Mixing Prozac and Alcohol

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It is common for individuals with alcohol use disorder (AUD) to have a co-morbid disorder, such as depression.¹ A common drug used to treat depression is fluoxetine (Prozac). This is a type of antidepressant medication called an SSRI or selective serotonin reuptake inhibitor.² Medication treatments for AUD often interact with alcohol, causing unwanted side effects and risks. Prozac and alcohol are no exception, as mixing alcohol and Prozac can be dangerous.³

In this article:

Why Prozac and Alcohol Do Not Mix
Can You Drink Alcohol on Prozac?
If You Are Mixing Alcohol and Prozac
How to Manage Depression and Alcohol Use Disorder

Why Prozac and Alcohol Do Not Mix

To understand why Prozac and alcohol do not mix, it is helpful to look at how each works.

How Prozac Functions and What It Combats

Fluoxetine is an SSRI often referred to by its brand name, Prozac. This medication increases serotonin in the brain to ease symptoms of depression.⁴ Someone struggling with depression may experience the following symptoms:⁵

Having little interest or pleasure in past activities
Feeling down, depressed, or hopeless
Trouble falling asleep, staying asleep, or sleeping too much
Feeling tired or drained of energy
Changes in appetite (eating more or less than previously)
Strong feelings of personal failure or having disappointed themselves or their family
Trouble concentrating when reading or listening
Moving or speaking slower than normal
Fidgeting or restlessness
Thoughts of self-harm

If five or more of these symptoms occur most of the day, this may indicate a diagnosis of depression. In addition, these symptoms will recur nearly every day for at least two weeks. Such symptoms often impact daily life or functioning.⁵

What Happens When Mixing Alcohol and Prozac

In general, antidepressants have a chemical interaction when taken with alcohol. However, SSRIs like fluoxetine have been shown to interact less with alcohol than other antidepressants, such as tricyclic antidepressants (TCAs). SSRIs tend to be less sedative than TCAs. Nevertheless, monoamine oxidase (MAO) inhibitors and atypical antidepressants have a greater risk of increasing your blood pressure than an SSRI if you drink wine. This is due to the interactions these medications have with a compound called tyramine. Tyramine naturally forms in fermented foods and drinks, such as cheese, wine, and chocolate.⁶

Prozac attempts to decrease depressive symptoms in the brain, while alcohol acts as a depressant on the body’s central nervous system (CNS).⁷ The CNS is responsible for controlling most mind and body functions. When an individual drinks alcohol, it slows down the body and brain. As a result, this can interfere with a person’s mood, behaviors, and ability to restrain oneself.⁷

One possible side effect of taking Prozac is feeling fatigued.⁸ Since alcohol acts as a depressant on the brain and body, this combined impact can lead to an individual feeling sedated or extremely drowsy. Furthermore, each person’s body metabolizes medications and substances differently. Thus, you might not know how many drinks induce this effect for you. For some, it may be only one drink.⁹

Prozac can be a safe and effective drug in treating depression. However, just like other SSRIs, mixing alcohol and Prozac is not recommended.⁸

Can You Drink Alcohol on Prozac?

It is advised not to drink while taking Prozac. Mixing psychiatric medication with other substances like alcohol can impact the effectiveness of the medication. Additionally, some antidepressant medications, when mixed with alcohol, may increase the medication levels in the body significantly.

However, for SSRIs such as Prozac, that is not the case. This is due to the lower rate of sedative-to-stimulant activity.⁶ Importantly, with Prozac, the alcohol does not interfere with the metabolism in the liver the same way other antidepressants can.

Specifically, the risks of mixing alcohol and Prozac include drowsiness, dizziness, increased feelings of depression or hopelessness, and an increased chance for overdose.¹⁰

If You Are Mixing Alcohol and Prozac

If you have mixed Prozac and alcohol, you may feel more depressed or anxious. These side effects of fluoxetine may increase when consuming alcohol. One of the most common side effects of Prozac is fatigue or sedation, which can intensify when mixing in alcohol.⁸ To be effective, fluoxetine must be taken consistently. Therefore, do not alter the days or times you take your medication based on your use or time of alcohol consumption. Moreover, do not skip a dose or doses of Prozac to drink. Inconsistent medication use or skipping doses of an antidepressant can cause serious withdrawal symptoms, including:¹¹

Anxiety
Increase in life-threatening thoughts
Difficulty sleeping
Sudden changes in mood
Tiredness
Flu-like symptoms

If you experience no symptoms, continue to monitor changes in your mood. However, if you experience any of the symptoms above and have taken Prozac and alcohol together, contact your doctor immediately.

