Alcohol and antidepressants are two widely used substances in the United States. Both are legal substances that are relatively affordable and easy to obtain.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) shares that, in 2015, more than 86 percent of people reported having used alcohol at some point during their life. Nearly 27 percent of this group reported binge drinking or heavy alcohol use in the past month, with more than 6 percent of people meeting the criteria for an alcohol use disorder. NIAAA’s findings reflect the widespread pattern of alcohol use across the U.S.
Likewise, antidepressants are one of the three most commonly used therapeutic medications in the United States, reports the U.S. Centers for Disease Control and Prevention (CDC). From 2011 to 2014, about one in eight people over age 12 reported taking antidepressants in the past month.
The rate of antidepressant use had increased significantly, rising by almost 65 percent over the previous 15 years.
Alcohol and Antidepressants Together?
Although both substances are legal and can be used safely in moderation on their own, it is not recommended to use them both at the same time. Several risks arise when alcohol and antidepressants are mixed that can produce unforeseen consequences for users.
Potential side effects of mixing alcohol with antidepressants include:
- Worsening of symptoms of depression
- Worsening of side effects of your medication
- Impaired judgment, coordination, and reaction time
- Excessive sedation and drowsiness
- Increased risks of alcohol abuse
- Trouble sleeping
The above list of symptoms is a collection of general symptoms that may be experienced if an antidepressant is mixed with alcohol. There are five main types of antidepressants, however, that can be expected to cause a range of side effects. Each class of antidepressants works slightly differently in your system and thus will pose slightly different risks when mixed with alcohol.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIS)
SNRIs are one of the most commonly prescribed types of antidepressants. They are used to treat symptoms of major depression, mood disorders, and occasionally attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, menopause, fibromyalgia, and neuropathic pain. SNRIs work by increasing levels of serotonin and norepinephrine in the brain, which help to stabilize mood.
Common SNRIs include:
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Pristiq (desvenlafaxine)
SNRIs are not known to have any serious adverse interactions when combined with alcohol, though general symptoms of drowsiness and reduced alertness are likely.
Selective Serotonin Reuptake Inhibitors (SSRIS)
SSRIs are the most commonly prescribed antidepressant, as they are highly effective at treating depression and typically cause fewer adverse side effects than some of the other types of antidepressants. SSRIs work by blocking the absorption of serotonin in the brain, which allows messages to be more freely sent and received throughout the brain. The intended result is a better and more stable mood.
Common SSRIs include:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
In comparison to the other types of antidepressants, SSRIs don’t typically cause as many negative side effects when taken with alcohol. Consuming alcohol while also on SSRIs is still not advised, however, since alcohol can cause excessive drowsiness for someone on this type of antidepressant.
Tricyclic Antidepressants (TCAS)
TCAs are an additional form of antidepressant that can be prescribed for the treatment of depression, fibromyalgia, some types of anxiety, and chronic pain. TCAs work by increasing levels of norepinephrine and serotonin in the brain while blocking acetylcholine. Scientists believe this interaction helps to restore proper balance in the brain and can help to alleviate symptoms of depression.
Common TCAs include:
- Elavil (amitriptyline)
- Anafranil (amoxapine-clomipramine)
- Norpramin (desipramine)
- Sinequan (doxepin)
- Vivactil (protriptyline)
When used in combination with alcohol, TCAs become relatively ineffective at reducing symptoms of depression. Additionally, alcohol can increase the sedative effects of TCAs.
Monoamine Oxidase Inhibitors (MAOIS)
MAOIs were one of the most commonly prescribed antidepressants before SSRIs and SNRIs were introduced to the market, and they offered fewer side effects. MAOIs work by restricting the action of monoamine oxidase, which is responsible for breaking down neurotransmitters like serotonin. As a result, more serotonin is available in the brain to stabilize mood.
Common MAOIs include:
- Nardil (phenelzine)
- Parnate (tranylcypromine)
- Marplan (isocarboxazid)
- Eldepryl (selegiline)
MAOIs are no longer the first line of antidepressant use because they are known to interact poorly with certain foods and medications, including alcohol, in ways that can produce dangerously high blood pressure.
Noradrenaline and Specific Serotonergic Antidepressants (NASSAS)
NASSAs can be prescribed for the treatment of anxiety disorders and personality disorders as well as depression. They work by blocking negative feedback of norepinephrine and serotonin and thus increasing the amount of these mood-stabilizing neurotransmitters in the brain.
