Jaime Lewis (Host): Alcohol use is widespread in our society, but its impacts on mental health are often overlooked from anxiety and depression to medication interactions. Understanding this relationship is crucial for overall well-being. Here to discuss this important topic is Dr. Muhammad Awais Aftab, a Psychiatrist at Southwest General Health Center.

He'll explore how alcohol affects mental health in both the short and long-term, and provide practical guidance for maintaining a healthy relationship with alcohol. This is Southwest General Health Talk, the podcast from the specialists at Southwest General Health Center. I'm Jaime Lewis. Dr. Aftab, thank you for being here today.

Muhammad Awais Aftab, MD: Thank you, Jaime.

Host: So many people enjoy alcohol socially without thinking about its mental health effects. I know that I have done that for sure. Could you explain how alcohol impacts our brain chemistry and our mood both immediately and over the long term?

Muhammad Awais Aftab, MD: Yes. So alcohol has both short term and long term effects. Usually when someone, you know, as an alcoholic beverage or consumes alcohol in some form; in the short term, there are several changes in brain neurotransmitter systems. So one, there are increases in gaba neurotransmission, and this is the neurotransmitter that is involved in sedation and calming effect.

And there are also increases in the dopamine system, which is involved in pleasure and, and a sense of reward. And this accounts for the fact that people feel relaxed, people feel somewhat disinhibited and they enjoy the pleasant effects of alcohol. But at the same time, alcohol is also affecting other neurotransmitter systems as well.

One of them is glutamate and it suppresses that activity and that results in several undesirable side effects. Like memory gets fuzzy, they have difficulty with remembering things, coordination, and gait gets affected. Speech gets affected and, the higher the amount of alcohol is consumed, the more negative effects we see with regards to the effects on memory, on thinking, on speech, on gait.

And after alcohol kinda use has peaked and its concentration right in the blood and the person feels better, then there's a process of rebound where the alcohol is broken down by the body. And then, people often feel a sense of irritability or there can be a sense of tiredness, fatigue, things like that.

And for people who are consuming large amounts of alcohol, that rebound can be destabilizing and can have negative effects. In general, if alcohol is consumed infrequently and in moderate amounts, poses little risk and people can manage. But if it is being consumed very frequently and in heavy amounts, then this cycle of changes in these neurotransmitters and then kind of blood alcohol level coming down and people experiencing rebound or all of that can, lead to the brain getting adapted to the presence of alcohol in a negative way. And it increases mental health risk and increases the risk of variety of physical problems.

Host: Well, I mean, I know you say during the holidays or on 4th of July or something, people talk about feeling stressed out and they want to have a drink to relax. I mean, that's, it's in movies, it's in, you know TV, all of that. I'm wondering how effective that approach really is from a psychiatric standpoint, and what concerns should people be aware of when they're using alcohol to self-medicate?

Muhammad Awais Aftab, MD: That's an excellent question. In general, it's from a medical point of view, it's difficult to say that any amount of alcohol is completely safe. Even small amounts of alcohol presents some degree of risk, both in terms of mental health risks as well as physical health risks.

Such as the amount of alcohol we consume is linked to increased amounts of increased risk of cancer, as well as mental health difficulties. If we want to be entirely safe, the best option is to not consume alcohol at all. But oftentimes, reasonable use of alcohol offers enough advantages to people, they feel temporarily relaxed. It offers kind of advantages in social setting that they're willing to put up with a, you know, small amounts of risk. So if alcohol is being used infrequently here and there, especially in social settings and its use is not getting out of hand, the risks for most people are manageable in those kind of situations.

So, although it's not something that is medically recommended or any medical professional recommends, but if someone desires it, then the risks are acceptable for a lot of people.

Host: Well, we know that the rates of people who are on medication for depression and anxiety go up. So if the number of people who are drinking socially, casually stays the same, we know that more people are drinking while they're on some kind of medication. I want to know what are the potential risks for combining these kinds of things with alcohol.

Muhammad Awais Aftab, MD: There are certain risks to keep in mind. The biggest one is that there are psychiatric medications that have sedating effects. And then alcohol has sedating effects too. And if they're used in combination, then people can feel excessively drowsy. People can feel excessively lethargic.

They might get impaired to a point where it might not be safe for them to drive. That is something that has to be kept in mind. And so this certain types of antidepressants are more sedating, many mood stabilizing and antipsychotic medications are more sedating.

So caution is warranted in that case. Also, frequent use of alcohol typically interferes with the effects of medication. So if someone is on an antidepressant medication or anti-anxiety medication and they're consuming alcohol frequently, then they're probably not getting as much benefit out of the medication as they could be because the alcohol is interfering with the, with the clinical effects of the medication. In the elderly, combining psychiatric medication and alcohol use can also increase the risk of memory problems, can increase the risk of developing dementia, can increase the risk of falls. So in the elderly, these concerns become even more serious. And, with certain kinds of medications, there are more specific concerns. So a mood stabilizing medication commonly used in psychiatry is lithium. And if people are regularly consuming alcohol, they are at higher risk of dehydration. And that dehydration can put people at higher risk of lithium toxicity.

That is something to keep in mind as well. The general recommendation, again, is to minimize alcohol use as, as much as possible. The safest thing being, not using alcohol. I tell most patients that if they use alcohol judiciously, you know, a few times a month in reasonable amounts, that poses little interference with their psychiatric medications in most cases. But it starts becoming a problem if they're drinking most days in a week or they're drinking large amounts. That is where the interaction with medications becomes more concerning.

Host: Let's talk kind of chicken and the egg here. I know there's research that suggests links between regular alcohol consumption and conditions like depression and anxiety. Could you discuss what we know about those connections? Does one beget the other or what, what information do we have at this point?

