Do Sertraline (Zoloft) and Alcohol Mix?

Sertraline — more commonly known as Zoloft — is often prescribed for depression, anxiety, and other mood disorders. As a selective serotonin reuptake inhibitor (SSRI), it works by increasing our levels of serotonin, a neurochemical responsible for feelings of well-being and happiness.

SSRIs are incredibly common, and sertraline is the most commonly prescribed antidepressant in the United States, with nearly 8.5 million Americans taking it daily. If you’re like 2% of Americans, you may be taking Zoloft as part of a treatment plan for depression. But have you ever wondered if it’s okay to have a drink while on Zoloft? What are the interactions between Zoloft and alcohol, if any? Let’s find out more!

Background on SSRIs

Before we dive into the nitty-gritty of Zoloft and its interactions with alcohol, let's take a brief look at the interesting history of SSRIs.

• 1960s: setting the stage. The late 
20th century was a ground breaking
era for understanding and treating mental health. Before SSRIs, the primary treatments for depression were tricyclic antidepressants and monoamine oxidase inhibitors. While these medications did offer some relief, they came with a host of unpleasant side effects and dietary restrictions, so the medical community continued to search for better options.
• 1970s: the birth of SSRIs. Picture the 1970s — disco balls, bell-bottoms, and ... the birth of SSRIs! During this decade, the first SSRI (fluoxetine — better known as Prozac) was developed. Its targeted action on serotonin — the neurotransmitter linked to mood, appetite, and sleep — meant fewer side effects compared to its predecessors. 
• 1987: Prozac takes the lead. In the late 80s, Prozac was introduced to the market, quickly taking off in popularity and revolutionizing the treatment of depression.
• 1991: Zoloft hits the scene. Following the success of Prozac, other pharmaceutical companies focused on developing their own SSRIs. Pfizer (a perennial heavy hitter in the pharma world) introduced sertraline — brand name Zoloft — in 1991. Zoloft's chemical structure is a bit different from Prozac, but it works in a similar way by increasing the serotonin available in the brain.


  
  Zoloft quickly became a popular option for treating depression and other conditions such as panic disorder, PTSD, and social anxiety disorder. Its wide range of applicability and a generally favorable side effect profile made it a go-to for many healthcare providers.
• Today and beyond. SSRIs, including Zoloft, are currently among the most prescribed antidepressants (and prescribed medications) worldwide. Scientists continue to explore even more targeted and effective treatments for mood disorders, ensuring that future generations have even better tools at their disposal.

The Science of Serotonin

Before discussing the ways Zoloft and alcohol interact, let’s take a closer look at serotonin and its functions within the body. 

• Mood regulation. Serotonin’s biggest responsibility is regulating mood. Adequate levels of serotonin are associated with feelings of well-being and happiness. Conversely, decreased levels of serotonin are linked with mood disorders, notably depression.
• Appetite. Serotonin helps regulate appetite. Eating certain foods increases serotonin levels, which in turn decreases appetite. Excessive serotonin in the gastrointestinal tract can cause nausea and vomiting — that’s why many prescription anti-nausea medications are serotonin blockers. Conversely, low serotonin levels can increase appetite.
• Sleep cycle. As a precursor to melatonin — the hormone responsible for sleep-wake cycles — serotonin plays a crucial role in sleep regulation. 
• Pain perception. Serotonin can affect how we perceive pain. Increased serotonin levels in the spinal cord can suppress pain signals.
• Digestion. Serotonin is involved in the regulation of bowel movements and function. It influences the rate at which the intestines push out waste and the overall health of the gastrointestinal tract.
• Bone health. Studies suggest that high levels of serotonin in the bones can decrease bone density, making bones weaker.
• Blood clotting. Serotonin released by platelets (a type of blood cell) plays a role in blood clotting, helping reduce blood loss from injured tissues.
• Sexual function. Serotonin can influence sexual desire and function. Elevated levels of serotonin are often associated with decreased libido, a common side effect of SSRIs.

