Sunlit Water

April 5, 2010

I Hate Doctors

Filed under: Personal — by teofilo @ 10:27 am

So I went to a psychiatrist today.  The backstory of this is now lost in the bowels of Unfogged, but the gist of it is that I was taking Wellbutrin to control my depression for a couple of years until I ran out a couple of weeks ago.  I flailed around for a while but eventually called the counseling center at school and got an appointment with a psychiatrist, but not until after the counselor I talked to acted all shocked that I had just stopped taking the pills after I ran out, which I didn’t think was very nice of her.  The psychiatrist I talked to today was better, and I feel pretty good about her.  She wants me to get some bloodwork done tomorrow before I fill the prescription she gave me, which kind of freaks me out because I have a thing about needles but also reassures me that she’s taking this seriously and acting like a real doctor.

The main issue I have is that she wants me to quit drinking, both because of the known risk of seizures as a result of combining alcohol and Wellbutrin and because alcohol is a depressant and she can’t understand why someone would want to take antidepressants to fight depression while at the same time drinking alcohol, which reinforces it.  The fact that she doesn’t understand this makes me a bit hesitant to trust her, because it seems pretty obvious to me that my drinking (which I don’t think is at all excessive) hasn’t caused me any problems so far with the Wellbutrin and helps counteract some of the problems with social anxiety I have by lowering my inhibitions.  I would have challenged her more on this, but I was kind of intimidated, as I usually am with authority figures in new settings.  She also mentioned that I might want to try counseling, which I may, but the way she put it was that I should just call up and get an appointment, which made me realize that she had no idea how hard that would be for me to do.  I guess I didn’t say anything about my social issues because this visit was all about the more pressing problem of the depression, which is a totally separate thing as far as I can tell.  So while the visit was a success overall, I’m a little apprehensive of how complicated my life has suddenly become.  I guess I’ll try not drinking, at least for a little while, but I can just see how it’s likely to totally destroy my social life.  It’s not so much that I can’t go to social events and not drink, which shouldn’t be a problem.  The real problem is that getting myself to go to those events in the first place, and talk to people once I’m there, requires something to overcome my inhibitions, and that’s generally alcohol.  I don’t know what else could replace it.  I guess I could try anti-anxiety drugs, but I’ve heard bad things about some of those and I’m hesitant to try them.

So yeah, the appointment went okay but afterward I actually felt more depressed than before, mostly because of all the changes she seemed to be forcing on me.  I don’t like change, and I have a hard time dealing with it.  I even considered just forgetting about the whole thing and continuing to suffer, but I realize that that’s a dumb and juvenile thing to do and I should at least give this a try.  Anyone have any advice or thoughts?

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19 Comments »

  1. I could call up and make a counseling appointment for you. Seriously.

    Also, how much drinking are we talking about here? From reading your post and reading a few quick hits on the subject, it sounds as though individual reactions to Wellbutrin and alcohol vary, and that if you’ve found moderate drinking worked in the past without ill effects, it probably will in the future. And also that it’s a serious risk, not just of seizures but of turning into some kind of out-of-control gorillaman.

    Comment by K-sky — April 5, 2010 @ 10:41 am |Reply

  2. Two to three drinks, two to three times a week is what I’d estimate lately (and is what I told her when she asked). And yeah, my impression from the general practitioner who initially gave me the prescription was that moderate drinking without a personal or family history of seizures was unlikely to be problematic. The psychiatrist, though, who obviously has much more experience with this, basically seemed to feel that the risk was still much too high.

    Comment by teofilo — April 5, 2010 @ 10:48 am |Reply

  3. Maybe I’m reading her remarks as relayed by you uncharitably, but “alcohol is a depressant and she can’t understand why someone would want to take antidepressants to fight depression while at the same time drinking alcohol” just sounds silly to me. Alcohol is a depressant because it depresses the functioning of the central nervous system, which is only tangentially related to the thing we call “depression” that is treated by antidepressants. I mean, alcohol might indirectly contribute to depression, but it seems like a pretty distant connection. “Antidepressant” isn’t the opposite of “depressant” — otherwise caffeine would keep us all happy.

