Loose boundaries

The psychiatrist eyes me over his glasses, notepad in hand. The day is too bright, the room too noisy, even in silence. Me, a social worker, a trainee clinical psychologist, and the psychiatrist. He seems affable; in my memory he has a short beard, a stereotypical shrink. But memories are unreliable, and my memory of this time more unreliable than most.

“You’re right”, he comments, “SSRIs have, in general, only slight efficacy. It depends on the person and their situation, obviously. We don’t really understand it.

But it seems, from what you’ve said, that they affect you a great deal more than most”

Generally, I take this to be a good thing.

*

My alcohol consumption has rocketed.

Normally I drink only at weekends, a few glasses (OK, bottles) of wine with a meal, with friends. If we’re going out, obviously I drink more, but again this is a weekends thing.

And I have a curious relationship with alcohol, in that it reliably makes me feel good. Yes, I can get maudlin, but warmly so. Even in my depression, it can lift me. Fact is, I enjoy being drunk. And I thank whatever guardian angels I have that, for some reason, this has never quite twigged with my subconscious. When I’m depressed, I don’t drink – I drink socially, I drink randomly, but I never drink to get happy. I never self medicate.

Which is why it’s curious that my consumption has rocketed. And I’ve got to put it down to the meds. SSRIs actually make most people more sensitive to alcohol, so you’d expect they’d drink less; but while I do get more sensitive, I end up drinking more. Lunchtime pints, nipping in to the pub after lab, staying for one more, one more, another more, more.

And it’s impulse control. I somehow lose impulse control on these drugs. I get some of it back after a few weeks, but initially there’s this loosening of my behavioural boundaries. Curiously, this is one of the mechanisms by which SSRI medication is presumed to trigger suicide behaviour (don’t worry, that’s not going to happen). It’s also something which alcohol itself disrupts – which is why drunk people can be so, well, impulsive. I don’t pretend to know the ins and outs of it (and I doubt anyone does), but it’s strange to watch yourself from the outside, behaviour staggering more than you’d anticipated, willpower veering, only half in control. Sober, acting drunk.

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4 thoughts on “Loose boundaries

  1. “I somehow lose impulse control on these drugs.” <— I have experienced this BIG TIME on SSRIs! I found myself doing and saying things I would never do. It was scary and almost messed up my marriage. Tread lightly, which it sounds like you are already doing by writing about it and exploring it further.

    • I actually don’t like sertraline because it it goes too far with this. I don’t say inappropriate things, but I definitely become more ‘flighty’, with money, relationships, etc. Citalopram at least settles down after a while.

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