Mixing Alcohol and Antidepressants: Can You Do It Safely?


If you’re currently taking alcohol and antidepressants, you’re not alone. The latest government statistics found 17% of the adult population in the UK are currently prescribed antidepressants. Of that number, many will be either drinking alcohol or wondering if they can mix antidepressants and alcohol safely. This article aims to address that question and clear up some of the confusion surrounding the topic. 

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Can Alcohol Trigger Depression?

Alcohol is a depressant. This means it can affect your brain’s chemical messengers which can, in turn, affect your feelings, thoughts and behaviour. 

Many people are surprised that alcohol is a depressant. After all, those first few drinks often make people feel great, euphoric even. That’s because alcohol works on the part of your brain in charge of inhibition, so it can help you to unwind and feel less anxious and more confident. Sadly these effects are short-lived and the chemical changes that have now taken place in your brain can conversely lead to more negative feelings, including anxiety and depression. 

Over the long term, alcohol actually reduces the number of those chemical messengers in your brain. But we require a certain amount to protect against anxiety and depression. 

Perhaps unsurprisingly then, people who drink alcohol are more likely to develop mental health problems. Research has found that drinking often and heavily is associated with depression. The good news is, studies have shown reducing or stopping drinking can boost your mood and sense of well-being. In fact, research has found that people who suffer from depression often find cutting alcohol out for as little as four weeks has a big impact on how they feel. 

Drinking Is Not a Healthy Habit for Managing Depression

Depression is a common mental health condition and it can be severely life-limiting in certain cases. People with mental health conditions, including depression, are more likely to use alcohol as a form of treatment. This is known as self-medication. It’s essentially a coping mechanism, as it allows the person suffering from depression a brief respite from their symptoms. However, because of the brain chemical changes we outlined above, it’s not a healthy coping mechanism. 

What are Serotonin and Norepinephrine Reuptake Inhibitors? (SNRIS)

Serotonin-noradrenaline reuptake inhibitors (SNRIs), like duloxetine (Cymbalta and Yentreve) and venlafaxine (Efexor), were designed to be a more effective antidepressant than selective serotonin reuptake inhibitors (SSRIs).

Serotonin is associated with positive feelings of well-being and norepinephrine impacts your energy levels, so the idea was that by better utilising both of these chemical messengers, depression would be relieved. 

As time has passed, there is no robust evidence to suggest SNRIs are more effective in treating depression than SSRIs. So far the evidence suggests that some people respond better to SSRIs and other SNRIs. 

It is not fully understood how antidepressants work. The theory was that it was by boosting the ‘feel good’ chemical serotonin, however, a recent meta analysis found there is no clear evidence that serotonin levels or activity are responsible for depression.

Side effects of SNRIs include:

  • Feeling sick 
  • Headache
  • Dizziness
  • Decreased or increased appetite
  • Heart palpitations
  • Increased blood pressed 
  • Increased heart rate
  • Agitation
  • Inability to orgasm

Alcohol Use Disorders and Antidepressants

It is not clear whether depression or alcohol abuse comes first. Everyone is different and it’s likely that it varies from person to person. Either way, having one of these issues increases the odds of experiencing the other. 

People who drink frequently are more susceptible to experiencing depression, this may then cause them to drink more in a bid to feel better. And people who frequently experience depression may use alcohol to self-medicate. Both scenarios can spiral and worsen over time if not treated. 

There are various overlapping risk factors that make a person more likely to experience both depression and alcohol abuse

Trauma: Those who have experienced trauma in their lives, whether childhood or more recent, are more likely to be both depressed and abuse alcohol. 

Personality: Certain traits, such as having low self-esteem or a negative mindset, can cause a person to experience depression as well as abuse alcohol. 

Genetics: Those with a family history of either depression or alcohol abuse have a higher risk of experiencing the condition themselves. 

Because of this clear overlap, many people may be suffering from an alcohol use disorder and be prescribed antidepressants for their depression. 

How Do Antidepressants and Alcohol Alter Your Thinking and Judgment?

Both antidepressants and alcohol can impact your thinking and judgement. Antidepressants work on the brain, in fact, studies have shown that just one dose of SSRI can change the brain’s architecture within hours. As a result, antidepressants come with side effects, including reduced alertness and inability to focus. This can happen especially once you first start taking them and it can negatively impact your ability to perform skilled tasks, such as driving. 

It’s well documented that alcohol impacts both thinking and judgement by lowering inhibitions. This can lead to impaired decision-making and doing things you wouldn’t normally do if you were not under the influence of alcohol. 

What Are the Worst Antidepressants to Mix with Alcohol?

Different types of antidepressants react differently when mixed with alcohol. These effects are not just limited to the class of antidepressants, but even specific brands. Overall, there are some common side effects of mixing antidepressants and alcohol which include:

  • Reduced alertness
  • Dizziness 
  • Increased depressive episodes 
  • Feelings of doom or hopelessness 
  • Reduced motor control
  • Increased risk of overdose

Then there are specific side effects you are more likely to experience depending on the class of antidepressant you are taking. 

SSRIs: While it is generally considered safe to consume low levels of alcohol on SSRIs, there is still the chance you could experience side effects which often look like a more exaggerated effect of inebriation. 

SNRIs: You should avoid drinking alcohol, especially in large volumes, while taking SNRIs. Drinking while you take SNRIs can result in worsened liver damage. 

