Anxiety and alcohol

[SmithsFan]

How badly do other sufferers of health anxiety find that alcohol affects their symptoms?

I was a heavy drinker when I was younger but rarely overindulge these days. Overall this makes me feel a lot better, physically and mentally, but it does also mean that my tolerance is nowhere near what it was. Consequently, when I do get drunk the effect hits me hard.

The reason I came across this site was because of my worst ever episode of anxiety when I became convinced I had a rare form of dementia that affects younger people, then MS.

I've spent the past month or so working to de-stress, simplify my life, change the way I think, think about the roots of my problem and accept that my brain can cause both physical and mental symptoms. I have been getting much better but a heavy session on Sunday appears to have set me back considerably. My fear that I did something stupid or offended someone has got worse, as have the post-drinking blues, and the symptoms have increased in proportion.

The symptoms that caused me to panic in the first place - speech problems, difficulty finding words, language confusion, tingling, stabbing pains, cold limbs - have got much worse again. I've also been fretting about the health of my son and nephew a lot. I'm coping better than previously because I'm recognising why the symptoms are appearing but I'm annoyed at myself for letting so much progress go to waste.

How are others affected? Is this a trigger for your symptoms? Do you abstain completely? Or does moderation work for you?

[Fishmanpa]

There are a couple of threads on the boards currently that affirm what you're saying. My opinion is no, anxiety and alcohol are not a good combination and the interaction of many meds can be and are detrimental.

If you can handle it great, but if it causes you issues then you know what you should do.

Positive thoughts

[dizzy daisy]

Hi. I understand what you're saying. When I started with anxiety I was off to university a short while after. I used to drink, get drunk and it didn't bother me but once anxiety was on the scene it changed things because I'd panic about the sensation of being drunk and also hang over. Now I will drink but in moderation. I'll allow myself to be tipsy but I really don't like being out of control and I can't stand having hangovers anymore it's too stressful. Xx

[SmithsFan]

Thanks Fishmanpa and dizzy.

I certainly think I'll simply need to avoid getting drunk from now on or I'll never get on top of things. The thing is, I actually prefer to have a relaxing couple these days. The feeling of being out of control never bothers me when I'm drinking but it hits me hard the next day and, if I have any kind of blackout, for some time after. The guilt and regret is crippling.

I knew drinking contributed to my depression when I was younger but only having come to understand about health anxiety recently this is the first time I've noticed a link to the symptoms I suffer from.

[MyNameIsTerry]

The threads FMP is talking about are not straight forward since one about someone who has been self medicating and has an alcohol dependence issue. Alcohol dependence is bad no matter who you are, anxiety may play a factor but the same can equally be said about depression, gambling, bereavement, etc. So, I don't think you can ask your question and apply that case as the vast % of anxiety disorder sufferers are not in that boat.

The other thread, in my opinion, is not a good quote either as that person has been drinking fine but drank a lot more and had a wobble. Having said that, yes there are plenty of threads on here saying anxiety was spiked by alcohol BUT so does caffeine. How many people on here drink tea or coffee? Do we all post threads saying "had a lovely cup of tea today and no anxiety"? No, we don't, but you can bet people who do suffer increased anxiety from drinking tea or coffee will raise a thread about it. This is why in science a lack of evidence is not the same as evidence to oppose something. Thats a feature of a psychology concept called Confirmation Bias - we look for evidence of what we belief but seldom evidence to contradict.

For me, I do believe there will be some people who just can't keep using alcohol BUT there are so many questions about it that it is far from the simple argument I see people raising in threads. For instance, if someone was so anxious they can barely operate on any level, of course alcohol is going to spike them. If someone is in a good recovery position, there is a very good chance they will experience nothing more than any non anxiety disorder sufferer. Part of this difference is the sensitivity of the severe sufferer (who is likely going to be the same with caffeine, B vitamins, high protein meals, exercise, etc) and another part is that the recovered sufferer won't be placing as much focus on their symptoms hence don't react as badly and make them worse.

