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Antidepressants And Alcohol: Interactions, Side Effects, Recommendations

Many people enjoy drinking alcohol while socializing as a way to have fun and/or enhance a social experience. Although not everyone enjoys recreational drinking, many people enjoy having an occasional beer or glass of wine while out with friends. For individuals that are taking antidepressants, it is important to be aware of potential interactions that medications can have with alcohol.

Nearly all antidepressant manufacturers specifically warn consumers to avoid consumption of alcohol while taking an antidepressant to avoid interaction side effects. Doctors and psychiatrists typically advise against consumption of alcohol while taking antidepressants. Research demonstrates that antidepressants can intensify the effects of alcohol and in certain cases the interaction between the two substances can be dangerous.

Antidepressants and Alcohol: Interactions

Alcohol is a known depressant of the central nervous system (CNS) that is known to interact with many drugs. A significant number of drugs can affect the effects, absorption, and metabolic breakdown of alcohol and vice versa. In some case, the interaction between alcohol and antidepressants can occur even after drinking a small amount.

  • Enhanced antidepressant effects: In some cases the alcohol can enhance the effects of your antidepressant medication. There’s no telling what exactly you will experience, but many people note that they feel more sedated. Feelings of increased sedation is common, especially if your particular antidepressant is more sedating than stimulating.  This can actually lead some people to feel “really good” when they drink on their medication.
  • Increased drunkenness: Most people who drink alcohol while taking antidepressants notice that the drugs enhance the effect of alcohol. In other words, you may become “hammered” after just a couple beers due to the interaction between the drug and alcohol. If you didn’t read your medication label closely, you may have missed the warnings to avoid alcohol consumption while taking your antidepressant. You may go out and have a few drinks and notice that you feel like a lightweight – in other words just a few drinks will make you feel trashed.
  • Metabolism of antidepressants: The liver is responsible for breaking down most antidepressant medications. Additionally the liver is the organ that metabolizes alcohol. When alcohol is consumed while on an antidepressant, the breakdown of either the medication and/or the alcohol can be affected.
  • Serotonin levels: When a person drinks alcohol, serotonin levels in the brain significantly increase. Alcohol tends to modify serotonin activity throughout the brain in regards to both signaling and neurotransmission. Since your antidepressant medication prevents reuptake of serotonin, it may lead to elevated levels of serotonin, which could cause manic symptoms, risky behavior, and dangerous mood swings.

Mixing Antidepressants and Alcohol: Side Effects

Below are some side effects that can occur in the event that you combine alcohol with antidepressant medications.

  • Adverse effects: In some cases, alcohol can interact with antidepressants and lead to unpredictable adverse effects such as seizures, drowsiness, dizziness, and/or fainting. Your chances of experiencing adverse or rare side effects is thought to increase if you consume alcohol while on an antidepressant.
  • Death: Under various circumstances, people have died from mixing alcohol with antidepressants. This is more common if a person is combining alcohol with an antidepressant and another pharmaceutical drug, particularly if the drug is a depressant (e.g. analgesic or anxiolytic). Although it is not common for someone to die from this interaction, it has happened.
  • Deeper depression: Although alcohol can sometimes help temporarily improve depressive symptoms, once a person sobers up, their depression may be worse than it was before they drank. This could be due to the fact that alcohol consumption can affect neurotransmission and is thought to lower serotonin levels over time. Additionally, some people may notice worsened mood swings and increased depression when they take consume alcohol while on antidepressants.
  • Impaired cognition / motor skills: It is already documented that alcohol consumption slows reaction time and judgment. This means that you will not be able to make good decisions and/or react well when operating heavy machinery or a motor vehicle. Combining alcohol with antidepressants is thought to intensify the impairment of cognitive function and mental processing speed.

Why you shouldn’t drink if you’re depressed…

There are various good reasons to avoid drinking if you are depressed. In many cases drinking can make your depressive symptoms worse and/or serve as an unhealthy way to cope with your emotions. If you begin turning to alcohol to cope with your depression, you may become more depressed, develop anxiety, and develop an addiction.

  • Alcohol addiction: If you are depressed, you are considered to be at increased risk of developing an addiction to alcohol. Many people that are depressed initially abuse alcohol as a coping mechanism. This can lead to a person becoming addicted to alcohol and creating another difficult problem to deal with. If you know you have a problem with alcohol, be sure to get help prior to going on antidepressants.
  • Increased depression: Individuals who are depressed are more likely to turn to substances such as alcohol to help them cope with how they feel. Alcohol may temporarily block out emotional pain and initially seem like an appealing option to treat depression. The more you drink though, the more your brain function becomes impaired – thus further exacerbating depressive symptoms. Additionally serotonin levels are noted as being significantly lower among individuals with alcoholism. To avoid increasing your depression, you will likely want to stay away from alcohol.
  • Sleep problems: Consuming alcohol is known to affect our ability to maintain a healthy sleep cycle. Depression is also thought to contribute to a variety of sleep problems such as insomnia or hypersomnia. If you drink, you may increase these problems and have a very tough time getting adequate sleep.

