Alcohol can be instantly rewarding, relaxing, euphoric, and disinhibiting, depending on how quickly you drink it and how quickly your blood alcohol rises.
However, most people do not realize that while the pleasant effects of alcohol are almost immediate, the negative effects are delayed. It often takes hours or days.And that lag makes it difficult to understand the relationship between alcohol and its adverse effects.
My patient, a man in his mid-40s whom I was being treated for depression, became inexplicably anxious, insomnia returning and depressed after weeks of definite improvement. was When he asked him about stressors at work and at home, he claimed nothing upsetting happened.
I then asked him about his alcohol consumption and discovered why his mood was heading south. He soon resumed his normal habit of drinking two or three glasses of wine with dinner.
He was skeptical when I explained that alcohol has a depressive effect and was likely the cause of his relapse. he said. So I suggested an experiment. “Stop drinking for the weekend and see how you feel on Monday.”
He was stunned and convinced by the result. His sleep has become normal and his mood has improved significantly. It wasn’t just that he was unaware that alcohol had destroyed his mood and his sleep. He began drinking more each night to combat the very anxiety caused by the previous night’s alcohol, setting up an autonomous cycle of depression, anxiety, and drinking.
You don’t have to suffer from clinical depression or anxiety to experience the ill effects of alcohol. They also occur with moderate levels of alcohol consumption typical of normal social drinkers without mental illness.
How alcohol interferes with sleep
Have you ever had a glass or two of wine and immediately fell asleep and woke up hours later?
Alcohol has an impressive sedative effect and targets GABA receptors in the brain. GABA receptors mediate the sedative effects of alcohol by increasing the activity of GABA, the major inhibitory neurotransmitter in the brain. (Ambien, and benzodiazepines such as Klonopin and Ativan, also modulate his GABA receptors, but at different sites.) Sleep problems are usually resolved within 2-5 hours as the alcohol is rapidly absorbed. That is. Midnight Hyper Alert.
Alcohol makes you sleepy, but it also suppresses REM or dream sleep and wakes you up later in the night. There is a possibility. This makes your insomnia worse and you need more alcohol to fall asleep. And now you’re in a self-perpetuating downward spiral.
Another patient who had no definite psychiatric disorder, but who drank heavily at night, asked if Ambien could be prescribed for insomnia. I told him I could Although he was dissatisfied with the advice, he was satisfied with the results.
What about alcohol’s negative effects on everyday mood? There is strong empirical evidence that alcohol has a depressive effect and, above certain thresholds of individual variation, can lead to clinical depression.
The GABA-enhancing effects of alcohol dissipate quickly, so it’s common to experience an increase in anxiety overnight after even moderate drinking.
Did we forget to mention the potential effects of alcohol on cognition? There is no doubt that heavy drinking is bad for the brain, but recent evidence suggests that even small amounts of drinking (4-5 glasses of wine per week) , has been shown to slow executive function and reaction time.
A recent study of about 20,000 people found that alcohol consumption exceeding 3.5 glasses of wine per week was associated with higher iron levels in several brain regions and lower performance on cognitive tests. The good news from other studies is that these cognitive effects usually reverse when you stop drinking.
So if you’re feeling anxious, depressed, tired, or mentally giddy, try abstaining from alcohol for a week or two. You may be pleasantly surprised.
And if you’ve already committed to a dry January, you may feel so good that you don’t want to rush back to alcohol in February. You may decide to cut back on your drinking.
Richard A. Friedman is Professor of Clinical Psychiatry and Director of the Psychopharmacology Clinic at Weill Cornell Medical College.
We welcome your comments on this column. OnYourMind@washpost.com.
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