There are threads on here about vitamin B with mixed responses of spike vs. no spike. You can't live without vitamin B! It's in your food so you can equally be spiked by that too.

I drank on Citalopram for a week and I drank enough to get daily hangovers. I cleared it with my GP because I was going on holiday and hadn't drank since my anxiety started. He said it would be fine in moderation, which I didn't stick too :whistles:Yes, I had hangovers but I had no increased anxiety whatsoever. A couple of years prior to this, even watching TV and hearing certain noises was spiking me. So, of course if I drank at my worst times I would have been spiked.

So, there are many questions. I've seen threads on here, and on this board, where someone has drank and been raising a thread about it. I don't judge anyone about it, but in the case of some it was only ever going to end in tears because they were active posters who were panicked over their HA and for me, this is someone who should not be trying anything stimulating or a depressant because they need to rebuild their strength first and calm down their anxiety. It's like someone with Panic Disorder or GAD watching a horror movie, it will cause problems, but when you are recovering you are much more resilient to triggers and lose many of them.

I don't see people asking these types of questions so we end up with a load of assumptions.

How about this thread on the Sertaline board where a load of people are saying they can drink fine?

http://www.nomorepanic.co.uk/showthread.php?t=173378

Some of them are HA sufferers.

[Fishmanpa]

While I can't see all the responses, I can only imagine :wacko:... It comes down to holding your hand over a flame really. Some people can do it, warm their hands and not get burned but there's that saying about playing with fire that comes to mind. Some people can't and there's plenty of evidence that it can be harmful. If you keep getting burned or don't want the risk, stop doing it!

Positive thoughts

[SmithsFan]

The threads FMP is talking about are not straight forward since one about someone who has been self medicating and has an alcohol dependence issue. Alcohol dependence is bad no matter who you are, anxiety may play a factor but the same can equally be said about depression, gambling, bereavement, etc. So, I don't think you can ask your question and apply that case as the vast % of anxiety disorder sufferers are not in that boat.

The other thread, in my opinion, is not a good quote either as that person has been drinking fine but drank a lot more and had a wobble. Having said that, yes there are plenty of threads on here saying anxiety was spiked by alcohol BUT so does caffeine. How many people on here drink tea or coffee? Do we all post threads saying "had a lovely cup of tea today and no anxiety"? No, we don't, but you can bet people who do suffer increased anxiety from drinking tea or coffee will raise a thread about it. This is why in science a lack of evidence is not the same as evidence to oppose something. Thats a feature of a psychology concept called Confirmation Bias - we look for evidence of what we belief but seldom evidence to contradict.

For me, I do believe there will be some people who just can't keep using alcohol BUT there are so many questions about it that it is far from the simple argument I see people raising in threads. For instance, if someone was so anxious they can barely operate on any level, of course alcohol is going to spike them. If someone is in a good recovery position, there is a very good chance they will experience nothing more than any non anxiety disorder sufferer. Part of this difference is the sensitivity of the severe sufferer (who is likely going to be the same with caffeine, B vitamins, high protein meals, exercise, etc) and another part is that the recovered sufferer won't be placing as much focus on their symptoms hence don't react as badly and make them worse.

There are threads on here about vitamin B with mixed responses of spike vs. no spike. You can't live without vitamin B! It's in your food so you can equally be spiked by that too.

I drank on Citalopram for a week and I drank enough to get daily hangovers. I cleared it with my GP because I was going on holiday and hadn't drank since my anxiety started. He said it would be fine in moderation, which I didn't stick too :whistles:Yes, I had hangovers but I had no increased anxiety whatsoever. A couple of years prior to this, even watching TV and hearing certain noises was spiking me. So, of course if I drank at my worst times I would have been spiked.

