine receptors) and excitatory ones (N-methyl-D-aspartate (NMDA) and non-NMDA glutamate-activated channels and the 5HT3 subtype of serotonin receptors).
The inhibitory aspect occurs due to a hyperpolarization of neurons, secondary to an influx of chloride ions. The neuron becomes less likely to achieve the threshold membrane potential. The excitatory receptor is dependent on the NMDA and non-NMDA glutamate receptors that control the influx of sodium and calcium, which bind to endogenous neurotransmitters (glutamate or aspartate) and depolarize the neuronal membrane. The NMDA receptor seems to have a high permiability to calcium, which acts as a catalyst to several intracellular events.
Chronic exposure to alcohol seems to alter the NMDA receptors and this may play a role in the clinical symptoms of alcohol withdrawal. In vitro studies have demonstrated an increase in the binding sites for MK801 (dizocilpine) in neurons chronically exposed to alcohol. This rise may account for the acclimation process, in which greater concentrations of alcohol are needed to cause experimental and clinical symptoms of intoxication. NMDA can cause seizure activity. Mice that have been exposed to chronically elevated levels of alcohol reveal increased numbers of NMDA receptors and NMDA related seizure activity. The NMDA antagonist MK801 has been shown to decrease the severity of seizures in these mice during withdrawal. Through a complex process of cell membrane ion pumps and neurotransmitter stimulation, the multi-faceted effects of alcohol and alcohol withdrawal are becoming better understood.
studies with animals show that high doses of alcohol lead to a disruption in the growth of new brain cells; scientists believe it may be this lack of new growth that results in the longterm deficits found in key areas of the brain (such as hippocampal structure and function)
Brain Structure affected:
Frontal Lobe (A) Loss of reason, caution, inhibitions, sociability, talkativeness and intelligence
Parietal Lobe (B) Loss of fine motor skills, slower reaction time, shaking
Temporal Lobe (C) Slurred speech, impaired hearing Occipital Lobe (D) Blurred vision, poor distance judgement
Cerebellum (E) Lack of muscle coordination and balance
Brain Stem (F) Loss of vital functionsAlcohol can increases the risk and intensity of some of the side effects associated with SSRIs. Though there have been many different side effects reported during the use of SSRIs, most are infrequent, but some are more common and even expected. Here is a quick list of the side effects of SSRIs that can be heightened by alcohol use.
Clouded Judgment
Drowsiness
Slowed Reflexes
Suicidal ThoughtsAlcohol can interfere with the SSRI as it attempts to treat your depression. Alcohol is a depressant and SSRIs are anti-depressants, so it doesn't make sense to combine the two.
Most physicians who prescribe SSRIs do not know that alcohol also increases the level of serotonin in the brain which may cause essentially too much seretonin in the brain. This is called the "serotonin syndrome " which can be very dangerous physically and mentally.
Eric
Posted by jono_in_adelaide on September 17, 2012, at 0:00:02
In reply to Re: alcohol, meds » gman22, posted by phidippus on September 16, 2012, at 22:33:33
Is there any evidence that a standard dose of SSRI plus 2 beer or 2 glasses of wine, have ever caused seretonin syndrome?
As for alcohol being a depressant, amitriptyline is a depressant, and an antidepressant. You're playing on words there.
Posted by brynb on September 17, 2012, at 0:06:26
In reply to Re: alcohol, meds » gman22, posted by phidippus on September 16, 2012, at 22:33:33
Eric,
As I read your response, I couldn't help but think of benzos as interchangeable with alcohol.
I struggled with benzo dependence and abuse for many years, and while I no longer take them on a daily basis, I still use them when needed (not excessively, though). Makes me wonder if they did, in fact, cause some permanent (and unsavory) changes in my brain chemistry. (I especially relate to the temporal lobe changes.)
-b
Posted by Zyprexa on September 17, 2012, at 0:28:56
In reply to alcohol, meds, posted by gman22 on September 15, 2012, at 17:55:57
I take 150mg sertraline and drink a moderate amount of alcohol. It does not affect the actions of the sertraline. They usualy tell you not to drink with meds because the sedation is affected by alcohol, addative. Also some meds can affect the liver more and alcohol makes it worse. That just mean don't take the alcohol and med at same time.
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