Alcohol and Antidepressants
The Effects of Drinking While Taking Antidepressants
Antidepressants are commonly prescribed medications used to treat various mental health conditions such as depression, anxiety and obsessive-compulsive disorder.
Data from the NHS in the UK for the year 2022/23 shows that over 17% of the population are prescribed some form of antidepressant. And, as this figure is based on total population and not just adults, the data means around 1 in 5 adults in the country are taking them.
Despite them being prescribed in such numbers, there is often confusion surrounding whether it is safe to consume alcohol while taking these medications.
How Antidepressants Work
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), work by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that helps regulate mood and emotions. By blocking the reuptake of serotonin, SSRIs help to increase its effects, diminishing symptoms of depression and anxiety.
It’s important to note that SSRIs are the most commonly prescribed class of antidepressants, and include well-known medications such as citalopram, sertraline and fluoxetine (prozac).
Alcohol and Antidepressants
Moderate alcohol consumption may not necessarily interfere with the effectiveness of SSRIs, however it’s still advised to exercise some caution. Alcohol is actually a central nervous system depressant that, while consuming it might make one feel more relaxed, actually increases symptoms of depression and anxiety. Additionally, alcohol interferes with the efficacy of antidepressant medication, often making it less effective in treating your condition.
Dr Sarah Ramsay Andrews, a psychiatrist at the Johns Hopkins University School of Medicine, said in a NY Times article that heavy alcohol consumption can hinder the effectiveness of antidepressants. Naturally, it is important to ensure the medications work as effective as they can when treating such conditions as anxiety and depression.
Which Came First, Alcohol or Depression?
The co-occurrence of alcohol misuse and depression is common due to a variety of factors.
People with an alcohol problem are at a higher risk of developing depression due to alcohol’s impact on brain chemistry and neurotransmitter function which leads to mood disturbances.
Conversely, people with depression can develop alcohol misuse issues as a form of self-medication or as a coping mechanism.
The presence of one condition can intensify the other, with depression increasing alcohol craving and consumption, while alcohol use can worsen the symptoms of depression.
This comorbidity – where two or more diseases or medical conditions in a patient coexist at the same time – poses challenges for treatment, as addressing both conditions need to be undertaken in order for real and long-term recovery to take place.
Often, when people who drink too much visit their doctor, they usually describe low mood, lack of energy and a difficult lifestyle – all symptoms of alcohol misuse. These are also symptoms of depression. And, as discussed above, depression can lead to drinking to much as a coping strategy or to use alcohol to relieve the feelings of low mood.
GPs, naturally, then prescribe antidepressants in a lot of cases, and if the patient is honest about their drinking habits, then doctors usually recommend cutting down or stopping altogether.
This makes the issue of drinking alcohol whilst taking antidepressants a very tricky situation for which there is no one-size-fits-all solution. Depression leads to drinking too much, and drinking too much can lead to depression.
In order to treat these co-occurring conditions, doctors and other medical professionals usually take a holistic approach to this to treat the conditions together. Usually a combination of alcohol abstinence, antidepressants, behavioural therapy and other treatments such as mindfulness can work to help recovery from both ailments.
Combining Alcohol and SSRI Antidepressants
Combining alcohol with SSRIs can result in intensified side effects and increased sensations of drowsiness, fatigue and/or dizziness. Some people have reported feeling more intoxicated than usual after consuming just one drink. Alcohol may also interact with the medication in ways that lead to unpredictable effects on your mood and overall well-being.
It’s best to follow recommended alcohol consumption guidelines provided by health experts. In the UK, the current recommended drinking guidelines suggest that people limit their alcohol intake to around 14 units of alcohol or on average 6 drinks per week (for example, six medium glasses of wine or six beers). These guidelines aim to promote better mental health outcomes and can also minimise potential interactions with antidepressant medication.
Alcohol and TCA or MAOI Antidepressants
While SSRIs are less likely to interact negatively with alcohol, other classes of antidepressants can pose a greater risk. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) have a higher likelihood of interacting with alcohol leading to potentially dangerous outomes.
For instance, combining alcohol with MAOIs can result in dangerous spikes in heart rate and blood pressure which may require hospitalisation treatment. Therefore, people taking MAOIs should refrain from consuming alcohol entirely.
Similarly, the antidepressant bupropion – which generally NOT prescribed as an anti-depressant in the UK but rather for smoking cessation – has the potential to increase the risk of seizures when combined with excessive alcohol consumption.
Understanding Individual Differences and Medication Types
Specific responses to alcohol and antidepressants can vary due to everyone’s biological individuality. Some people may experience greater sensitivity to the effects of alcohol or medication or the two combined, while others may be less affected.
While SSRIs are generally considered to have a lower risk of interactions with alcohol compared to other classes of antidepressants, it is still worthwhile consulting with your doctor. They can provide personalised advice based on your specific medication, medical history and individual circumstances.
Should You Drink on Antidepressants?