So, there are many questions. I've seen threads on here, and on this board, where someone has drank and been raising a thread about it. I don't judge anyone about it, but in the case of some it was only ever going to end in tears because they were active posters who were panicked over their HA and for me, this is someone who should not be trying anything stimulating or a depressant because they need to rebuild their strength first and calm down their anxiety. It's like someone with Panic Disorder or GAD watching a horror movie, it will cause problems, but when you are recovering you are much more resilient to triggers and lose many of them.

I don't see people asking these types of questions so we end up with a load of assumptions.

How about this thread on the Sertaline board where a load of people are saying they can drink fine?

Some of them are HA sufferers.

Interesting stuff. I guess I'm just trying to make sense of my health anxiety now that I acknowledge it and am trying to find out as much as I can about other people's experiences.

I'm looking upon the other night as an inadvertent experiment. It did make my anxiety much worse, and has also left me still feeling depressed four days later as well as experiencing my "MS" and "dementia" symptoms. I'm still trying to unpick my depression and anxiety and work out the link between the two but the bottom line is that excessive alcohol consumption does appear to be a trigger for both and should be avoided. In a weird way I'm glad to have set this trigger off as it's helping me to accept how interlinked all of this is and that I can help myself rather than ruining my life my panicking about my health and constantly feeling like I'm going to die.

I have a fair idea of the level I can safely drink to without causing myself any issues so i'm going to take this, reduce it by a few units per week and see if sticking to this, along with the other changes I'm making, helps.

As much as anything else I'm incredibly glad to have found this forum and be able to speak to people who understand what I'm going through.

[MyNameIsTerry]

That sounds like a good plan. I think it has to be the same for someone who is considering trying alcohol again - start small & build up to see what happens. Treat it like an exposure hierarchy. Some people drink a load straight away and then have the spike but what if they could drink half of that and be ok?

Your plan is sensible because one of the issues we have to be careful of its avoidance. If we avoid it out of fear, we just create another association in our subconscious of a feared scenario. The more we add these, the more we shrink our "bubble". For some there may be no choice but to abstain and some may do it for positive reasons e.g. They don't enjoy it anymore. I know of people on here who have done that and fair play to them. But what if you just need to adjust the volume or wait until you are better? Why intentionally add another avoidance to restrict your life? That's a negative thing to do. Some argue that we don't need alcohol to live, which is true, but the mindset had to be right because there are so many social norms we could say that about.

[Lifelonganxiety!]

I don't find alcohol making me feel worse when I'm drinking. Usually I feel a lot better when I've had a couple of beers.

The worst thing though is that if you wake up with a hangover, the symptoms can send anxiety through the roof. Headaches, nausea, dizziness, tired etc... all can be completely misread to someone with HA. Not a good deal!

[Fishmanpa]

It did make my anxiety much worse, and has also left me still feeling depressed four days later as well as experiencing my "MS" and "dementia" symptoms. I'm still trying to unpick my depression and anxiety and work out the link between the two but the bottom line is that excessive alcohol consumption does appear to be a trigger for both and should be avoided. In a weird way I'm glad to have set this trigger off as it's helping me to accept how interlinked all of this is and that I can help myself rather than ruining my life my panicking about my health and constantly feeling like I'm going to die.

I have a fair idea of the level I can safely drink to without causing myself any issues so i'm going to take this, reduce it by a few units per week and see if sticking to this, along with the other changes I'm making, helps.

Mind you, I don't suffer in any degree like many here. I had some bouts with depression and "scanxiety" due to my illnesses and came to the forum for other reasons. That being said, I've learned a lot and its helped me understand the illness and help my daughter who suffers from anxiety and depression as well as provide some tools to deal with my own issues.

Concerning alcohol? Certainly the decision is yours. Your post and countless others on the forum reflect the same sentiment. If it means not drinking to save yourself a few rough days, then so be it. If it means abstaining totally to avoid the risk of the same few rough days, then so be it. There's absolutely no harm in that and if you're on meds, the vast majority of drug makers recommend abstaining or limited use at best. Again, I go back to the "playing with fire" analogy. I don't know about you, but I've always found it difficult to stop at a couple and while I'm WAY past the days of partying till I drop, my body's tolerance has been extremely diminished. I'm a total lightweight. At most a beer or two (max) with a good meal is all I can deal with and even then, it's very few and far between if I indulge at all.

