Hello all,
I've been taking 50 mg Nal religiously since last September. I originally started out with 1/4 tablet and slowly ramped up as it made me feel like I'd been it by a bus. I now take 50 mg daily, 1 hr before drinking, and don't notice much if any change in my drinking or desire to drink yet. I've kept taking it because I read that it can take a long time to "kick in" and for some people to reach extinction. However, at this point I still haven't gotten much benefit and am concerned that it's not going to work for me. I'm wondering it I should increase?
I can't go to a doctor for Nal as I am in healthcare and am concerned about it potentially having an impact on my license. If people want to weigh in on this too, I would appreciate it. I typically consume a bottle of red wine per evening and have never allowed it to impact my work but I would rather be safe than sorry. I'm worried that the psychiatrist would need to report it to my licensing board.

Any advice would be greatly appreciated!!!

Most people need 50mg, but some do need a higher dose, some do fine with a lower dose per my own TSM doc. Are you taking any other medications?

Yes, I take a few medications, including an antidepressant, and a lot of supplements/fish oil/etc.

I also forgot to mention that I'm not a particularly large person. I'm about 5'5" and weight 135 but I do take a lot of supplements (including milk thistle) and eat very clean.

Some SSRI antidepressants can make some people crave alcohol more, but you would have to think back to when you started it or when you increased the dosage and what effect it seemed to have on your drinking. It could even be that it helped you drink less, or that it made no difference at all. Benzos and Z-drugs can thwart TSM as well, but not in every circumstance.

I've been on my medication (Wellbutrin and Adderall) for 15+ years and the dosage hasn't been changed since that time. I'm not on any benzos but I'm not familiar with "z-drugs." Thanks again for your help!

The Z-drugs were replacements for benzos that supposedly weren't as addictive or habit-forming. Ambien is an example:

https://en.wikipedia.org/wiki/Z-drug

Wellbutrin is a NDRI (Norepinephrin Dopamine Reuptake Inhibitor), so a different class than the SSRIs.

What is your drinking pattern like? Daily at a certain time, until you feel you can fall asleep or binge-style drinking, etc?