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Greetings,Customer Thank you for submitting your question(s) to JustAnswer.com in the category of HEALTH. My name isXXXXX I am a licensed physician, trained throughout Internship, Residency/Fellowship at the Mayo Clinic in Rochester, MN in the specialties of Internal Medicine and Critical Care.
Zoloft and alcohol are listed as two items to be avoided together because of CNS (central nervouse system) depression, meaning that they are concerned that your level of consciousness will be reduced dangerously low. As you know, these warnings are very often true, but also stated for reasons of liability for the manufacturer.
You have taken Zoloft for many years while ingesting a moderate alchohol intake. I know of no evidence listed for brain damage from Zoloft. We do know that alcohol is a nerve toxin when present in significant levels.
The toxic effects of alcohol on the brain, per se, are not intesified by Zoloft. In viewing the most recent literature of this issue, I just do not see this listed as a concern. The alcohol alone brings about concerns of neuron injury in the brain, but no additive effect of Zoloft to this process has been studied.
There is no long-term evidence of Zoloft damaging the brain or causing neuron injury. There is a suggestion that I can offer, however, if you truly wish to evaluate this process, realising that there is some degradation in cognitive thinking and processing possible with again alone.
You could take an extensive biobehavioural and cognitive series of tests, that can be arranged by your psychiatrist or healthcare provider. These testing series can be repeated at intervals to assess you for any cognitive decline or biobehavioural injuries or changes.
From a molecular biology standpoint, I cannot propose a mechanism of interactive brain cell (neuron) injury from the combination, but from the standpoint of alcohol as a neurotoxin itself, I can expect on at least some scale, perhaps small or large, there is neuron injury occurring.
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Depression, OCD, anxiety ... all of these as well as alcohol can lead to varying levels of memory concerns. The memory concerns you may have notices could very well be transient and vary from day to day related to the former, while the alcohol tends to have a slower, rather insidious accumulative effect.
You seem incredibly insightful to me. That degree of insight, recall, and your fluency in describing your concerns reassures me, as a physician, that the most important memory and cognitive functions are quite capable. Your being a paramedic, as well, clearly shows that you have had to assimilate vast amounts of knowledge, and be able to apply them in a logical, organised, and orderly manner in your testing and recertifications.
Medicine, be it as an MD or a paramedic, is an anxiety provoking field. We all have little or more traces of OCD because of the organisational requirements thrust upon us. We also see the best and worst in people, which in itself can be a source of anxiety and depression. It's a diffucult and stress-drenched field we work in, don't you think? I sure do.
I am not concerned about the Zoloft-Alcohol combination being synergistic to memory decline or nerve injury. I haven't seen any studies on this specific issue to show me this to be true. I am more concerned about the purely neurotoxic effects of alcohol.
In contrast, studies have show that people with 1-2 ounces of ethanol consumption per day receive benefit in terms of longevity and blood pressure. So there is a study showing moderate intake with benefit. Don't you love all these strangely contradictory studies we have to wade through and about?
I don't think the alcohol intake that you have is excessive, and I also do not see patterns of alcoholism as it's generally applied. I do like the idea of serial studies testing memory and cognition over time. I think it will not only give us a more objective answer, but if it shows no memory decline or deficits outside of those that are age-adjusted, that it may put a great deal of your anxiety at ease. I hope this makes sense and seems a helpful respsonse.
I understand that you have also approached Dr. Gould about this subject, and his answer is quite in line with my own. The two together are not going to present you with a synergistic brain damage scenario, like 1+1=5. The alcohol you take in, is not excessive, and that likewise doesn't give me great concern.
Please don't hesitate to ask further questions or present additional concerns. As always, I wish you the best and am happy to help.
I agree, I think that with time, everything you describe could be explained a great deal by multiple factors involved more than a scenario of neuron damage or injury. I think the Depression, OCD, Anxiety likely play a role along with our normal aging process. With age, there is that untangible loss of wonderful plasticity and dynamic nature we once enjoyed in earlier years. There are memory and brain exercises, however, that may be helpful. I have often considered these myself, and recently have found Sudoku Puzzles to challenge me, maintain my interest and attention span, and make me feel better and more mentally sharpened. I also like certain video games that keep my hand-eye coordination honed.
Here are a few sites I visit on a regular basis:
These things, and things of this sort, along with proper treatment of the underlying psychiatric health, physical health & exercise, a healthy appetite for good things surrounding you in your life -- good friends, positive surroundings, and pleasant or soothing ambience -- will also strengthen your overall sense of well being. I am truly of the opinion that we are all captains of our own ships, and we must make every effort to keep her in safe and sound waters, condition, and direction. Part of this process, at least for me, also includes my spiritual health being exercised and strengthened. I love being a scientist, but I always try to emulate the greatest scientist of them all, my Lord. I don't want to proselytise or even attempt to force my beliefs in this regard on anyone, but it is helpful to me and other whom I know who share similar faith.
If you have any other concerns or questions, please don't hesitate to ask!
I wouldn't expect significant memory lost in a 26 year old, but once we added in the other contribtory and additive factors as mentioned earlier, the perceived memory loss may seem disproportionate.
There are no interactions between coffee and Zoloft, other than the antagonism between Zoloft's "sleepy" side effect and caffeine pushing the other way. Otherwise there is nothing in the literature on problems with these two chemicals. :)
Correct, sort of. Generally, ethanol is removed from an averaged size person of 60-70kg at a rate of 1 ounce per hour. In light of no liver disease, it's okay to take up to 4 grams of Tylenol per 24 hour period. Ah yes, a little codeine cloud may slow the neurons a bit, too, and may have some amnestic effects. Ah yes, a little codeine cloud may slow the neurons a bit, too, and may have some amnestic effects.
