Brief Answer: No underlying disorder, but alcohol withdrawal. Detailed Answer: Hi, Welcome to Healthcare Magic! What you are experiencing after a night of binge drinking are a manifestation of alcohol withdrawal. Many people believe that withdrawal occurs only after regular drinking for years, but it is not so. Even after binge drinking, withdrawal is seen and is commonly called "hangover" which is just a mild form of alcohol withdrawal. In many people, the severity of withdrawal symptoms increases after repeated withdrawal episodes and this exacerbation is attributed to a kindling process which sensitizes the brain. That is why, you are gradually seeing a worsening of symptoms after each successive binge drinking episode. During the binge-drinking episode, the body, particularly the brain, adapts to the presence of alcohol by compensating for alcohol’s effect on the central nervous system (CNS). Alcohol has an overall suppressing effect on CNS activity. Accordingly, the adaptation process involves several mechanisms to increase the excitability of nerve cells (i.e., neurons) in the brain—that is, their ability to become activated in response to signals from other neurons. When alcohol is eliminated from the body during abstinence, this compensatory activation of the CNS remains in effect for several more days, resulting in excessive excitability of the CNS (i.e., hyperexcitability). This hyperexcitability manifests itself as alcohol withdrawal, with symptoms ranging from anxiety, palpitation, tremors and agitation to even seizures and delirium tremens. While these symptoms that you are experiencing do not indicate the presence of any underlying disorder, heavy alcohol intake is known to affect the liver, gastro-intestinal system and the heart in addition to the brain. So if you inform the doctor about your alcohol drinking pattern, he will himself ensure that all required tests are done. Alcohol may also have a role in your Generalized Anxiety Disorder (GAD) and you will see a benefit in GAD as well if you can give up alcohol. Alcohol induced anxiety disorders are very common. I hope this answers your query. Please feel free to ask if you need any clarifications. Please also remember that successive binge drinking episodes may be followed by seizures or delirium tremens. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: You have very good insight! Detailed Answer: Hi, Thank you for writing back! I agree with you that you might have been using alcohol to overcome social difficulties. You are also right in saying that CBT will be a more healthy and constructive way to overcome the social difficulties. However, if your doctor suggests that you take SSRIs (escitalopram, sertraline, paroxetine etc), then in my opinion, you should agree for a trial of SSRIs as I feel that they will make a big difference for you. I am not sure but perhaps your doctor has already started you on an SSRI. CBT requires a certain degree of intelligence and psychological understanding, which in my assessment, you have. So CBT will also give you good results if you can get a good therapist. But if it is going to take some time to be able to arrange CBT sessions, then it would make sense to start medicines first and start CBT later when possible. Take care. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: A follow up appointment should do. Detailed Answer: Hi, I do not think that you need an emergency consultation at present, and a follow up appointment should do. You will see a gradual improvement over time. I expect you will be fine in five to six days. If, however, at any point you notice any worsening in confusion, then please seek an emergency consultation. Take lots of water. Eat light foods in adequate amount. Wait for things to improve. You may have difficulty in sleeping. But do not worry. Best wishes. Dr Preeti Parakh MD Psychiatry

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