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Medication or psychotherapy or...both?

Old 10-13-2019, 11:39 AM
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Medication or psychotherapy or...both?

Hi there. In an effort to establish a stronger foundation on which to build sobriety, I have looked into therapy recently. But it is a long haul that won't produce instant results. I have been considering whether to go on an anti-depressant to feel better in the shorter term and as another tool to fortify my sobriety.

My question is: would this somewhat nullify the point of therapy - as I'd be engaging in it already medicated and so we wouldn't be able to dig as deep, so to speak? I.e. is the absolute optimal scenario to engage in longer therm therapy unmedicated? Was curious if anyone had any experience of this and what their views are? I intend to ask a doctor this also but I feel that hearing from those with direct experience of same would be useful.
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Old 10-13-2019, 12:20 PM
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This is an unpopular opinion, but I never did see the point of therapy. I saw a therapist once in my teens after stealing junk food (I was a white collar kid with a food addiction) for about a year, and it was absolutely useless. He was very nice but the whole thing was pointless. It felt like paying someone to listen to me say a bunch of things I could have journaled instead. He never offered an opinion or advice, I think that’s common, so it was me masturbating my thoughts kind of like I do on my own. I think therapy helps people feel less lonely. But making friends and getting out to do things that interest you can accomplish the same thing.

As for medications: for deeper depression that renders someone nonfunctional, it can help. But pay attention to the most recent research out there before medicating, unless you are in danger. Nutrition and exercise therapy is accomplishing what antipressants can do: and without the impotence and zombie after effects, too.

Sorry. Lots of therapy folks and medication folks here, who can give you an opposite opinion from mine if you’re interested.

Cleaning up your Side of the fence before adding things in can help.

Sleep hygiene is CRUCIAL. Are you sleeping?
Exercise is NECESSARY. Not optional. Necessary.
Are you taking time to go outside? Going outside is necessary for mental health. I know you hike so that’s probably a yes.
Are you getting the protein, vitamins, minerals and macro ratios you NEED on a daily basis?
Are you eating processed foods?
How is your gut? Your digestion? Your gut health and regularity is a potent clue.

These things all in order? If not: consider that alcohol is a wasting element. It wastes protein, wastes vitamin b, wastes minerals: drinking alcohol GIVES us malnutrition, and this is years of abuse! How many years it takes to replace what we’ve wasted is unknown, yet not getting what you need can cause depression. That’s simply a fact.

I’m not saying Friday night ice cream or staying up all night on Saturday to watch movies or spend time with friends shouldn’t ever happen. I’m saying is the rest of your self care in order?
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Old 10-13-2019, 12:25 PM
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Congrats on your sobriety.

Do you have a history of depression? I have struggled with depression my whole life, with or without alcohol, so antidepressants are a major part of my recovery. I also see a therapist because I have trauma issues - medication would not help for that, unfortunately.

The best scenario depends on your particular situation. And, this is not a one-time shot. You can try either/or and change things as needed.

Personally, I made more rapid progress in my therapy when I resumed antidepressant medication. I had a long history of antidepressant usage already, so I knew what worked and what didn't and I didn't need to "try out" medication before finding one that fit.

I would advise you to stay in therapy, no matter what.

Take care.
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Old 10-13-2019, 03:03 PM
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I'm always puzzled at why this is an either/or question. My position in a nutshell: good drs can assess whether we will benefit from meds based on our mental health condition and situation. If we take them and they are the right fit, they benefit us in every way. Conducting therapy (on top of life) as best functioning as we are able gives us the best chance for therapy to help us grow and learn ways to engage with ourselves and everyone else.

