The Risks of Mixing Alcohol and Antidepressants (And Their Causes)

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When you take an antidepressant, you may wonder why the medication carries a warning against consuming alcohol. Many antidepressants have serious potential interactions with alcohol. You do not have to take the antidepressant at the same time you drink alcohol to experience these risks. Interactions from mixing alcohol and antidepressants can occur even if you, for example, take the medication once daily in the morning and then use alcohol in the evening.¹

In this article:

• Alcohol and Antidepressants Interactions
• Side Effects of Antidepressants
• Short-Term Effects of Mixing Alcohol and Antidepressants
• Long-Term Effects of Mixing Alcohol and Antidepressants
• Managing Alcohol Use and Depression

Alcohol and Antidepressants Interactions

An interaction means that when two or more substances are present in your body: ²

• One or more of the drugs isn’t as effective due to the presence of the other(s)
• Unexpected side effects occur
• An overdose of a chemical occurs in the body

Alcohol-medication interactions have two different types. The first is that alcohol can enhance the effects of the medication. Specifically, alcohol increases the sedative effects of certain types of antidepressants.³

The second type of interaction is alcohol affecting the way the body metabolizes or processes the medication. Like alcohol, some antidepressants are metabolized by the liver. The antidepressant has to compete with the alcohol to be metabolized. This can lead to increased levels of the antidepressant in the blood, leading to heart rhythm disturbances and convulsions.³

Side Effects of Antidepressants

Antidepressants come with potential side effects even when used as prescribed and without alcohol. These side effects can include:⁵

• Headache
• Nausea
• Sleep problems
• Restlessness
• Sexual problems

These side effects usually last for a short period. Inform your doctor of any side effects that you experience, including these or any others.

Note that for psychotropic drugs such as antidepressant medications, it can take up to three to four weeks to experience the full benefits of the medication or for side effects to appear.

Alcohol and antidepressants side effects can exist with any antidepressants, including reuptake inhibitors, which are the most common types of antidepressants prescribed. Reuptake inhibitors work by controlling your brain’s ability to reabsorb certain neurotransmitters that regulate mood. When the reabsorption rate is slowed, or inhibited, the chemical balance required for you to feel emotions such as contentment, pleasure, and happiness may be restored.  Types of reuptake inhibitors include:⁴

• Selective serotonin reuptake inhibitors (SSRIs)—SSRIs are the most common class of antidepressants. SSRIs prevent the reabsorption of serotonin in the brain. Serotonin is linked to feelings of wellbeing and happiness, as well as sleep, eating, and digestion regulation. SSRIs include aripriprazone (Abilify), escitalopram (Lexapro), and fluoxetine (Prozac).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)—SNRIs are, on the whole, a newer drug class than SSRIs and block the reuptake of norepinephrine in addition to serotonin. Norepinephrine works with adrenaline in the body to regulate alertness, concentration, reaction times, and energy levels. SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
• Norepinephrine and dopamine reuptake inhibitors (NDRIs)—The NDRI drug class includes only one drug: bupropion (Wellbutrin). Bupropion prevents the reuptake of norepinephrine and dopamine rather than serotonin. On an emotional level, dopamine interacts heavily with the pleasure and reward centers of the brain. Dopamine also supports executive motor functions, including memory and physical movement.

Antidepressants you may be prescribed also include several other drug classes: ⁴

• Serotonin antagonist and reuptake inhibitor (SARIs)—Unlike SSRIs, SARIs work by both preventing serotonin reuptake and by redirecting serotonin to prevent it from binding to certain receptors. SARIs include nefazodone (Serzone) and trazadone (Desyrel).
• Tetracyclics—Rather than preventing neurotransmitter reuptake, tetracyclics prevent specific neurotransmitters from binding with chemical receptors in order to raise the level of those neurotransmitters and improve mood. Tetracyclics include mirtazapine (Remeron) and as amoxapine (Asendin).
• Tricyclic antidepressants (TCAs)—This older class of antidepressants blocks the reabsorption of serotonin and epinephrine, like reuptake inhibitors. Epinephrine—or adrenaline—regulates instinctual emotions like anger and fear and stimulates changes in blood pressure, heart rate, metabolism, and so on. However, TCAs have higher risks of cardiac issues for certain demographics so they are only prescribed under certain circumstances. TCAs include amitriptyline (Elavil) and desipramine (Norpramin).
• Monoamine oxidase inhibitors (MAOIs)—MOAIs block the effect of the monoamine oxidase enzyme, an enzyme that breaks down serotonin, epinephrine, and dopamine. MOAIs have the most interaction with other medications, as some other medications are also metabolized by this enzyme. These medication interactions include problems processing stimulants and certain cold and flu medicines. When used with other medications that raise serotonin, MOAIs also present a risk of excessive serotonin buildup. MOAIs include phenelzine (Nardil) and tranylcypromine (Parmate).

Note that this is not an exhaustive list of all antidepressant medications; talk with your doctor about any antidepressant you take.

Short-Term Effects of Mixing Alcohol and Antidepressants

Possible short-term effects of mixing alcohol with antidepressants include:¹

• Drowsiness
• Dizziness
• Increased depression or developing feelings of hopelessness
• Cardiovascular problems
• Increased risk of overdose

One example of potential overdose when mixing alcohol and antidepressants is serotonin toxicity, which can be life-threatening. Serotonin affects various processes such as mood, anger, appetite, memory, and sexuality. SSRIs, SNRIs, SARIs, TCAs, and MAOIs regulate serotonin in the body to improve mood.⁶

Symptoms of serotonin toxicity can include:⁶

• Agitation
• Disorientation
• Muscle jerks or spasms
• Tremors
• Rapid heartbeat
• Excessive sweating
• High blood pressure

If you experience any of these symptoms, get medical attention immediately.

