Alcohol and Antidepressants: A Dangerous Combo

Are people more depressed now than ever? It’s a question worth considering, given that prescriptions for antidepressants have skyrocketed over the years, particularly over the course of the COVID-19 pandemic. But even before the emergence of COVID, 1 in 8 American adults was taking an antidepressant drug. According to one estimate, that number rose by 18.6% during 2020. 

As with any other medication, there are important things to know about antidepressants, such as any side effects and things to look out for. It’s especially important to understand the effect of alcohol on antidepressants. Consuming alcohol while taking antidepressants can not only increase our risk of experiencing side effects, but it may also make our depression worse. 

Understanding How Antidepressants Work

Antidepressants work by increasing the levels of certain naturally-occuring chemicals known as neurotransmitters in our brain and body. These chemicals carry signals between nerve cells in our brain and play a significant role in our thoughts, feelings, and mood.

The most common class of antidepressants is referred to as selective serotonin receptor inhibitors (SSRIs). SSRIs work by increasing our brain’s level of serotonin, a neurotransmitter that helps regulate mood, emotion, and sleep.

After carrying a message between nerve cells, serotonin is usually reabsorbed by the nerve cells, a process known as “reuptake.” SSRIs work by blocking (“inhibiting”) reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells. 

There are many different types of SSRIs, but Zoloft (generic name: sertraline) is one of the most popular antidepressants prescribed. In fact, it’s now the 12th most commonly prescribed medication in the United States.

How Alcohol and Antidepressants Mix

Drinking alcohol affects many parts of our body, including our central nervous system, or CNS, made up of our brain and spinal cord. This affects how our brain processes information and leads to drowsiness, slurred speech, and the overall feeling of being drunk.

SSRIs — including Zoloft, Prozac, Lexapro, Celexa, and Paxil — also affect the CNS by boosting levels of serotonin. Because alcohol and SSRIs both affect the CNS, drinking alcohol with this type of antidepressant can worsen the medication’s side effects.

Some of the most common side effects from antidepressants include drowsiness, dizziness, nausea, vomiting, diarrhea, or sexual side effects, such as decreased libido. Many of these side effects are similar to the effects of alcohol, so whenever we drink alcohol on antidepressants, the effects may become more severe. Combining alcohol and antidepressants can also cause our thinking, judgment, coordination, and reaction time to be more impaired than they typically would be from alcohol alone. 

Another antidepressant, monoamine oxidase inhibitors (MAOIs) — including Azilect, Eldepryl, Zelapar, and Marplan — is one of the most dangerous kinds of antidepressants to mix alcohol with. Tyramines, chemicals in drinks like beer, wine, and sherry, can cause dangerous spikes in blood pressure that may require immediate medical attention.

Similarly, drinking alcohol while taking serotonin and norepinephrine reuptake inhibitors (SNRIs), another type of antidepressant, can lead to liver damage. And tricyclic antidepressants (TCAs), such as Elavil, Anafranil, and Norpramin, can cause increased intoxication effects when mixed with alcohol. Another class of antidepressants, called atypical antidepressants, can increase our risk of seizure when mixed with alcohol. Wellbutrin, which has become a more commonly prescribed antidepressant, falls into this category.

Alcohol and Antidepressants Can Worsen Depression

In addition to interfering with antidepressants, alcohol can also potentially worsen symptoms of depression. Alcohol acts as a hypnotic-sedative, depressing crucial bodily functions when taken in excess. It’s also a depressant, altering the balance of chemicals in our brain that can make us feel depressed. If we drink alcohol while taking antidepressants, we’re essentially making it harder for the medication to work effectively. 

One major danger with all SSRIs is the potential for suicidal thoughts, particularly in people under 25 years old. This risk is typically highest shortly after starting or changing the dose of SSRIs, such as Zoloft. Since drinking impairs our judgment, this can be a particularly dangerous situation for someone already having suicidal thoughts. 

In general, alcohol may seem to improve our mood in the short-term, but its overall effect can increase symptoms of depression and anxiety in the long run.

Is Any Amount of Alcohol Safe With Antidepressants? 

As we’ve learned, alcohol can have different effects on different types of antidepressants. For this reason, some healthcare providers say that it’s okay to drink a small amount of alcohol while taking certain antidepressants, specifically SSRIs, if they have a low risk of alcohol abuse. This typically means one serving of alcohol per day.

However, people taking MAOIs are advised to avoid alcohol altogether, since it is a potentially lethal combination. In general, however, experts agree that it can be dangerous to drink any amount of alcohol with any type of antidepressant. 

Furthermore, while some people might be tempted to skip a dose of an antidepressant in order to drink alcohol, doing so can be harmful. Missing doses of antidepressants can cause a variety of symptoms: muscle aches and tiredness, headaches, dizziness, anxiety, irritability, nausea and vomiting. Furthermore, antidepressants take at least several days to be eliminated from our body, so not taking medication for just 1 or 2 days doesn’t make drinking alcohol any safer.

Sadly, the link between depression and alcohol misuse is strong. In fact, one study found that nearly 65% of people who were dependent upon alcohol were also depressed, suggesting that the two conditions go hand-in-hand for many of us. A review of multiple studies also found that alcohol misuse disorders were prevalent among people with major depressive disorder. Tragically, alcohol misuse plays a major role in suicide attempts.

The Bottom Line

Mixing alcohol with antidepressants can be unsafe because it can lead to excessive or dangerous side effects, in addition to worsening symptoms of depression. If we’re taking antidepressants and having trouble limiting our alcohol consumption, we should seek immediate help from a medical professional. Reframe can also help you cut back on your alcohol consumption, equipping you with the knowledge and tools you need to enhance your physical and mental well-being.