Tricyclic antidepressants (TCAs): Small volumes of alcohol are thought to be largely safe while taking TCAs, however, binge drinking on TCAs can make depressive episodes worse. You will also notice an exaggerated effect of inebriation.

Monoamine-oxidase inhibitors (MAOIs): MAOIs are an older type of antidepressant that have been largely phased out. They can cause potentially serious side effects so are only rarely prescribed. They are one of the most dangerous types of antidepressants to mix alcohol with. This is because certain chemicals in certain alcohol can cause spikes in blood pressure which may need immediate medical assistance.

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Types Of Antidepressants

The main types of antidepressants used in the UK are: 

SSRIs: These are the most commonly prescribed type of antidepressant. The reason is twofold; they often cause fewer side effects and an overdose is likely to be less serious. Some of the most common names include fluoxetine (Prozac), citalopram (Cipramil) and escitalopram (Cipralex). 

SNRIs: The idea behind designing an antidepressant focused on noradrenaline as well as serotonin was that it would be more effective than an SSRI. However, the evidence for this is not robust. SNRIs are often prescribed when a person doesn’t respond to SSRIs. Examples include duloxetine (Cymbalta and Yentreve) and venlafaxine (Efexor). 

Noradrenaline and specific serotonergic antidepressants (NASSAs): These have similar side effects as SSRIs, but it’s reported that they cause fewer sexual problems. The main one used in the UK is mirtazapine (Zispin).

Serotonin antagonists and reuptake inhibitors (SARIs): Typically this type of antidepressant is only prescribed when others haven’t worked or have caused too many side effects. The main one prescribed in the UK is trazodone (Molipaxin).

Tricyclic antidepressants (TCAs): An older type of antidepressant, they are rarely used as a first line of treatment as an overdose can be more dangerous, plus they typically come with more side effects. TCAs are usually reserved for people suffering from severe depression who are unresponsive to other treatments. Examples include amitriptyline, clomipramine and dosulepin. 

Monoamine oxidase inhibitors (MAOIs): Like TCAs, MAOIs are an older type of antidepressant that aren’t often prescribed anymore. This is because they can cause quite serious side effects, so are only prescribed by specialists. Types of MAOIs include tranylcypromine, phenelzine and isocarboxazid.

Can I Skip a Dose of My Antidepressant to Drink Alcohol?

It is not advisable to stop taking medicine in order to drink. Skipping antidepressants for even one dose puts you at risk of withdrawal or side effects. Plus, getting into a stop-start pattern with antidepressants can worsen your underlying depression. 

The Dangers of Mixing Antidepressants With Alcohol 

Mixing antidepressants and alcohol is not a good idea. The specific side effects you face will depend on several factors including the type of antidepressants you’re on. However, you may experience the following:

Increased depressive symptoms: Alcohol is a depressant. Drinking it can counteract the benefits of your antidepressant and ultimately make your condition harder to treat. 

Impaired judgement: You may suffer from poor judgement, reduced coordination and motor skills and a delayed reaction time. While alcohol alone can cause this, the results will likely be intensified with antidepressants. 

Drowsiness: Certain antidepressants can make you feel drowsy and have a sedating effect, which alcohol can have too. Together the combined effect can be much more intense. 

What Is Dual Diagnosis?

A dual diagnosis is when someone has an addiction, such as to alcohol, along with a mental health problem, like depression. Sometimes it’s called co-occurring disorders or co-morbidity. 

Dual diagnosis is challenging because there is no one straightforward treatment approach, instead, each person and combination requires a bespoke treatment plan. 

You can learn more about dual diagnosis here and learn about our approach to treatment when you’re dealing with both an addiction and a mental health condition. 

Treatment for Depression and Alcoholism

Treatment for alcohol addiction and depression will be informed by various factors. However, here at Castle Craig, we recommend all dual-diagnosis patients attend treatment for a longer period of time, starting at the Intensive Care clinic before moving on to our Extended Care programme. 

When it comes to treating alcohol addiction and depression, there are various steps to take which include:

Detox: This is usually the first step and is best managed in a medically supervised setting. This allows your body to become free of its physical dependence on alcohol and from here you will be able to better respond to further treatments. 

Medications: If you are not already on antidepressants, you may consider starting antidepressants. 

Therapy: There is a range of therapies which can help both depression and alcohol addiction. Which therapy is right for you will depend on your unique case and preferences. Options include both individual and group addiction counselling, especially cognitive behavioural therapy (CBT), family therapy and trauma and PTSD therapy, among others. 

Castle Craig is a world-leading rehab clinic that has helped people overcome alcohol addiction since 1988. Our experienced experts have treated both alcohol addiction and depression, as well as those suffering from a dual diagnosis of both. If you’d like to find out more, give our team a call at 0808 271 7500

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FAQs 

What Happens if You Drink Alcohol With Antidepressants?

Drinking alcohol while taking antidepressants can cause a number of side effects including impaired judgement, drowsiness and increased depressive symptoms. Which ones you experience will depend on various factors including the specific type of antidepressants you are on.

Which Antidepressants Are Ok With Alcohol?

It is not advisable to drink alcohol while taking any antidepressants. Some guidelines suggest that minimal drinking is largely safe while taking SSRIs. 

Do You Get Drunk Quicker on Antidepressants?

Mixing alcohol with certain antidepressants can exaggerate the effects of alcohol. 

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