I AM ON MEDICINES FOR DEPRESSION, CAN I CONSUME ALCOHOL?

Hi friends,

                  One of the commonest questions that I am asked while treating clients is “Doctor, Is it okay to drink when I am on the medication?” Many others do not ask the question but assume that it is not okay. Therefore, they skip the dose of the medicine on the day they intend to drink. So what is the correct approach?

            Firstly, the term ‘psychiatric medicines’ or psychotropic agents refers to a wide group of chemical agents and therefore cannot really be taken as one group. So, there is no general answer to the above question; it really depends upon the specific medicine one is on. For convenience sake, let me divide the medicines into three groups.

            The first group of medicines is those that are popularly known as ‘sleeping pills’. Chemically, these medicines usually belong to the class of benzodiazepines (and related drugs). They are generally not recommended to be taken along with alcohol. They have several properties that are remarkably similar to alcohol itself. This implies that on taking them along with alcohol, their effects become supra-additive; resulting in extreme intoxication and potentially depressed functioning of the heart and lungs. This can occasionally even be fatal. Although a lot depends on the doses of alcohol and the benzodiazepine in question that is being taken, it would generally be considered unsafe to combine the two.

            The second group of medicines are those that are not generally regarded as ‘sleeping pills’ and whose primary use is something different, but they also have a significant sedative effect. A number of antidepressant and antipsychotic medicines can be considered under this category. Unlike the benzodiazepines, although these medicines are sedating, the characteristics are very much different from that of alcohol. Nevertheless, caution should be exercised while combining these medicines with alcohol. Excessive sedation may result and can be potentially dangerous in people who are already medically compromised.

            The third group consists of those medicines which have minimal to no sedating effects, and in any case, has effects that are qualitatively completely different from that of alcohol or benzodiazepines. They are generally safe with alcohol use. Missing a dose of this medicine in order to consume alcohol would be seen as a double whammy – the deleterious effects of alcohol plus the lack of protective effects of the medicine. A number of modern antidepressant and antipsychotic medicines belong to this category.

It is important to understand that alcohol (with or without the medicine) is generally detrimental in those suffering from psychiatric/ emotional problems of any kind. It might seemingly make one feel better in the immediate aftermath of drinking, but in the medium to long term (and in many even in the short term), it is likely to worsen the existing condition. So if you are worried about the interaction between alcohol and the medicine, skip the alcohol, not the medicine!

So that was what I had to discuss this time around. Please let me know if there is anything that you want me to discuss in particular, by typing in the comments section below.

Write in at stayhappy.prakash@gmail.com

So until next time, STAY HAPPY!

Dr. Sathya Prakash, MD, Dip. CBT

Consultant Psychiatrist, Psychotherapist and Behavioural Sciences Expert

lybrate.com/dr.sathyaprakash

MY PAIN IS REAL, BUT DOCTOR SAYS IT IS PSYCHOLOGICAL! HOW IS THIS POSSIBLE??

Hi friends,

               

           When I see a client for the first time, I often get this question: “I came here for my chest pain and headache, not to see a psychiatrist! Do you think I am a ‘psychiatric patient’??”  The scenario often repeats itself with people presenting with a wide range of other symptoms such as body ache, leg pain, back pain, vomiting, fainting and so on. So what is this peculiar presentation? Can psychological problems present with physical symptoms? Does that mean that the pain is ‘not real’? Does it mean that the patient is ‘faking’ the symptom? Well, that is what we shall be discussing today.

            It is extremely common for a lot of people to have physical symptoms that do not have a medical disorder explaining it. This, however, does not mean that the symptoms are not real. It also does not mean that the patient is faking the symptom. Unfortunately, these symptoms are very often considered (and wrongly so) unreal, fake and ‘all in the head’ by laypersons and sometimes physicians too. Psychiatrists often receive referral from their medical colleagues for such complaints. So how do we make sense of this?

            Psychological problems very often present with physical symptoms. Without going into a detailed discussion and medical jargon, it suffices to say that physical symptoms may represent the only symptoms of a psychiatric condition, part of the symptom repertoire of conditions such as depression or may represent an exaggerated version of the symptoms of an underlying medical disorder.

                              So how can a psychological problem lead to a physical symptom?

Many people are unable to accurately identify and label their own emotional state. For instance, they may be sad, but be unable to acknowledge and identify that they are sad. All they can make out is that they are feeling uncomfortable and distressed. But when this distress needs to be conveyed, it often takes the form of physical sensations (eg. heaviness in the chest) that are associated with the sadness. In due course of time, excessive attention and magnification of these bodily sensations (heaviness in the chest) becomes a problematic symptom (pain in the chest) in itself. Similar explanations also hold true in situations where one is culturally not expected to show certain emotions and associated behaviors (men not expected to cry). So the distress gets expressed in physical terms. But here is the catch! All these processes are unconscious and the person is often not aware of it!

