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Annabelle Chen, 40, was feeling terrible. She was hung over and nursing a headache. Her boyfriend and family were upset about some text messages she had sent them. But she couldn't remember anything about it as she was drunk when she did it.
A family doctor referred her to a psychiatrist to help her overcome her drinking problem. It took her a year to make an appointment.
Chen, a teacher, didn't think she had a drinking problem. The very idea of having to see a psychiatrist upset her. Sitting in the waiting room for her first appointment, she had scratched deep, bloody lines on her arm with a paper clip, shocking herself and the nurse.
Chen (whose name has been changed for patient confidentiality reasons) met Professor Munidasa Winslow, executive director and senior consultant psychiatrist at Promises health clinic, who began with treating the cuts on her arm.
Over the next few sessions with Winslow, Chen slowly revealed her feelings. She could not shake the belief that her life was miserable, and drinking helped ease the burden.
She had been drinking since her teens. Over the years, she drank more and more - half a bottle of wine a day and much more on weekends. The weekend drinking binges were starting to spiral out of control and led to other problems, like drunken arguments with her then-boyfriend, falls and even a car accident.
Winslow knew that for therapy to even begin, Chen needed to acknowledge that the drinking was a problem. He first had to find out her motivations and goals in life. He helped her see that drinking was an obstacle to achieving her dreams. Chen was now motivated to stop drinking.
Winslow arranged for her to undergo a five-day detoxification programme at a hospital. Sudden and complete withdrawal of alcohol by a person who drinks regularly can result in seizures. Alcohol depresses certain functions of the brain by stimulating an inhibitory neurotransmitter called gamma-aminobutyric acid, so it inhibits neurons more effectively.
Therefore, long-term use of alcohol causes neurons to become hypersensitive to certain chemicals. A sudden withdrawal of alcohol can cause tremors and seizures as the over-sensitised neurons overreact to those normal chemicals in the brain.
During detox, Chen was given sedatives or light hypnotics to help her sleep and to take the edge off her anxiety.
As she was weaned off alcohol, it became clear she was very depressed. Her persistently low mood, insomnia, sense of impending doom, high anxiety, panic attacks, isolation from friends and self-loathing were some of the signs.
Winslow explained that depression has biological and environmental components. Serotonin is a type of neurotransmitter that is responsible for a lot of the positive feelings we experience. Consider it your body's 'happy hormone'.
When one's environment creates a lot of stress and emotional strain for a prolonged period, serotonin levels can be depleted, and it may be physically difficult for the person to feel well.
During periods of stress, people might sleep and eat poorly and fail to exercise or look after themselves properly. This behaviour can also have an impact on serotonin production. Exercise, for example, can be as effective in raising mood as popping an antidepressant, Winslow explained.
Some people may also have a genetic predisposition to depression, which is sometimes linked to the body's ability to produce or receive serotonin.
People might also fall into a cycle of negative thinking, which not only fuels the emotional strain on the body, but can also create other stressful situations, further draining serotonin stores.
Hence, Winslow said a three-pronged approach was necessary to treat depression - medication, behaviour modification and cognitive therapy.
When Chen finally accepted that she had depression and needed help, Winslow put her on a particular antidepressant that would not interact with alcohol. She did end up drinking again a few times and eventually joined Alcoholics Anonymous for group support.
As the antidepressant helped buoy and stabilise Chen's mood, the real work could then begin. Winslow worked on helping her take better physical care of herself, to boost self-esteem and mood. He also helped her modify her thought patterns so that she learned to respond to people and situations in more positive and less self-defeating ways.
During therapy, it also emerged that Chen had been sexually abused by her father when she was a teenager, resulting in the self-loathing that crippled her self-esteem and emotional health. It took her years of therapy to come to terms with her childhood abuse and realise she was not at fault.
Slowly, Chen started to take a new interest in life: she started exercising, picked up new hobbies and made new friends. She also turned to religion and found strength in her new faith. She grew calmer and came to accept that she was not a bad person, but rather a sick person on the road to recovery.
Four years since her first appointment, she continues to take the antidepressant. But she has given up alcohol and is coping well with life. She sees Winslow once a month to review her progress.