Good luck with your healing journey. Your posts are quite rational and on point. You obviously have a rational handle on things and it appears you're on the right path IMO.

Positive thoughts

[Sparkling_Fairy]

Alcohol in general is a bad idea for depression. While it makes you feel happy and chill at the time, it makes you feel all the worse the next day, mentally. So if you already suffer from slight depression, it makes it worse.

I tend to drink 1 glass of something every other day usually. Either a glass of wine, or a glass of beer, after work to relax. Sometimes it helps, other days when I feel high anxiety it makes my physical symptoms worse.

I know after a night of heavy drinking, I will wake up in the middle of the night with a racing heart! And I don't know whether that's anxiety related, or alcohol related. Needless to say, I RARELY go out drinking a whole night anymore.

You need to see for yourself how it makes you feel. Overall the studies show that alcohol have a negative effect on your mood. But not everyone has that problem. I guess us anxiety sufferers have to be a bit more careful with it

[yogibear]

I'm totally with you on this one! I have become pretty intolerant of alcohol the last few years. I expect a lot of this is to do with me having bad anxiety the last few years so going to feel more shit after drink. When I actually drink I'm a barrel of laughs and feel bloody fantastic, no exaggeration! But then I wake early and the nightmare begins. I feel dizzy, I'm sweating and jittery and I then work myself up and end up in and out of panic attacks all day long. I certainly wouldn't be leaving the house! Then day two can be worse a lot of the time. My last piss up was about a month ago and I ended up house bound for a week, hangover literally lasts a week and ours my anxiety all out and do get the blues too! You would think I would avoid alcohol fully but I enjoy the release it gives me in the moment so much! I use drink a lot before but nowadays I have abt 4 binges a year so improving a bit.
I would advice you quit as it does mess us types up so much. When you say you're worrying that you offended someone etc, did sonething happen or have you know evidence of this but your mind is just going into overdrive? Just curious as a friend of mine that has social anxiety always thinks the same after a night out even though he's a really sensible quiet drunk! He can obsess over the night or a week thinking he's done sonething bad and gets really depressed then starts to get better after a few days. Alcohol is deadly really. Hope you feel better soon x

[MyNameIsTerry]

Alcohol is a CNS depressant and suppresses Serotonin. People with anxiety/depression have a habit of having low Serotonin already, hence why they use SSRI's to treat them. So, the more you drink, the greater the effect on this...and there you go.

Sparkling_Fairy, dehydration will do that to you too. So, whilst not strictly alcohol since you could dehydrate for many reasons, perhaps ensuring you are hydrated will help? Again, volume plays a part in this. You also have to remember that your liver has to clear the toxins and there is a reason why people take Milk Thistle for hangovers...it makes the liver more efficient in clearing toxins.

It's all about whats best for the person.

---------- Post added at 05:00 ---------- Previous post was at 04:55 ----------




There's absolutely no harm in that and if you're on meds, the vast majority of drug makers recommend abstaining or limited use at best.

The drug companies list it in their Patient Information Leaflet (PIL) BUT and it's a big BUT, the online interaction checkers actually explain it in more detail as a Moderate food interaction hence saying use caution as it could cause side effects. So, out of all these people saying alcohol doesn't work with their anxiety, how many are on meds and how many can rule out it isn't the med because when they come off them, that situation could change? Again, the devil is in the detail.

Some of these meds carry more useful interaction warnings and I think those are the ones to be really careful with. The others tend to carry the same bland warnings an antibiotic will, yet millions of people drink on those fine. The funny thing is about my med, I don't recall Pfizer ever being prosecuted due to a lack of clinical evidence against them yet they agreed to change the PIL to include "avoid if a heavy drinker" or words to that effect because of the liver disease cases. I find that strange, maybe it was a best practice agreement as opposed to a sanction since the FDA can't force them to print that for the licences outside of the US, but they do.

