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Antidepressants & Alcohol

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What are Antidepressants?

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

Antidepressant medications can negatively interact with alcohol. Drinking while on them puts your 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, keeping it in there longer. Serotonin is a chemical in your brain responsible for feelings of well-being. Common SSRI brands include Lexapro, Zoloft, and Prozac.

2. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

These block reuptake of sertonin and norepinephrine.

Norepineprhine is a brain chemical responsible for focus and memory. Popular SNRI brands include Cymbalta, Effexor, Pristiq, and 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. They have more side effects than newer medications and are less common today.

Some notable TCA brand names include Anafranil and Norpramin.

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. Brands include Nardil, Marplam, and 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, and Mirtazapine.

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Side Effects & Risks of Antidepressants

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

Other common side effects of SSRIs include:

  • Sexual dysfunction
  • Dry mouth
  • Constipation
  • Weight fluctuation
  • Headaches
  • Insomnia

Some more serious side effects in rare cases include:

  • Bleeding
  • Extreme agitation
  • Withdrawal symptoms

SSRIs may actually raise the risk of suicidal thoughts and behaviors, at least at first. Since they ease but don't eliminate depressive symptoms, patients may feel "in control" just enough to take their lives.  

For some, this could include taking their own lives. Patients should be closely watched by loved ones and healthcare providers during the first few weeks of treatment.

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 due to it being linked to acute liver failure.11 

Common side effects of TCAs include unwanted weight gain, sedation, sexual dysfunction, and risk of suicidal thoughts.

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 slows down your body's processing of the medication. Because your body is "busy" with the alcohol, it can take longer to process other medications. This makes blood levels of the medication higher than expected, which can lead to an overdose.
  2. Pharmacodynamic interactions — the alcohol amplifies the medication. The sedative effect of alcohol combines with that of some drugs.

Different people metabolize alcohol and medications in various ways. Because of this, it is hard to assess the risk of a bad interaction in 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 greater risk of impulsive and violent behavior.

Does Alcohol Counteract Antidepressants?

Drinking alcohol can undermine treatment for depression since alcohol is a depressant. 

People with alcohol use disorder are often have other co-occurring mental health conditions. If you have problems with alcohol and mental health, it is essential to seek help.

Evidence suggests that even moderate drinking can interfere with the production of serotonin.  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 

Consequences for drinking while taking them include impaired memory and impulsive behavior.

This can lead to a blackout. A blackout is when your memory is so impaired that you may not remember what you did the night before.

Can You Die From Mixing Antidepressants and Alcohol? 

Mixing alcohol and depression medication can cause difficulty breathing, heart problems, and internal bleeding.

One study found combining SSRIs with alcohol raises the risk for Rhabdomyolysis, a life-threatening condition.10 

If you drink alcohol while taking MAOIs, you may increase your risk for dangerously high blood pressure.

And while it may produce euphoria in the moment, alcohol makes depression worse in the long run. It can also lower inhibitions, which may lead to an increased risk for suicide.

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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 those that abuse alcohol are 3.7 times more likely to have depression.7 

People who mix alcohol with antidepressants may therefore be at greater risk of alcohol use disorder.

Some symptoms of alcohol use disorder include:

  • Solitary drinking
  • Drinking to excess
  • Inability to stop drinking or drink in moderation
  • Issues with friends, work, or family members centered around drinking
  • 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, a motivational intervention, involves respectfully confronting the patient.

The patient is made to understand the importance of being accountable for themselves.

All approaches can take place in both one-on-one settings and within a larger support group.

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Updated on April 8, 2022
11 sources cited
  1. DeVido, Jeffrey J., and Roger D. Weiss. “Treatment of the Depressed Alcoholic Patient.DeVido, Jeffrey J, and Roger D Weiss. “Treatment of the depressed alcoholic patient.” Current psychiatry reports, 2012.
  2. Hall-Flavin, Daniel K. “Antidepressants and alcohol: What's the concern?Mayo Clinic, 2017.
  3. Herxheimer, Andrew, and David B. Menkes. “Drinking Alcohol during antidepressant treatment - a cause for concern?The Pharmaceutical Journal, 2011.
  4. Laban, Tahier Sub, and Abdolreza Saabadi. “Monoamine Oxidase Inhibitors (MAOI).NCBI Bookshelf, 2020.
  5. National Institute on Alcohol Abuse and Alcoholism. “Harmful Interactions Mixing Alcohol with Medicines.” www.niaaa.nih.gov.
  6. Ogbru, Omud, and Jay W. Marks. “Antidepressants Side Effects, List, Types, Uses, and Alcohol Interactions.” www.medicinenet.com.
  7. Pettinati, Helen M., and William D. Dundon. “Comorbid Depression and Alcohol Dependence.Psychiatric Times, 2011.
  8. Ramsey, Susan E., et al. “Alcohol Use Among Depressed Patients: The Need for Assessment and Intervention.Professional psychology, research and practice, vol. 36, no. 2, 2005, pp. 203-207. Alcohol Use Among Depressed Patients: The Need for Assessment and Intervention.
  9. Weatherman, Ron, and David W. Crabb. “Alcohol and Medication Interactions.Weathermon, R, and D W Crabb. “Alcohol and medication interactions.” Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism vol. 23,1 : 40-54., vol. 23, no. 1, 1999, pp. 40-54.
  10. Sung, Dong Jun, et al. “Combination of Antidepressant and Alcohol Intake as a Potential Risk Factor for Rhabdomyolysis.Iranian journal of public health, vol. 47, no. 2, 2018, pp. 1424-1425.
  11. Khawam, Elias A., et al. “Side effects of antidepressants: An overview.Cleveland Clinic journal of medicine, vol. 73, no. 4, 2006 351-3, 356-61. PubMed.gov.

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