Antidepressants & Alcohol: Understanding the Risks

Can You Mix Antidepressants & Alcohol?

Alcohol use is a common coping mechanism for those suffering from depression. Mixing alcohol with antidepressants can weaken the drug’s effectiveness and result in dangerous interactions. Therefore, combining antidepressants with alcohol has the potential to cause deadly stroke and seizures.

What Happens When You Mix Alcohol & Antidepressants?

Alcohol affects the frontal lobe, which leads to impaired judgment and decision making. Moreover, drinking may cause people to miss a dose of antidepressants. Hence, it is important to take antidepressants without alcohol as prescribed and never miss a dose.

Typically, mixing these two increases depression, and negatively impacts individuals’ judgment, coordination, motor skills, and reaction time. It may also reduce individuals’ ability to perform tasks that require attention and focus. Studies show a large percentage of those using alcohol are deficient in folic acid and other essential nutrients, also causing depression.²

Side Effects of Mixing Antidepressants & Alcohol

Taking alcohol with antidepressants may increase the risk of drug overdose and cumulative side effects.³ Alcohol may not only damages brain functions but may also lead to liver disease and heart damage. Liver toxicity is another reason why a person should not mix the two.

Side effects of mixing antidepressants and alcohol may include:*

• Worsened depression: Alcohol acts as a depressant on the central nervous system, worsening depression symptoms. Alcohol can also interfere with the absorption of antidepressants in the gut, reducing their therapeutic effect. Alcohol lowers brain activity by decreasing levels of brain chemicals necessary to your sense of well-being.
• Suicidal thoughts: Taking alcohol with antidepressants interferes with the treatment, and potentiates suicide risk. Research indicates that even slight alcohol consumption by individuals being treated for depression, may reduce the antidepressant effect, decrease drug compliance, and increase impulsivity, all of which can increase the risk for suicidal ideation.
• Hangxiety: Feeling anxious or depressed the morning after drinking alcohol is hangxiety when the alcohol wears off. Individuals may experience shaking and sweating, undue worry, and heart palpitations. It may last for several hours and usually resolve within one day. This symptom occurs for people who take antidepressants and for people who don’t take them.
• Fatigue and drowsiness: Both cause drowsiness. Mixing them can significantly increase fatigue, and make driving or operating machinery difficult.
• Impaired judgment and coordination: Both can impair cognitive function, coordination, and reaction times. This increases the risk of accidents and falls.
• Serotonin syndrome: A dangerous condition when taking alcohol with antidepressants can increase serotonin levels in the brain. It is characterized by agitation, rapid heartbeat, high blood pressure, and seizures. It is a potentially life-threatening condition that requires immediate medical attention.
• Liver damage: Both can put a strain on the liver and heighten the risk of liver damage by interfering with the liver’s ability to process drugs effectively.
• Increased risk of bleeding: Both can increase the risk of bleeding leading to problems like easy bruising, nosebleeds, or even more serious internal bleeding.

*Antidepressant medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Consuming alcohol when depressed can lead to the following adverse effects:

• Folic acid deficiency: Alcohol may lower levels of folic acid and other essential nutrients that impact mood. It may cause anemia, exhaustion, depression, and a higher risk of memory loss (dementia).
• Interfering with sleep: Alcohol can disrupt sleep patterns, thus making antidepressants less effective. Lack of sleep can contribute to ongoing depression or anxiety symptoms.
• Feelings of worthlessness: A severe side effect that may make you lose control, feel remorseful, and self-loathing, which rebounds the symptoms of depression.

What Are the Most Significant Dangers of Mixing Antidepressants and Alcohol?

Mixing these substances leads to worsening depression and increases suicide risk.* Health dangers can also be life threatening, with some people may lose consciousness and breathing. Abnormalities in the brain’s serotonin system appear to play a critical role in the brain processes mixing alcohol and antidepressants.⁵

Serotonin is an important brain chemical (neurotransmitter) to communicate information among nerve cells. Interaction between alcohol and some antidepressants cab result in serotonin syndrome, a fatal condition characterized by high fever, agitation, rapid heartbeat, high blood pressure, shivering, muscle rigidity, and seizures. Serotonin syndrome can cause death if not treated.

*Antidepressant medications have a black box warning. These are the most serious type of warnings from the Food and Drug Administration (FDA). Antidepressants can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of age, you should talk with your doctor about risks with antidepressants before starting treatment.

