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Updated on September 14, 2023
8 min read

Worst Antidepressants to Mix with Alcohol

Can You Drink Alcohol While on Antidepressants?

Healthcare providers do not recommend drinking alcohol while on antidepressants. When these two substances interact, it worsens the depressive effects of alcohol and limits the benefits of antidepressants.

Antidepressants are prescribed for people suffering from depression and other mental health conditions. Both alcohol and antidepressants affect the central nervous system and can worsen each other’s side effects.

What Happens When You Drink Alcohol While on Antidepressants?

Healthcare providers do not recommend mixing alcohol and antidepressants for the following reasons:1,2,3,4

Depression and Anxiety

While alcohol may lighten your mood in the short term, it’s a depressant and may interfere with antidepressants. The combination may worsen symptoms of depression and anxiety and even make treatment harder.

Amplified Side Effects

A few antidepressant medications may make people drowsy, dizzy, and uncoordinated. The same also goes for alcohol. Combining the two substances may amplify their sedative effects.

Mixing alcohol and antidepressants may increase a person’s risks of falls, injury, and accidents. It can also affect one’s ability to perform routine tasks (like driving or operating a piece of machinery). 

Dangerous Results

Mixing alcohol and antidepressants may lead to potentially deadly results, like:

  • Sudden increases in blood pressure: Antidepressants called Monoamine Oxidase Inhibitors (MAOIs) may cause potentially deadly increases in blood pressure when combined with certain alcoholic beverages.
  • Serotonin syndrome: This is a potentially life-threatening condition characterized by excessive accumulation of serotonin. Alcohol temporarily increases serotonin. Combining alcohol and serotonin-increasing drugs (like selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors) may lead to dangerous surges in serotonin levels. 
  • Liver damage: The liver breaks down alcohol and various medications. Alcohol can place an additional burden on your liver and cause liver damage with long-term use. This affects how the body processes alcohol and some antidepressants, resulting in people experiencing worse and more dangerous side effects. 
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The 6 Worst Antidepressants to Mix with Alcohol

Here are some antidepressant drugs known to have potentially dangerous interactions with alcohol:

1. Tricyclic Antidepressants (TCAs)

TCAs, such as amitriptyline, nortriptyline, and imipramine, have significant sedative side effects. These effects are most pronounced during the first few weeks of a person taking the medications.

Alcohol can amplify TCAs’ sedative effects, leading to symptoms like:

  • Extreme drowsiness and dizziness
  • Impaired coordination
  • Respiratory depression

One specific interaction involves amitriptyline, a TCA used in the off-label treatment of migraines. Conversely, drinking alcohol may trigger migraines, countering the effectiveness of amitriptyline.2,3,4,5

2. Monoamine Oxidase Inhibitors (MAOIs)

MAOIs, such as phenelzine and tranylcypromine, are a class of antidepressants that affect monoamine oxidase, an enzyme involved in the breakdown of neurotransmitters. 

MAOIs are not commonly used today because of their potentially harmful effects. Other medications are also better at treating depression and other mental health issues.

Doctors prescribe MAOIs only when other antidepressant medications are proven ineffective. This is because they may cause a severe reaction called the “cheese effect.”

This effect means a person taking MAOIs experiences sudden and dangerous spikes in blood pressure after consuming food and drinks high in tyramine.

These food and drinks include:

  • Aged cheeses
  • Cured meats
  • Beer
  • Red wine

The cheese effect can lead to adverse conditions like: 

  • Rapid heartbeat
  • Severe headaches
  • Nausea
  • Sweating
  • Hypertensive emergency
  • Stroke

People on MAOIs should talk with their doctors and know the safe foods and drinks to consume while taking the medication.3,4,6

3. Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), are commonly prescribed antidepressants. They block the nerve’s reuptake (reabsorption) of serotonin, ensuring this neurotransmitter is at high levels. 

Mixing alcohol and SSRIs presents the risk of serotonin syndrome. Alcohol can temporarily increase serotonin. Combine that with SSRI, and the body may accumulate excessive serotonin levels. 

If left untreated, serotonin syndrome can lead to life-threatening complications, such as: 

  • Organ failure
  • Seizures
  • Death

Minus serotonin syndrome, SSRI-alcohol interactions are generally moderate. However, alcohol may still intensify SSRI’s sedative effects. Doctors usually recommend limiting drinking or abstaining while taking Prozac or Zoloft.4,7

4. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs, such as venlafaxine and duloxetine, are another group of antidepressants with known interactions with alcohol. They block nerves from reabsorbing serotonin and norepinephrine, ensuring these neurotransmitters are at high levels. 

Like SSRIs, SNRIs’ interactions with alcohol may not be as severe as TCAs or MAOIs. However, combining alcohol and SNRIs can still lead to amplified sedative effects and serotonin syndrome. 

One specific case involves duloxetine. This SNRI is sometimes used to treat neuropathic pain. Drinking alcohol, especially in excessive amounts leading to substance abuse, can damage nerves, countering the effects of duloxetine.2,4,7 

5. Benzodiazepines

Benzodiazepines, such as diazepam (Valium) and alprazolam (Xanax), are technically not classified as antidepressants. They are prescription medications commonly used to treat anxiety disorders. 

Nevertheless, mixing benzodiazepines with alcohol can potentiate the sedative effects of both substances. Like with other medications, it is crucial to avoid alcohol when taking benzodiazepines.

6. Atypical Antidepressants

Atypical antidepressants, such as mirtazapine (Remeron) and trazodone (Desyrel), have varying degrees of interaction with alcohol.

