I know I'm repeating myself, but there is one explanation that could account for all her behaviors. Everyone is welcome to pick holes in this, but please don't just argue that "SSRIs could not do this because they are not dangerous and besides my sister-in-law says they saved her life." Just bear with me on that one. I recommend visiting cchr.org for more information FIRST. And I'm not trying to come between anyone and their medication.
All right. Diane knows she has a drinking problem, and she's just at the stage where the stress of her job and two small children and a husband who's home when she isn't and vice versa is pushing her drinking into the danger zone--even she knows it.
So she makes a decision, all on her own, without consulting anyone (because no one can know), to white-knuckle it. For a while she handles it, but her nerves are frayed and she has no support system for a struggling alcoholic that she feels she can turn to. Not AA, not a doctor, not a church, not a friend. No one must know. What a lonely place!
Maybe she has headaches. Maybe she feels sick to her stomach. Maybe she can't sleep. Maybe she makes an appointment with a GP to see if there's anything she can do to alleviate her symptoms and her craving. Or maybe she goes to her OB-GYN. She doesn't have to go to a psychiatrist at all. Anyone with an MD can prescribe antidepressants for anything from mild dysthymia to PMS to insomnia to anxiety to hot flashes!
Wow, that was easy! Easier than scoring herb! Free samples! She doesn't even need to go to a pharmacy and fill the scrip! No one will know. Twenty milligrams a day, the doc said. Make you feel a LOT better, help you sleep, you'll be thanking me. No side effects. Take them at bedtime, they might make you a little sleepy, but didn't you say you had insomnia? Call me if you have questions. Try them for a couple of weeks, see how you feel. Can't hurt you. I prescribe these every day. You'll be thanking me.
So she goes home with her Prozac (or Serafem) or Zoloft or Lexapro or Paxil or Wellbutrin. They work GREAT. She has energy, her aches and pains go away, she sleeps, she eats, she's more productive than ever at work. Those first two months are heavenly! Quitting drinking is going to be easy! No one will know.
She's flying! Housework, child care, work, no problem. Hypomanic! Having a great time! Can handle anything! Even a heart-to-heart talk with hubby, one that she's been too shy up until now to address. They're going on a camping trip, that'll be a good time for a good talk. This time she won't back down.
Maybe it doesn't go well. Maybe there's lots more stress. Maybe she's been sleeping a little less because of the SSRIs, maybe she feels irritable, edgy, like she could just pop. She doesn't eat well, and her blood sugar goes up and down, making her more unnerved.
Maybe she needs a drink, really needs a drink, just one. The doctor doesn't know she drinks (she may even have in her medical record that she's a nondrinker--is the doc going to check up on her?), so he says nothing to her about mixing alcohol with SSRIs.
Or she could have upped her dose, on her own, with the doctor's tacit or explicit condonation. Take forty instead of twenty, or sixty. It's okay, they're safe.
There's a condition called neuroleptic (i.e., psych drug) malignant syndrome. It can happen without warning, and can happen on a single dose of SSRIs or after a period of time using them. It's fairly rare, but it's real. Here are the symptoms as described in Wikipedia (and sourced):
The first symptom to develop is usually muscular rigidity, followed by high fever, symptoms of instability of the autonomic nervous system such as unstable blood pressure, and changes in cognition, including agitation, delirium and coma. Other symptoms may include muscle tremors and pharyngitis. Once symptoms do appear, they rapidly progress and can reach peak intensity in as little as three days. These symptoms can last anywhere from eight hours to forty days.
It didn't have to be NMS. It could simply have been a manic reaction to a suddenly changed dose of SSRIs. This woman was self-medicating with alcohol--why not prescription drugs?
So she's overexcited and emotionally distressed, and then she finds the vodka that came with them to the campsite. She drinks alcohol and the reaction to the mix of SSRIs and alcohol--and pot--are such that she becomes semi-psychotic. The SSRIs keep her awake and moving, but in a strange confused state. She may have genuinely mistaken the exit ramp for an on ramp, and she may have been in a manic drive-drive-drive state of mind that was aggravated by alcohol and pot and No one must know.
She doesn't want to be found out. She knows that. She doesn't want to say she was using SSRIs and besides, no one told her there were any effects from this drug that could be distressing or dangerous. She was told there were no side effects except maybe sleepiness. And she sure doesn't feel sleepy, she feels on fire, like lightning bolts are jabbing out of her skin, like her skin is quivering off her. So she thinks it can't be the Paxil or the Zoloft or the Wellbutrin.
She tries to calm down with alcohol and it doesn't work. The amount she's accustomed to drinking doesn't settle and steady her like it's supposed to. She tries to settle herself with a joint. It doesn't work. Nothing works. She's hyperexcited, confused and impaired and just wants to get home. And no one must know!
The author speaks from personal experience with SSRIs (all brands), considerable study of literature both pro and con, a medical background, and authoritative sources. Anyone wishing to know what sources I have is welcome to contact me personally. These are my opinions and speculation only.