Here's an analogy, as well: taking meds without (talk) therapy is like being "dry" without working some kind of recovery program. For me, why solve only part of the condition/problem, and shortchange ourselves of our potential for growth and happiness?
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Old 10-13-2019, 03:15 PM
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We're all different.
Sounds like a good idea to ask your own doctor and/or therapist Briansy

D
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Old 10-13-2019, 06:48 PM
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Regular exercise, good nutrition and self care were huge for me when I first stopped drinking (still are). However, I knew I needed more support to help me create a solid foundation to my recovery and set me up for success. Routine was huge, visiting SR regularly to read and post, journaling and becoming as knowledgeable as possible about my addiction and how to move through the cravings were key. I didn't go to AA because I have used AA as a tool in the past and it didn't work for me. So...I began seeing a therapist. I didn't realize that I was depressed (and had been for many years) until I started therapy and began taking antidepressants. Like many, I thought that anti-depressants altered ones personality and gave you a high. It wasn't until I became more knowledgeable that I realized I was wrong. When I first stopped drinking I was prescribed Lexapro and Wellbutrin. Neither of which made me feel like a zombie or gave me a feeling of being "high". I simply felt leveled out. Early this year I stopped taking the Lexapro. Initially I worried that I would have a negative reaction and begin feeling unhappy again. But I really didn't feel any changes in my behavior or attitude once I stopped taking it. Next year I will stop taking the Wellbutrin. If I don't feel that I need it, great! If I do, then I will begin taking it again. For me, the goal is to enjoy life, look forward to each day and live life to the fullest....all while being the best version of me. If that means that I need an anti-depressant to feel the way I do today, so be it.

Lastly, I have seen many different therapists and every one of them have been different. I too used to think that my friendships were as good as talking to a doctor. Not true...if you find the right therapist, you will FEEL the change in how you see life.

Best of luck to you in your recovery. You're smart to think through what tools you will need. Plan the Work...Work the Plan!

CT
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Old 10-13-2019, 07:26 PM
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“..... as I'd be engaging in it already medicated and so we wouldn't be able to dig as deep, so to speak?”

“medicated” in reference to a medication that is prescribed for a mental health condition is not synonymous with making you unable to “dig deep”. in fact, it might do the opposite and make you able to tolerate deeper digging .
just a thought, could be totally off base.
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Old 10-14-2019, 12:30 AM
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Thanks very much all. I kinda framed the question in such a way that people would counter the point that therapy is less effective when on medication. And there seems to be a good body of opinion out there that suggests medication can actually make therapy more effective. It seems like it's quite a polarising subject, but I have decided to do both based on what I have read.
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Old 10-14-2019, 04:53 AM
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Good deal, Briansy.

Overall, I do much better when I take my prescribed medications. My cynical self says this is a placebo effect, but I don't care. It's not harming me, and in that way it's helping.

In addition to taking an antidepressant and anxiety medication, I've been taking antabuse. That choice is entirely prophylactic and I'm grateful to myself for making the choice to take it every day. Knowing I have this medication in my system helps me to easily dismiss those wispy passing thoughts about potentially possibly drinking someday. It brings my focus back to Now. Right now, today, I am not drinking. And that's all that really matters because it's always Now.

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Old 10-14-2019, 06:38 AM
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I also have to throw in that putting it into the hands of a good dr rather than doing what I thought was best (ie taking meds or not) was exactly why I saw that dr. As I have gone, yes, it is up to me to report symptoms and such - partly to inquire if anything I've experienced is typical of that med, and partly to give info so we determine if another one is better.

For me, it's a simple equation: substance gone + proper prescribed and taken (KEY) meds + program/therapy/support = good life.
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Old 10-14-2019, 07:23 AM
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IMO, medication only works with therapy. And therapy is bolstered by medication.

You don’t unlearn all the bad thinking/emotional coping mechanisms, etc just by taking a pill. That takes work. But what the pill does is level the playing field so your brain is able to function like neurotypical ones. It helps you look at things rationally, understand why you are having specific responses, and clears the fog of depression and anxiety so you can then start to rebuild.

Obviously, a better lifestyle is also very important, but those things are also much easier to do when your brain is doing what it’s supposed to.

