Is It Safe to Mix Antidepressants & Alcohol?

What are Antidepressants?

Antidepressants are medications prescribed to treat depression. There are different types, and each comes with various side effects.

Antidepressant medications can negatively interact with alcohol. Drinking while on them puts you at higher risk for serious side effects.¹

5 Types of Antidepressants

There are five major classes of antidepressants. Each takes a different approach to treating symptoms of depression and has different side effects. The five classes are:

1. Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most popular class of antidepressants. They increase serotonin levels in the brain by stopping nerve cells from re-absorbing it and keeping it there longer. Serotonin is a chemical in your brain responsible for feelings of well-being.

Common SSRI brands include:

• Lexapro
• Zoloft
• Prozac

2. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

These block reuptake of serotonin and norepinephrine. Norepinephrine is a brain chemical responsible for focus and memory.

Popular SNRI brands include:

• Cymbalta
• Effexor
• Pristiq
• Paxil

3. Tricyclic antidepressants (TCAs)

These are an older class of antidepressants that have been in use since the 1950s. Similar to SNRIs, they increase serotonin and norepinephrine levels in the brain.

Some notable TCA brand names include Anafranil and Norpramin. They have more side effects than newer medications and are less common today.

4. Monoamine oxidase inhibitors (MAOIs)

MAOIs are the oldest class of antidepressants. They have mostly been discontinued due to unpleasant side effects, such as hypertension and interactions with alcohol and other drugs.

MAOIs increase serotonin, norepinephrine, and dopamine levels in the brain. Dopamine is a type of neurotransmitter responsible for feeling pleasure.

Brands include:

• Nardil
• Marplam
• Emsam

5. Atypical antidepressants

These medications do not fit into any particular class of antidepressants. Because of this, the mechanisms of action and possible side effects all differ.

Some brands include:

• Bupropion (Wellbutrin)
• Trazodone
• Mirtazapine

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Side Effects of Antidepressants

The side effects of antidepressants depend on the class of antidepressants and your specific biology.

SSRI & SNRI Side Effects

SSRIs may actually raise the risk of suicidal thoughts and behaviors, at least at first. Because the drug eases a person's depressive symptoms, they may feel "in control" enough to take their lives.  

Other common side effects of SSRIs and SNRIs include:

• Agitation, shakiness, or anxiety
• Feeling and being sick
• Indigestion and stomach aches
• Diarrhea or constipation
• Appetite loss
• Dizziness
• Headaches
• Sexual dysfunction
• Dry mouth
• Weight fluctuation
• Insomnia

Some more serious side effects in rare cases include:

• Bleeding
• Extreme agitation
• Withdrawal symptoms

MAOI Side Effects

Side effects of MAOIs include headaches and insomnia. In rare cases, eating certain foods while taking them can cause hypertension and cerebral hemorrhage. An early MAOI, Iproniazid, was discontinued because it was linked to acute liver failure.¹¹ 

TCA Side Effects

Common side effects of TCAs include:

• Unwanted weight gain
• Sedation
• Sexual dysfunction
• Risk of suicidal thoughts

Atypical Antidepressant Side Effects

The side effects of atypical antidepressants can vary. For example: 

• Trazodone: Has been linked to orthostatic hypotension, dizziness, and headaches
• Bupropion: Side effects include irritability, insomnia, headache, tremors, and nausea 
• Mirtazapine: Side effects include sedation, irritability, dizziness, dry mouth, and disturbing dreams

What Happens When You Mix Antidepressants and Alcohol?

Alcohol affects your body's ability metabolism. This makes getting the dosage of medications right more complicated.

There are two ways that alcohol alters the body’s ability to metabolize certain antidepressants:

1. Pharmacokinetic interactions: Alcohol can slow down how your body metabolizes other medication. This makes blood levels of the medication higher than expected, which can lead to an overdose.
2. Pharmacodynamic interactions: The sedative effect of alcohol combines with that of some drugs, amplifying their effects.

Different people metabolize alcohol and medications in various ways. Because of this, it is hard to assess the risk of a bad interaction with a particular person.

Alcohol and Antidepressants Side Effects

Alcohol consumption while taking antidepressants can lead to various negative side effects. Antidepressants can strengthen the effects of alcohol, increasing impairment.

For example, some antidepressants have sedative effects, which can combine when taken with alcohol. Combining alcohol with MAOIs can lead to high blood pressure. Additional side effects include impulsiveness and violent behavior.

Does Alcohol Counteract Antidepressants?

Drinking alcohol can undermine treatment for depression. This is because alcohol is a depressant. People with alcohol use disorder (AUD) often have other co-occurring mental health conditions. If you have problems with alcohol and mental health, seeking professional help is essential.

Evidence suggests that even moderate drinking can interfere serotonin production.  Heavy drinking is linked to a higher risk for mood disorders. Alcohol dependence can also induce feelings of guilt and low self-worth, worsening symptoms of depression.

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Antidepressants and Alcohol Blackouts

Evidence shows some people have a lower tolerance for alcohol while taking antidepressants.⁵ This can lead to a blackout where your memory is so impaired that you may not remember what you did the night before.

Can You Die From Mixing Antidepressants and Alcohol? 

One study found combining SSRIs with alcohol raises the risk of Rhabdomyolysis, a life-threatening condition.¹⁰ While it may feel euphoric, alcohol can make depression worse in the long run.

Other dangers of mixing alcohol and depression medication include:

• Increased risk of suicide
• Breathing difficulties
• Heart problems
• Internal bleeding

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Is Mixing Alcohol With Antidepressants a Sign of Alcoholism?

According to a national survey, 16.9% of the 20.3 million people who suffered depression also reported substance use disorder (SUD).¹ The bulk of those said alcohol was their drug of choice.¹ 

Another survey found that those abusing alcohol are 3.7 times more likely to have depression.⁷ People who mix alcohol with antidepressants may be at greater risk of AUD.

Symptoms of AUD include:

• Solitary drinking
• Drinking to excess
• Inability to stop drinking or drink in moderation
• Issues with friends, work, or family members
• Craving alcohol

Treatment for Antidepressants and Alcohol Misuse

Treatment options break down into three principal approaches:

1. Sequential: Treating the primary disorder first, then addressing the secondary disorder
2. Parallel: Treating both disorders at the same time but in different settings
3. Integrated: Treating both disorders at the same time

Limited research indicates the third approach is the most effective in many situations. One possible technique is a motivational intervention that helps you understand the importance of taking accountability. All approaches can take place in both one-on-one settings and within a larger support group.