[SmithsFan]

MyNameisTerry - I agree about avoidance. For better or worse, much of our social life in this country is centred around alcohol and avoiding completely would make me think my anxiety/depression is inhibiting my life more than it is. The best time of week for me is a Friday night when my wife and I get our baby safely to sleep then sit down and enjoy a few drinks together. I never feel anxious either then or the next day. It's when a couple becomes a session that I start to have problems.

Fishmanpa - Stopping at a couple. That's the challenge isn't it? It's easy to say and harder to do. Like you I drink heavily less frequently than ever but there are always those times when the drink tastes lovely, has put you in a wonderful frame of mind and the momentum of the night carries you on far before your intended stopping point. As per my point above it's up to me to exert some discipline though and ensure that alcohol remains something I can enjoy rather than aggravates my issues and causes me to stop drinking altogether.

Yogibear - The Fear I get post-binge is based on probably no more than a few dozen incidents over the past 20-plus years in addition to alcohol's effect on the CNS. Only a fraction of them were anything other than me making a fool of myself but those times where I did offend someone, get into a fight or similar continue to haunt me to this day. I find myself apologising to people for incidents that happened 15 years ago that they have no memory of.

The accumulated effect of this, plus the fact that anything more than 8 pints these days and I'm blacking out large part of the night makes me terrified that I've done something shameful. I think a lot of this is about a loss of control and I would say it's got worse since I got married and became a father as I feel I have so much more to lose now. Like how the deaths and illnesses of others affect my health anxiety, I suspect knowing people who've messed up their entire life as a result of a stupid, drunken incident makes me very edgy unless I can trace every single step and convince myself my behaviour was beyond reproach.

[Fishmanpa]

Fishmanpa - Stopping at a couple. That's the challenge isn't it? It's easy to say and harder to do. Like you I drink heavily less frequently than ever but there are always those times when the drink tastes lovely, has put you in a wonderful frame of mind and the momentum of the night carries you on far before your intended stopping point. As per my point above it's up to me to exert some discipline though and ensure that alcohol remains something I can enjoy rather than aggravates my issues and causes me to stop drinking altogether.

I have real health issues. I'm also on several meds to help control those issues. I have a chill pill for when things get rough. All of those drugs have alcohol interaction warnings. So for me a taste is all I can or will do. I do enjoy a good brew with a meal while at a restaurant or with a meal at home "on occasion". But other than having a little wine for cooking, it's rare to see alcohol in our home. You can Google and find something to counter anything but ultimately why take a chance?

It's true, alcohol is a large part of social interactions. On the other hand, there are those that don't need it to have a good time. I personally don't feel it's adding to avoidance behaviors by abstaining. That's just total nonsense! If someone has a bad reaction to a certain food or beverage, is it an avoidance behavior to stop consuming it? C'mon really? My wife has reflux and has a list of foods and drinks that aggravate it. Is she building negative psychological walls? There's a big difference in abstaining because you feel like crap anxiety or otherwise and the typical avoidance behaviors one sees on the boards. Heck, two good IPAs and I'm feeling it and I feel it the next day! Like I said... a lightweight ~lol~ Is that avoidance? Don't think so!

Ultimately, you're going to do what's best for you. You know yourself best. You know why you posted this thread in the first place and its a rather common theme on the boards. Use your common sense and continued success on your healing journey.

Positive thoughts

[SmithsFan]

I have real health issues. I'm also on several meds to help control those issues. I have a chill pill for when things get rough. All of those drugs have alcohol interaction warnings. So for me a taste is all I can or will do. I do enjoy a good brew with a meal while at a restaurant or with a meal at home "on occasion". But other than having a little wine for cooking, it's rare to see alcohol in our home. You can Google and find something to counter anything but ultimately why take a chance?