Ah yes ... j/k
I will be leaving for business to Chicago over the weekend and I won't be available to answer questions for a couple of days. It has been a pleasure discussing your concerns with you. I hope that I have put many of your worries to rest or at least offered you dependable information that help you gain even more insight into your health. I think you are an intellectual young man with a lot on his plate in term of anxiety and a frequent need for reassurance. I do believe you will be fine doing as you are, addressing and treating the underlying conditions that interfere with your living a normal life. It seems to me that you are doing the right things to maintain a long and healthy life. I will try to check in early this morning to see how you are doing and wrap up any loose ends or other concerns you might have.
I have never watched Law & Order, although I have been at locations very briefly where it was playing on TV at the time I was present. I really didn't pay much attention to it, except that I recognised an actor (Jeremy Sisto) from the now retired HBO series "Six Feet Under" ... he played the character of Billy Chenowith.
I would not label anyone with brain damage for not recalling characters in a television show. It's not how we would test this hypothesis. As I have mentioned, the gold standard, if you are truly concerned about this, is to undergo serial cognitive and behavioural testing and specialised memory assessments that are stadardised and adjusted for confounding or conflicting variables.
Did you try any of the brain exercise links I posted earlier? I love those things. I recently tested my reaction time to a box that flashes on the screen when I was freshly awake and alert, and again after two nights without sleep following intense work covering for colleagues who were sick or needed me in for backup. At around the 58 hour mark of being awake continuously, here are my results, each an average of 10 successive attempts each:
Freshly Awake Reaction Time: 230 msSleep Deprived Reaction Time: 312 ms
I don't know of any that are better, per se. A Psychiatrist will be much better versed on the comparative studies. What I have seen listed in recent literature reviews were "Meta Analyses" showing that SSRI's have replaced clomimpramine as first line therapy for OCD. They have the ancillary benefit of being antidepressants, too, of course, but the doses to treat OCD are generally higher than the doses to treat depression. There have been no head-to-head studies addressing the cognitive/memory concerns that you have. The newest SSRI's, like Lexapro and Cymbalta, have not been indicated for use in OCD, yet.
Prozac (fluoxetine) is commonly used to treat OCD and depression, and in one of the meta analyses it was no better than Luvox (fluvoxamine). A nice ancillary benefit to Prozac is that it has a very long elimination half-life in the body, and once it's stopped, it generally auto-tapers itself out of the body without withdrawal symptoms.
We discussed earlier that alcohol has neurotoxic affects in and of itself when present in quantities that exceed some arbitrary threshhold. We don't know what that threshhold is, but it is generally accepted that 1 to 2 ounces per day is okay. Binge drinking, on the other hand, clearly is not. I am not sure what type of drinks you are mentioning here, but 6-8 drinks could be 6-8 ounces of alcohol as hard liquor, or it could be 3-4 ounces of alcohol as beer. In either case, this value is too much and will injure neurons ... how many and to what extent we don't know, but this amount exceeds the threshhold and would likely damage more neurons than our normal rate of age-related neuron loss. See the following NIH link on this topic:
I still feel that if you have done this at a rate of only once per month, that you haven't done excessive harm, but I would advise that you absolutely stop the binge-type drinking, from a purely medical and physiological standpoint. Make sure you don't drive if you do drink this amount, using the assumption that we metabolise 1 ounce of alcohol per hour. You mentioned "over the night," which reassures me that you are likely spreading your drinks out ... this causes less of the binging peak alcohol levels that are concerning for alcohol-related brain injury. I still advise against this amount, even once per month and spread out over longer periods. Alcohol has an accumulative effect.
In light of alcohol use, I do believe that B-vitamin supplementation (including and especially thiamine) and folic acid (folate) are reasonable things to take. Given your infrequent but more heavy drink ingestion once or twice a month, you are still in a much better position than others who drink more often and in large amounts. From the outset, however, I have made it evident that alcohol is a neurotoxin, and with such overwhelming fear of brain damage as you seem to display, it would seem you would likewise have an overwhelming desire to minimise anything that could insult and injure the brain.
Zoloft is not causative of "brain damage" based on any evidence that I am aware of to-date. Alcohol is the neurotoxin ... the more that is binged, the greater the potential for neuron damage. Zoloft, to the best of my knowledge, does not add to the neurotoxicity of alcohol. Tylenol with codeine is not additive or associated with brain damage, to the best of my knowledge, in the presence of alcohol, any more than the alcohol neurotoxicity alone. Alcohol neurotoxicity is seen with higher blood alcohol levels, especially those considered to be binges.
HiCustomer Alcohol's ability to injure neurons is dose-dependent, so the higher the dose (the number of drinks) per unit time, the more neurotoxicity the alcohol will have. I do notice significant characteristics of the OCD/Depression peaking through during our discussion ... mostly the OCD and anxiety over aspects concerning brain damage. I can sense you want/need of reassurance from many differrent sources online, not just here. It's almost taking over your entire thought process, and is concerning to me. At the same time, I commend you strongly on your excellent insight and apparent desire to do well for yourself and your health. As with your Psychiatrist, I believe that your memory concerns are more due to the multiple factors of combined OCD, Depression, and Anxiety. I recommend trying to abstain from alcohol use, as well.