    Comment by essear — April 5, 2010 @ 10:55 am |Reply

  4. Caffeine keeps me happy. But that sentence is very silly. Even if the meanings of “depressant” were the same, it’s still silly that she is completely puzzled why someone might enjoy moderate drinking.

    Comment by heebie-geebie — April 5, 2010 @ 10:59 am |Reply

  5. That part’s nearly verbatim, and yeah, it was the main thing that made me really question what she was saying. I was pretty sure “depressant” in that context didn’t really mean what she was implying it meant, but I don’t know very much about biochemistry or physiology, so I wasn’t about to get into a big dispute over it with a doctor. I think she’s probably Muslim, at least culturally (she doesn’t wear a headscarf or anything, but she does have a very Muslim-sounding name), which may have an effect on her attitude toward alcohol. Working at a campus health center, where alcohol-related issues are a big focus, may also play a role.

    Comment by teofilo — April 5, 2010 @ 11:00 am |Reply

  6. Another voice for the chorus of “This sounds like bullshit, find another doctor.” It’s a bit of a maddening Catch-22, though — it’s hard to argue about it without the obvious response being “You seem very reluctant to give up drinking, have you ever thought about seeking treatment for your drinking problem?” (Which, to be clear, at the described level of drinking, of course you don’t have.)

    Comment by elizardbreath — April 5, 2010 @ 12:27 pm |Reply

  7. This is totally anecdotal, but I know a lot of people on anti-depressants, and almost all of them drink in moderation. I think most doctors know this when prescribing medications. It’s one thing when you’re taking antibiotics, where you really need to get better and abstaining from alcohol for 5 days isn’t very hard, but come on.

    I know this sounds horrible, but I would just ignore her demand that you not drink. Is that awful?

    Comment by m. leblanc — April 5, 2010 @ 12:30 pm |Reply

  8. I don’t agree that you need to find another doctor. I vote w/ leblanc to just ignore the no-drinking response. She is the fastest path to getting a prescription, and it sounds like she is otherwise going to do all the standard medical stuff.

    I believe in withholding irrelevant information from your doctor, if it is predictable that they’ll get all unnecessarily PSA on you if they knew.

    Comment by heebie-geebie — April 5, 2010 @ 12:39 pm |Reply

  9. Yeah, I am kind of inclined to just ignore her and keep drinking, especially since I’ve been doing just fine with the exact same medication and dosage she’s prescribing for years now. The thing is, though, aside from the “but alcohol is a depressant!!” nonsense, the seizure issue is a very real risk, and I am concerned about it. (I think it’s specific to Wellbutrin, which differs from other antidepressants in several ways.) Like I say, I’ve been okay so far, I’ve never had a seizure and don’t have a family history of seizures, and my impression from what my previous doctor said was that under those circumstances a consistent, moderate level of alcohol use is unlikely to be problematic. But I do still kind of worry.

    Comment by teofilo — April 5, 2010 @ 12:48 pm |Reply

  10. Yeah, but you can research and assess that risk far better on the web than you’ll ever get in a straight answer from her. At least IMO, from mapping my experience with my OB onto your doc. My OB never gave me honestly gray answers; it was always scare-tactics.

    Comment by heebie-geebie — April 5, 2010 @ 12:52 pm |Reply

  11. That is, while some of what she was saying was clearly just anti-drinking propaganda, there is a genuine medical issue here, and she is a doctor. So I’m not inclined to just totally reject her opinion on this, despite some of the weird stuff she said. Getting a second opinion might be a good idea, but that’s so much work, and as the post title notes, I kind of hate talking to doctors.

    Comment by teofilo — April 5, 2010 @ 12:54 pm |Reply

  12. Looking for online information is another option, of course, but I’m not sure I know enough about this stuff to judge its credibility. I suppose I might as well at least take a look.