I believe that milder forms of anxiety and depression can be helped by therapy alone, but other more serious cases do need chemical help. Exercise is not a cure all. Eating veggies is not a cure all. You gotta really buckle down and do some work.

I would give it a shot. My life improved dramatically when I stopped drinking, got my meds figured out, and really hit hard with therapy. As long as you are supervised by a professional, it doesn’t hurt to give it a try.

Best of luck, dude.
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Old 10-17-2019, 03:20 PM
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My opinion is that it can be good to explore various things. Either or, in combinations - so many versions to try and see how they work, then stick with what's effective. Often one approach that has been beneficial for a while, in a certain period, is no longer helpful... move on then and try something else.

I had a couple years of "love affair" with therapy a few years ago, to the extent even that I considered training to practice a form of it part-time. I had been very curious about it for a long time prior, so went with a wide open mind. I saw a few different therapists, some only for 1-2 sessions and worked with two a bit more long-term (about a year each, and sometimes I juggled both in parallel). It was interesting but nothing life-changing or tremendously helpful for me and I often had a tendency to use it more as a distraction from actually truly dealing with my issues. I work in the mental health field myself and have always been introspective, interested in understanding how I work, self-improvement - these things come naturally to me. Surely alcoholism distorted a lot of that, certainly did not make me improve, and it took a while in sobriety also to really regain my mental clarity and balance (or develop new forms of it). So therapy was exciting for me for a while, mostly because of the mental stimulation and novelty it provided, the ways I was trying to figure out how to use it and what to make of it. Overall though, for me, it wasn't anything super useful. I stopped going after about two years total. Don't regret trying it but I doubt I would go again in any foreseeable future, I can't really see what for.

I also tried psych meds and experienced mild benefits for a while with some, with others pretty much just unpleasant side effects, and some brought a combination of a somewhat helpful and annoying. Most of my medicating was during the times when I also did therapy. I stopped experimenting with those as well.

What tends to work best for me, and I can say quite stably and long-term now, is many of the self-care approaches mentioned already above. The variety is endless really - I love to try new methods in this area. I tend to respond very well to novelty, so sometimes simply just exploring new things can give a boost of mental health. The most important factor for me though is trying to keep a reasonable balance in my lifestyle. Fortunately, I'm finding that aging (and of course sobriety) has brought a very significant decrease in my tendencies for obsessiveness, excess and extremes (I think this is very common) - it's actually pretty easy now.

I don't have strong negative or positive opinions on either therapy or psychiatric medication. What I think most important is the context, the individual person and issue. I haven't been using any professional mental health treatment now for >2 years and, in general, feel better than ever. I really think it is the much healthier and balanced lifestyle. I do experiment with nutritional supplements sometimes but not ones that are too mysterious or dicey. The only emotional challenge I continue having to some degree is anxiety... but that's also the one I have had in my whole life. A good lifestyle, including good habits and discipline, helps me more than anything with the anxiety as well.
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Old 10-17-2019, 10:23 PM
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I think Therapy is a wonderful idea!

I took an SSRI the first 6-8 months of sobriety.. it helped a lot !

Wishing you the best
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Old 10-18-2019, 01:53 AM
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Appreciate all of the responses everyone.

I'm seeing someone again for therapy on Monday.

I was prescribed citalopram and only took one tablet on Tuesday morning. I had bad side effects such as massive drowsiness, teeth grinding, a worsening of tinnitus and, the one that made me not take another, really bad insomnia including not being able to sleep at all the first night and very poor sleep since. Granted, these take a while to get through the initial side effects, but insomnia is something I cannot do for even a short period and if I am to be totally honest with myself, I am not really sure I meet the clinical "threshold" for anti-depressants. It seems that when I get really down that it's situational and temporary. I do definitely have anxiety issues - general and particularly around socialising and sleeping - exacerbated by and quite possibly caused by alcohol - although the social anxiety goes way back to childhood - and something I just thought some people were pre-disposed to - but clearly I now see it can and should be addressed / improved.