Can Mixing Alcohol & Antidepressants & Alcohol Cause Death?

Mixing antidepressants and alcohol can be extremely dangerous as it can lead to a fatal overdose. Overdose symptoms may include respiratory depression and even death.⁶

Symptoms of an Overdose of Antidepressants & Alcohol

Drinking alcohol while taking antidepressants can cause drug overdose, and potentially worsens depression. If people take their antidepressants with alcohol and develop low heart rate, dizziness, difficulty breathing, or suicidal thoughts, call 9-1-1 or go to the nearest emergency room immediately.

Symptoms of an overdose of antidepressants and alcohol include:⁷

• Drowsiness and dizziness
• Anxiety and depression
• Sleeping difficulties
• Headaches
• Dry mouth and constipation
• Nausea, vomiting, and abdominal pain
• Shaking and excessive sweating
• Excessive urinating
• Lack of coordination
• suicidal thoughts and actions
• sexual problems

How Does Alcohol Affect Different Types of Antidepressants?

Alcohol can cause depression, anxiety, and confusion. However, it may lead to breathing problems, coma, or even death in extreme circumstances. Older antidepressants, like tricyclics (TCAs) and monoamine oxidase inhibitors (MAOIs), can cause serious side effects.

TCAs may lower blood pressure and cause irregular heartbeats and sudden death. Whereas MAOIs can trigger a potentially fatal headache from a hypertensive crisis or “cheese reaction” (caused by tyramine present in drinks or foods). Additionally, MAOIs can even cause life-threatening serotonin toxicity.

Here is how alcohol affects different types of antidepressant medications:⁴

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression. They increase serotonin levels in the brain which improves and stabilizes your mood. When using SSRI with alcohol, a serotonin surge can sometimes occur, which can lead to serotonin syndrome characterized by high blood pressure, agitation, muscle twitching, and diarrhea.

SNRIs

Taking serotonin and norepinephrine reuptake inhibitors (SNRIs) with alcohol can cause drowsiness and rhabdomyolysis (RML). Additionally, over time the two may even cause liver damage or liver failure as the liver works hard to process the overload of both.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) may be prescribed for major depressive disorder (MDD). They carry a risk of seizures, life-threatening irregular heartbeat, and blackouts when combined with alcohol. Alcohol and TCAs together may impair reaction, coordination, and attention.

Monoamine-oxidase Inhibitors (MAOIs):

Monoamine oxidase inhibitors were the first antidepressants discovered. It is often considered when other antidepressants are unsuccessful due to the high risk of drug and food interactions. Their side effects are potentially serious when combined with alcoholic beverages high in tyramine. A potentially fatal side effect is high blood pressure (hypertensive crisis), which could lead to a life-threatening stroke or brain hemorrhage.

Atypical Antidepressants

They increase levels of dopamine, serotonin, or norepinephrine neurotransmitters in the brain. Bupropion may increase the risk of seizures, while nefazodone may increase the risk of liver failure when coupled with alcohol.

Can You Ever Drink While Taking Antidepressants?

Although drinking a small amount of alcohol might make you feel better at first, any positive effects quickly decrease as you continue to drink. There is less research on the amount of alcohol use with antidepressants, typically, it is unsafe to take antidepressants with alcohol. People must discuss the risk of mixing the two with their healthcare providers. They consider your mental and physical health history, and overall risks before choosing a safe and effective antidepressant.

Older antidepressants, such as TCAs, have a higher risk of sedation, while MAOIs can cause dangerous effects on heart rate and blood pressure that may require hospitalization. If you’re taking MAOIs, it is crucial not to drink alcohol at all.

It is also important to stick to the recommended U.S. dietary guidelines for alcohol consumption (two drinks or less per day for men, one drink or less per day for women) to avoid interfering with your depression or anxiety treatment.

Can I Skip a Dose of My Antidepressant to Drink Alcohol?