    Comment by teofilo — April 5, 2010 @ 12:56 pm |Reply

  13. Ditto to the above comments. I took wellbutrin w/lexapro for a few months and neither doctor nor pharmacist even mentioned the alcohol thing. I happened to notice the little “no martini” sticker on the bottle after a couple of weeks, in which time I’d been drinking moderately as you describe, a couple of social beers or a glass of wine with dinner, etc. No problems at all. At one point I drank enough to actually get drunk, and I recall thinking it felt like my tolerance was lower than it should have been, but it wasn’t dramatic. If you had a history of seizures it might be a different story, but from my experience and the bit of online research I did at the time I don’t think it’s very serious otherwise. I found discussion forums like this one to be helpful for putting the labels and physician’s comments into context.

    Regarding taking a “depressant” when you’re depressed, whatever. Our psycho-emotional register has more than one axis, and obviously there’s ways that “depressing” one process could “stimulate” the others that you want to focus on, like having a social life. There’s other reasons to be concerned about alcohol+depression, like maybe that one social beer is undercutting your development of healthy attitudes towards socializing or whatever. Maybe you’ll want to look into that kind of thing, but not with someone who’s going to try to reduce you to a point on a line.

    Comment by Adam Henne — April 5, 2010 @ 1:15 pm |Reply

    • That’s helpful; thanks. (And sorry for the delay in posting. Your comment ended up in the spam folder for some reason. I’m not sure why.)

      Comment by teofilo — April 5, 2010 @ 1:49 pm |Reply

  14. This is the only paper I can find on PubMed that directly addresses the issue. It’s not very helpful in a practical sense.

    Comment by teofilo — April 5, 2010 @ 1:16 pm |Reply

  15. My (pretty substantial) experience with doctors is that psychiatrists will generally tell you not to drink at all, no matter what else is going on. Their baseline story, as uncharitably interpreted by me, is “crazy people should never be drunk and since they’re crazy and can’t control themselves, we should tell them all never to drink alcohol ever.”

    This doesn’t ever seem to have much to do with actual drug interactions or usage history or anything. So I’m with the chorus: ignore particular advice and use the doctor for prescriptions.

    If there’s a real drug interaction risk, that’s a different story- you might think about switching to a different medicine? Although just from the fact that it seems hard to find any studies online makes me think the risk is being oversold…

    Comment by Cecily — April 5, 2010 @ 1:34 pm |Reply

  16. Yeah, I’m thinking the risk is being oversold. There don’t seem to be any actual studies on the combination of alcohol and bupropion in humans (just the mouse study I linked in 14). The prescribing information says:

    Patients should be told that the excessive use or abrupt discontinuation of alcohol or sedatives (including benzodiazepines) may alter the seizure threshold. Some patients have reported lower alcohol tolerance during treatment with WELLBUTRIN XL. Patients should be advised that the consumption of alcohol should be minimized or avoided.

    “Excessive use” isn’t defined, of course, but note that “abrupt discontinuation” is apparently a problem too. Honestly, I haven’t seen anything that indicates that moderate drinking is likely to be problematic, although there is frustratingly little information available.

    Comment by teofilo — April 5, 2010 @ 1:44 pm |Reply

  17. For what it’s worth, not drinking (or, rather, drinking infrequently and in limited amounts) does seem to help in addressing my depression. Possibly just because of how alcohol interferes with solid sleep. My doc prescribed short-term “as-needed” Xanax on top of Zoloft. This has helped in general, and may also be a helpful adjunct for you on the social anxiety issues. Use your judgment. I’d be leery of withholding info from the doctor. I’d rather challenge her conclusions if she seems to be too preachy. Seems like it’s good to have accurate medical records.

    Comment by M.T. Lincoln — April 11, 2010 @ 5:40 pm |Reply

    • Yeah, I may cut back a bit, though I doubt I’ll stop entirely. The sleep thing is a good point; I tend to have a lot of trouble sleeping, and I know alcohol can contribute to that. And yeah, I don’t think I’ll be keeping information from the psychiatrist. My next appointment isn’t for a few weeks, so I have some time to figure out how to deal with all this.

      I’ve started on the pills again, btw, and they seem to be helping.

      Comment by teofilo — April 11, 2010 @ 9:08 pm |Reply


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