While the risk may be lower compared to other antidepressants, people should still exercise caution and consult with a healthcare provider regarding alcohol consumption.

Mental Health, Alcohol Consumption, and Antidepressants

Alcohol use alone is linked with higher chances of developing depression.8 Mixing alcohol and antidepressants can lead to more serious implications.

The combination can counter the intended benefits of antidepressants, potentially leading to the reduced relief of depressive symptoms or even treatment failure.

Long-Term Side Effects of Antidepressants and Alcohol

Both antidepressants and alcohol can have long-term effects on physical and mental health.

Prolonged alcohol consumption can result in conditions like: 

  • Liver damage
  • Cardiovascular complications
  • Increased risk of certain cancers
  • Development of alcohol use disorder

On the other hand, long-term use of antidepressants can lead to various side effects, depending on the medication, including: 

  • Weight gain
  • Sexual dysfunction
  • Sleep disturbances
  • Decreased bone density

Combining alcohol with antidepressants may increase the risk and severity of these conditions and side effects.

Those taking antidepressants should discuss any concerns or questions about long-term effects with their healthcare providers. Medical professionals can offer personalized guidance based on the specific antidepressant prescribed, the person's medical history, and current circumstances.

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Frequently Asked Questions

Can Antidepressants Make Alcoholism Worse?

Antidepressants are not directly responsible for causing alcoholism. However, they have an impact on alcohol consumption patterns, both negatively and positively.

If people who resort to alcohol misuse for mental health issues start using antidepressants, the treatment may reduce their need to drink. 

On the other hand, if people on antidepressants stop taking them, their depression may worsen. They may instead turn to alcohol as self-medication. Alcohol is a depressant, and consuming it may aggravate depression.8,9

Interestingly, some reports link selective serotonin reuptake inhibitors, like sertraline (Zoloft), with increased alcohol consumption. SSRI-induced alcoholism is seen in both sexes and all ages, and the information has come from various countries.10

Before starting antidepressant treatment, a safe approach is for people diagnosed with alcohol use disorder (AUD) to seek professional guidance first.

How Many Alcoholic Drinks Can You Have While on Antidepressants?

It is generally recommended to avoid drinking alcohol while taking an antidepressant medication. Even makers of SSRIs and related antidepressants are consistent in strongly discouraging alcohol use.9

However, since many people are unwilling to give up alcohol, experts have looked at combining alcohol and antidepressants in the safest way possible.

Some doctors may allow moderate drinking. In line with CDC’s guidelines, this means one drink per day for women and two for men.1,11

These drinking limits are not absolute. Various factors have to be considered, like:

  • The type of antidepressant (particularly MAOIs’ interaction with alcohol)
  • Individual factors (including the person’s tolerance to the combined side effects)
  • Any underlying medical conditions

Whether you exceed the limit or not, know that mixing alcohol and antidepressants still potentially affects your depression treatment and may expose you to long-term effects and other dangers.

To ensure the utmost safety and effectiveness of the antidepressant treatment, those taking the medication should consult their healthcare providers regarding guidelines for consuming alcohol.

How Long Should I Wait to Drink Alcohol After Taking Antidepressants?

The timing between taking antidepressants and consuming alcohol may vary depending on the specific medication and individual factors. As a general guideline, people should wait a significant period after taking the antidepressant before drinking alcohol. 

For example, it may be two weeks or more for MAOI takers. This period should allow the medication to be metabolized effectively and reduce the risk of adverse interactions.

It’s crucial to consult with a healthcare provider regarding specific recommendations for timing. Factors such as the type of antidepressant, dosage, and individual tolerance can influence the ideal waiting period.

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Summary

The bottom line is that there are many reasons not to combine alcohol with antidepressants. 

Mixing alcohol with antidepressants can make depression worse, counteract the intended effects of antidepressants, and lead to increased risks to physical and mental health. 

Additionally, certain antidepressants, such as TCAs and MAOIs, have a higher risk of dangerous interactions with alcohol. 

If you’re on antidepressants, consult your healthcare providers regarding guidelines on consuming alcohol and discuss any concerns or questions. You can optimize your mental health treatment and overall well-being with informed decisions and by prioritizing personalized care.

Updated on September 14, 2023
11 sources cited
Updated on September 14, 2023
All Alcoholrehabhelp content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies.
  1. Can I drink alcohol while taking antidepressants?” National Alliance on Mental Illness (NAMI).
  2. Le, K. “Can I Drink Alcohol With Antidepressants Like Cymbalta or Amitriptyline?” GoodRx Health, 2021.
  3. Anderson, L. “Antidepressants and Alcohol Interactions.” Drugs.com, 2022.
  4. Cautions - Antidepressants.” NHS, 2021.
  5. Pope, C. “Tricyclic antidepressants.” Drugs.com, 2023.
  6. Pope, C. “Monoamine oxidase inhibitors.” Drugs.com, 2023.
  7. Fletcher, J., West, M. “Is it safe to mix Zoloft and alcohol?” Medical News Today, 2023.
  8. Kuria et al. “The Association between Alcohol Dependence and Depression Before and After Treatment for Alcohol Dependence.” ISRN Psychiatry, 2012.
  9. Herxheimer, A., Menkes, DB. “Drinking alcohol during antidepressant treatment — a cause for concern?” The Pharmaceutical Journal, 2011.
  10. Brookwell et al. “Ninety-three cases of alcohol dependence following SSRI treatment.” Int J Risk Saf Med, 2014.
  11. CDC Alcohol Guidelines: “Dietary Guidelines for Alcohol.” Centers for Disease Control and Prevention (CDC), 2022.
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All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice.
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