Consistency is key when taking antidepressants, as skipping doses can render the drug ineffective and lead to withdrawal symptoms after prolonged use. These symptoms may include flu-like symptoms, burning, tingling, electric or shock-like sensations, and vivid dreams, along with the possibility of relapse and exacerbation of depression (suicidal ideation, self-harm, recurrence of panic attacks, and severe anxiety).⁸

Additional Questions to Ask Your Health Team About Antidepressant & Alcohol Use

Always discuss a treatment solution with a healthcare provider if you or your loved ones are struggling with depression and alcohol misuse. They guide you on coping mechanisms and tailor a plan that fits your health problems. They can answer all your concerns, like how drinking can deteriorate your health and make treatment ineffective. Moreover, they may educate you on how alcohol use can make a regularly prescribed drug dose an overdose.

Questions to ask your care team about antidepressant and alcohol use:

• Is there a safe amount of alcohol that I can consume with antidepressants?
• If someone wants to drink, should they stop taking antidepressants for the day?
• Is there anxiety medication or depression medication that isn’t negatively affected by alcohol?
• What should I do if I decide to drink anyway and have an adverse reaction?
• Do antidepressants make a person get drunk faster?
• Can I take antidepressants if I am pregnant or nursing?
• How many times per day do I take the drug?
• What other prescription drugs should I avoid while taking antidepressants?
• Can this medication cause side effects that I need to immediately inform?
• Can I stop taking the drug if I start feeling better?
• What will happen if I accidentally overdose or skip a drug dose?
• Are there any self-help programs or resources that you can recommend for my problem?
• Will group therapy or drug and alcohol education resolve my problem faster?
• Is it safe to use alcohol with amitriptyline or other TCAs?

Who Is at Risk of Mixing Alcohol and Antidepressants?

Individuals who suffer from untreated alcohol dependence, substance abuse disorder, and depression may be at risk of combining alcohol with antidepressants.⁹ This condition increases vulnerability to using substances to try to help manage negative emotions, stress, and traumatic memories, including post-traumatic stress disorder. This combination worsens the side effects of both substances, causing serious mental and physical illnesses. It may even result in oversedation, coma, and death.

Alcohol Use Disorders & Antidepressants

Depression and alcohol use disorder (AUD) are the most frequently diagnosed co-occurring conditions. Using both substances simultaneously heightens the severity of symptoms and increases the risk of suicidal thoughts and acts. Some people turn to alcohol as a means of escaping the stress in their lives or managing emotional strain, hoping for quick relief.

Treatment for Antidepressants & Alcohol Abuse

Alcoholism treatment plans may range from residential to outpatient and inpatient healthcare settings.¹⁰ A doctor or counselor decides the treatment plan based on several factors such as the severity of the condition, mental health, family support, and living situation. Inpatient treatment can be done in hospitals or special clinics which involves staying at the facility while receiving therapy during the day or evening. This type of treatment is often recommended for individuals with mental health or physical problems, those who lack family support, or those who live far from healthcare facilities.

A residential program is a part of inpatient treatment where the length of stay can vary from several weeks to a year depending on individual recovery. Treatment specialists directly work with individuals to create an effective treatment plan including a recommended length of stay in residential treatment.

After completing inpatient treatment, it is recommended to attend outpatient treatment for additional counseling and group therapy. Outpatient treatment takes place at mental health clinics, counselors’ offices, hospital clinics, or local health department offices, but does not require overnight stays.

Outpatient programs can assist in developing the necessary skills to handle daily challenges, often through group counseling. Additionally, these programs can address medical and mental health concerns alongside alcohol use disorders. Standard outpatient treatment typically involves 1 or 2 weekly group therapy sessions and may continue for a year or longer.

When to Seek Professional Help

If you or someone drinking alcohol while taking antidepressants, be aware that you could experience harmful side effects. Seek medical help right away if you notice a slower heart rate, feeling you are going to pass out, shallow breathing, severe confusion, sudden periods of high energy, loss of consciousness, or thoughts of suicide.¹¹

Some risk factors for substance abuse are mental health issues (depression, anxiety, schizophrenia, and personality disorders), parental substance use, childhood sexual abuse, and family rejection of lifestyle or personal choices. Signs of substance use disorders may include sudden weight loss or weight gain, bloodshot eyes and abnormal-sized pupils, tremors, slurred speech, or impaired coordination. Often these individuals encounter legal problems related to substance use and financial and relationship difficulties.

In My Experience

In my experience, seeking help for substance use issues is a big first step in recovery. Because the consequences can be life-threatening, medical care and treatment are essential. While antidepressants can relieve symptoms of depression, they are most effective when combined with an active lifestyle that includes regular exercise, sufficient sleep, and a balanced diet.