Dear Doctor, I observed a friend who called me for help who has a history of alcoholism since age 16 who has battled this addiction off and on for 39 years. He lost his father and went through a horrific divorce while having issues at work with his manager and started with panic attacks which he was hospitalized for around 4 years ago. He is a retired veteran with 20 plus years serving in the Air Force. He only has Tricare insurance and has been unable to get into alcohol rehab. He has never been to rehab to date. Now he is on Claritin 10 mg qd for allergies, Propranolol ER 60 mg qd for HTN and Venlofaxine ER (Effexor SR) 150 mg and 75 mg each qd for major depression despite drinking vodka heavily. I observed him today and he was coherent and interacting appropriately without slurring of words. He stepped into another room to retrieve some paperwork for possible alcohol rehab and returned and I observed him rapidly decompensate in front of me within 10 minutes to the point he was unable to converse and became incoherent staggering and tearful and fearful loosing all rationality and on the verge of paranoia. Unable to be reasoned with and verbally hostile and blaming me his best friend for messing up his life. I suspected he gulped some vodka because I found empty vodka bottles in the room where he retrieved the papers from. I have never seen anyone go from sanity to beyond intoxicated that quickly. Could the Effexor be contributing to the potentiated effect? His PCP was informed of his alcohol consumption on more than one occasion by his son and told my friend s son who accompanied him to his PCP visits. The Nurse Practitioner (NP) said that the patient s alcohol consumption it was not an issue to be concerned about relating to the Effexor and any interactions. the patient was encouraged to decrease his consumption , but I believe the anxiety is worsening therefore he is increasing his self medication (vodka consumption) which is a depressant. The NP also said she had done some sort of special mail out blood test that indicated that Effexor was the proper medication for the patient. I believe this to be hogwash. He is now missing work and risks his livelihood because he has progressively become worse since starting on the Effexor which his PCP continues to increase. Can Effexor exacerbate alcohols depressive effect and increase anxiety and contribute to a near hallucinatory condition to the point he babbles, repeats himself, talks nonsensical and acts like he is going insane? No ability to process information or interact with another person, lashing out at those closest to him? I almost called 911 today, but instead after 2 hour got him called down to wear he fell asleep. I watched him until he awoke nearly an hour later and got up and then laid back down to sleep. I called his son s who one is staying with him and another who looks in on him daily. If this happens again we, his son s and I plan to take him to the ED for an emergency assessment. Also we plan to get him under the care of a physician PCP with appropriate training, a MD or DO. Is this a reasonable plan? Thanks, RJ