It’s difficult to watch your child experience emotional pain. It’s even more difficult to see physical signs of their pain. Cutting is the act of purposely cutting yourself with a sharp object, such as a knife or razor blade. It’s an unhealthy way to relieve emotional pain, sadness, intense frustration, and anger.

Cutting commonly occurs on the arms, legs, or torso. These are places that can be hidden by clothing. Cutting affects men and women of all ages. It usually starts in the teenage years and is more common in girls. Except in rare cases, cutting is not a sign that your child has thoughts of suicide. If you are concerned your child is cutting, learn the warning signs and speak with your child’s doctor.

Path to improved emotional well being

Even though cutting causes physical pain, people cut because they believe it brings them emotional relief. It may be in response to problems at home, school, or in other areas of their life. If your child is cutting, they may not be able to cope with their feelings. These can include loneliness, confused sexuality, deep anger, rejection, guilt, self-hatred, or panic.

Cutting is a clear sign of your child’s emotional distress. However, it usually catches most parents by surprise. Teenagers cleverly cover up their cuts. Unless you know what to look for, it may go undetected for a long period of time. Warning signs that your child is cutting include:

• Multiple, fresh cuts across the skin, and usually clustered together in the same area
• Scarring and bruising
• Having sharp objects nearby for no apparent reason
• Wearing long sleeves and pants at odd times, such as when it’s hot outside
• Making excuses about the reason for the cuts you see

Additionally, your child may be experiencing problems with a relationship. They may be making statements about poor self-worth or hopelessness. Your child may be questioning their identity and reason for living. They could be showing signs of behavioral issues, such as impulsivity and unpredictability.

If you suspect or see evidence of your child’s cutting, do not yell or criticize your child. Offer your support, express your concern, and tell them that you will do what it takes to help them with whatever is causing the urge for cutting. Speak with your child’s doctor. Your doctor will want to see your child and can provide you with referrals for treatment with a mental health professional.

Counseling or psychotherapy is commonly used to treat unhealthy coping methods, such as cutting. Counseling can take the form of one-on-one sessions with your child, family sessions, or a combination of the two. There are many different types of psychotherapy treatments, including:

• Cognitive behavioral therapy (CBT), which identifies and replaces unhealthy behaviors and beliefs.
• Dialectical behavior therapy (DBT), which teaches skills to handle, manage, or balance your emotions and improve relationships.
• Psychodynamic therapy, which helps you identify past experiences that may be at the root of your emotional stress.
• Mindfulness-based therapy, which teaches you how to live in the moment with appropriate thoughts and actions.

Your child’s therapy will depend on their emotional health and the seriousness of their cutting. Counseling and psychotherapy are not one-time treatments. It generally takes time, maybe even years, to uncover the reason for your child’s cutting and teach healthy strategies for coping.

Beyond emotional treatment, your doctor may need to treat the physical effects of cutting to reduce infection, permanent scarring, or severe (or potentially fatal) injury. Additionally, your doctor can help determine if there is an underlying medical condition (such as anxiety or depression) that may benefit from medications.

Things to consider

Continue to pay attention to your child’s friends. Research shows that people who cut spend time with friends who cut. Drug and alcohol use also increase your child’s risk of cutting. While thoughts of suicide aren’t common with cutting, your child could accidentally cut deep enough or cut an artery that could result in death if not treated immediately.

Questions to ask your doctor

• What is the best way to raise the issue of cutting with my child?
• If I confront my child about cutting, will this make them want to cut more and hide it more?
• How do I know if what I see is an accident or true cutting behavior?
• Is this behavior an inherited mental health condition?
• Should I talk to my child’s doctor before bringing them to the office?
• What if I’m wrong? Will I put the idea in my child’s head?

Resources

Centers for Disease Control and Prevention: Self-Directed Violence

National Institutes of Health, MedlinePlus: Self-Harm

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Emotional health is an important part of your overall health. People who are emotionally healthy are in control of their thoughts, feelings, and behaviors. They’re able to cope with life’s challenges. They can keep problems in perspective and bounce back from setbacks. They feel good about themselves and have good relationships.

