How Lexapro and Alcohol Affect Serotonin (And Each Other)

When someone is clinically depressed, doctors may prescribe Lexapro, an antidepressant medication.1 It’s important to consult with a doctor to understand how Lexapro works in the body, including how it can interact with other substances and sometimes cause physical and psychological reactions.2

Medications like Lexapro are part of a daily routine. You take the same dose at the same time each day according to prescription instructions.3 Because it becomes so routine, it’s easy to overlook possible interactions with other substances. For example, you are invited to happy hour after work for a few drinks. You accept the invitation, have a few drinks, and experience unexpected negative symptoms. You may think they are related to intoxication from alcohol, but these symptoms may be due to a negative interaction between Lexapro and alcohol.

What Happens When You Mix Lexapro and Alcohol?

Lexapro is a selective serotonin reuptake inhibitor (SSRI). This means that it increases the level of serotonin in your brain, lifting your mood. It excites the circuitry in the brain, unlike alcohol, which sedates brain circuitry.1

Alcohol is a central nervous system depressant. Drinking alcohol impairs everything you do because it slows down brain activity, hindering decision-making, speaking, walking, and functioning.4

Alcohol interferes with serotonin receptors, even when consumed in small amounts. Researchers have found that SSRIs and alcohol change the brain in similar ways by releasing serotonin into the brain’s reward system.5

However, due to the unnaturally high level of brain activation produced when an SSRI is combined with alcohol, individuals may find it difficult to feel the same feelings of happiness and pleasure associated with activities they enjoy, their favorite foods, or social events. This feeling of profound euphoria can encourage an individual to continue mixing drugs and alcohol. The more someone uses substances over time, the more likely they are to develop a substance use disorder.6

Side Effects of Mixing Lexapro and Alcohol

Misusing Lexapro alone can put you at risk for serotonin syndrome, cardiac problems, and withdrawal syndrome.7

Serotonin syndrome is potentially life-threatening and can happen as a result of taking too much medicine or interactions between Lexapro and recreational substances like alcohol. Symptoms include altered mental status, autonomic dysfunction, neuromuscular excitation, tremors or shakes, gastrointestinal problems, and psychiatric illness.9

In one case documented in Clinical Pharmacology, a young male patient taking Lexapro and the tricyclic antidepressant clomipramine (Anafranil) for major depression experienced agitation, disorientation, muscle twitching, overactive reflexes, tremor, fast heart rate, excessive sweating, and high blood pressure after drinking beer. Doctors concluded he met the criteria for serotonin syndrome due to a mixture of Lexapro and alcohol.10

Misusing alcohol alone carries risks like alcohol-related blackouts and accidents and injuries from falling, tripping, or loss of motor skills. Alcohol causes slowed reactions that can be life-threatening when completing tasks like driving or swimming. Long-term misuse of alcohol can negatively impact vital organs, leading to liver and heart disease and cancers, including breast and liver cancer.11

Alcohol affects judgment and decision-making skills that can contribute to high-risk behavior, such as unprotected sex or using alcohol with other substance.12

The National Institute on Alcohol Abuse and Alcoholism reports that potential side effects of mixing Lexapro with alcohol include increased:13

  • Drowsiness
  • Dizziness
  • Disorientation and confusion
  • Impaired motor skills
  • Risk for overdose
  • Feelings of depression or hopelessness
  • Alcohol effects

Additional side effects of mixing drugs and alcohol that may cause permanent injury or be life-threatening include cell death caused by oxidative stress. When under oxidative stress, body has a more difficult time with metabolism. Mixing substances can also cause gastrointestinal bleeding, fluctuations in blood pressure, convulsions or seizures, and heart rhythm disturbances.14

What Are the Dangers of Misusing Lexapro and Alcohol?

Using alcohol while on an SSRI can make your antidepressants ineffective, increasing your depressive symptoms. These symptoms may be severe immediately after alcohol use, especially during periods of hangover or alcohol withdrawal.

The scope of intentionally misusing antidepressants is unknown, but reports claim that misuse of drugs like Lexapro is more common in people who misuse other substances, like alcohol.7

Misusing antidepressants includes any intentional use of Lexapro that does not comply with your prescription for any reason. For example, taking more Lexapro than prescribed, taking someone else’s medicine, mixing Lexapro and alcohol, or choosing not to take your Lexapro knowing that you will be using alcohol. Varied reactions can occur. For some, mixing Lexapro and alcohol can create stimulant-like effects or euphoria.7

Over time, the effects change. To achieve that initial feeling of reward, you may increase the amount you consume.