It's true, alcohol is a large part of social interactions. On the other hand, there are those that don't need it to have a good time. I personally don't feel it's adding to avoidance behaviors by abstaining. That's just total nonsense! If someone has a bad reaction to a certain food or beverage, is it an avoidance behavior to stop consuming it? C'mon really? My wife has reflux and has a list of foods and drinks that aggravate it. Is she building negative psychological walls? There's a big difference in abstaining because you feel like crap anxiety or otherwise and the typical avoidance behaviors one sees on the boards. Heck, two good IPAs and I'm feeling it and I feel it the next day! Like I said... a lightweight ~lol~ Is that avoidance? Don't think so!

Ultimately, you're going to do what's best for you. You know yourself best. You know why you posted this thread in the first place and its a rather common theme on the boards. Use your common sense and continued success on your healing journey.

Positive thoughts

Sorry to hear about your other health issues.

I get what you're saying there and I wholeheartedly agree that people who have issues resulting from the consumption of alcohol should abstain. I also agree that it is not a necessity and if it came to it then I would stop completely. I'm trying to figure out if that is required or whether I need to exert more control.

Having a few social drinks is something I enjoy whereas going beyond that point is something I'm enjoying less and less but still occasionally fall into. This is all new to me so I'm trying to work out what the best course of action is and I'm interested in other people's experiences.

[MyNameIsTerry]

While I can't see all the responses, I can only imagine :wacko:

Thanks for the "Wacko". :doh: And lets remember you can see all the responses, you have chosen not to. It's just a button click away.

Don't worry though, I'm not easily offended. I'll let the facts speak for themselves for the rest.

---------- Post added at 05:03 ---------- Previous post was at 04:36 ----------


All of those drugs have alcohol interaction warnings.

Yes, and lets have a look at a couple of the most prescribed. Interesting comments are bolded red:

Citalopram

http://www.drugs.com/citalopram.html

Drinking alcohol can increase certain side effects of citalopram.

How about looking at the interactions page on that med:

Alcohol (Ethanol) ↔ citalopram

Moderate Drug Interaction

Using citalopram together with ethanol can increase nervous system side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with citalopram. Do not use more than the recommended dose of citalopram, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

citalopram ↔ food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Setraline

http://www.drugs.com/sertraline.html

What should I avoid while taking sertraline?

Drinking alcohol can increase certain side effects of sertraline. Do not take the liquid form of sertraline if you are taking disulfiram (Antabuse). Liquid sertraline may contain alcohol and you could have a severe reaction to the disulfiram.

How about looking at the interactions page on that med:

sertraline ↔ Alcohol (Ethanol)

Moderate Drug Interaction

Using sertraline together with ethanol can increase nervous system side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with sertraline. Do not use more than the recommended dose of sertraline, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

sertraline ↔ food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of sertraline. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills. In addition, limited clinical data suggest that consumption of grapefruit juice during treatment with sertraline may result in increased plasma concentrations of sertraline. The proposed mechanism is inhibition of CYP450 3A4-mediated metabolism by certain compounds present in grapefruit. An in-vitro study demonstrated that grapefruit juice dose-dependently inhibits the conversion of sertraline to its metabolite, desmethylsertraline. In a study with eight Japanese subjects, mean plasma levels of sertraline increased by approximately 100% and maximum plasma concentrations increased by 66% after the ingestion of three 250 mL glasses of grapefruit juice per day for 5 days and administration of a single dose of sertraline 75 mg on the sixth day. In another small study with 5 patients, mean sertraline trough levels increased by 47% after taking sertraline for at least 6 weeks, then taking sertraline with 240 mL grapefruit juice daily for 1 week. The clinical significance is unknown; however, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability. The possibility of significant interaction in some patients should be considered.

MANAGEMENT: Patients receiving sertraline should be advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how sertraline affects them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities. Some authorities recommend that consumption of grapefruit juice should be avoided during sertraline therapy.