                   We are all familiar with the fact that when we are quite happy, pain does not bother us as much as it does when we are otherwise distressed or irritated. Thus, psychological problems interfere with, and often alter the perception of pain itself. This in turn results in non-painful sensations being perceived as pain or, mild pain being perceived as severe pain. Also, it is common knowledge that there is a large inter-individual variation in the tolerance to pain. While a soldier serving the nation in a war zone can withstand the pain of a gunshot wound, city dwellers may find it difficult to tolerate pain related to a thorn prick. What is considered a light touch by one person may feel like a deep pressure to another. What is considered pressure may be perceived as pain by another. Thus, the label given by the brain to an incoming sensation varies from individual to individual, and depends a lot on one’s genetics, upbringing, life experiences, demands of the situation and many other factors. Sometimes, physical symptoms provide the only available way of diverting one’s attention from unacceptable psychological distress/ conflict or handling guilt (physical problems explaining one’s inability to achieve goals set for himself and resultant shame/ guilt). Again, these processes are often unconscious!

            At a neurobiological level, all these processes are orchestrated by a wide array of chemical substances operating within and outside the brain. Medicines often correct these chemical abnormalities and provide relief from pain. Obviously, the regular pain killers are not effective in these scenarios!

Thus, the bottom-line is that it is not only possible but is also extremely common to see people having seemingly unexplained physical complaints that are actually part of a psychological problem.

THE PAIN IS REAL AND THE PERSON IS NOT DELIBERATELY FAKING IT. SUGGESTING THAT HE/ SHE IS FAKING IT WILL ONLY WORSEN THE CONDITION!

So the right approach is to look at these symptoms as a sign of distress and evaluate it in a non-judgmental manner. A judicious combination of psychotherapy and medicines often works best in these scenarios.

So that was the discussion for this week friends. Hope you liked it!

Please let me know if you want me to discuss any specific issue by typing in the comments section below.

Write in at stayhappy.prakash@gmail.com

So until next time, STAY HAPPY!

Dr. Sathya Prakash, MD, Dip. CBT

Consultant Psychiatrist, Psychotherapist and Behavioural Sciences Expert

lybrate.com/dr.sathyaprakash

MANAGING ANGER... THINGS THAT WORK...

Hi friends,

                  Anger is an emotion that all of us have experienced to varying extents. However, sometimes, anger can go a bit out of hand, and result in untoward consequences. For some, it is a regular feature of their personalities, while for others, it has developed after a certain change in their lives or onset of a disorder. Irrespective of the situation, anger often results in impulsive decision making, damage to property, physical violence and strained relationships. Very often, after a bout of anger, the person repents for what he has done in a fit of rage. So how can we reign in anger? That is the topic of discussion for today!

                        Anger that is particularly damaging, has certain properties which we shall use to gain control over it and minimize damage. It can be divided into two sections - minimizing damage & targeting the origins of anger.

Minimizing damage

            Typically, anger has a rapid onset. After an instigating event/ stimulus, it peaks within a short time, and gradually cools of over a period of time. Although, the time periods vary from person to person, typically the peak lasts from a few minutes to an hour. This peak is particularly associated with risk of physical violence, property damage or impulsive decision-making. So, if we were to somehow while away this critical period, much of the damage could be minimized. 

           There are many different and effective ways of distracting and whiling away this critical time period, but they all have one thing in common - they are pre-planned to every little detail with an understanding to put them to use without much thinking when anger breaks out. 

This is akin to the emergency instructions issued on boarding a flight. The exact details of  where the exits are located, what steps to take first and what to do later are all explicitly laid down beforehand; because when panic strikes, one is unable to think clearly and is likely to react in a habitual fashion, which is not necessarily the ideal one for the situation. Similarly, here too, when one is angry, he/ she is unable to think clearly and therefore, this need for a pre-determined action plan. 

         Typical measures include going to a different room and drinking a glass of cold water, reverse counting, listening to a pre-determined set of songs on a smartphone, talking to a specific person, going out to the park and so on. Many of these can be combined and needs to be individualized to suit each person, depending upon his/ her preference and comfort. 

However simplistic this might seem, it works very effectively if implemented properly!

Anger can also be controlled in certain scenarios using medications prescribed under a psychiatrist's supervision.

Targeting the origins

If the anger is arising in the context of a clinical disorder, it will need appropriate expert management. Psychotherapy and counseling, such as Cognitive Behavioral Therapy (http://drsathyaprakash.blogspot.in/2016/06/what-is-cognitive-behavioural-therapy.html) can go a long way in identifying the roots of the anger, correcting maladaptive beliefs and conclusions and alleviating anger. Medications can also be helpful in certain scenarios to target specific disorders that give rise to excessive anger.

If you have an anger problem that has caused needless damage and you repent over it later, don't waste time! Seek expert help and see your life change for the better!!

So that was about anger management friends! Hope you liked it!

Please let me know if you want me to discuss any specific issue by typing in the comments section below.