So, I think I am going to forget the meds. I would be lying if I said I wasn't thinking clearly - yes, negatively, and head a bit all over the place post withdrawal, but I am not sure I am veiled in such a depression that it would hamper any progress made in therapy. I also need to consider that sometimes down periods just happen, and it has been grey, windy, rainy, damp and cold for about a month solid here in London. It definitely has an effect.

I would love to take some time off to deal with all of this stuff in a vacuum - and be able to afford to go to therapy more than once a week. One 50 minute session is so far short of scratching the surface. But, sadly, life must go on!
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Old 10-18-2019, 04:17 PM
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Are you sure the insomnia and the other symptoms were caused by that single citalopram tablet?

Another form of therapy available these days, which is not forced into single session compartments a week, is online. You could look up Betterhelp, for example, and there are other sources as well. You basically email or online chat back and forth with a therapist in a more unstructured and continuous way. It does not cost more than regular 50 min weekly sessions and, I think, some of the sites offer a free initial trial period. I haven't tried it but know many people who have and some find it quite useful. And if you don't like one therapist, can ask for others from the same platform.
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Old 10-22-2019, 02:01 PM
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I tried both. I started with Therapy, and then tried a couple of different meds, but not until several months into my therapy. I actually changed therapists once before trying meds too - I was scared to take anything, which makes no sense since I self medicated with alcohol for decades.

Long term my experience and opinion is that the meds really only helped the symptoms, the therapy helped with the source of the symptoms. I tried an anti-depressant first and it was not a good experience. The second med I tried was a more targeted anxiety med and it was helpful initially. I took it for about 6 months and then weaned off.

My personal opinion is that a holistic solution works best. In my case my condition is Anxiety, and the solution involved Therapy, meds ( for a bit ), exercise, diet changes ( reducing caffeine/sugars ), sleep and behavior modification. Reading about and practicing mindfulness and mediation was helpful too.
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Old 10-22-2019, 02:45 PM
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Originally Posted by Briansy View Post
Appreciate all of the responses everyone.

I'm seeing someone again for therapy on Monday.

I was prescribed citalopram and only took one tablet on Tuesday morning. I had bad side effects such as massive drowsiness, teeth grinding, a worsening of tinnitus and, the one that made me not take another, really bad insomnia including not being able to sleep at all the first night and very poor sleep since. Granted, these take a while to get through the initial side effects, but insomnia is something I cannot do for even a short period and if I am to be totally honest with myself, I am not really sure I meet the clinical "threshold" for anti-depressants. It seems that when I get really down that it's situational and temporary. I do definitely have anxiety issues - general and particularly around socialising and sleeping - exacerbated by and quite possibly caused by alcohol - although the social anxiety goes way back to childhood - and something I just thought some people were pre-disposed to - but clearly I now see it can and should be addressed / improved.

So, I think I am going to forget the meds. I would be lying if I said I wasn't thinking clearly - yes, negatively, and head a bit all over the place post withdrawal, but I am not sure I am veiled in such a depression that it would hamper any progress made in therapy. I also need to consider that sometimes down periods just happen, and it has been grey, windy, rainy, damp and cold for about a month solid here in London. It definitely has an effect.

I would love to take some time off to deal with all of this stuff in a vacuum - and be able to afford to go to therapy more than once a week. One 50 minute session is so far short of scratching the surface. But, sadly, life must go on!
In addition to therapy, I can’t stress exercise enough.

I am like night and day with exercise. If I don’t put in an hour of cardio and weightlifting enough days of the week, I’m in the hole.

Then I go back to exercise and I’m back. I’ve even told my family “when you see me sink down, please remind me to go to the gym.”

Of course they haven’t done that so I spent a recent two weeks in the hole, just muddled and depressed, and didn’t pull out of it until I went back to exercise. I have done 3 days in a row and might just do daily. I figure even if I just do a light row and some sit-ups, I’ve at least moved enough to nudge my brain chemicals in the right direction.

