By: Gia Gittleson, MSN, BA, RN
Psychiatric Nurse
Resilience Treatment Center

The holidays: a perfect storm of emotions, family dynamics, food, and booze. What could possibly go wrong? For starters, nip some of this seasonal discomfort in the bud by taking your meds. I’d capitalize “taking your meds” if I could, but that would be rude. Or flash my nurse face—the look all nurses have when a client does something contraindicated.

‘Tis the season for excess. Alcohol is big component of the holiday season. Every conceivable reason to drink is available whether you’re at home or out and about. School’s done for the year. Office parties are awkward. Relatives you see only once a year remind you why you prefer to see them only once a year. You’re home visiting your old crowd and picking up right where you left off. Or you’re home craving some solitude. However, if you’re taking psychiatric medications, please lay off the booze. The mixing of anti-depressants or anti-psychotics with alcohol can increase depression, lead to profound sedation, and severely impair judgment. There are medical risks, too. Adding alcohol to anti-depressants like monoamine oxidase inhibitors (MAOIs)—such as Emsam (selegiline) and Nardil (phenelzine)—creates a risk for an acute hypertensive crisis. MAOIs block an enzyme known as monoamine oxidase, which is needed to break down tyramine, an amino acid in your body. Red wine, beer, sherry, and liqueurs all contain tyramine and the build-up of it can lead to a rapid spike in blood pressure. The severity of this medical emergency can result in life threatening stokes, heart attacks, and kidney failure. [1]

At this time of year, many of us are traveling with real and emotional baggage. If your MD or NP has suggested anxiolytics, take them as prescribed. Don’t white knuckle it. The holiday season increases stimuli that can trigger generalized anxiety, panic attacks, and obsessive-compulsive behaviors. Just don’t share these meds. And remember that medications like Ativan (lorazepam), Valium (diazepam), and Klonopin (clonazepam) can lead to confusion and lack of coordination. It goes without saying that combining these particular drugs with alcohol is dangerous. Booze with benzodiazepines potentiates the effects of both, making you more sedated, and if older, at greater risk for life-altering falls.

If you’re of the clean and sober persuasion, there are plenty of drugs that aren’t sedatives-hypnotics or benzodiazepines, but still decrease anxiety. Beta-blockers for high blood pressure lower our adrenaline (aka epinephrine). That’s the fight or flight hormone. Inderal (propranolol) and (Tenormin) atenolol are commonly prescribed to decrease anxiety with no sedating effects. In Carl Elliott’s Atlantic Monthly article, he examined how performers and athletes prefer beta-blockers because its “value as a performance enhancer comes from its ability to mask the effects of anxiety.” [2]

Antiepileptic drugs such as Neurontin (gabapentin) and Gabatril (tiagabine) have also been found to decrease social anxiety. These two medications inhibit the uptake of GABA so more of this neurotransmitter can bind with receptors in the brain. [3] Antihistamines such as Vistaril/Atarax (hydroxyzine) work as anxiolytics by blocking histamine receptors in the brain. [4]

As a psych nurse, I have met so many clients who once again experience a variety of can’t-get-out-of-bed depression, psychosis (club drug-induced or otherwise), and bouts of mania that make people drive recklessly, shop furiously, or empty the ATM because most drug dealers require cash. And why? People stopped taking their meds because they were feeling better. One on level this makes sense. But we feel better precisely because we are taking our medication—and continue to do so.

And it’s not all about medication management. When we’re compliant with our medications, psychopharmacology provides a foundation. With this foundation, therapy (group, art, music, one-on-one, family, DBT, CBT, EMDR) invites us dig deep in our psyches, face traumas, and find forgiveness. Don’t let the holidays derail your mental health. Take your meds and find comfort that the new year is around the corner.

References
[1] Mayo Clinic. (2014). Depression (major depressive disorder). Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231
[2] Elliott, C. (2008). In defense of the beta-blocker. Atlantic Monthly. Retrieved from http://www.theatlantic.com/magazine/archive/2008/08/in-defense-of-the-beta-blocker/306961/
[3] Urbano, M. R., Spiegel, D. R., Laguerta, N., Shrader C. J., Rowe, D. F., & Hategan, L. F. (2009). Gabapentin and tiagabine for social anxiety. Journal of Clinical Psychiatry, 11(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2708011/
[4] Shiffman, J. E. (2011). Anti-anxiety medications explained. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/anxiety-help/201111/anti-anxiety-medications-explained