Being emotionally healthy doesn’t mean you’re happy all the time. It means you’re aware of your emotions. You can deal with them, whether they’re positive or negative. Emotionally healthy people still feel stress, anger, and sadness, but they know how to manage their negative feelings. They can tell when a problem is more than they can handle on their own. They also know when to seek help from their doctor.

Research shows that emotional health is a skill. There are steps you can take to improve your emotional health.

Path to improved health

Emotional health allows you to work productively and cope with the stresses of everyday life. It can help you realize your full potential. It also helps you communicate with other people and contribute to society.

Your emotional health affects your physical health. Research shows a link between an upbeat mental state and physical signs of good health. These include lower blood pressure, reduced risk of heart disease, and a healthier weight.

There are many ways to improve or maintain good emotional health:

• Be aware of your emotions and reactions. Notice what in your life makes you sad, frustrated, or angry. Try to address or change those things.
• Express your feelings in appropriate ways. Let people close to you know when something is bothering you. Keeping feelings of sadness or anger inside adds to stress. It can cause problems in your relationships at home, work, or school.
• Think before you act. Give yourself time to think and be calm before you say or do something you might regret.
• Manage stress. Learn methods to cope with stress. These could include deep breathing, meditation, and exercise.
• Strive for balance. Find a healthy balance between work and play, and between activity and rest. Make time for things you enjoy. Focus on positive things in your life.
• Take care of your physical health. Exercise regularly, eat healthy meals, and get enough sleep. Don’t abuse drugs or alcohol. Try to keep your physical health from affecting your emotional health.
• Connect with others. Make a lunch date, join a new group, or say hi to strangers. We need positive connections with other people.
• Find purpose and meaning. Figure out what’s important to you in life, and focus on that. This could be your work, your family or friends, volunteering, caregiving, or something else. Spend time doing what feels meaningful to you.
• Stay positive. Focus on the good things in your life. Forgive yourself for making mistakes and forgive others. Spend time with healthy, positive people.

Things to consider

People who have good emotional health can still have problems. Mental illness often has an emotional and physical cause. There could be a chemical imbalance in your brain. Stress and problems with family, work, or school can trigger mental illness or make it worse.

Counseling, support groups, and medicines can help people who have emotional problems or mental illness. If you have an ongoing emotional problem, talk to your doctor right away. They can help you find the right type of treatment.

Questions for your doctor

• What steps should I take to improve my emotional health?
• Are there medicines that could help me cope better?
• Should I see a therapist or counselor?
• How does my physical health affect my emotional health?
• What stress management techniques would work best for me?

Resources

National Institutes of Health: Emotional Wellness Toolkit

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Caring for a loved one who is chronically ill can be challenging. Many family caregivers also work outside the home. If you do, you might feel overwhelmed by the difficulty of balancing all your responsibilities. You’re not alone.

Path to improved health

If you are having trouble balancing work with caregiving, there are some things you can do. Here are some tips to help you ease the burden.

Research employer policies and programs

Talk with your human resources department and look through your employee manual. Determine whether your company has policies in place or benefits available to help you manage your roles. Examples may include:

• The Family and Medical Leave Act (FMLA) – gives eligible employees 12 weeks per year of unpaid leave. They can use this to care for an ill family member. Taking this leave would not impact your health insurance coverage or job security.
• Employee assistance programs – help employees deal with problems that might affect their work. Often, these programs include short-term counseling and referrals to services in the community.
• Flex time – allows you to work a flexible work schedule. If your company offers flex time, your employee handbook should define it. Usually, there is a core period of time when you must be at work. You then create your schedule around these hours. For example, you may choose to work from 10 a.m. to 6 p.m., or from 7 a.m. to 3 p.m.
• Telecommuting – allows you to work from another location, such as your home or your loved one’s home.
• Job sharing – when two people work part-time to share a job normally held by one person full-time.

Talk to your supervisor

Think about your company’s policies and what changes would help you better manage your responsibilities. Draft a proposal, then schedule a meeting with your supervisor to talk it over. Be honest about your situation and open to any ideas your supervisor may have. Be sure to communicate how the changes you’ve proposed will benefit your employer.

