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How Dangerous is Mixing Alcohol with Antidepressants?

Anyone with an antidepressant prescription should have received a warning from either the prescribing physician or pharmacist regarding antidepressants and alcohol. Mixing alcohol with antidepressants presents potential dangerous side effects. Healthcare professionals discourage drinking and antidepressants for several reasons. Alcohol is a sedative that depresses the central nervous system. So alcohol can exacerbate the side effects of antidepressants, and antidepressants can worsen the side effects of alcohol. For some individuals, mixing the two can also make depression symptoms worse. Many people wonder why the two should not be mixed, and ask questions such as, “Does alcohol stop antidepressants from working?” This article explains why individuals should not mix anti-depression meds and alcohol.

Antidepressant and Alcohol Interactions

Physicians and pharmacists discourage mixing antidepressants with alcohol across the board. No matter what type of medication, drinking while taking antidepressants presents dangerous side effects. Each type of antidepressant has a specific reason why it is bad to mix antidepressants and alcohol.

SSRIs (Selective Serotonin-Reuptake Inhibitors)

SSRIs help a lot of people treat their depression symptoms. Doctors in the United States prescribe SSRIs such as Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft), and Vilazodone (Viibryd) to manage several mood disorders. Those include major depressive disorder, bipolar disorder, anxiety disorders, obsessive-compulsive disorder (OCD), panic disorders, eating disorders such as bulimia, and post-traumatic stress disorder (PTSD). People taking SSRI antidepressants may experience worsening side effects of SSRIs. Those side effects may include:

  • Feeling agitated, shaky or anxious
  • Feeling or being sick
  • Indigestion
  • Diarrhea or constipation
  • Loss of appetite and weight loss
  • Dizziness
  • Blurred vision
  • Dry mouth

Aside from worsening side effects of the prescription medication, alcohol is a depressant. So it can make depression symptoms worse on top of worsening side effects. In addition, serotonin syndrome induced by SSRIs and SNRIs can lead to acute renal failure.

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SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)

SNRIs work similarly to SSRIs, but they also affect norepinephrine. Norepinephrine acts as both a neurotransmitter and hormone and plays an important role in the body’s fight or flight response. Common SNRIs include Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Levomilnacipran (Fetzima), and Venlafaxine (Effexor XR). They are generally used to treat the same mood disorders as SSRIs (sometimes as an off-label use). SNRIs present a particular risk factor for Rhabdomyolysis (RML) when combined with alcohol intake. RML risk is exacerbated when either substance is ingested directly after exercise.

TCAs (Tricyclic Antidepressants)

TCAs have proven to be effective in treating alcoholism in certain individuals when not combined with alcohol itself. But clinical trials have also shown that combining the two can more dramatically impair coordination and judgement than alcohol alone. This puts individuals at higher risk of dangerous behaviors such as driving under the influence. Also, combining TCAs with alcohol increases the side effects of feeling drowsy and dizzy.

MAOIs (Monoamine Oxidase Inhibitors)

MAOIs are an extremely strong class of antidepressants. They change the level of the brain chemicals norepinephrine, serotonin, and dopamine. The enzyme monoamine oxidase helps increase the levels of these chemicals in the brain which can help with depression. Doctors do not prescribe them often because MAOIs carry a risk of changing the way that other medications work and could lead to high blood pressure. MAOIs approved by the FDA to treat bipolar depression include Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Emsam), and Tranylcypromine (Parnate).

MAOIs should never be mixed with other medications that increase serotonin levels in the brain. It can lead to a dangerous amount of serotonin that triggers serotonin syndrome. Mixing MAOIs with alcohol can also lead to dangerously high hypertension. As levels of norepinephrine elevate, blood pressure climbs and may create a hypertensive crisis.

Atypical Antidepressants

Some medications do not fit neatly into the larger categories of antidepressant medications. Sometimes they are used as off-label to treat depression. Atypical antidepressants include trazodone, mirtazapine (Remeron), vortioxetine (Trintellix), vilazodone (Viibryd) and bupropion (Wellbutrin). All of these medications function very differently in the body and have their own individual reasons that they should not be mixed with alcohol. These reasons can be found in the medication package inserts provided with the prescription.

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What are the side effects of mixing alcohol with antidepressants?

Depression and Anxiety Symptoms Get Worse

Alcohol seems to improve mood in the very short term, but it creates a greater risk of deepening depression and higher anxiety. Other than the inadvertent health side effects, mixing antidepressants with alcohol can significantly reduce the efficacy of antidepressants. Drinking while on these medications can make depression and anxiety symptoms even worse.

Dizziness and Loss of Control

Mixing some antidepressants with alcohol can amplify the natural loss of coordination that comes with a higher blood alcohol content (BAC). Individuals who mix alcohol with antidepressants are at greater risk of injuring themselves or others due to lack of motor control.

Potentially Dangerous Interactions

As listed in the interactions above, many time mixing alcohol with antidepressants can lead to unexpected crisis events. This may be a hypertensive crisis or a higher likelihood of engaging in dangerous behavior like drunk driving.

Does Mixing Antidepressants with Alcohol Mean Someone is an Alcoholic?

Alcoholism classifies as a medical disease. That said, it requires a self-diagnosis for individuals to recognize and treat. Mixing antidepressants with alcohol doesn’t necessarily mean an individual is an alcoholic. However it may be a symptom. If alcohol is being consumed to escape or use of it is compulsive/out of control, that individual may be suffering from alcoholism. If someone is on an antidepressant and drinks despite the known dangerous side effects, that person needs help for alcohol abuse disorder.

Due to the side effects of mixing medication with alcohol, people with alcohol use disorder may discontinue their medications in order to keep drinking. This typically leads them into a deeper depression and may spiral out of control if not managed. If you or someone you loved is struggling with alcoholism, our mental health counselors are available 24/7 by phone: 855-997-4702