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Psychiatry & Psychology--General/Drinking with Prozac/Seroquel and anxiety issues

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Hi Dr. Harrop,

I have OCD and have been prescribed Prozac and Seroquel.  Unfortunately, I have a problem: although I know that I am not supposed to drink while on psychoactive medicines, I've been doing so anyway because I usually have no problems after drinking small amounts.  However, larger amounts over extended periods cause me to have bad mood swings and, yesterday, I had a very bad anxiety attack after drinking just one beer.  Such a reaction is very unusual for me, but I've also been sleep-, exercise-, and sunlight-deprived over the past two weeks.

I spoke with my psychiatrist today, and she agreed that my drinking had been excessive (it had been as much as 2 and change drinks/day on average) and that I should not have more than 1-2 drinks per week at a maximum.  Now, the challenge for me is actually sticking to this limit.  

I tend not to do well with "arbitrary" limits (I set a number of drinks and then, once I've had my limit, I say"just one more won't kill me!"), and if I choose not to drink in a situation where I normally could, I feel that I am depriving myself of something and start to feel anxious (the same thing happens when I'm at a restaurant and see the dessert menu.)  Another problem is that I am going on a month-long trip to Europe in a week and I know that the temptation to overindulge in alcohol will be ever-present, especially since I am travelling with two other twentysomething guys :). But, of course, that would be the absolute worst time to have an anxiety attack.

Do you have any advice for me on how I can stick to the limit my psychiatrist gave me?  I feel like I could do it easily if I could overcome the anxiety of "missing out" and/or substitute some other pleasurable activity for drinking.

Thanks!

P.S.  I feel a lot better today but I'm still a little moody -- since I'm not going to drink at all, can I expect my mood to stabilize over the next day?  or would it take a while?

Answer
One key is "substitute some other pleasurable activity for drinking."  If weight is not a problem, then fruit juices might work or food snacks.  If don't have an alcohol or drug problem, then the fake beer might help (this is NOT recommended if there is a substance abuse problem). Other substitutions: exercise, music, other audio products (comedy, old radio shows), even TV -- something to get your mind on something else.

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Daniel S. Harrop, M.D.

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Dr. Daniel S. Harrop received his B.A. and his M.D., both from Brown, and his M.B.A. from the Edinburgh Business School, Scotland. Board-certified in adult and geriatric psychiatry, he is a past president of the R.I. Psychiatric Society and a member of the Committee on Medical Quality of the American Psychiatric Association and the Committee on Continuing Medical Education of the R.I Medical Society. He serves as a consultant to four of the top five major medical management companies, including OptumHealth/United Healthcare, Magellan Behavioral Health Services, ValueOptions and APS Healthcare, and maintains a private practice in Providence, R.I. He also serves as chief psychiatric consultant on the Medical Advisory Board at the R.I. Workers Compensation Court. He was formerly on the faculty at the medical schools at both Brown University and Harvard University.

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