While serotonin has these bodily effects, it doesn't work alone. It operates in conjunction with other neurotransmitters and systems that function cooperatively to regulate these functions. 

How Does Zoloft Work?

During clinical depression, serotonin levels drop, leading to a host of unpleasant symptoms such as low mood, lethargy, or decreased motivation. As a selective serotonin reuptake inhibitor (SSRI), Zoloft works by boosting serotonin levels in the brain. Here’s the mechanism behind it:

• Neurotransmission. Neurons (brain cells) communicate with each other by releasing neurotransmitters, which then bind to receptors on neighboring neurons — a process known as neurotransmission.
• Reuptake process. After a neurotransmitter (in this case, serotonin) has done its job and sent a signal to a neighboring neuron, it needs to be cleared away to ensure that neurotransmission is precise and doesn't continue indefinitely.


  
  To clear away the serotonin, the neuron that originally released it reabsorbs it — a process known as "reuptake.” Once inside the neuron, serotonin can be recycled for future use or broken down by enzymes.
• Zoloft's role. Zoloft (like other SSRIs) inhibits the reuptake process. By blocking the reabsorption of serotonin, it ensures that more of this neurotransmitter remains available for binding. With more serotonin available, neurotransmission becomes more effective, leading to mood stabilization. 
• Therapeutic effect. With continued use of Zoloft, this increased availability of serotonin helps ease the symptoms of depression and other mood disorders.

While Zoloft increases the availability of serotonin in the synaptic cleft (the space between neurons), it doesn't directly increase the brain’s production of serotonin. The goal is to optimize the effect of the serotonin already present, making neurotransmission more effective. With more of this mood-enhancing neurotransmitter available, we often feel uplifted and more balanced!

A Timeline of Effects

While everyone's experience differs slightly due to factors like dosage, individual physiology, and the specific conditions being treated, here's a general timeline of what we can anticipate when we start taking Zoloft.

• Week 1. We may experience mild (and usually temporary) side effects such as nausea, upset stomach, or diarrhea when we first start taking Zoloft. At this point, it’s too soon to see a decrease in depression or anxiety symptoms.
• Weeks 2-3. Around this time, we may begin to notice subtle shifts in mood or anxiety levels. It might be a bit easier to get out of bed or face daily tasks. Side effects might peak around this time, but they should start to subside thereafter.
• Weeks 4-6. By this point, many of us start feeling Zoloft’s therapeutic effects. Mood often improves, and anxiety should be noticeably decreased 
• Weeks 6-8. For many of us, this is the period where we truly begin to feel "better" if Zoloft is going to work. The full therapeutic effects are more pronounced by this point and side effects have diminished or disappeared.
• Moving forward. The benefits and side effects of Zoloft stabilize with continued use. At this point, Zoloft should be providing consistent relief from their symptoms.

Zoloft doesn’t work for everyone; about half of people prescribed Zoloft get relief, and about a quarter of people find that the side effects are intolerable. If Zoloft were the only answer, there wouldn’t be so many different SSRIs! There are many other options to explore if Zoloft doesn’t get the job done, including other SSRIs, other types of antidepressants, or a combination therapy.

Zoloft can make a huge difference for many of us — but it doesn’t exist in a vacuum. Our doctor will likely recommend lifestyle changes (such as nutritious diet, time outside, regular exercise, proper sleep) and potentially some form of psychotherapy. 

Side Effects of Zoloft

Like all medications, sertraline carries the possibility of side effects. Although everyone's experience can vary, we are likely to experience at least one of these side effects for some period of time (most likely in the beginning or when increasing the dose). These are some of the most common side effects:

• Nausea or upset stomach
• Diarrhea
• Dry mouth
• Dizziness
• Sweating
• Weight changes
• Mood swings
• Insomnia
• Decreased libido
• Sexual dysfunction
• Rarely, worsened symptoms

Side effects don't mean we’ve hit a dead end, however. They're simply a sign to consult with a healthcare provider to potentially tweak our wellness plan.

