Thanks for the reply..
Well, now let me explain to you what happened that day when you were all so confused and disoriented .
Since you have been drinking alcohol for quite a long period of time and that too in a major quantity ( 2 quaters to 1 full bottle / day , as you mentioned) so this has started effecting your cognition ( that is thought process ) , leading to clouding of your consciousness and reality testing and disorientation with time and place, which as of now occurs on and off , but if you continue to drink the way you are drinking right now , so not only this may lead to delirium ,but also may cause brain damage and predispose you to Dementia
, as alcohol is one of the predisposing factors for Dementia , also your age is quite near the age where dementia usually sets in , so with all honesty , i would like to request you to stop alcohol , if you cannot do it on your own , then check into a rehabilitation center or seek your doctor's /psychiatrist's help in alcohol withdrawl , but please stop alcohol intake, as it has started showing its harmful effects , that incident where you had gone into a short term delirium ( clouding of consciousness, loss of judgement and impaired reality testing , poor perception) is a warning sign for you to give up on alcohol as soon as possible .
So, below mentioned is the regime that you should follow.
1) Consult your psychiatrist / doctor and discuss with him alcohol withdrawl and getting started on withdrawl of alcohol. I will suggest you a drug called as Acamprosate , which is used in preventing craving from alcohol and along with carbamazepine it is used in safe alcohol withdrawl , so i will ask you to discuss the use of these two drugs with your concerned doctor and get them prescribed and start them to help you in your withdrawl.
2) Also , i will suggest you get a CT scan brain done , to see, if there is any brain damage that has been caused due to years of alcohol addiction , i would not have suggested the CT scan , but since the past episode of delirium , i would want brain damage to be ruled out , so kindly do the needful , you may discuss this with your doctor as well.
3) You may continue on Wellbutrin , klonopin and estrace , but i will want you to get off cymbalta ( duloxetine) , as overloading with anti depressants ( currently you are on 2 anti depressants -- celexa and wellbutrin) may furher add
to your clouding of consciousness and confusion episodes , as cymbalta itself causes some sedation.
But, you need to come off from cymbalta slowly in order to prevent Cymbalta discontinuation/ withdrawl syndrome , which occurs when you abruptly stop cymbalta .
So, i propose that since currently taking 1 and half tablets of cymbalta , and each cymbalta tablet is of 40 mg , that means you are taking 60 mg / day of cymbalta .
So, to start with ,reduce to 40 mg dose , that is take only 1 tablet / day instead of 1 and a half tablet , continue on this for 1 week . Then after 1 week , reduce the dose further to 20 mg / day that is half a tablet / day , and continue on this for 1 week , and then after end of this week of taking half tablet / day , you shall stop the drug cymbalta . So, in this way you will have a safe withdrawl in 2 weeks period. You may discuss this with your doctor and this withdrawl can be carried out with your alcohol withdrawl.
So, i sugegst you discuss the plan of action that i have mentioned above with your concerned doctor and i will again reinforce, it that you need to quit Alcohol , and this i stress
upon with full concern about your health and as a duty being a doctor. As far as you being embarrassed about meeting up with your doctor , i will say that there is no need to be embarrassed about this , as you have been courageous enough to admit that you have a problem with alcohol and doctors are there to help patients like you , after all that is our duty , and it is your right to get the right treatment , so stop thinking too much about this , and leave aside your apprehension and get going and meet up with your doctor and dscuss the regime mentioned above and get started on withdrawl .
I am quite hopeful that once you are through with the withdrawl , you will get back to your normal routine daily life and will be as profesionally and socially functional as ever , but just take it as a resolution to not to take up alcohol again ,as you have already completed your quota of alcohol intake, and now if taken again it will have harmful effects on your body.
I wish you all the best and rapid recovery to the best of health.
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