The technical term for mixing alcohol with Lexapro or misusing two or more substances is polysubstance misuse, which can lead to polysubstance use disorder and puts you at a higher risk for negative outcomes.8

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Polysubstance Tolerance and Dependence

When an individual takes medication and uses substances like alcohol for long periods, they develop tolerance. Tolerance is the need to use more of a substance to achieve the same effect you did when you first started taking it.15

As your tolerance becomes higher, you will notice specific symptoms appear when you try to stop drinking, reduce the amount you use, or do not have access to antidepressants or alcohol. These are called withdrawal symptoms—signs your body has become dependent on Lexapro and alcohol in your system and needs them to function. Many people continue to misuse drugs and alcohol to avoid polysubstance withdrawal.15

Polysubstance Withdrawal

Anyone who misuses alcohol and antidepressants can experience withdrawal symptoms. Factors like age, weight, duration of use, and amount of substance used play a role in withdrawal symptoms, which can range from mild to severe and may include:16

  • Hand tremor
  • Insomnia
  • Agitation
  • Delusions
  • Seizures
  • Hallucinations
  • Elevated blood pressure
  • Delirium
  • Paranoid ideas
  • Anxiety
  • Nausea, vomiting

You can experience withdrawal symptoms from Lexapro if you suddenly stop taking your medication, which can also range from mild to severe. Reports of withdrawal symptoms from antidepressants like Lexapro include trouble with the senses. For example, you may experience ringing in the ears, also known as tinnitus. Others report altered taste and blurred vision.

Mood changes seen when withdrawing from Lexapro can include: 17

  • Confusion
  • Disorientation
  • Irritability
  • Agitation
  • Anger outbursts
  • Depression

Physical symptoms like muscle tension and perspiration are also common. Some people report having flu-like symptoms and sleep disturbances. Gastrointestinal issues like diarrhea, nausea, and vomiting may occur.17

How Is Polysubstance Use Disorder Treated?

All substance misuse and addiction treatment begins with an extensive assessment by a licensed mental health, drug, and alcohol specialist. During the evaluation, you will review risk factors for polysubstance use disorder, like:18, 19

  • Family history of substance misuse—Family history can indicate if there are possible genetic influences that contributed to the development of depressive symptoms or substance misuse. Another family factor is whether you were exposed to substance misuse growing up and, if so, how much.
  • Underlying medical and psychological conditions—Some people who have medical or behavioral conditions may develop substance use disorders as a secondary condition as they attempt to self-manage and alleviate their physical or mental symptoms.
  • Unprocessed personal traumas or stressors—Certain experiences, such as surviving a natural disaster or assault, are associated with an increased risk of depressive symptoms and potential development of substance use disorder. Your treatment plan may include trauma-informed therapy to address these contributing factors.
  • Home environment and social circle—Where you live and who you have to support you can contribute to the social aspects of addiction and recovery. Your clinician will take your home environment into account, such as by recommending a sober living home if you do not feel secure at home.

It’s important to note that having any or all of these risk factors does not predict, dictate, or guarantee the development of substance misuse or addiction. Your clinician will use this information to understand which needs you may have in recovery. For example, if you had a history of alcohol misuse long before you received a depression diagnosis, this may inform the treatment approach. The results from your assessment will be used to create your treatment plan. Because there is no one-size-fits-all polysubstance use disorder, personalized forms of treatment are needed.19

Detox

If you experience extremely uncomfortable or medically significant withdrawal symptoms when you stop using alcohol or it is not safe for you to stop taking Lexapro suddenly, detox may be indicated. If you do not need detox services for alcohol, your doctor will determine if you should stop taking Lexapro before entering addiction treatment and how the dose can be gradually stopped to minimize or eliminate withdrawal symptoms. Your doctor will also decide if you should transition to another antidepressant, mood stabilizer, or other medication to manage clinical depressive symptoms in addiction treatment without the Lexapro.