A Special Note

A rare but notable potential side effect of Zoloft is worsened depression or anxiety, particularly for preteens, teenagers, and young adults. In rare cases, Zoloft can increase thoughts of suicide, especially in these groups of young people. Even more rarely, it can happen in adults. Regardless of age, it’s important to regularly check in with doctors and be on the lookout for this reaction.

If you are experiencing thoughts of suicide, please seek medical attention. In the United States, you can call the national mental crisis hotline by dialing 988. Click here for a list of mental crisis phone numbers by country.

Alcohol and Serotonin

Alcohol is a central nervous system depressant that interacts with several neurotransmitters in the brain, including GABA, glutamate, dopamine, and — yes — serotonin.

• The initial mood boost. When we start drinking, alcohol can actually increase serotonin levels in the brain. It also increases levels of GABA, a calming neurotransmitter, and dopamine, which is responsible for pleasure. Meanwhile, alcohol diminishes the function of glutamate, which is responsible for stimulation. The result? Things start to slow down and we start to feel good.
• The downward spiral. The initial mood-boosting feelings are short-lived. Neurotransmitter levels quickly swing in the opposite direction, which is why we tend to feel anxious, low, or agitated after we sober up. Chronic alcohol consumption and binge drinking both reduce serotonin levels over time and interfere with the enzymes needed to produce it. 
• Mood implications. Given serotonin's pivotal role in mood regulation, it's no surprise that its reduction can have emotional consequences. Decreased serotonin is linked to sadness, lethargy, and depression. Even though alcohol might provide a temporary lift in mood, its long-term use can be counterproductive, potentially leading to mood disorders or exacerbating existing ones.
• Impaired decision making. Serotonin also plays a role in impulse control and decision-making. With decreased serotonin levels, we might find ourselves making impulsive decisions or struggling with self-control.

Zoloft and Alcohol Interaction

A drug that increases serotonin and a drink that decreases it … it’s clear where the friction lies. Let’s look at three outcomes we could be facing if we mix alcohol and Zoloft.

Counteracting Effects

When two strong forces meet, there's bound to be some push and pull, and that's precisely what happens when Zoloft and alcohol cross paths. While Zoloft is working to lift serotonin levels, alcohol is doing the opposite. While this tug-of-war can resolve within a few days after drinking, chronic and regular alcohol use ensures our medication will be less effective and our symptoms will continue (or get worse). 

Moreover, one critical factor for the effectiveness of medications like Zoloft is maintaining steady levels in the bloodstream. Alcohol can disrupt this stability in several ways, leading to fluctuating medication levels and, subsequently, fluctuating moods. This inconsistency can be a challenge if we want to achieve a steady emotional well-being (who doesn’t!).

Cognitive Functioning 

Combining Zoloft and alcohol amplifies the sedative effects of both, impairing cognitive functioning. This might show up as slowed thinking, difficulty concentrating, or challenges in processing information. Two major effects stand out, however:

• Poor memory. Alcohol causes memory lapses or blackouts. When mixed with Zoloft, these memory issues might become more pronounced. It's not uncommon for us to forget conversations or events that occurred while under the influence of both.
• Impaired decision making. Both alcohol and Zoloft can influence the brain regions responsible for judgment and decision making. When taken together, we’re more likely to make impulsive or poor choices, potentially leading to risky behaviors such as driving under the influence or making snap judgments without considering the consequences.

Side Effects Amplified

Both alcohol and Zoloft come with their own set of side effects. If we combine them, we may see a rise in the following: 

• Drowsiness. Zoloft and alcohol each can cause drowsiness on their own. When combined, this effect can be amplified, leading to heavy drowsiness or lethargy.
• Dizziness and disorientation. Dizziness is another side effect of both substances. Combining the two can intensify this sensation, making walking, standing up quickly, or just moving around more challenging, and increasing the risk of falls and injuries, especially in older adults.
• Nausea. For some, Zoloft can cause mild nausea. Throw alcohol into the equation, and this nausea can become more pronounced or prolonged.
• Impaired coordination. Both alcohol and Zoloft can affect coordination and reflexes. When taken together, the impairment can be even more pronounced, increasing the risk of accidents. Activities that require precision and alertness — such as driving or operating machinery — can become particularly risky.
• Intensified dehydration. We may experience dry mouth with Zoloft. As a diuretic, alcohol makes us dehydrated. The combination can leave us feeling particularly parched, with increased thirst and dry mouth.

