Can You Drink On Lithium?

After reading the pamphlet with the paragraphs of tiny text that the pharmacist handed you with your lithium prescription, you may still be scratching your head. While the warnings do advise against drinking alcohol, they’re not exactly clear. Can you still drink alcohol while taking lithium?

Let’s take a closer look at the interactions between alcohol and lithium.

What Is Lithium Used For?

Lithium compounds such as lithium carbonate and lithium citrate are approved by the Federal Drug Administration (FDA) as prescription medications to treat bipolar disorder and other mood disorders. They act as mood stabilizers, which can help regulate changes between high mood (mania) and low mood (depression).

While most commonly used to treat bipolar disorder, lithium also hasbeen used off-label for neutropenia, depression, vascular headaches, Huntington’s disease, and more. 

Despite its various uses, all forms of lithium are known for their delayed initial onset. According to the National Health Service (NHS), lithium can take anywhere from a week to months to take effect when it is taken initially.  

How Long Does Lithium Stay in Your System?

Once lithium takes effect, its half-life ranges from 18-36 hours, implying that a single dose can stay in our system for up to 72 hours. However, we don’t see the peak effects of lithium until about five hours after ingestion, depending on the form and dosage. To maintain consistent efficacy throughout the day, doctors prescribe lithium to be taken at regular intervals. 

This means that our first dose will still be lingering in our system when it’s time to take the second dose, which is why it’s difficult to pinpoint exactly how long it takes our body to eliminate lithium. It may take a week or more to be eliminated. So, is it okay to drink after a week of not taking lithium?

Before we’re able to determine if we can drink during and after taking lithium, let’s first understand how alcohol can interfere with our mood, which lithium is commonly prescribed to help regulate.

Alcohol’s Effects on Your Mood

Alcohol affects our mood through chemical messengers in our brain known as neurotransmitters. Serotonin and dopamine are two of the main neurotransmitters that affect our mood. 

• Serotonin. Known as the “feel-good” hormone, serotonin can promote happiness and pleasure. When we drink, alcohol increases the release of serotonin, which can temporarily boost our mood. 
• Dopamine. As part of the brain’s “reward system,” dopamine increases our feelings of pleasure. Like serotonin, alcohol increases dopamine release and signals to our brain that it makes us feel good — and we should keep coming back for more. 

After drinking, as our body metabolizes and eliminates alcohol, our serotonin and dopamine levels dip, causing more drastic fluctuations in our mood. 

Over time, excessive and prolonged drinking can lead to permanent changes in our brain chemistry. Our brain will produce less serotonin and dopamine, which can prolong periods of low mood. Long-term alcohol use is also connected to impairments in our hypothalamic-pituitary-adrenal (HPA) axis, which can decrease our stress tolerance — increasing the risk of more drastic fluctuations in our mood. 

These changes in our brain chemistry explain why long-term drinking is associated with mental health conditions such as anxiety, depression, and more. Alcohol and lithium both impact our mood, but how do they interact with each other?

Interactions Between Alcohol and Lithium

Alcohol interacts with many drugs, including lithium. To determine if we can drink alcohol while taking lithium, let’s better understand the direct interactions between the two.

• Neurotransmitters. When we drink, alcohol stimulates an initial increase in the amino acid GABA but depletes levels of GABA over time. Lithium, on the other hand, helps to stabilize our mood by increasing GABA production and decreasing excitatory neurotransmitters such as dopamine and glutamate. In other words, if lithium is a magnet between high and low moods bringing them closer together, alcohol is the opposite — pushing them farther apart.
• Brain structures. Lithium and alcohol both impact our brain structures. Although the exact mechanisms of lithium’s effects are uncertain, research suggests that it preserves and increases the volume of brain structures that are involved in helping regulate our emotions — the prefrontal cortex, hippocampus, and amygdala. Conversely, alcohol has been found to decrease brain volume in the same areas.
• Oxidative stress. Often detected in patients with mania or depression, this condition is an imbalance of free radicals (toxins) and antioxidants. While lithium reduces oxidative stress, alcohol counteracts it by reducing antioxidants. 