Factors that influence antidepressant / alcohol interactions

There are several factors that will influence the interaction and side effects from combining antidepressants with alcohol. These factors include things like: the antidepressant you are taking, amount of alcohol consumed, the dosage of your antidepressant, whether you take other medications, and your individual tolerance to alcohol.

1. The Antidepressant

There are many different types of antidepressants that people take to treat depression. Common examples include: SSRIs, SNRIs, atypicals, tricyclics, and MAOIs. It is thought that different classes of medications could elicit greater interactions with alcohol than others. Additionally, some researchers believe that different drugs within classes could have slightly different interactions with alcohol than others.

It is known that certain medications tend to be stimulating, while others tend to be more sedating. A person taking a medication with sedating properties and then adding alcohol may blackout if they aren’t aware of this fact. Anytime you combine multiple depressants of the CNS, you are putting yourself at significant risk. Even with a stimulating antidepressant like Wellbutrin, it is thought that antidepressants could increase risk of adverse effects such as seizures.

2. Alcohol consumed

How much alcohol did you consume while taking your antidepressant medication? Although it is recommended to avoid consumption of alcohol while taking an antidepressant, many people drink anyways. In many cases the amount of alcohol consumed will play a role in determining the side effects and interaction.

If a person drinks a lot of alcohol while on their antidepressant, there is increased likelihood of dangerous side effects occurring. On the other hand, if a person only has a small glass of wine, they may not even be aware of an interaction.

3. Dosage

The amount of the antidepressant you are taking can play a role in determining the severity of an interaction with alcohol. If you are on a lower dose, chances are that the interaction will be less than someone who is taking a very high dose of an antidepressant. Anyone who is taking a high dose of an antidepressant and chooses to drink alcohol is increasing their chances of an interaction.

4. Other drugs

If you are taking other psychiatric drugs with your antidepressant, combining alcohol could be a recipe for disaster. The more drugs that you are on, the greater you are increasing the potential potency of an interaction. In some cases these interactions can be fatal, so make sure you talk to your doctor about any potential interactions if you are even considering alcohol. Many drugs already interact with each other and if alcohol is added, consequences could be deadly.

5. Tolerance

Do you have a high tolerance to alcohol? Individuals with a high tolerance to alcohol may notice less of an interaction while taking their medication than someone who doesn’t drink very often. With that said, just because you have a higher tolerance to alcohol does not mean that it’s safe to drink while taking your medication.

Someone with a low tolerance taking high doses of an antidepressant may pass out after one drink. It should also be noted that some speculate that you may have more of an interaction if your body is also not tolerant or adapted to your antidepressant medication. In other words, if you are new to a specific medication, some believe that the effects when combined with alcohol could be more severe.

Types of Antidepressants and Interactions with Alcohol

Different types of antidepressants have different reactions when combined with alcohol. In general, the safest class is thought to be the SSRIs as well as the SNRIs. Certain reversible MAOIs, tricyclics, and atypical antidepressants are also thought to be fairly safe. With that said, always talk to your doctor before trusting something you read on the internet.

  • MAOI: The Monoamine Oxidase Inhibitors also have significant interactions with alcohol. Many beers and wines contain the protein called “tyramine,” which is known to interact with MAOIs – leading to dangerous increases in blood pressure. For this reason, it is recommended to avoid alcohol while taking an MAOI medication. With that said, if you are taking a reversible MAOI that doesn’t react with “tyramine” such as Moclobemide, you will be less likely to experience adverse effects. Always talk to your doctor if you are considering drinking while on a reversible MAOI.
  • Tricyclic: These tend to cause more sedation than other classes of medications, specifically due to the fact that they affect histamine receptors. When alcohol interacts with a TCA, it can result in both increased intoxication and elevated effects of the drug. This could result in seizures and possible heart rhythm changes. Additionally you may feel especially drowsy with impaired motor skills and cognition. It should also be mentioned that alcohol tends to have a more potent interaction with TCAs during the first few weeks of treatment.
  • SNRI: Many of the SNRIs are considered to be similar to SSRIs in their reaction to alcohol. All of the manufacturers specifically warn to avoid alcohol while taking an SNRI medication. Interactions may cause unwanted side effects, increased drowsiness, impaired coordination, etc. However, just like the SSRIs, these are considered one of the safer classes of drugs in regards to side effects and interactions.
  • SSRI: All SSRI manufacturers advise against drinking alcohol while taking their medication. No matter what SSRI you are taking, there is a risk of increased side effects as well as drowsiness while taking the medication. Perhaps the worst culprits for alcohol interactions include: Luvox and Paxil. These drugs tend to cause severe impairments in motor skills and cognition. Although some think Celexa, Lexapro, Prozac, and Zoloft may not impair cognition to the degree of Paxil, interactions have been reported with all SSRIs. Of any class of drugs, SSRIs are regarded as being the “safest class” for interactions with alcohol.
  • Atypical: These are antidepressants with unique properties that cannot fit into one specific class. Therefore, interactions that some of these drugs have with alcohol will be completely dependent on the drug. Certain drugs like Remeron may impair motor skills and cause drowsiness, while others like Wellbutrin may increase the risk of seizures. Another drug like Viibryd may react similarly to SSRIs when combined with alcohol. Always talk to your doctor if you have questions about how alcohol with your antidepressant.