Common NASSAs include:
- Tolvon (mianserin)
- Remeron, Avanza, and Zispin (mirtazapine)
NASSAs are also unlikely to cause serious threats to your health when combined with alcohol, though drowsiness, sedation, and an increase of symptoms of depression are concerns.
What Are the Worst Antidepressants to Mix with Alcohol?
Several different types of antidepressants and medications are used to treat depression and other mental health issues. In fact, there are different types of depression, and each one may have a different profile of first-line medications that are used. Antidepressants are usually associated with SSRIs and SNRIs, but there are other kinds as well.
For instance, when first-line drugs like SSRIs are ineffective, drugs like bupropion (Wellbutrin) are used. Bupropion may be among the worst antidepressants to mix with alcohol. The drug is known to lower your seizure threshold, which means people with conditions that make them vulnerable to seizures may be at greater risk when taking bupropion. Alcohol doesn’t usually cause seizures unless you drink heavily and quit drinking suddenly. Alcohol withdrawal is associated with seizures and other dangerous side effects. If you drink regularly and cut back or quit while on bupropion, you may be more likely to have a seizure.
As previously mentioned, MAOIs (monoamine oxidase inhibitors) are another group of antidepressants that can be dangerous when mixed with alcohol. They are known as a particularly strong class of antidepressant medications, and they may not be used if other options are available and effective. Certain alcoholic beverages contain a chemical called tyramine, which can be deadly when mixed with MAOIs. When combined, they can cause your blood pressure to rise sharply, which raises the risk of a stroke or heart attack.
Benzodiazepines are a group of drugs used to treat anxiety. If you have anxiety-related depression, you may be treated with a benzodiazepine if your mental health symptoms don’t respond to first-line medications. While benzodiazepines are not typically grouped with antidepressants, they are used to treat mental health and can be deadly when mixed with benzodiazepines.
They work in the brain in a way that’s very similar to alcohol. When the substances are taken at the same time, they can cause potentiation, which is when symptoms become more intense. At relatively moderate doses of each, you could experience overdose symptoms, including respiratory depression and death.
Can You Drink While on Antidepressants?
Antidepressants are common prescription drugs, and they are often used safely without significant side effects. So is it ever safe to mix antidepressants and alcohol? Are there alcohol-safe antidepressants? Your physician may consider your health and prescription and allow low-to-moderate drinking on occasion. However, you should not drink alcohol after taking an antidepressant without first consulting your doctor. It’s important to discuss how alcohol may interact with your medications and how you can moderate it effectively. Each person is different, and each medication is different.
Your doctor can also help you determine what safe alcohol moderation looks like for you. Since alcohol affects people differently based on age, sex, and weight, it can be helpful to speak to your doctor when deciding how much is safe to drink.
It’s important that your doctor can assess your case before you start drinking while taking a prescription. It may also be important to periodically check your overall health if you’re taking prescription medication long-term, especially if you drink alcohol. In particular, you may need to check your liver and kidney health every so often. The same is true for many prescriptions, even rounds of certain antibiotics.
Is There a Safe Amount?
In general, mixing alcohol with antidepressants or any other drug is never recommended. Alcohol is known to interact with antidepressants in ways that can produce unsafe side effects. Increased blood pressure and excessive sedation are just two reasons why it is best to refrain from alcohol use while taking antidepressants.
Some antidepressants, such as SSRIs and TCAs, may be safe to mix with a small amount of alcohol, though it does put you at risk for some side effects. Consuming any amount of alcohol is strongly discouraged if you are taking MAOIs, however, because of the risk of serious health consequences.
In addition to causing unwanted side effects, alcohol runs the risk of making your antidepressant ineffective, which could make your depression worse.
Alcohol is a depressant substance that causes your body and mind to feel relaxed when taken in small amounts. When misused, however, alcohol can cause feelings of depression. Consuming alcohol while on antidepressants may counteract the benefits of the medication that you have worked so hard to achieve.
Some doctors recognize that many of their patients will not want to give up alcohol entirely while on antidepressants, especially since many people take antidepressants for many months or years.
Most types of antidepressants are not likely to cause life-threatening side effects, so doctors may tell patients they can limit themselves to very moderate drinking, if necessary.
A drink a day for women or two drinks per day for men is unlikely to cause serious side effects when mixed with antidepressants.
It is always important, however, to have a good understanding of how you react to your antidepressant first before mixing in alcohol.
You can monitor the likelihood of experiencing symptoms of drowsiness and alertness after drinking alcohol if you already know how your antidepressant affects you.
If you must drink alcohol while taking antidepressants, do so with extreme moderation, and stay informed about the potential side effects.