• Drug interactions. Lithium has direct interactions with other drugs, including diuretics. Alcohol is a diuretic, meaning that it promotes excess water loss. This can severely impact the level of lithium found in our blood — leading to a dangerous condition (which we’ll get into in more detail later).

Alcohol and lithium interact in many different ways, so is it still okay to drink?

Can You Drink Alcohol on Lithium?

Drinking alcohol while taking lithium can be extremely dangerous. This is largely because lithium has a narrow therapeutic index, meaning there’s a small window between an effective dose and a toxic dose of lithium. Even subtle changes in fluid levels caused by drinking alcohol can lead to lithium toxicity — a life-threatening condition. 

A study reviewing patients who were admitted to a psychiatric hospital found that 6.8% of patients being administered lithium had toxic levels of lithium at some point during their treatment. This is without any alcohol and in a highly controlled hospital setting. Adding alcohol into the equation (even one drink) can greatly increase the risk of lithium toxicity or other adverse effects.

But what if it’s just one drink? Since alcohol affects each of us differently, it’s difficult to determine a safe amount of alcohol that can be consumed without experiencing any negative effects. It’s best to avoid drinking altogether. Let’s take a closer look at the associated risks.

Risks of Drinking on Lithium

When alcohol interacts with lithium, our body can experience varying adverse effects. There are four direct consequences of drinking while taking lithium.

• Decreased effectiveness. Since alcohol and lithium both act on the central nervous system, alcohol can counteract the effects of the medication. 
• Exacerbated side effects. Alcohol and lithium interact and can cause serious side effects such as intense dizziness and drowsiness.
• Increased mood disruptions. Not only can drinking alcohol decrease the effectiveness of lithium medication, but it can also cause further mood disruptions. 
• Lithium toxicity. Due to lithium’s narrow therapeutic index, toxicity is common. Mild to moderate toxicity may cause symptoms, such as muscle weakness, GI issues, tremors, drowsiness, twitching, and more. Severe symptoms include confusion, agitation, blurred vision, ringing in the ears, low blood pressure, excessive urination, and more.

While taking lithium, alcohol can lead to many complications, but what about after discontinuing the medication?

Can You Drink Alcohol After Taking Lithium?

The dangers of drinking after discontinuing lithium are less clear than while taking the medication. However, due to alcohol’s negative effects on our mood, it’s not advisable to drink even after discontinuing lithium. 

If we choose to drink, it’s best to first consult with a physician. After discontinuing lithium, it may take some time before it’s completely eliminated from our system — making us susceptible to lithium toxicity. Depending on individual circumstances, other medications may also be prescribed — opening the door to other drug interactions. Drinking after taking lithium and while on the medication is not recommended, so how should we go about it? 

Approaching Lithium and Alcohol Consumption

Lithium and alcohol go together like oil and water. However, with alcohol being such a large aspect of our social culture, we may be faced with the choice of whether or not we should drink when taking lithium. If the situation does arise, there are ways we can prioritize our health and safety.

• Find alternatives. Other activities such as physical movement, social outings, and hobbies can be healthy distractions that can boost our mood and keep us away from drinking. Plenty of alcohol-free drink options are available to help us join in on enjoying a beverage, without harmful effects to our health and mental well-being.

• Track symptoms. If we choose to drink while taking lithium or after, we can closely monitor our side effects and consult with a doctor regarding personal recommendations.
• Seek medical attention. Lithium toxicity and other severe side effects can be life-threatening. If experiencing any serious side effects, call 911 for emergency medical attention.
• Seek co-treatment. If we are concerned about our alcohol consumption and have other co-occurring conditions, we may benefit from co-treatment models that can help us navigate multiple concerns.

By following these tips, we can navigate lithium and alcohol consumption safely.

Beyond the Warning Label

Warning labels on lithium medication may not be entirely clear on whether or not drinking is okay while taking these medications. However, a closer look at the interaction between lithium and alcohol reveals that drinking while taking lithium can lead to serious adverse effects — even in minimal amounts. Fortunately, healthy alternatives and support when needed can help us approach lithium and alcohol safely.