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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 3999
Experience:  MD Psychiatry
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I dont quite know where to start. Basically, I am a 63 year

Resolved Question:

I don't quite know where to start. Basically, I am a 63 year old woman. I have been a teacher, counselor and travel writer. I am also alcoholic. I have put myself in treatments four times. I have been sober for years at a time. I am a functioning alcoholic but getting worse, mentally. Last week, I left my first session with a Psychologist who I felt good talking with. After I left, I had a break from reality. Filled with anxiety, I had to ask directions to get out of the building, was totally confused and hardly anything seemed the same as I tried to go visit my sister and husband who live about 7 miles from the Psychologists office. I felt anxiety and fear...I finally made it to the area where there house is and I couldn't remember which one it was. I kept going up and down streets and finally found them since my brother in law has seen me park outside and then drive off. I was lost.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 5 years ago.
Hi there,

Welcome to Just answer !

Kindly answer a few queries .

1) Were you under the influence when you had gone to see your sister ?

2) How often do you take alcohol -- everyday ?

3) What all medications are you currently taking?

Kindly answer the questions against their numbers .

Regards..

Customer: replied 5 years ago.
Dear Dr. Kaushik,

1. Not, I was not under the influence when I went to my sisters, after the Psychologist session.

2. When I drink, I only drink in the evenings from about 5-8pm. It entails one-half to one bottle of 750 liters. I have been stopping for several days and then drinking again.

3. I am taking Celexa (I believe this is a bene? as the last treatment place wanted me to stop them but I was afraid to stop them and alcohol at the same time. I also take wellbutrin, estrace and klonopin.


Expert:  Dr. Kaushik replied 5 years ago.
Thanks for the input and the information.

One more question what is the dose of celexa that you are taking as of now?

Regards..
Customer: replied 5 years ago.
I take 1 and half tablets of celexa (40 mg) per tablet each day.
Expert:  Dr. Kaushik replied 5 years ago.
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.

I hope my answer serves your query according to your satisfaction.

Please press the ACCEPT button if you are satisfied with the answer as only then will I be credited for my service.

Regards...
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 3999
Experience: MD Psychiatry
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