Be an activist

Your company or supervisor might not be able to accommodate your requests. Try not to be upset. Instead, set an example. Work with human resources to help your company’s leaders understand caregivers’ needs. Keep the channels of communication open and try again after some time has passed.

Things to consider

Some people have done everything they can to balance work with caregiving, but they still need help. If this is your experience, here are some resources that can help:

• Referral services – Many local, county, or state governments have agencies on aging. They can help you locate programs and services in your area. The U.S. Administration on Aging offers information on area agencies and other services. This can be found through its online Eldercare Locator tool.
• Adult day care – These centers offer social and therapeutic activities in a safe environment. They often provide meals, personal care, medical care, and even transportation.
• In-home care – This can be an informal arrangement with a friend, neighbor, or volunteer. It can also be a formal arrangement with a private aide or a home care agency.

Questions to ask your doctor

• What can I do to keep from getting overwhelmed when trying to balance work with caregiving?
• What signs should I look for that I’m doing too much?
• Can you fill out FMLA paperwork for me to give to my employer?
• Can you refer me to an agency on aging so I can find more help caring for my loved one?

Resources

U.S. Administration on Aging: Eldercare Locator
U.S. Department of Labor: Family and Medical Leave Act

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Professional therapy and counseling can improve your mental wellness. This therapy can help people who are experiencing emotional or behavioral problems. Also, it can help people who have a mental health disorder. Therapy is sometimes called psychotherapy or talk therapy. Many times, therapy is used in combination with prescription medicine to treat a mental health disorder. Therapy will usually improve the results you get from the medicine.

There are different types of mental health providers. Professionals trained in psychotherapy include those representing the following types:

• Psychiatry
• Clinical psychology
• Mental health counseling
• Clinical social work
• Marriage and family therapy
• Rehabilitation counseling
• Psychoanalysis

Fee structures and access to prescriptions is different for each. For example, a psychiatrist has a medical degree and is allowed to write prescriptions. A counselor does not have a medical degree and is not allowed to write a prescription. Your doctor can suggest a professional that is right for you.

Some people do not want professional therapy or counseling. They feel ashamed of their problems. Others believe therapy and counseling are for seriously mentally ill or “crazy” people. However, this is not true. Don’t let shame and fear stop you from getting the help you need. Good mental health is part of your overall health and wellness.

Path to improved health

Different types of therapy use different techniques. In most types of therapy and counseling, the person receiving treatment talks with a professional therapist. However, therapy is more than just talking about your problems. Therapy can teach you new ways to think about the situations that bother you. It can help you cope with feelings and situations. It can help with feelings of anger, fear, anxiety, shyness, and panic. It also can give you tools to help fight low self-esteem and depression.

Therapy can help treat a variety of problems. Some common reasons people seek therapy include:

• Depression
• Marriage problems, infidelity, divorce, or other relationship issues
• Sexual problems
• Stress and anxiety
• Addictions and compulsions
• Grief, loss, or bereavement
• Anger
• Career choice
• Parenting or family problems
• Phobias
• Insomnia
• Fertility issues
• Chronic pain or illness
• Domestic violence or abuse
• Eating disorders

If you are not sure if therapy and counseling are right for you, talk to your family doctor. Your doctor can refer you to a trained professional who can help with your problems.

If you choose therapy or counseling, you’ll talk about any problems you’ve been having and how you’ve been feeling. You’ll also talk about your goals for therapy. You and your doctor will decide how frequently you will meet. Your doctor, therapist, or counselor will help you decide what’s right for you.