Muhammad Awais Aftab, MD: Yes. So the alcohol and mental health problems like depression and anxiety have what we call a bidirectional relationship. People who have depression and anxiety issues, they are predisposed to alcohol use problems and people who have alcohol use problems, they are predisposed to experiencing more depression and anxiety issues and the effect is pretty large as well. People who have alcohol use problems, they are two to three times higher risk of developing depression and anxiety disorders compared to someone who is not drinking. So the effects are substantial and they go both ways. In some cases when people struggle with overwhelming depressive emotions, anxiety, nervousness, they sometimes use alcohol to self-medicate.

And, they try to use alcohol as a tool of blunting down their emotions. When in fact a better strategy might be to use psychiatric medications in a prescribed manner or undergo psychotherapy due to manage the difficult emotions. And, when people have developed a kind of alcohol addiction or an alcohol use disorder, the effects of alcohol on the brain over the long term are pretty negative.

As the brain gets used to those surges of gaba and dopamine that alcohol produces, it slowly adapts. And the brain's own ability to produce dopamine, for example, or, make use of the dopamine system goes down. And this leads to a state of kind of anhedonia where a person can have difficulty experiencing positive emotions and they can, have a sense of low mood and purposelessness.

So the, chronic effects, the long-term effects of alcohol, predispose a person to experiencing depression, anxiety.

Host: Okay. Well, speaking of that, what are some warning signs that people can look for when alcohol use is maybe negatively affecting their mental health? What are some of the, we'll just call them symptoms of that being a problem.

Muhammad Awais Aftab, MD: Yeah, so, a couple of different things that people can watch out for. One is that if they're noticing that as their alcohol use goes on, they're noticing increased irritability, they're noticing increased anxiety, they're noticing worsening depression or low mood, and it's getting to a point where they have to take alcohol to feel like their normal selves again. That's a pretty good sign that things have gotten out of hand and, some kind of a clinical problem with alcohol use is happening. If there's increasing alcohol use over time, so as kind of days and weeks go by, the person finds themselves drinking alcohol in more and more quantities, drinking alcohol more and more frequently; if they're needing alcohol to handle their stress, if they're needing alcohol to go to sleep, if they're needing alcohol to socialize, 'cause otherwise the anxiety is too unbearable; those are additional signs that something is going on. When people develop problematic patterns of alcohol use, they often start having memory issues.

Or they can have blackouts or they can have difficulty concentrating and making decisions, and their work performance starts to suffer and their family relationship starts to suffer. And, if they go by periods of not consuming alcohol, they can experience withdrawal symptoms and, these withdrawal symptoms can at times be quite significant.

So, those are, all signs that an alcohol use problem or an alcohol addiction, is brewing. And, the person needs help to manage their alcohol use.

Host: The word moderation comes up a lot, right? With all things. But with alcohol especially, I think people wonder about what is the place of moderation in consuming alcohol? Are there general guidelines that you know of for alcohol consumption that support good mental health, that are actually beneficial? And how do those vary for different individuals?

Muhammad Awais Aftab, MD: Yeah, so there, are general guidelines available regarding moderate or safe drinking. And these have been issued by the CDC and by the National Institute of Alcohol Use and Addiction. The general recommendation for low risk drinking is that for women, it is on average one drink per day or, less than seven drinks in a week.

Versus for men, it is two drinks per day on average or less than 14 drinks in a week. And for people who have a binge type pattern of drinking, the recommendation is to avoid having more than four drinks in one setting, and for men avoid having more than five drinks in one setting.

So these are for the general population, for people who are otherwise healthy, who don't have a lot of physical health problems or mental health problems. When people have history of psychiatric disorders, they need to be extra cautious and safe levels for them are going to be substantially lower.

So, so people who have been diagnosed with depression, anxiety, psychotic disorders, people who are on psychiatric medications, people who have family history of alcoholism, the safest thing again is to abstain completely from alcohol, but if that is not a possibility, then infrequent use, kind of like, you know, a few times in a month, idling in social settings, is generally okay, but it's going to be lower than what is safe for the general population.

Host: I'm sure as you're talking right now, there are people who are listening who maybe they think of somebody that they're concerned about. I mean, this is so widespread, right? And or maybe they're thinking of themselves. For somebody like that, what are the resources that are available at Southwest General to help them.

Muhammad Awais Aftab, MD: The best starting point is probably talking to one's primary care physician. Because primary care physicians are trained to screen for and assess these initial difficulties. Then they can provide additional details about safe drinking, moderate drinking, and refer people to resources.

For people who already have developed an alcohol use problem, and let's say they're experiencing active withdrawal, then emergency room is the best setting. If someone is acting, is in an active state of withdrawal. If they require the help of a psychiatrist in treating an alcohol addiction that has been developed; then we have psychiatric services available where they can meet with a psychiatric provider and consider different medications that can help with that. And we have counselors available as well who specialize in addiction services. And, the most important thing, we have a substance use intensive outpatient program, which is designed for people who are struggling with alcohol use problems, as well as other substance use problems.

And this is an intensive, three days a week, program in which people come in the morning, they stay till the early afternoon and they receive kind of group therapy. They receive psychoeducation, they receive a lot of resources in a structured environment and structured support to help them get on the path of recovery.

Host: Fantastic. I'm glad to know that's there for them. Thank you, Dr. Aftab, for all of your expertise and experience.

Muhammad Awais Aftab, MD: Thank you for having me.

Host: That was Dr. Muhammad Awais Aftab, Psychiatrist at Southwest General Health Center. To schedule an appointment or to learn more about behavioral health services, visit swgeneral.com.

And thank you for listening to Southwest General Health Talk, the podcast from the specialists at Southwest General Health Center.