Write in at stayhappy.prakash@gmail.com

So until next time, STAY HAPPY!

Dr. Sathya Prakash, MD, Dip. CBT

Consultant Psychiatrist, Psychotherapist and Behavioural Sciences Expert

lybrate.com/dr.sathyaprakash

I HAVE A LOT OF MOOD SWINGS; AM I SUFFERING FROM BIPOLAR DISORDER?

Bipolar disorder is said to be characterized by fluctuation of mood from sad to happy repeatedly. So, if I have a lot of mood swings, does it mean that I have bipolar disorder?

So, this is the question that is often asked and I shall discuss it here today. 

The understanding of bipolar disorder is rapidly evolving and different hypotheses have been formulated from time to time by experts. However, here, we shall restrict ourselves to a simplified model for easier understanding.

          Classically, bipolar disorder is characterized by either repeated manic episodes or both manic and depressive episodes. Manic episodes are usually characterized by sustained elevated mood or irritability, increased self esteem, grandiosity, over-religiosity, over-generosity, decreased requirement for sleep (sleeps less but is visibly not tired), increased activity, authoritative behavior and so on. These symptoms typically last from days to weeks to months. A somewhat milder version of this is known as a hypomanic episode. These episodes may alternate with depressive episodes characterized by sadness, fatigue, pessimism, suicidal ideation and so on. Depressive episodes typically last from weeks to months and are generally longer than manic episodes.

Now to answer the question: Does mood swings represent bipolar disorder?
No, what is commonly referred to as mood swings by most people is short lasting fluctuations of mood and the extent of mood variation is also limited. for instance one might feel a little confident for a few minutes to hours and then somewhat less confident with associated changes in mood from happiness to sadness or irritability. Thus, besides being short lasting, the intensity of change is also mild (increased confidence but not grandiosity; decreased confidence but not suicidal ideas).

            It may be seen in normal people, in women in the days preceding menses, in those with a borderline personality, during alcohol withdrawal, during onset of menopause and so on.

But should it be treated? What if it is very discomforting?
If the symptoms are troublesome, yes, it can be treated. Typically, women with premenstrual dysphoria, alcohol withdrawal etc are treated with good results.

An important cautionary note: In those persons with already well diagnosed bipolar disorder, however, new onset mood swings may indicate emergence of a new episode or a partially controlled episode. This must be reviewed by a specialist and appropriate treatment measures instituted.

I hope it has been a useful discussion, friends.

Please let me know if there is any specific issue that you want me to address. Write in at stayhappy.prakash@gmail.com

So until next time, STAY HAPPY!

Dr. Sathya Prakash, MD, Dip. CBT

Consultant Psychiatrist, Psychotherapist and Behavioural Sciences Expert

lybrate.com/dr.sathyaprakash

icliniq.com/drsathya

ARE PSYCHIATRIC DISORDERS CURABLE?

Are psychiatric disorders treatable? Are they curable? How long will I have to take medications?
These are some of the common questions clients ask me.

The answer to the first question is easy! Yes, they are treatable.
The second and third? Not so simple! Are they curable? Depends on the condition in question and what you mean by a cure.
Medications, how long? Again depends on the condition.

Let me explain the answers to second and third questions in more detail. Psychiatric disorders are of many different kinds. Many disorders such as depression, adjustment disorders, certain anxiety disorders often go away by themselves, or with relatively brief treatment. But without treatment, they may last longer and have a higher possibility of emerging again. However, more severe forms of illnesses such as obsessive compulsive disorder, bipolar disorder and schizophrenia will more likely continue unabated without treatment, although there may be periods of relative freedom from symptoms. With treatment, the story can be different! For instance, up to 30% of patients with schizophrenia lead normal lives with treatment and another 30-40% experience only mild problems. If leading a normal life after treatment is what you call a cure, well then, a large proportion of patients with schizophrenia may be considered cured!

So how long do I continue treatment? For an isolated depressive episode or adjustment disorder, medications may not be needed at all! 
Even if they are needed, few months at best should suffice. However, if we are looking at schizophrenia or bipolar disorder, the situation gets trickier. Longer the illness (or more the number of episodes), lengthier the treatment.

So if treatment is sought early, the duration of treatment is shorter and outcome better; a double benefit! So in the first instance or episode, close to an year of treatment may suffice.
But if treatment is sought late, or medications are not taken regularly, it results in poor outcome as well as longer duration of treatment; a double whammy!

Therefore, for the best case scenario, consult early, take treatment regularly and get cured quickly!

Hope this helps!
STAY HAPPY!

If you need to contact me, feel free to write in at stayhappy.prakash@gmail.com

You might also want to check out my you tube channel Stay Happy!

Dr. Sathya Prakash, MD, Dip. CBT


Consultant Psychiatrist, Psychotherapist and Behavioural Sciences Expert

lybrate.com/dr.sathyaprakash