I know everyone is so different. Sometimes people have gotten upset with me for mentioning that exercise worked better than medication.

But keep in mind there is a lot of solid research about this, enough that some psychotherapists prescribe walks, or do therapy while walking with patients.

Some food for thought, just sharing my experience.
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Old 10-23-2019, 03:02 AM
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Originally Posted by Stayingsassy View Post
In addition to therapy, I can’t stress exercise enough.

I am like night and day with exercise. If I don’t put in an hour of cardio and weightlifting enough days of the week, I’m in the hole.

Then I go back to exercise and I’m back. I’ve even told my family “when you see me sink down, please remind me to go to the gym.”

Of course they haven’t done that so I spent a recent two weeks in the hole, just muddled and depressed, and didn’t pull out of it until I went back to exercise. I have done 3 days in a row and might just do daily. I figure even if I just do a light row and some sit-ups, I’ve at least moved enough to nudge my brain chemicals in the right direction.

I know everyone is so different. Sometimes people have gotten upset with me for mentioning that exercise worked better than medication.

But keep in mind there is a lot of solid research about this, enough that some psychotherapists prescribe walks, or do therapy while walking with patients.

Some food for thought, just sharing my experience.
I used to run a lot. Up to 15k. Felt amazing when I did it. But I haven't in over a year now as I have really bad ligament laxity that probably requires surgery (which I can't currently afford). It's really crap. Not to be able to do that and also the weak ankle has affected my golf game to the point that I don't enjoy it much anymore. Really not ideal.

In a proper rut here. I'm sure it will pass but, frankly, right now, I'm not really in a place where I am motivated for that to happen.
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Old 10-23-2019, 03:04 PM
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Originally Posted by Briansy View Post
I used to run a lot. Up to 15k. Felt amazing when I did it. But I haven't in over a year now as I have really bad ligament laxity that probably requires surgery (which I can't currently afford). It's really crap. Not to be able to do that and also the weak ankle has affected my golf game to the point that I don't enjoy it much anymore. Really not ideal.

In a proper rut here. I'm sure it will pass but, frankly, right now, I'm not really in a place where I am motivated for that to happen.
Running, which I used to do a lot of (I ran a marathon on a bad knee in 2003, I was 32. Bum knee and still managed 4:39 limping the last six miles!) is actually pretty damaging to most bodies over 40.

Some bodies can take it. Most can’t. My friends on FB that have gone back to running have had back surgeries, knee replacements, injury after injury.

I row, Boulder and lift, for that reason. Even in CrossFit the short amount of running and jumping would cause foot pain for weeks.

It’s a matter of finding something else. Biking. Rowing. Climbing. Body weight exercise (don’t discount this, mastering a pull-up is actually thrilling), elliptical, Olympic weight lifting (deadlifts, squats and bench press) are all a lot more fun than you realize.

Find something that doesn’t batter your ankle, do it several times a week and report back to me. If you’re still depressed, go from there.
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Old 10-23-2019, 03:30 PM
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Such a good thread. I've noticed feeling better the next day after some strenuous exercise, not the gym but pushing my granddaughter on her bike up hill when I had a bad back and other things I had to force myself to do lol.. I need to find some less painful method and I did buy myself some weights which I must get aroun to using as I've read that working with weights is actually very good for as long as you get the right level for yourself.
i also have beenhelped alot with Prozac. Infact I don't know how I would have survived this long without it.
A lot of people have talked about getting their lives and interests back giving up drinking. I never had any get up and go or interests before drinking life was always a tremendous effort, so giving up wasn't going to magically make that happen. It wasn't until I started on Prozac that I started to get interests. I started being able to enjoy sunsets or rain on streets, just day today things that I'd only ever had an occasional glimpse of way back in my teens and it never lasted long and wasn't very often. So it's really changed my life but even then it's taken years , it wasn't over night or even a year it wasn't until after I upped my dose that things gradually changed.
I've been going down hill lately and need to get it sorted so I can get some joy back in my life.
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