Things to consider

Different kinds of therapy and counseling are based on different ideas about how the brain works. Also, it considers what causes people to act in certain ways. Many therapists use more than one type of technique to help you. Common kinds of therapy include:

• Family counseling. This helps family members understand problems within the family and how to resolve them.
• Cognitive therapy. This is sometimes called cognitive behavior therapy. It’s based on the idea that your thoughts cause your feelings and actions. If you change the way you think about something, you can feel or behave better even if the situation doesn’t change. This kind of therapy helps you understand negative or false thought patterns. Negative thought patterns cause troubling feelings and behavior.
• Behavior therapy. Sometimes called behavior modification therapy, this treatment focuses on changing unwanted or unhealthy behaviors. You replace them with healthy ones. This treatment involves using a system of rewards and reinforcement of positive behavior.
• Psychoanalytic therapy. This type of treatment encourages you to think and talk about memories and feelings from the past. These memories will help you understand how you act and feel today.
• Group therapy. Group therapy is led by a qualified professional. He or she facilitates a small group of people who have similar issues or problems. Groups can improve honesty with others. Members support each other during times of crisis.
• Couples therapy or marriage counseling. This treatment can help couples solve problems together, communicate in healthier ways, and learn to work out differences.

Questions to ask your doctor

• What if my partner or child is resistant to therapy?
• How do I find a therapist that’s right for me?
• Can my child’s therapist tell me what they talked about?
• Will my therapist recommend prescription medicine?
• What if I don’t like my therapist? Can I change?

Resources

National Alliance on Mental Illness: Types of Mental Health Professionals

National Institute of Mental Health: Psychotherapies

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Mental illness is a common health problem and nothing to be embarrassed about. It happens because of a change in your brain. It includes a range of conditions, such as depression, anxiety, and bipolar disorder. Mental illness affects people’s thoughts, feelings, and behavior. Most often, people have and show early signs of illness. Learn what these signs are so you or someone you know can get help.

Path to improved health

Warning signs of mental illness vary by person and problem. Below are some of the most common signs. Talk to your doctor if more than one of these occur. Also note if they happen suddenly.

• Changes in mood. Your feelings may alter over time or all of a sudden. In addition, they can shift back and forth. For instance, you may feel happy or excited one day or in a certain situation. Then, you may feel sad or upset the next day or in a new situation.
• Changes in sleep.You may be sleeping too much and feel like you can’t get out of bed. Or you may feel like you don’t need to sleep much at all.
• Fear or uneasiness. You may start to feel afraid, anxious, nervous, or panicked.
• Decreased performance. Your work suffers. You may find it harder to complete things that once were easy or enjoyable. If you’re in school, you may notice your grades begin to drop.
• Lack of interest. There are several things that can cause you to lose interest in certain things or people. This can lead to broad or complete withdrawal.
• Altered senses. Your basic senses—sound, smell, touch, or sight—may become more or less sensitive.
• Lifestyle changes. You may sleep longer than usual or have a hard time sleeping. You also could develop an eating disorder, where you eat more, less, or not at all.
• Troubled mind. It’s possible to have clouded thinking that makes it hard to focus, remember, or process things.
• Changes in behavior. Your actions may alter in ways that are abnormal for you.
• Loss of control. Over time, you may lose the ability to manage stress, tasks, or life’s demands.
• Out of touch with reality. Mental illness can cause you to become detached from your surroundings. You may feel lost, distant, or numb. You may have hallucinations or nightmares. You may forget how to relate to others or show care or concern.

Other possible warning signs include:

• Alcohol or drug abuse
• Sexual abuse
• Feelings, thoughts, or actions of anger or violence
• Unexplained physical symptoms, such as stomach pain and headaches

Things to consider

It’s important to know the signs of mental illness because it affects so many people. You or someone you know may have a problem at some point in your life. If you know the warning signs, you can detect them early. The sooner you see a doctor and get diagnosed, the sooner you can begin treatment.

Don’t ignore these warning signs. It can make mental illness worse and cause harm to others. When you learn about mental illness, share information with others, and talk about your story, you help stop the stigma.

When to see your doctor

Contact your doctor if you have multiple warning signs. They will do an exam and discuss your state of health. Only a doctor can diagnose mental illness. If someone you know displays these signs, talk to them about your concerns. Suggest that they visit a doctor to find out what’s going on.

Seek help right away if you have thoughts of murder or suicide. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). As of 2022, you can also dial 988 for the Suicide and Crisis Lifeline.

