AJ is a woman in her early 40’s who complained to me that she couldn’t stop drinking. She said she had been depressed for many years. She told me she drank a fifth of hard liquor every day.
She had never been sober for more than a year. She had been in multiple rehabilitation programs over the years and relapsed as quickly as a week later.
She spent the day, by herself, laying around, watching television, napping, and drinking. She quit seeing her friends. Previously, she was very social and friendly. She said she worried a lot about her future.
She told me that she had been on antidepressants before and had not seen much benefit.
Dr. Uhr’s Approach
Dr. Uhr educated AJ about the symptoms, genetic predisposition, and treatments for alcohol dependence and depression. She also explained the basics of how the medications work.
Dr. Uhr treated AJ for alcohol withdrawal and said she would re-evaluate her for depression in several weeks. Dr. Uhr explained that her mood may improve after she stops drinking.
She prescribed Librium to reduce symptoms of alcohol withdrawal and Campral to reduce cravings. She warned her about potential side effects so AJ wouldn’t be taken by surprise if she experienced any of these.
She suggested AJ return to AA and get a sponsor with a long history of sobriety. AJ did this within the first two weeks. She also went to a group led by an addiction therapist. Three weeks later, off alcohol, AJ still felt down and anxious. Dr. Uhr started her on a new antidepressant, called Pristiq , that works on two chemicals in the brain called serotonin and norepinephrine that are involved with depression.
AJ’s mood began to improve. She felt more positive and energetic. Her sleep improved. In therapy, she worked on her self esteem, ways to reduce stress, and how to feel more comfortable with herself.
She and Dr. Uhr outlined an action plan of what to do when AJ experienced cravings.
AJ calls her sponsor every day now and is working the 12 step program. She is now six months sober, in a good mood, is active going out with friends, and shows pride in herself.
LC is in his late 40’s. He is a successful business man who is married with three children. A family friend suggested he come in for an evaluation because he didn’t seem like himself these days.
He had had a big work disappointment the year before which still bothered him. He was already on an antidepressant, Prozac, that he had taken for six years.
His wife said he wasn’t participating in the family. He quit playing with the kids and was “napping the week-ends away.” She said he is quick to anger and they aren’t getting along.
LC told me he wasn’t on top of his game at work and had lost enthusiasm for everything, including golf, which was his favorite sport.
Dr. Uhr’s Approach
Dr. Uhr educated LC about the symptoms of depression. She also explained that an antidepressant can wear off over time and that this is very common with the antidepressants, such as Prozac, that work on a chemical in the brain called serotonin.
She told LC he has developed a tolerance to the medication and that lack of energy is very common when this occurs. Dr. Uhr tapered him off the Prozac over two weeks and started him on Wellbutrin which works on norepinephrine instead of serotonin.
He had several days of feeling “out of sorts,” but quickly adjusted to the new medicine.
He called several times over the first two weeks and said the new medicine wasn’t working. Dr. Uhr explained that the Wellbutrin may take two to four weeks to take effect.
She encouraged him to “stay the course.” By the fourth week, LC had quit napping altogether and felt like his energy was improving. Dr. Uhr increased his Wellbutrin and counseled him about side effects.
After six weeks, LC joked with her during his appointment. He says he felt amazed how much difference the Wellbutrin had made. He hadn’t realized how depressed he was feeling on Prozac.
He said he felt like a “new man.” His wife accompanied him and said they were getting along better than they had in several years. She said he wasn’t snapping at her or the kids and that he was an active participant in the family again.
On the last visit, LC said he was excited about work and was looking forward to his golf game on the week-end.
JS is a single woman, in her early twenties, who is a physical therapist. Two weeks ago, she suddenly felt her heart racing, a need for more air, and her chest felt tight.
She called an ambulance because she thought she was having a heart attack. She was told she had had an “anxiety attack.” She said two more attacks came “out of nowhere.”
She had quit going to work, running errands, and driving by herself for fear of having an attack and not getting help right away. She was afraid to be alone and was staying with her parents.
She admitted to being a “worrier and a perfectionist” like her mother. Her mother brought her to the appointment.
Dr. Uhr’s Approach
Dr. Uhr educated JS about Panic Disorder and explained that her symptoms were very typical. She told her that she had a genetic predisposition for anxiety.
She also explained that the anticipation of an attack is often more crippling than the actual panic attack and can lead to avoiding normal activities to the point that some people become “agoraphobic” or housebound.
She put JS on Paxil which is an antidepressant that works on serotonin and is effective for decreasing panic attacks within four to six weeks. She also prescribed Klonopin for immediate relief, but only for the short term because it is addicting.
She also worked with JS in therapy on finding a better balance between work and her personal life as well as becoming less of a perfectionist.
JS was initially afraid of the medication, but felt calmer on the Klonopin right away. She felt on the verge of panic three or four times during the first few weeks.
After a month, she had had no “full blown” panic attacks. The thought of having a panic attack was in the back of her mind, but didn’t dominate her thoughts. She no longer felt the compulsive need to be perfect.
She was driving again, functioned well at work, and was back in her own apartment. She had even started dating and was more comfortable taking normal risks outside of her previously very routine life.
She reported a new sense of confidence and freedom from worry.
ALCOHOL/COCAINE ABUSE AND ANXIETY (Dual Diagnosis)
BG is a twenty-one year old woman who was brought in by her father. She said she had been drinking alcohol and using cocaine since she was sixteen years old.
However, she had not maintained sobriety for more than one month in the last year despite several rehabilitation programs.
Her parents were at their wits’ end. They were arguing with each other about providing her with any more financial support. In taking BG’s history, it was obvious to Dr. Uhr that BG suffered from anxiety that had not been previously addressed.
BG said she never felt comfortable in her own skin, worried all the time, and didn’t sleep well.
Dr. Uhr’s Approach
Dr. Uhr explained to BG and her father that anxiety can be a major trigger for relapse. Dr. Uhr outlined options for treating her anxiety with Remeron. She explained it is an antidepressant that works on serotonin and norepinephrine and that it is very good for treating anxiety and insomnia.
She went over the potential risks of the medication.
BG said she was ready to stop drugs and alcohol. Dr. Uhr outlined a detoxification program. However, BG went on a cocaine and alcohol binge in the next two weeks and ended up in another 30 day program. However, Dr. Uhr had previously started her on Remeron which was continued in her rehabilitation.
BG returned to Dr. Uhr after a month. She was living in a halfway house and had returned to her job.
She went to AA and was working the twelve steps. She said she felt much calmer and was sleeping the best she had in years. She said she did not have any cravings.
She said she was twice as productive at work because she was able to concentrate. On her last visit, she told me that she felt comfortable in her own skin and was enjoying being around people.
She had had three months of sobriety and was very proud of herself.
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Dr. Sarita Uhr