Additional short-term effects can occur when combining alcohol with specific antidepressants, including the following:¹

• Impaired motor control associated with mixing alcohol and quetiapine (Seroquel) and mirtazapine (Remeron)
• Intensified effects of alcohol with bupropion (Wellbutrin)
• Dangerously high blood pressure from combining alcohol with tranylcypromine (Parmate)

Long-Term Effects of Mixing Alcohol and Antidepressants

If you regularly mix alcohol with your antidepressant medication over a long period of time, there is a high risk that:¹

• The medication will become less effective
• Your depression symptoms will worsen

Additional long-term effects associated with specific antidepressants include:¹

• Liver damage associated with mixing alcohol and duloxetine (Cymbalta)
• Serious heart issues associated with mixing alcohol with tranylcypromine (Pamate) or phenelzine (Nardil)

Older adults are more vulnerable to harm from drinking alcohol because of physiological changes associated with age. This also leads to greater risks with combining alcohol and medications for older adults. For example, older adults have an increased risk of sedation when combining alcohol and psychotropic medications—those that affect brain function—such as antidepressants.⁶

Adolescents to who mix alcohol and antidepressants can experience a higher risk for damage to the liver, kidneys, and other organs. This risk is due to the statistically high rates of excessive and binge drinking among teenagers and young adults who use alcohol.⁷

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Managing Alcohol Use and Depression

If you take an antidepressant, you can prevent alcohol and antidepressants side effects by doing the following.

Take Your Medication Only as Prescribed

Do not make any changes to your medication regimen without consulting your doctor. It can take a few weeks before you notice the positive effects of antidepressants, therefore do not stop taking them if your depression doesn’t improve right away.⁶

Additionally, taking a dose larger than what is prescribed in an attempt to manage side effects can lead to an increased risk for serotonin toxicity.

Do Not Alter How You Take Your Medication in Order to Use Alcohol

Antidepressants need to be consistently taken to be effective.⁴ Moreover, suddenly stopping the medication can cause painful and uncomfortable symptoms, such as lack of balance or control of movements, pain, numbness, sleep changes, and digestive issues. ⁹ Suddenly ending your medication routine can also bring back your depression symptoms.⁹

These risks are why when patients are ready to discontinue their antidepressants, doctors slowly reduce the dosage of the medication over time.

Seek Treatment or Therapy for Alcohol Misuse

Even a few counseling sessions with motivational interviewing (MI) have been demonstrated to reduce heavy drinking among adults in treatment for depression.¹⁰

It is common to experience mixed feelings about reducing or stopping alcohol use. Though you may know the benefits of doing so, it might be hard to reduce or stop use out of habit, social influence, or the positive effects of using it (e.g., reducing emotional pain).

MI is a therapy technique designed to help you work through your conflicting feelings about alcohol and help you get closer to reducing your use. You can receive MI or other therapeutic treatment from a therapist or in an alcohol addiction treatment center.

Consult With Your Doctor About Your Risks

If you are struggling with depression and an alcohol use disorder (AUD), speak with your doctor to determine the best treatment option for you.

One option your doctor may offer is medication-assisted treatment for AUD. Medication for AUD can often be taken with antidepressants.¹¹ One such medication for alcohol addiction treatment is naltrexone (Vivitrol®, Revia®), which works by reducing your cravings for alcohol.¹²

As a general rule, when it comes to medication treatment, inform your doctor of:

• Any allergies to medications you have
• Any medications, including over-the-counter medicines, that you are taking
• If you are pregnant or if you plan on becoming pregnant
• Any medical or mental health concerns you have
• Any family history of medical or mental health concerns

If you are concerned about your level of alcohol use or that of a loved one, please call 800-948-8417 Who Answers? for 24/7 help.

Resources

1. National Institutes of Health. (2014). Harmful Interactions.
2. S. Food and Drug Administration. (2013). Drug Interactions: What You Should Know.
3. Weathermon, R. & Crabb, D.W. (1999). Alcohol and medication interactions. Alcohol Research & Health, 23(1), 40-64.
4. National Institute of Mental Health. (2021). Antidepressants.
5. Berger, M. Gray, J.A., & Roth, B.L. (2009). The expanded biology of serotonin. Annual Review of Medicine, 60, 355-366.
6. Suzuki, A. & Otani, K. (2019). Serotonin syndrome after an alcohol intake in a patient treated with escitalopram and clomipramine. Clinical Neuropharmacology, 42(3), 103-104.
7. Holton, A.E., Gallagher, P., Fahey, T., & Cousins, G. (2017). Concurrent use of alcohol interactive medications and alcohol in older adults: a systematic review of prevalence and associated adverse outcomes. BMC Geriatrics, 17.
8. Weitzman, E.R., Magane, K.M., Wisk, L.E., Allario, J., Harstad, E., & Levy, S. (2018). Alcohol use and alcohol-interactive medications among medically vulnerable youth. Pediatrics, 142(4).
9. Harvard Medical School. (2020). Going off antidepressants. Harvard Health Publishing.
10. Satre, D. D., Leibowitz, A., Sterling, S. A., Lu, Y., Travis, A., & Weisner, C. (2016). A randomized clinical trial of Motivational Interviewing to reduce alcohol and drug use among patients with depression. Journal of Consulting and Clinical Psychology, 84(7), 571–579.
11. Foulds, J.A., Sellman, J.D., Adamson, S.J., Boden, J.M., Mulder, R.T., & Joyce, P.R. (2015). Depression outcome in alcohol dependent patients: An evaluation of the role of independent and substance-induced depression and other predictors. Journal of Affective Disorders, 174, 503-510.
12. National Institute of Mental Health. (2021). Naltrexone. MedlinePlus.