Dr. Arvinder Kaul, MD

Negative thinking can lead to depression and anxiety. You van change your thought process by cognitive behavioral therapy. You seem to have good insight since you are able to identify the fact. Tripple column tech is a good treatment module of CBT which help you to change your negative cognition to positive by reflecting on your situation, emotions generated by the situation and negative thoughts arising from the two and then replacing that negative thought with positive by reflecting on positive experiences of your life.

It's never safe to take any drug with alcohol. Best would be to stick with social drinking rather than everyday . You should also consult the doctor who prescribed it

Yes that will work. He or she can then refer you if needed

It's a good question and you are so right about chicken or egg situation. It's difficult at times to figure that out, especially if there is no h/o a psychiatric problem like depression.

You might want to ask yourself some questions like what was the feeling you got when you first started drinking. If that made you feel normal, that means you were probably dealing with some anxiety or depression and now felt comfortable. You took it as your coping skill, something that worked for you and never felt the need for help. With time, you started developing tolerance and started feeling guilty and drank more. Ultimately, alcohol started drinking you. So that's probably what happened in your case depending on your childhood and circumstances growing up.

6 months of sobriety is good, but beware of the tendency to relapse every 3 months. Usually, we wait one month after detox from drugs or alcohol to diagnose psychiatric problems whether it was alcohol and drug-related or has been masked by the use. Continue Zoloft, it's a good choice.

We treat the signs and symptoms of Asperger syndrome. There is a role of stimulants to treat attention and concentration problems, hyperactivity and impulsivity and mood stabilizers to treat mood component, which also include antipsychotics like risperidone.

Guided meditation, stop procrastinating and leaving projects to the last minute, do not obsess over the future and the past, take one day at a time, make small goals limiting them to 2-3 a day and accomplish them to increase your self-esteem and stay on track.

Do not spend more than 30 minutes in bed if you cannot sleep. Get up and distract yourself by reading a book, or drink warm non-fat or 2 percent milk about half a cup which contains tryptophan and that converts into serotonin which has sedative properties and relaxes you. That is why people from older generations drank milk at night though they didn't know the science behind it, but it worked. Hope this helps you some.

Let me ask you a question about what kind of a caregiver are you? Certified, licensed or lay.

You are right. Treating anxiety , depression and pain is becoming increasingly tough because of the CMS guidelines according to which the pain MEDS and benzodiazepines like xanax , Valium and klonopin can not be prescribed simultaneously. The reason being that they are CNS depressants and can have adverse reactions when given together. However the treatment also depends on the severity of symptoms and these medicines can be given if all other treatment options have been exhausted. You need to see a psychiatrist who can or will be able to take care of your anxiety , depression as well as fibromyalgia. You might want to try Valium and neurontin with Effexor rather than xanax and flexeril. Valium helps with muscle spasms and stay in your system longer than xanax

Before I can make any diagnosis and comment on your condition I would need some more information. I would like to know if your chest pain is related to a stressful situation, How often do you get the chest pain and for how long does it last.If there are any associated symptoms like increased heart rate,feelings of being smothered and difficulty breathing, tingling in fingers or other parts of the body, feeling dizzy and excessive sweating accompanying the chest pain. The chest pain can be cardiac or non cardiac in nature and need EKG depending on the age and other risk factors like hypertension, smoking, high cholesterol , cardiovascular disorders or history of these disorders in the family. If age is more than 40 yrs with chest pain and no risk factors, then EKG is needed to rule out cardiac cause of chest pain . And age is less than 40 with chest pain plus any of the risk factors mentioned above would need EKG to r/o the cardiac chest pain before declaring it non cardiac and not life threatening in nature. Cardiac chest pain is indicative of heart attack and could be life threatening in nature. Non cardiac chest pain is mostly related to anxiety and could be uncomfortable but not life threatening in nature. I feel that you are having panic attacks but need above mentioned information before labeling your condition. After determining the cause of chest pain to be non cardiac , it can be treated with appropriate anxiolytics and cognitive behavioral therapy.

There are different possibilities here to look at. I would first try and rule out any underlying medical condition which could be causing mental fogging or fatigue. For example, hypothyroidism, anemia, and obstructive sleep apnea need to be ruled out. Then depression is another cause of difficulty concentrating . Adult ADD is another consideration. What I think you need is a medical evaluation followed by psychiatric evaluation if no underlying medical cause is detected.