Lets also remember that side effects of these meds are limited to generally the first 4-6 weeks of starting or adjusting a dose. So, whether that warning even applies after that point is an unknown to me.

This is my med, Duloxetine:

http://www.drugs.com/cymbalta.html

What should I avoid while taking Cymbalta?

Avoid drinking alcohol. It may increase your risk of liver damage.

How about looking at the interactions page on that med:

Alcohol (Ethanol) ↔ DULoxetine

Moderate Drug Interaction

Talk to your doctor before using DULoxetine together with ethanol. DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

DULoxetine ↔ food

Moderate Food Interaction

DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

What a cheery thought for me. Something else my GP never told me.

Even in the face of liver damage, use of the word "may" would indicate they don't know. So, going back to those SSRI's, we have lots of "may" going on in there as well as "may" or "can" increase side effects which you won't even be expecting to be experiencing once settled on them.

---------- Post added at 05:31 ---------- Previous post was at 05:03 ----------


I personally don't feel it's adding to avoidance behaviors by abstaining. That's just total nonsense! If someone has a bad reaction to a certain food or beverage, is it an avoidance behavior to stop consuming it? C'mon really? My wife has reflux and has a list of foods and drinks that aggravate it. Is she building negative psychological walls? There's a big difference in abstaining because you feel like crap anxiety or otherwise and the typical avoidance behaviors one sees on the boards. Heck, two good IPAs and I'm feeling it and I feel it the next day! Like I said... a lightweight ~lol~ Is that avoidance? Don't think so!



The problem with not reading my actual post is that you don't understand what I am discussing hence go off on a tangent by guessing & assuming, which you've only demonstrated here.

Your wife has a medically diagnosed condition which means she has avoid them to avoid aggravation. She has little choice. Choice, something people need to remember there I reckon. Did she decide to stop eating them because she was afraid they would cause her anxiety symptoms? No. So, how about we take her reflux out of the equation and say she is someone who is afraid of the sensations her food gave her (I've lived this one and I'm not the only one on here). What if she chooses not to eat those foods because she fears they may cause an increase to her anxiety? She could go her whole life without needing to eat them but hasn't she just made an association between certain foods and anxiety? In someone without anxiety it would be no problem because we are talking about a scenario where the personal has an anxiety disorder, and anxiety disorders are based on irrational fear.

How about another example?

You don't need to fly on a plane in your lifetime. Some people choose not to. So, if someone doesn't like going abroad because of what is there which doesn't appeal to them or simply prefers their own country - they have made a positive choice. So, how about someone who is afraid of flying because they fear they will have a panic attack? Do they make a positive choice not to fly? Of course they don't, they don't fly because they are afraid and as any therapist will tell you - to overcome that fear you will need to test it to ensure you have done so. In CBT they use Exposure Response Prevention (ERP) therapy for that very reason. Are all the CBT therapists wrong then? No, they are not.

Here is a good example of one of my problems over the years.

I was exercising when I went off work due to stress & panic. I was taking all sorts of stimulating supplements (all legal) and decided to add a strong one to my concoction. I had a 30 minute solids adrenaline rush, not a panic attack. From this point on I associated exercise with panic & loss of control & unpleasant physical sensations. Also associated supplements with this too. Just avoid stimulants eh, FMP? Cool. I did. What happened? This fear progressed into not being able to take even vitamin C, probably the safest thing you can take. I couldn't take paracetamol and pretty soon I couldn't even take my asthma meds due to fear of sensations. The result was an asthma attack after a few weeks. I had to quickly get back onto them and it was an anxious experience. I then had to do the same for the rest and I'm still working on this now with lots of success.

