Reflections on Psychiatry & Psychology

Cravings for drugs or alcohol are controlled by a variety of brain chemicals, including norepinephrine, dopamine, and glutamate.  Many people describe their cravings as coming out of nowhere, as if these chemicals pop into their brains and create a cravings spontaneously. These chemicals and the manifestations of cravings are actually triggered by stimuli from external environmental cues and internal mood states, particularly anxiety, irritability, and dysphoria.  Environment

After 20 years of depression, Jack improved in 2 weeks on Paxil. But feeling better upended his “depressed” life—job, friends, marriage—causing crisis. Lesson: patients with chronic illness must prepare for change and continue therapy when they improve.

Joe was in his mid-fifties, an accomplished attorney who has been suffering from recurrent depression since his early adulthood. The depression was difficult to treat; many different medications have been tried, including mood stabilizers (medications for bipolar disorder), but those were prescribed such a long time ago that Joe had  a hard time remembering how he was feeling when they were prescribed. All he knew that for at least the last ten years he was only depressed, so

Suicide is the 10th leading US death. Predicting it is hard; only clozapine, lithium, and ketamine reduce risk. Genetics, stress, and access to means all contribute.

After quitting drugs, many feel bored because drugs flood the brain with dopamine, dulling natural rewards. With time and practice engaging in healthy activities, the brain can relearn to find pleasure in everyday life.

Drug labels can mislead: meds are named for first uses, but act by mechanism. Topiramate (Topamax) began as seizure and migraine treatment, yet is also used off-label for mood stabilization or weight loss, among others.

Hypervigilance to bodily sensations can trigger faster breathing and hyperventilation, lowering CO₂ and reducing oxygen delivery to tissues. This causes dizziness, tingling, and panic. Alcohol may give brief relief but worsens anxiety later; therapy can help.