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How to Manage Depression and Alcohol Use Disorder

There is high co-occurrence of alcohol use disorder and depression. Crucially, having both depression and alcohol use disorder has been shown to worsen prognosis. Additionally, having either depression or alcohol use disorder increases the risk of developing the other disorder.¹² Conversely, research has also shown that improving one disorder positively correlates with improving the other.¹³ So, it is possible to manage and treat these two disorders together. Signs and symptoms include:⁵

Unsuccessful attempts to reduce or control alcohol use
Cravings for alcohol
Drinking more or more often than intended
Giving up or reducing vital life activities due to alcohol use
Interpersonal problems caused by alcohol use
Developing a high tolerance to alcohol
Withdrawal symptoms when abstaining from alcohol use
Continuing to consume alcohol despite physical or psychological problems caused by alcohol use

If you have six or more of the above symptoms, you may have a severe alcohol use disorder. This may require treatment.⁵

A combination of medication management and therapy is the standard recommended treatment for these disorders. Furthermore, adding support methods, such as a 12-step program, may improve the outcomes of individuals with these co-occurring disorders.

Pharmacological Treatments

SSRIs such as Prozac usually are the first line of treatment for individuals with a depressive disorder. Additionally, there exist medications tailored to help individuals with alcohol use disorder. These medications include disulfiram, naltrexone (oral or injectable), and acamprosate.¹² Moreover, it is imperative to talk to your doctor about which medication is right for you and your situation.

Therapeutic Treatments

Therapy has been empirically supported to help reduce, treat, and manage symptoms of both alcohol use disorder and depressive disorders. Certain treatments are recommended for the treatment of alcohol use disorder and depression. These include:¹²

Cognitive-Behavioral Therapy (CBT): CBT focuses on addressing thoughts and behaviors with short-term treatment goals achieved in a collaborative therapeutic environment.
Dialectical Behavioral Therapy (DBT): DBT is an effective combination of cognitive and behavioral therapies. Its goal is to transform negative thinking patterns and destructive behaviors, such as self-harm, into positive outcomes.
Group Therapy: Group therapy is a group of individuals struggling with similar difficulties or disorders. A mental health professional leads discussions of various psychotherapy topics or processing issues.
Motivational Interviewing (MI) and Enhancement Therapies: MI is a therapy that attempts to resolve your uncertainty about alcohol use.

Mutual-Help Programs

Peer support for alcohol use disorder is helpful, such as 12-step programs like those offered by Alcoholics Anonymous (AA). Additionally, peer support is available for individuals struggling with depressive symptoms. Programs such as the Depression and Bipolar Support Alliance (DBSA) and the National Alliance on Mental Illness (NAMI) have programs worldwide.

Talk to a treatment specialist at 800-948-8417 Who Answers? to discuss your treatment options for depression and alcohol use disorder.

Resources

Brière, F. N., Rohde, P., Seeley, J. R., Klein, D., & Lewinsohn, P. M. (2014). Comorbidity between major depression and alcohol use disorder from adolescence to adulthood. Comprehensive psychiatry, 55(3), 526-533.
National Library of Medicine. (2021). Fluoxetine. MedlinePlus.
National Institutes of Health. (2014). Harmful Interactions.
Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. The mental health clinician, 6(4), 191-196.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
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.
National Library of Medicine. (2021). Alcohol. MedlinePlus.
Eli Lilly and Company. (2021). Prozac Medication Insert.
Cederbaum A. I. (2012). Alcohol metabolism. Clinics in liver disease, 16(4), 667-685.
National Institute on Alcohol Abuse and Alcoholism. (2014). Mixing Alcohol With Medicines.
Guy, A., Brown, M., Lewis, S., & Horowitz, M. (2020). The ‘Patient Voice’: Patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition. Therapeutic Advances in Psychopharmacology, 10, 204512532096718.
DeVido, J. J., & Weiss, R. D. (2012). Treatment of the depressed alcoholic patient. Current psychiatry reports, 14(6), 610-618.
McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol Research: Current Reviews, 40(1), arcr.v40.1.01.