Antidepressants may increase alcohol cravings

There are many self-reports circulating throughout the internet of individuals who claimed that taking antidepressants significantly increased their alcohol cravings. The increased craving for alcohol is thought to be linked to reward-circuitry in the brain. When a person takes an antidepressant, it is thought to alter activity in the reward center of the brain, increasing sensitivity of neurotransmitter responses.

Specifically, serotonin may enhance both the intoxication and pleasurable feelings associated with alcohol consumption. This is due to the fact that when you drink, your serotonin levels increase from the alcohol. Combine this with an SSRI antidepressant that is preventing reuptake of serotonin and you could experience euphoria or an alcohol-induced mania.

Although not enough research has been conducted to verify these hypotheses, there is clear evidence that some people are more drawn to alcohol consumption while on antidepressants. Findings among tests with rats indicated that although various antidepressants initially reduced chances of alcohol consumption, after a few weeks, alcohol consumption significantly increased.

For these reasons, it is thought that antidepressant usage among alcoholics could be problematic in certain cases. If you know that you have problems with alcohol, be aware of the fact that an antidepressant could actually make you crave more of it. If you believe that your antidepressant is making you crave alcohol, you should talk to your psychiatrist and consider switching medications.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23551979

Should you stop taking antidepressants to drink alcohol?

Under no circumstances is it recommended to discontinue your antidepressant just so that you can drink alcohol. Assuming you are serious about keeping your depression under control, it is important to continue safely treating your depression. During this time you may need to give up or cut back on social drinking as part of your treatment for depression.

It should also be noted that if you simply stop taking your medication so that you can drink alcohol, you may experience significant withdrawal symptoms including: dizziness, headaches, flu-like symptoms, and brain zaps (electric shock sensations throughout your brain). You may also experience a resurgence of deep depression and suicidal thoughts. For this reason, it is best to follow through with your antidepressant treatment and avoid alcohol.

In the meantime, if you want to drink and take antidepressants, talk to your doctor to get more information about how alcohol could interact with your medication. Prior to having a drink, you should be aware of potential adverse effects that could be caused by your medication interacting with alcohol.

Mixing Antidepressants and Alcohol: The Bottom Line

In general, the mixing of antidepressants with alcohol is highly discouraged by all manufacturers and medical professionals alike. Most antidepressants will interact with alcohol, leading to increased drunkenness and other side effects. It is also thought that even small amounts of alcohol consumed on a daily basis can reduce the efficacy of an antidepressant medication. Therefore the more you drink, the greater the chances of your medication becoming less effective.

Although you may get away with drinking alcohol while taking an antidepressant, not everyone has the same experience. It is important to avoid giving friends or other people advice about this subject because everyone is on a different dose of medication, drinks a different amount of alcohol, and you really don’t know how the interaction will affect someone.

Due to the significant number of interactions between alcohol and antidepressants, it is tough to recommend a “safe” amount of alcohol to consume while taking an antidepressant. If you do drink alcohol while taking an antidepressant, it is highly recommended to consume as little as possible and be aware of the potential interactions.

Additionally you should be advised against operating heavy machinery and/or a motor vehicle because the interaction could affect your motor skills. Any questions you may have about the interaction between your medication and alcohol should be discussed with a licensed medical doctor. Feel free to share your thoughts on drinking alcohol while on antidepressants in the comments section below.

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{ 3 comments… add one }
  • Sarah March 14, 2016, 12:48 pm

    My Zoloft made me want to drink all the time. I drank for years while taking it. I am pregnant now and off of it and have not had a problem with wanting to drink. I am either going to switch meds or stop taking it.

  • Jon Jones June 6, 2016, 6:08 am

    There is a huge link between antidepressants and alcoholism. It’s sad how many people mix the two.

  • Rebecca Eibl July 21, 2016, 5:42 pm

    It makes me really want to drink more. I thought it was just me.

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