Drug & Alcohol Detox, Dual Diagnosis & Mental Illness

http://dragresti.com ~ (561) 386-7743

Dr. Agresti, Psychiatrist in West Palm Beach, Florida, talks about his preferred medications for treating depression.  Depression is more that just feeling sad for a few days.  Psychological symptoms of depression are sadness, lack of desire for fun, hopelessness helplessness, despair, worthlessness, guilt, thoughts of death and dying.  The physical symptoms of depression are changes in appetite and changes in weight. Problems with sleeping develop with people who suffer from depression.  Depression medications start working in a week or two and may take up to two months.  Anti-depressants commonly used are Wellbutrin, Prozac, Zoloft, Lexapro, Paxil, Remeron, Effexor and Pristiq.

Call Dr. Agresti today to get help for your depression.

The treatment depends on what state the individual is in and how severe.  Manic patients have a wide range of symptoms.  The severely agitated and psychiatric manic patient needs hospitalization and treatment with antipsychotics, like Risperdal, Seroquel, Geodon, and Zyprexa.  The less severe forms of mania respond to Depakote, Lamictal, Trileptal, Lithium, Abilify, Topamax and Zonegran.  The key here is to put someone on a medication which they can live with.  Most Bipolar patients require a lifetime of treatment.

What happens if they are depressed with a known history of mania?  You have to pre-treat with a mood stabilizer which I mentioned above and then use an anti-depressant.  Anti-depressant medications I like to use are Wellbutrin, Lexapro, Zoloft and Prozac.

(Note, some mood stabilizers like Abilify, Lamictal, Seroquel, and Zyprexa may be enough to treat both depression and mania.)

Situations do arise where bipolar patients can just be treated with antidepressants like Wellbutrin, Lexapro, Zoloft and Prozac.

No treatment presents problems.  These individuals feel so uncomfortable they may self medicate with alcohol, opiates and benzodiazepines.  Opiates are drugs like Oxycontin and Vicoden. Benzodiazepines are drugs like Xanax and Ativan.  Once addiction develops they can only be treated if the bipolar illness is treated.

Untreated bipolar patients also loose friends, lovers, jobs and their freedom. They frequently violate laws and wind up in jails.  They can destroy families with their violent inappropriate behaviors.

Treating opiate addiction (Oxycodone, Roxycodone dependency) since 1988 has taught me a few things.  Opiate dependency is all consuming.  Individuals become consumed with getting money for opiates, obtaining opiates and having time to use opiates.  All this mental energy is pulled from other activities.  Resources are taken from loved ones, leisure activities and business.  Individuals using opiates spend discretionary income on opiates (i.e. oxycontin), instead of going out to dinners, dating and playing.  Once on opiates the range of activities that individual engages in decrease.  Hobbies and sports fall to the side.  These individuals lack time and money to do fun things, but also lack desire to have fun.  There is no desire to have sex and desire to socialize decrease.  These individuals can maintain jobs and relations with a few close others.

They usually become depressed, crave sugar, and gain weight.  Their complexion changes to a grayscale cancer looking color.  They develop strange eating habits and sleeping habits.  Their sense of self worth and self-esteem decline.  They have feeling of emptiness and detachment from others.  One patient said she looked in the mirror and she saw a skeleton.  She no longer existed.  The opiate becomes everything.

The opiate becomes an individual’s lover and family.  The fear of going into withdrawal is so powerful.  When the possibility that the individual may be cut off from drugs, the beast comes out.

The opiate addict will do what ever it takes to get opiates.  Individuals come up with carrying solutions.  Stealing, lying prostitution, and selling everything come to mind.  The individual wakes up every day with one problem, how will I get opiates today?

Initially people started on opiates to get high.  That high gets less overtime, dependency develops.  The individual spends most of their time not high but getting enough drugs so they won’t go into withdrawal.

Initially coming off opiates involves acute detox.  That involves anxiety, abdominal cramping, goose flesh, leg jerking, yawning, nausea, vomiting, diarrhea, and headache and acute distress.  These pains end in five days.  After the detox ends, the real problems begin.  Individuals begin to experience intense craving for the opiate.  They become anxious, depressed and lethargic.  They have no energy and have trouble functioning.  Problems with sleep develop.  People describe feelings; they don’t know who they are or what their purpose in life is.  They have problems interacting with others because they are not sure how to act.  There’s the feeling of loss. Almost as if they are mourning the loss of a lover.  The loss of what they see as an exciting life and living outside the rules.  It’s very difficult for these individuals to be integrated back into society and live normal lives.  They always feel different.  Also in the addict mind is a grandiose sense they are better and superior.   This interferes with them finding jobs and forming relationships with others.  Commonly individuals who stop opiates relapse, use marijuana or alcohol. Involve themselves in toxic relationships.  Some develop gambling behaviors or inappropriate sexual activities.  They continue to look for the high.

Opiate addicts must make an initial step and say to themselves they no longer want to alter their mental state.  Decide the addict personality must go and a new one must be created.  Psychotherapy may be helpful.  Problems with depression, anxiety, insomnia, lethargy and drug cravings can be helped with non-addicting medication from a psychiatrist.

Forget one thing nicotine is usually what kills these people because they smoke too much.