Questions to ask your doctor

• How can I tell if I have a mental illness?
• How can I tell if someone I know has a mental illness?
• Are there other warning signs I should look for?
• What are the best resources to use if I want to learn more about mental illness?

Resources

American Academy of Family Physicians, Mental Health Myths

Mental Health America: Mental Illness and the Family: Recognizing Warning Signs and How to Cope

U.S. Department of Health & Human Services, mentalhealth.gov: What to Look For

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If you have depression, your doctor may prescribe medicine to treat it. This medicine is called an antidepressant. There are many types of antidepressants. Finding the one that’s right for you can take time. It’s important to work with your doctor to find it.

Path to improved health

Your doctor will consider many factors when choosing the antidepressant medicine to give you:

• If you were depressed before and a certain antidepressant worked well, that medicine might be the right choice for you again.
• If any of your brothers, sisters, parents, uncles, or aunts had depression and a certain antidepressant worked well for them, that medicine might work for you, too.
• The choice of an antidepressant depends on your health. Certain antidepressants may have a bad effect on a health problem you have. That medicine wouldn’t be the right choice for you.
• Antidepressants can have side effects. The right medicine for you may be the one that gives you the fewest side effects.
• The choice of an antidepressant may depend on how often you must take it. It is important to take antidepressants as prescribed and daily medications may make this easier.
• Some antidepressants cost more than others. Your doctor will choose an antidepressant that works for you and your budget.
• Your doctor will likely choose a medicine they have experience prescribing.
• Some antidepressant can help you with sleeplessness, anxiety, and lack of energy if these are part of your symptoms.
• If you’re taking other medicines, your doctor will consider how an antidepressant will work with these other medicines.
• Some antidepressants don’t work well with certain foods. If your doctor gives you one of these antidepressants, they will let you know which foods you should stop eating.

Keep in mind that antidepressant medicines are not “downers”  or “uppers.” You will not get  high when you take them. They are not addictive.

You’ll know if your antidepressant is working based on how you feel. You’ll be able to sleep better. You’ll have more energy to meet your day-to-day obligations. You can take care of yourself. Your appetite will be closer to normal. You’ll have an increased desire to engage in life. You and your family and friends will notice these changes. Be patient, though. It may take some time to get back to the way you felt before the depression.

While antidepressants can help with symptoms of depression, that’s only part of the treatment. These medicines work best when you try to have an active lifestyle with exercise, get eight hours of sleep a night, and eat healthy foods. Your doctor may also recommend working with a counselor to help you improve the thoughts of depression.

How to take antidepressants

Antidepressants are usually taken every day. It can take 1 or even 2 months to see the full results. You may need to try different doses or change medications to find the antidepressant that works best for you.

Your doctor will let you know how long to take your antidepressant. If this is the first time you have been treated for depression, you will probably continue to take this medicine for at least 6 months after you begin to feel better. If this is the second time you’ve been depressed, you might keep taking the medicine for at least a year. Depression that comes back a third time may require you to continue taking an antidepressant for a longer time.

Do not stop taking antidepressants suddenly.  You can get unwanted side effects if you stop taking your antidepressant suddenly. If you want to stop taking your medicine, talk to your doctor first. They can try to help you avoid these side effects.

Alcohol and antidepressants

Talk to your doctor about drinking alcohol while taking an antidepressant. You should be careful about drinking until you know how the medicine affects you. The effects of alcohol can combine with the effects of the antidepressant and cause problems. Regular heavy drinking can make it harder to treat depression. Certain kinds of medicine can lead to seizures for heavy drinkers.

Antidepressants and other medicines

Antidepressants can effect many other medicines. If you’re taking an antidepressant, tell your doctor about all other medicines you take, including over-the-counter (OTC) medicines and herbal health products (such as St. John’s wort). They can let you know if your regular medicines may cause problems when combined with an antidepressant.

Antidepressants for children and teens

In some cases, the use of antidepressants has been linked to an increase in suicidal thoughts and behavior in children, teens, and young adults. The Food and Drug Administration (FDA) now requires antidepressants to carry a warning about the risk of suicide in children, teens, and young adults 24 years of age or younger. However, this doesn’t mean that people in this age group shouldn’t take antidepressants. It means they should be carefully monitored by their doctor and loved ones while taking the antidepressant.

