Monday, September 28, 2009

Alcohol and Antidressants.

I see a great many clients about the challenges of managing their alcohol intake. For some it is about moderation - for other cessation is the only option. The therapies I provide can either reduce or eliminate their use of alcohol.

A disturbing trend over recent months has been developing. I see an increasing number of people who are by any definition alcoholic and who have been prescribed antidepressants by their doctors. Some antidepressants come with a warning against using alcohol while on antidepressants, though by no means all. Nonetheless, there is widespread knowledge and reports of interaction between most SSRI antidepressants and alcohol; and yet medical professionals still prescribe them to patients who make no secret of the fact that they are alcoholic.

These patients are not going to simply not drink. They often drink because they are unable to stop. Simply being on antidepressants is not by any stretch of the imagination going to change this. And yet the known interactions are not merely mildly harmful, they can be massively damaging.

I have had clients in my office, unable to walk because their doctor has prescribed them antidepressants while they've been drinking. In some cases they are completely incapable. One particular doctor on the North Shore has several patients that have ended up coming to me for help because they are so hopelessly unable to function - and yet that doctor continues to prescribe dangerous quantities of antidepressants to alcoholic patients. They become a danger to themselves and anyone around them.

Cipralex carries a gently worded notation in the inserted documentation provided with it: "No pharmacodynamic or pharmacokinetic interactions are expected between Cipralex and alcohol." It continues:

"As with other psychotropic pharmaceutical products, combination with alcohol is not advisable. When co-administered with alcohol in a double-blind, placebo-controlled, volunteer study, Cipralex did not further impair performance compared with alcohol alone; paradoxically, it significantly improved performance in some tests."

Reality is rather different. Firstly, not everyone responds the same to alcohol; secondly not everyone responds the same to Cipralex. Judging from direct experience of my own client base this is so ludicrously at odds with the reality of alcoholism that it is wildly irresponsible.

Much the same is true of Celexa. Some clients have had dreadful experiences on alcohol/celexa combinations.

In the end, the pharmaceutical companies simply do not know how you will respond to some pharmacy. Everyone is a little different - and some times not just 'a little'. When combined with another drug - such as alcohol - to even pretend to know is arrogant and irresponsible. If you are using antidepressants and experience an unusual reaction to alcohol don't be surprised. More importantly, be smart enough to steer clear of either the antidepressant or the alcohol, regardless of what a doctor tells you about how safe it is.

After all, for some people something as benign as sugar can be deadly.

Rob Hadley CHt.

Tuesday, September 1, 2009

Fear of Flying

When we work using regression we regularly see the most extraordinary results very swiftly. Suddenly things become plain to the client and they understand why something happened. Subsequently their ability to manage their issue becomes very much more easily understood.
Dave Elmans book, Hypnotherapy provides a good roadmap for anyone using regression generally to manage an issue. However the pattern occasionally swings out of the norm.

Typically an incident in the recent past is associated with an incident in the clients’ early life that had traumatic elements and introduced stress and anxiety. By reframing the earlier incident the issue in the recent past is resolved – and future occurrences defused. This is not an unfamiliar process to most hypnotherapists.

A client saw me recently about a fear of flying that put a rather unusual twist on regression. The client has been growing increasingly distressed with air travel. Recently he felt overwhelming anxiety on a plane heading to the east coast, and embarrassingly needed to be handled by flight crew. This is entirely out of character in what is a skilled professional at the front of his industry.
In pretalk several points came through:

· He plans to marry in the next few months, his fiancée having been with him about 5 years.
· He moved out to the west coast about 4 years ago, having finished his degree.
· His anxiety seems to abate if he talks about his concerns whilst they are happening. (This is interesting as it occupies the conscious mind, and seems to displace the anxiety. This suggests his conscious mind can be diverted from these feelings – and raises the question ‘is this really about flight’?
· The client has a good understanding of engineering. He knows that if there is a total systemwide failure an aircraft is design to return to straight and level flight. Rationally he understands this means an aircrash is generally survivable. His engineering background tells him he should not be afraid, yet he is.
· His parents separated when he was eleven.
· At 12 he was very ill with meningitis.
· His fiancée has a sister who cuts herself.
· He had flown with no problems at all many times prior to the emergence of the problem.

Once in hypnosis the client went swiftly to the moment of discomfort in the flight. They showed a clearly elevated heart rate, and visual displays of fear. He described his fears well, and there was no question that this was an extreme response. I then regressed the client to the first incidence of of similar feelings. I would expect this to be in early childhood.

To my surprise the client opened his eyes and sat bolt upright staring into the middle distance. He regressed not to childhood at all, but moments before the flight left.

"I’ve got it," he said. "It was in the terminal. It was an hour before. I was saying goodbye to my fiancée. I was afraid because I was leaving her with her sister who has all these problems. I was afraid for her. It reminded me of my parents. It was as though I was my father leaving my mother, when I was sick."

Around this time the client had come out to the west coast to find work, with no idea at all if he would be successful. His fiancée was very worried about their prospects. Additionally his fiancées sister was essentially in his charge. As a man of 30 years old, he found himself in the position of a husband and father with a sick child (the sister being 12 years old). The departure at the airport was almost a re enactment of a situation with his parents as they separated when he was 12, with the roles switched around and he was cast as his father.

The session ended quite swiftly with no doubt whatsoever in the clients mind that this was an issue now that had nothing to do with flying. It was entirely about his ‘desertion’ of his fiancée. The moment of realization was absolutely clear to the client; the problem simply ceased to exist. This had nothing to do with flying whatsoever.

I suggested he go and reassure his fiancée as demonstrably as possibly, for her but also his own good. He was quite a reserved person, but could see that this would lay to rest some of these anxieties. He knew now that this was something that could be easily managed and understood. It is truly wonderful when a client leaves the office so elated and relieved.