Can you see how fear spirals and overlaps into other areas? Why does it do this though? The subconscious makes associations between memory, sensations, feelings, emotions, events, thoughts, even location & time data, etc. Thats CBT 101! It uses those associations to recall and match to other scenarios or the same scenarios as they arise. These neurons are not arranged solely in groups, they can attach themselves to other neurons in other grouped associations via synapses (which are how they are attached anyway). So, my fears started and kept growing as I made more & more associations between innocent supplements that "could" make me feel like how I did on the stimulants. That's often how it starts and all you do is dig a bigger whole.

Thats why I think this way about alcohol. Why create yourself more fears through avoidance?

You say you don't see these fears on this board? I do, and I see them all over NMP too. Take fear of meds, whether antidepressant or simple antibiotics. You often find those people are also afraid of supplements, can have issues with food, etc. You missed the point completely, feeling like crap with anxiety due to alcohol will become another association - if you let it.

Total nonsense? I think you are mistaking your wish to disagree with me over the advice of CBT therapists and also the reasons behind avoidance itself. Whilst I know you won't agree no matter how much proof is put on here, I'll add this because it will be useful for people to understand the difference between avoidance and the positive choice we are discussing in the hope that they will read what real professionals say and take it onboard:

http://psychology.tools/avoidance.html

AVOIDANCE

Although avoidance is a natural mechanism for coping with many kinds of pain or trauma it also serves to maintain a wide range of psychological problems. In the short term avoidance can lead to the (reinforcing) reward of a reduction in real or imagined anxiety - this is the motivator for its use as a coping strategy. In the long term, though, avoidance can act to prevent the disconfirmation of unhelpful beliefs. Further, the use of avoidance as a coping strategy can lead to further unintended negative consequences.

Exposure is the most common therapeutic strategy used to overcome avoidance. There are many varieties of exposure including: in-vivo, imaginal, graded, and interoceptive. Exposure often involves asking a client to face their worst fears, and clear case formulation / coneptualization is critically important in presenting a rationale for exposure.

http://psychology.tools/safety-behaviors-worksheet.html

SAFETY BEHAVIORS WORKSHEET

DESCRIPTION
Safety-seeking behaviors are a response to a feared catastrophe. In situations that are perceived as dangerous people naturally act to keep themselves safe (and even have automatic evolved responses to promote safety - think 'fight or flight'). Unfortunately, while safety behaviors can lead to a feeling of relief in the short term (and are thus reinforced), they have the effects of reinforcing beliefs about threat, lead to beliefs going unchallenged, or lead to other unintended consequences. The Safety Behaviors Worksheet is a CBT worksheet providing a clear and comprehensive explanation of safety behaviors. It is essential for clients to have a strong understanding of the causes and consequences of safety behaviors if they are to be experimented with and relinquished.

What is the dierence between a safety behavior and adaptive behavior?
Just by looking at the behavior itself, there is no way of telling the dierence between an unhelpful safety
behavior and a helpful adaptive behavior. It is the intention which matters - safety behaviors are those which
are intended to avert a feared catastrophe. For example, if the strategy of distraction is used to cope with a
painful experience (e.g. a visit to the dentist) we say it is helpful. However, if distraction is used with the
intention of preventing a catastrophe (e.g. to avoid a feeling of panic that I fear will make me go mad) then it
can be viewed as an unhelpful safety behavior.

You have said how you believe in the effectiveness of CBT and encourage people to opt for it so I'll assume you are not going to say that CBT is wrong over the issue of alcohol? And that the descriptions there are correct since they have been written by trained professionals for use by other professionals. Can you see how the examples I have given above, and the reworking of your own one, match to the CBT worksheet's description?

Are they talking nonsense? Or are you assuming it is I who have said this? My therapist said the same as the above and so did any handout I had on it and every other place I've read not only about CBT but about anxiety too (not counting the garbage "guru" element who make their science up as they go along). Even the gurus will tell you that keeping yourself in a cycle of fear and avoiding your fears will only serve to reinforce them. Are they all wrong when it comes to the issue of avoidance? If so, it's a miracle any of them can treat anyone, isn't it?