Many doctors will want to see a child or teen sometime in the first few weeks after starting an antidepressant to assess any risk for suicide. If you’re worried your child may be suicidal, call your doctor right away or take your child to the nearest emergency room.

Things to consider

All antidepressants have some side effects. However, not all people taking antidepressants have these side effects. Most of the side effects happen in the early weeks of therapy and lessen over time. You may experience the following:

• Anxiety
• Bladder problems
• Blurred vision
• Constipation
• Diarrhea
• Dizziness when standing up
• Dry mouth
• Excessive tiredness
• Feeling of weakness
• Hand tremors
• Increased heart rate
• Increased sleepiness
• Insomnia
• Muscle twitching
• Nausea
• Sexual dysfunction (inability to ejaculate or to have an orgasm)
• Tremor
• Vomiting
• Weight gain or loss

Talk to your doctor if these side effects don’t go away. They may change your dosage or suggest another medication.

Considerations for women

If you’re planning to get pregnant, talk to your doctor about your medicines before you try to get pregnant. If you accidentally get pregnant while taking an antidepressant, tell your doctor right away. Your doctor will know if your antidepressant is safe to take while pregnant.

Most medicines you take can pass into your breast milk. That means it may be passed on to your baby. If you’re planning to breastfeed or you currently breastfeed, talk to your doctor about your medicine.

In most cases, it’s okay to take birth control pills or hormone replacement therapy (also called HRT) at the same time as depression medicines. Taking hormones may even help some depressed women feel better. However, if your birth control pills seem to be causing symptoms of depression, discuss it with your doctor. They may suggest you use another method to prevent pregnancy for several months to find out if your birth control pills are causing depression.

Antidepressant discontinuation syndrome

Antidepressant discontinuation syndrome can occur if you suddenly stop taking your antidepressant medicine. Antidepressant discontinuation syndrome is not dangerous or life threatening. It usually goes away within a week. The symptoms include:

• Anxiety
• Feelings of sadness
• Irritability
• Fatigue
• Headaches
• Nausea and vomiting
• Dizziness

You’re more likely to have antidepressant discontinuation syndrome if you stop taking certain antidepressants, such as paroxetine and sertraline. However, you can get symptoms from stopping any antidepressant medicine.

If you accidentally missed a dose of your antidepressant medicine, start taking it again as soon as possible. If you’re out of medicine, call your doctor so they can refill your prescription.

If you decided to stop taking your antidepressant medicine on your own, talk to your doctor about why you stopped. For example, was the medicine causing an unpleasant side effect? Did it cost too much? Your doctor can help by altering your dosage or suggesting another antidepressant.

If your doctor recommended you take a lower dosage of your medicine and you’re experiencing symptoms of antidepressant discontinuation syndrome, talk with your doctor. You may need to take a higher dosage before weaning your body from the medicine completely.

To keep antidepressant discontinuation syndrome from happening again, take your medicine exactly as your doctor tells you. If you want to stop taking it, talk to your doctor first. Just because you’re unable to stop taking your medicine suddenly doesn’t mean you’re addicted. Your body often needs time to adjust to lower levels of the medicine. That’s why your doctor may recommend tapering off an antidepressant rather than abruptly stopping it.

Questions to ask your doctor

• How can I know if I have depression?
• Are there ways to treat depression that don’t involve medicine?
• If I am depressed, should I also be talking to a mental health professional?
• Are there coupons I can use to help lower the cost of antidepressants?
• How long will it take to get the dosage right for my medication?
• How will I know the medicine is working?

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Naltrexone is a medicine used to treat alcoholism (addiction to alcohol). It reduces your desire for alcohol. It comes under the brand names ReVia or Vivitrol. After you quit drinking, naltrexone may help you stay sober for a long time. This medicine is not a complete cure for alcoholism. But it can help you stop drinking while you get any other treatments that your doctor recommends.