When considering whether it is safe to drink alcohol while taking antidepressants, several factors should be taken into account. These factors include your overall health, medical history and the specific type of medication you are taking.
If you have a history of alcohol, other substance misuse or addiction in general, say to gambling or food, it is especially important to discuss alcohol consumption with your doctor. They can provide guidance on the potential risks and help you develop a safe treatment plan.
Making an Informed Decision
In the end, the decision to drink alcohol while taking antidepressants should be based on careful consideration of the potential risks and benefits to you. It’s always wise to prioritise your mental health and follow the advice of medical professionals.
If you choose to drink alcohol, it is recommended to do so in moderation and within the limits set in the UK guidelines. It’s a good idea to pay attention to how your body responds to the combination of alcohol and medication. If you experience any adverse effects or worsening of symptoms it may be necessary to cut down or stop drinking altogether.
Naturally, if you are taking antidepressants and have an alcohol dependency, you are likely to drink more than is healthy. Also, if a real alcoholic, then abstinence would be favourable, never mind just cutting down for the sake of the antidepressant effectiveness.
Remember, open and honest communication with your doctor or an addiction specialist is essential when drinking. Your GP can give you advice based on your specific circumstances and help you work out if combining alcohol with antidepressants is working out well for you.
Alcohol and Sertraline
Medical professionals advise against drinking alcohol while taking Sertraline due to the dangerous interaction it can have. Sertraline, also known as Zoloft, is an antidepressant that works by blocking serotonin receptors in the brain. Alcohol temporarily increases serotonin levels and can cause similar side effects as Sertraline. Consuming alcohol while on the drug can lead to over-sedation and an increased risk of suicidal behaviour. There is no safe amount of alcohol that can be determined for someone taking Sertraline as alcohol and antidepressants are metabolised differently by each individual. If someone does drink alcohol while on it, they should do so with caution and stop if any adverse effects occur. Zoloft can also interact with other drugs, such as MAOIs, blood thinners and serotoninergic drugs, leading to potentially serious side effects. Additionally, caffeine may enhance the effects of antidepressant medications, but more research is needed in this area.
Alcohol and Citalopram
Drinking alcohol while on citalopram is very strongly discouraged by doctors, as it can have strong negative interactions. Citalopram does not influence the effects of alcohol, but alcohol can impact the effectiveness of citalopram. It is important to talk to your doctor before consuming alcohol while on the medicaiton to ensure your condition is properly treated. It has a long half-life, so even if you stop taking the medication, there is still a risk of alcohol interacting with Citalopram in your system. At best, it can cause drowsiness and dizzyness when mixed with alcohol, and at the far end can lead to serious side effects, including coma or sudden death. It may also increase the risk of serotonin syndrome and Long QT syndrome, particularly for older adults. Engaging in binge drinking can worsen these risks.
Alcohol and Escitalopram
Lexapro is an SSRI drug commonly prescribed to treat depression which affects the brain by blocking serotonin reuptake. While clinical trials haven’t shown if Lexapro increases alcohol-related impairment, mixing Lexapro with alcohol can worsen depression, increase anxiety, and lead to even more severe side effects, such as liver problems, insomnia, and dry mouth. The risk of alcohol is greater if you take the maximum dosage for depression of 20 mg, and Lexapro can also increase the risk of suicide. While not all people who take Lexapro will have side effects from drinking, most people should not drink alcohol during treatment, as it can interfere with the drug’s effectiveness and is associated with higher risks.
Alcohol and Fluoxetine (Prozac)
For individuals taking Prozac, it is generally recommended to consider avoiding alcohol due to the potential worsened side effects. While there is no specific prohibition against drinking while on Prozac, it can lead to intensified symptoms and make one feel mentally, emotionally, and sometimes physically worse. Skipping Prozac to drink is not necessary, as the medication remains active in the body for weeks. When considering drinking while on Prozac, it is crucial to consult with a healthcare provider to discuss any concerns and potential risks. Alcohol can exacerbate symptoms of depression and anxiety, even without taking an antidepressant. Mixing Prozac and alcohol can result in intensified side effects and gastrointestinal issues. It is highly unlikely to die as a direct result of mixing Prozac and alcohol, but discussing options and potential side effects with a provider is essential. If deciding to drink after discontinuing Prozac, it is advisable to wait at least two weeks and assess symptom management. It is also crucial to consider the effects of switching medications and any potential hazards of mixing the new medication with alcohol. When reintroducing alcohol to the system, it is important to do so slowly and be aware of lowered tolerance.
Seek Advice If Unsure
While the interaction between alcohol and antidepressants is a complex issue, it is generally advised to exercise caution when consuming alcohol while on medication. SSRIs, the most commonly prescribed class of antidepressants, have a lower risk of interactions with alcohol compared to other classes of medication. However, it is still crucial to follow the recommended guidelines for alcohol consumption and consult with your healthcare provider. Prioritizing your mental health and making informed decisions about your treatment plan are key to achieving positive outcomes.
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