Once detox is complete, you can transition to inpatient rehab for ongoing medication management and therapy.19

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Inpatient Programs

During inpatient rehab, you will attend education and therapeutic groups to learn the necessary skills to stay sober after leaving treatment. Early recovery, relapse prevention, self-care, communication, and conflict resolution are examples of the skills you can learn.19

You can also participate in individual and family counseling and 12-step groups.

Outpatient Programs

Intensive outpatient programs allow you to meet with group and individual supports for 10 or more hours a week. These may include other individuals with depression in recovery from alcohol addiction. You can take care of your family responsibilities and work or attend school while also getting the much-needed support to maintain recovery.19

Aftercare

Before you leave inpatient rehab or complete an outpatient program, you will create an aftercare plan with your counselor. Aftercare plans may include staying at a sober living residence before transitioning home.19

Sober living homes give you the chance to practice the skills you learned while in inpatient treatment before you go home. You live with peers who are also in early recovery, and you support one another while also participating in your community. You may also receive assistance with education or employment goals, such as applying for vocational programs or going to job interviews set up with the help of the home’s staff.19

During this time, you can connect with social support groups, like Alcoholics Anonymous (AA), and mental health support groups. You may also continue medication management if that is part of your aftercare plan.

If you are using Lexapro and alcohol together, you may recognize some of the symptoms listed above. If so, we can help. Even if you are not experiencing symptoms but want to stop mixing alcohol and drugs, there are treatment options.

Call our treatment specialists at 800-948-8417 Who Answers? . They are available 24/7 to answer your questions and help you decide which type of treatment may benefit you the most.

Resources

  1. Landy, K., Rosani, A., & Estevez, R. (2021, May 15). Escitalopram. StatPearls Publishing.
  2. Kamboj, A., Spiller, H. A., Casavant, M. J., Chounthirath, T., Hodges, N. L., Smith, G. A. (2018). Antidepressant and antipsychotic medication errors reported to United States poison control centers. Pharmacoepidemiology and drug safety, 27(8), 902-911
  3. S. National Library of Medicine. (2010). LABEL: LEXAPRO – escitalopram oxalate tablet. Daily Med.
  4. S. National Library of Medicine. (2021). Alcohol. MedlinePlus.
  5. Weathermon, R., & Crabb, D. W. (1999). Alcohol and Medication Interactions. Alcohol Research & Health: the Journal of the National Institute on Alcohol Abuse and Alcoholism, 23(1), 40–54.
  6. McLellan A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare? Transactions of the American Clinical and Climatological Association, 128, 112–130.
  7. Evans, E. A., & Sullivan, M. A. (2014). Abuse and misuse of antidepressants. Substance Abuse and Rehabilitation, 5, 107–120.
  8. Martin, C. S. (2008). Timing of Alcohol and Other Drug Use. Alcohol Research & Health, 31(2), 96-99.
  9. Simon LV, Keenaghan M. (2021, January 23). Serotonin Syndrome. StatPearls Publishing.
  10. Suzuki, A., & Otani, K. (2019). Serotonin Syndrome After an Alcohol Intake in Patient Treated With Escitalopram and Clomipramine. Clinical Neuropharmacology, 42(3),103-104.
  11. National Institute on Alcohol Abuse and Alcoholism. What are the consequences? Rethinking Drinking: Alcohol and Your Health.
  12. Tariq, N., & Gupta, V. (2021, July 14). High Risk Behaviors. StatPearls Publishing.
  13. National Institute on Alcohol Abuse and Alcoholism. (2014). Mixing Alcohol With Medicines.
  14. Brookwell, L., Hogan, C., Healy, D., & Mangin, D. (2014). Ninety-three cases of alcohol dependence following SSRI treatment. The International Journal of Risk and Safety in Medicine, 26(2), 99-107.
  15. National Institute on Drug Abuse. (2020). The Science of Drug Use and Addiction: The Basics.
  16. Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2017). Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4–16.
  17. Henssler, J., Heinz, A., Brandt, L., & Bschor, T. (2019). Antidepressant Withdrawal and Rebound Phenomena. Deutsches Arzteblatt international, 116(20), 355–361.
  18. Hartz, S. M., & Bierut, L. J. (2010). Genetics of Addictions. Clinics in laboratory medicine, 30(4), 847–864.
  19. Substance Abuse and Mental Health Services Administration (US), & Office of the Surgeon General (US). (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. National Library of Medicine.
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