Alcoholism is a chronic disease. That means that it lasts for a long time, or it causes problems again and again. The main treatment for alcoholism is to stop drinking alcohol. This can be difficult. Most people who are alcoholics still feel a strong desire for alcohol even after they stop drinking. Naltrexone can help.

Path to improved health

How does naltrexone work?

When you use alcohol and narcotics, parts of your brain make you feel pleasure and intoxication. Naltrexone blocks these parts of the brain. When these areas are blocked, you feel less need to drink alcohol. You don’t feel the “high” pleasure sensation that makes you want to drink. This helps you stop drinking more easily. Disulfiram (brand name Antabuse) is another medicine that is sometimes used to treat alcoholism. Disulfiram works by making you feel sick if you drink alcohol. Naltrexone does not make you feel sick if you drink alcohol while taking it.

How long will I take naltrexone?

You and your doctor will decide how long you should take naltrexone. Most people take the medicine for 12 weeks or more. Researchers have found that taking it for longer than 3 months is the most effective treatment. Be sure to take naltrexone as your doctor prescribes it. Don’t take extra pills, don’t skip pills, and don’t stop taking the pills until you talk to your doctor.

For those who don’t want to take a pill every day, naltrexone is also available in a shot. You get the shot once a month. It has the same effect as the pill form.

Will I need other treatments for alcoholism?

Like many other diseases, alcoholism affects you physically and mentally. Both your body and your mind have to be treated. In addition to medicine, your doctor may recommend psychosocial treatments. These treatments can help you change your behavior and cope with your problems without using alcohol. Examples of psychosocial treatments include:

• Alcoholics Anonymous or other support group meetings
• Counseling
• Family therapy
• Group therapy
• Addiction treatment program
• Hospital treatment

There may be special centers in your area that offer this kind of treatment. Your doctor can refer you to the psychosocial treatment that is right for you.

Things to consider

Like any medicine, naltrexone can cause side effects. Nausea is the most common one. Other side effects include:

• Headache
• Diarrhea
• Constipation
• Dizziness
• Nervousness
• Insomnia
• Drowsiness
• Anxiety

If you get any of these side effects, tell your doctor. They may change your treatment or suggest ways you can deal with the side effects.

Call your doctor immediately if you experience any of the following symptoms:

• Blurry vision
• Confusion
• Hallucinations (hearing or seeing things that aren’t there)
• Severe vomiting or diarrhea
• Vomiting up blood
• Excessive fatigue
• Bleeding or bruising
• Loss of appetite
• Pain in the upper right part of your stomach that lasts more than a few days
• Light-colored bowel movements
• Dark urine
• Yellowing of the skin or eyes

Talk to your doctor if you have a history of depression. Naltrexone may cause liver damage when taken in large doses. Tell your doctor if you have had hepatitis or liver disease.

What should I know before starting treatment with naltrexone?

Naltrexone blocks the brain areas where narcotics and alcohol work. So, you should be careful not to take any narcotics while you are taking naltrexone. These include codeine, morphine, or heroin. Do not take any cough medicine with codeine in it while you are taking naltrexone. Naltrexone can cause or worsen withdrawal symptoms in people who take narcotics. You must stop taking all narcotics 7 to 10 days before you start taking naltrexone.

You shouldn’t take naltrexone if you’re pregnant. Talk about birth control options with your doctor. It’s not known if naltrexone goes into breast milk. Do not breastfeed while you’re taking it.

Questions to ask your doctor

• I want to stop drinking. Is naltrexone a good option for me?
• What side effects can I expect?
• Can I still drink alcohol when I’m taking it?
• Will I still get drunk if I drink alcohol while I’m taking it?
• What happens if I take street drugs while I’m taking it?

Resources

National Institutes of Health, MedlinePlus: Naltrexone

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Grief is a person’s normal, healthy response to a loss. It describes the emotions you feel when you lose someone or something important to you. People grieve for many different reasons, including:

• Death of a loved one, including pets
• Divorce or changes in a relationship, including friendships
• Changes in your health or the health of a loved one
• Losing a job or changes in financial security
• Changes in your way of life, such as during retirement or when moving to a new place

The loss that triggers grief isn’t always physical. You can experience grief if you or a loved one are diagnosed with a major disease or face a serious illness. You may grieve plans you had made, or the ways life will change.

