Mixing Antidepressants with Alcohol

Taking alcohol with an MAOI specifically is especially dangerous, increasing the risk of a stroke due to this combination’s ability to spike blood pressure.

Why Do People Mix Alcohol & Antidepressants?

The use of multiple drugs together is called polydrug or polysubstance use. The reason people might mix alcohol and antidepressants isn’t well studied, but there are a few reasons people engage in polydrug use even when the drugs they’re using are known to have potentially dangerous interactions.

Unaware of Risks

The first is simply that a person isn’t aware of a given interaction. Some people may be using antidepressants and also decide to drink alcohol recreationally, not realizing that being on antidepressants can make alcohol use more dangerous. 

Alcohol Abuse 

Others may struggle with alcohol use and have difficulties stopping drinking even if they’ve been prescribed medications that can interact dangerously with alcohol. These individuals would likely qualify as having an alcohol use disorder, often just called alcohol addiction. If people are unable to reduce alcohol use and regain control over drinking on their own, it’s a sign that help is needed.

Self-Harm

Some people mix antidepressants and alcohol as a form of self-harm, trying to hurt themselves through a dangerous combination of drugs. By the nature of these drugs, many people taking antidepressants are at greater risk of self-harm. 

Additionally, some people may have a relatively rare reaction to antidepressants that makes them consider self-harm when they normally would not. This is why it’s very important to talk to a doctor if you experience thoughts of suicide or other types of self-harm when on a new medication. 

Euphoria

Finally, some people may mix alcohol and antidepressants in an attempt to achieve an altered state that is not normally possible when only taking antidepressants or drinking alcohol. The goal is often to achieve a state of euphoria or feeling good.

Risks & Dangers of Combining These Substances

The dangers of mixing antidepressants and alcohol can be separated into two types: short-term problems and long-term issues.

Short-Term Dangers of Mixing Antidepressants & Alcohol

Antidepressants and alcohol make a user drowsier, less alert, and less coordinated. When used in combination, these symptoms can become severe.

This combination can seriously impact motor skills and make normally commonplace tasks very dangerous, such as driving (even if someone hasn’t consumed enough alcohol that it would normally be illegal to drive). Combining these drugs can also heavily tax the liver and sometimes cause fatal toxicity to occur.

If someone mixes antidepressants and alcohol, you might spot severe medical problems (like unconsciousness or stroke symptoms). You might also notice wild and unusual behavior (like violence). 

Don’t be afraid to call 911 and ask for help. Tell the operator about the symptoms you see, explain where you are, and identify how much the person has taken. Stay with the person until help arrives. Your fast action could save the person’s life.

Long-Term Dangers of Mixing Antidepressants & Alcohol

Another risk less often discussed is that some people will skip a dose of their antidepressant in order to drink alcohol more safely. While preferable to mixing these drugs together, experts note that this often leads to a patient skipping their medication for longer periods than just the one or two days they originally intended and relapsing back into their depression or anxiety symptoms. Without medication, some people with depression are at risk of self-harm.

Alcohol is also notably a depressant and can reduce how effective antidepressants are at managing depression and anxiety symptoms. This can potentially lead to suicidal thoughts and actions when they otherwise would not have occurred.

Types of Antidepressants and How They Mix with Alcohol

Several different types of antidepressants exist, and they all target slightly different neurotransmitters. Their interactions with alcohol can be slightly different too. Here’s what you need to know about each type of antidepressant:

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) include medications like sertraline and fluvoxamine. They work by blocking the recycling of the neurotransmitter 5HT, so it builds up in the brain. That change can ease depression, making SSRIs a top choice for doctors treating depression.

In 2014, researchers confirmed that SSRIs can increase the impact of alcohol. People appeared profoundly intoxicated and disinhibited when they mixed SSRIs with alcohol, and in some cases, they became violent and killed other people.

Because combining SSRIs and alcohol can make you violent and less likely to make reasonable decisions, mixing is never encouraged.

SNRIs

Serotonin/norepinephrine reuptake inhibitors (SNRIs) include medications like duloxetine and venlafaxine. These drugs work by increasing serotonin and norepinephrine levels in the brain, so people feel more alert and less depressed.

SNRIs can cause rhabdomyolysis, a serious condition in which muscles break down and release harmful proteins in the bloodstream. Researchers say combining SNRI medications with alcohol can increase the risk of this dangerous condition. Mixing is unsafe for this reason.

TCAs

Tricyclic antidepressants (TCAs) include amitriptyline, clomipramine, and imipramine. They work by allowing norepinephrine and serotonin to build up in the brain. They can also work on histamine receptors in the brain, causing sedation. People using these medications might feel less depressed and more relaxed.

Since the 1990s, researchers have warned that combining TCAs with alcohol will increase sedation risks. Alcohol can also interfere with medication breakdown in the liver, allowing drugs to stay active much longer than they should. 

When TCAs last too long and levels build up, people can experience convulsions and heartbeat abnormalities. Never mix alcohol with TCAs.

MAOIs

Monoamine oxidase inhibitors (MAOIs) include selegiline and moclobemide. These medications work on many different chemicals in the brain, including serotonin, norepinephrine, and dopamine. Since they have such a broad method of action, they can interact with several types of medications. They’re rarely used for depression, as they can be dangerous when combined with other substances.

Drinking alcohol with MAOIs is particularly dangerous. Experts say this combination can cause a spike in blood pressure, triggering a stroke. Never drink while taking MAOIs.

Atypical Antidepressants

Atypical antidepressants include bupropion and mirtazapine. Each one works slightly differently and can have what experts call “various mechanisms of action.”

Researchers know that atypical antidepressants can cause sedation, especially when mixed with alcohol. It’s never smart to drink while using these drugs.

Is It Ever Safe to Combine These Drugs?

Fundamentally, it isn’t safe to combine alcohol with antidepressants. While there are different levels of risk and harm depending on how heavily one drinks alcohol while on antidepressants, it is best to completely avoid alcohol when on antidepressants. 

If you can’t or won’t stop drinking alcohol completely, you should at least monitor your alcohol intake while on antidepressants and certainly talk to your doctor about your intention to drink. Some physicians will allow one drink per day for women and two drinks per day for men. Drinking much beyond that is reaching a point where it is difficult to medically justify a patient using antidepressants if they can’t first reduce their drinking.

Talk to a Doctor Before Taking Antidepressants With Alcohol

If you intend to drink alcohol while on antidepressants, talk to a doctor first. A doctor can help you thoroughly understand the risks involved, answer any questions you have, and clear up any misconceptions on the subject. They can also make sure that you aren’t being put on antidepressants that are especially likely to have a dangerous interaction with alcohol, such as MAOIs.

Remember that hiding your intention to drink from a doctor can be dangerous. They need to know what drugs you’re putting in your body when making prescribing decisions. If you don’t let your doctor know you intend to drink, you could be endangering your life.

A medical professional can also help you to reduce your drinking if you don’t feel you can stop on your own but want to. Alcohol addiction is a serious medical condition, and it is typically very difficult to get control over without medical intervention. Addiction treatment specialists can help you form a treatment plan to start gaining control over your alcohol use and reducing your drinking long term.

Most addiction treatment programs are equipped to treat co-occurring disorders, so your depression can be treated alongside your alcohol abuse issues. This is the best way to ensure full recovery on all fronts.