Mood Roller Coasters

While Zoloft is intended to stabilize mood, alcohol can be a mood disruptor. In the presence of alcohol, some of the calming or mood-stabilizing effects of Zoloft can be overshadowed, leading to unpredictable mood swings or heightened emotional responses.

• The initial high. When we first consume alcohol, we experience an initial mood boost. This initial euphoria or relaxation is due to alcohol’s effect on various neurotransmitters, including a temporary boost in serotonin.
• Zoloft’s stabilizing traits. Zoloft is designed to stabilize emotional extremes. By increasing the availability of serotonin in the brain, it aims to provide a smoother, more balanced emotional journey. It helps to ward off the sudden drops or unexpected loops that can be associated with mood disorders.
• Alcohol's twists and turns. Alcohol, especially when consumed in larger amounts or over extended periods, can bring about unexpected mood changes. After its initial boost, alcohol can reduce serotonin levels, leading to sadness, irritability, or hopelessness. 
• The combination. As our body processes alcohol and Zoloft at the same time, we may experience a mood rollercoaster as our blood levels of each substance fluctuates. While Zoloft strives to keep the mood smooth and steady, alcohol can introduce sudden dives and loops, leading to amplified emotions responses and unpredictable swings.
• The descent and after-effects. The aftermath of mixing Zoloft and alcohol is often intensified fatigue, lethargy, or “hangxiety.” This can mean waking up the next day feeling emotionally drained or down.

The Verdict

So, can you drink on Zoloft? While an occasional drink might not lead to serious complications for everyone, it's best to approach the combination of Zoloft and alcohol with caution. Everyone’s body reacts differently, and what might be okay for one person might be harmful to another. It’s always best to consult with your doctor and be honest about your drinking habits. We may fear judgment if we tell the truth about our drinking, but it’s important our doctor has all the information they need to make the best recommendations for our treatment.

Taking Action: Steps to Safer Choices

Armed with this knowledge, we are now empowered to make informed decisions about our health and well-being. Here are seven action steps to consider when it comes to mixing Zoloft with alcohol:

• Stay informed. Always read the medication guidelines and potential interactions. When in doubt, consult your healthcare provider.
• Plan ahead. If you’re heading out, decide beforehand how much you’ll drink. Maybe order that mocktail you've had your eye on!
• Buddy up. If you’re comfortable, let a trusted friend know about your medication and your decision about how much you’re going to drink (if at all). They can support your choice and hold you accountable.
• Alcohol-free days. Schedule days in your week when you consciously choose to not drink. It’s a good way to break the habit and prioritize your mental health.
• Explore alternatives. The rise of the sober-curious movement has resulted in a boom of non-alcoholic beverages that are just as exciting as their boozy counterparts. Dive into the world of botanical sodas, craft mocktails, non-alcoholic beers, and more!
• Track your symptoms. Record how you feel after nights you do drink versus nights you don't. Observing patterns might provide extra motivation to cut back or quit.

• Seek support. Whether support comes from friends, family, or support groups, remember you’re not alone in this journey. (The forum on the Reframe app has hundreds of thousands of people on the same journey to improve their well-being!)

Next Steps in Your Journey

The intersection of Zoloft and alcohol is not just a simple crossroad — it’s a bustling junction. Unfortunately, there are no rules of the road when it comes to navigating mental health and well-being. One thing is very clear: there are many options for help.

Remember, every step towards understanding is a stride towards a brighter, healthier tomorrow. With deep knowledge and a commitment to self-care, we can create a future of balance, joy, and well-being.