Grief is different for everyone. It can include many emotional and physical symptoms, including:

• Feelings: Anger, anxiety, blame, confusion, denial, depression, fear, guilt, irritability, loneliness, numbness, relief, sadness, shock, or yearning
• Thoughts: Confusion, difficulty concentrating, disbelief, hallucinations, or preoccupation with what was lost
• Physical sensations: Dizziness, fast heartbeat, fatigue, headaches, hyperventilating, nausea or upset stomach, shortness of breath, tightness or heaviness in the throat or chest, or weight loss or gain
• Behaviors: Crying spells, excessive activity, irritability or aggression, loss of energy, loss of interest in enjoyable activities, restlessness, or trouble falling or staying asleep

Grief is sometimes described as a process of 5 stages: denial, anger, bargaining, depression, and acceptance.

These reactions to loss are normal. However, not everyone who is grieving experiences all of them, and not everyone experiences them in the same order. It is common to cycle back through some of these reactions, stages, and symptoms more than once.

Path to improved well being

There is no “right” way to grieve. Everyone is different. Give yourself time to experience your loss in your own way. At the same time, remember to take care of yourself:

• Feel your loss. Allow yourself to cry, to feel numb, to be angry, or to feel however you’re feeling. It hurts, but it’s natural and normal.
• Attend to your physical needs. Get enough sleep, eat a well-balanced diet, and exercise regularly.
• Express your feelings. Talk about how you’re feeling with others. Or find a creative way to let your feelings out. This could include art, music, or writing in a journal.
• Maintain a routine. Get back into your normal routine as soon as you can. Try to keep up with your daily tasks so you don’t get overwhelmed.
• Avoid drinking alcohol. Alcohol is a depressant that can affect your mood, so it could make you feel even more sad.
• Avoid making major decisions. It takes time to adjust to a loss and get back to a normal state of mind. Making an impulsive decision as you’re grieving could add more stress at an already difficult time. Try to wait a year before making a big change, like moving or changing jobs.
• Give yourself a break. Take breaks from grieving by participating in activities you enjoy. It’s okay to not feel sad all the time. It’s good for you to laugh.
• Ask for help if you need it. You don’t have to struggle. Seek out friends, family, clergy, a counselor or therapist, or support groups. If your symptoms aren’t getting better or you feel like you need extra help, talk to your family doctor.

There is no set timetable for grief. You may start to feel better in 6 to 8 weeks, but the whole process can last from months to years. You may start to feel better in small ways. It will start to get a little easier to get up in the morning, or maybe you’ll have more energy. This is the time when you’ll begin to reorganize your life around your loss or without your loved one. During this time, it may feel like you go through a series of ups and downs. You may feel better one day, but worse the next. This is normal.

Over time, you’ll begin to find interest in other people and activities again. If you’ve lost a loved one, it’s normal to feel guilty or disloyal to them during this time. It’s also normal to relive some of your feelings of grief on birthdays, anniversaries, holidays, or other special occasions.

Things to consider

While it’s normal to feel sad after a loss, the feelings associated with grief should be temporary. Sometimes the feelings last longer, or you may have trouble dealing with your emotions. When this happens, grief can turn into depression. The symptoms of grief and depression are similar. Signs that you could be depressed include:

• Not feeling any better as time passes
• Having ongoing difficulty with eating or sleeping
• Feelings disrupting your daily life
• Relying on drugs or alcohol to cope
• Thinking about hurting yourself or others

If you feel like you’re having trouble dealing with your emotions, ask for help. Your family doctor can help you treat your depression so you can start to feel better. He or she can also help you figure out what other kind of support you need. This could include a support group, individual therapy, or medicine.

Questions to ask your doctor

• Is what I’m experiencing normal?
• Could I be depressed?
• Should I go to a counselor or therapist?
• How long will it be until I feel better?
• Would medicine help me feel better?

Resources

American Society of Clinical Oncology: Understanding Grief and Loss

U.S. National Library of Medicine, Medline Plus: Grief

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