Mixing Antidepressants and Alcohol: Side Effects, Dangers, and Treatment

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Studies have found those who misuse more than one substance—such as antidepressants and alcohol—simultaneously experience a significantly higher number of problems related to their substance abuse. In some cases, three or more problems occurred. One reason is consuming various drugs can have cumulative or synergistic effects.¹Other reasons may be related to what occurs as your body builds a tolerance and becomes dependent on the substances, which can develop into addiction to multiple substances, clinically known as polysubstance use disorder.

Why Shouldn’t You Mix Antidepressants and Alcohol?

Antidepressants are a broad class of medications used to treat disorders like depression, anxiety, sleep disturbances, pain, and attention-deficit hyperactivity disorder (ADHD).² Antidepressants include medications that the levels of several different neurotransmitters. Alcohol is a legal addictive substance that includes all forms of wine, beer, and liquor.³

Antidepressant medications generally have warnings about the potential side effects of combining the medication with alcohol. Your doctor may recommend that you avoid all alcohol with certain types of antidepressants—such as monoamine oxidase inhibitors (MOAIs) like isocarboxazid (Marplan) and phenelzine (Nardil)—or may recommend no more than moderate alcohol use.

Both antidepressants and alcohol cause increased levels of neurochemicals related to elevated mood. Alcohol increases serotonin. Many classes of antidepressant—such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants—work by regulating your levels of serotonin and dopamine.

Alcohol Can Compromise Antidepressant Efficacy

Using alcohol when you are on antidepressants can interfere with your treatment. Alcohol can affect the efficacy of your antidepressants even if you do not take your medication and drink alcohol at the same time. Over time, the use of alcohol while on antidepressant therapy interferes with your brain’s natural processes, and you can become dependent on the combination of antidepressants and alcohol.⁴

Chronic Use Can Lead to Dependence and Withdrawal

Polysubstance use, like mixing antidepressants and alcohol, alters the structure of the brain and how neurotransmitters like dopamine and serotonin interact with the reward center in the brain. When you try to stop mixing antidepressants and alcohol, a decrease in the amount of serotonin being released in the brain creates unpleasant physical and psychological symptoms. Some people continue to mix alcohol and drugs to avoid these incredibly uncomfortable symptoms, which can lead to the development of a polysubstance use disorder.⁴

Risk Factors for Mixing Antidepressants and Alcohol

If approved by your doctor, moderate or occasional alcohol use should not affect how your antidepressants work or increase your risk for health complications related to polysubstance use.

However, alcohol misuse can affect your mental and physical health, especially when you mix alcohol with medications like antidepressants. You may be at higher risk of developing patterns of alcohol misuse based on the following:^4,5

Family—Exposure to substance use in your home of origin and home conflict or instability have been linked to an elevated risk of substance use in adulthood.
Personal history—Experiencing trauma, including abuse, death of a loved one, active military duty, a natural disaster, or assault can contribute to the risk of substance use.
Peers—Social influence and your access to alcohol and other substances may affect whether you use substances, how much, and how often.
Psychological and medical history—Certain psychological and medical characteristics are historically linked to a higher occurrence of substance use. One factor is a past history of substance use, especially in childhood or adolescence during early cognitive development.
Mental health—Major depressive disorder is one of the most common co-occurring conditions with substance use disorders. There is a complex relationship between depressive and anxious symptoms and substance use, including use of alcohol and other substances to alleviate these symptoms. You may have done this in the past before starting antidepressants or in times of high emotional stress.

You should not change how you take your antidepressants without direction from your prescribing doctor, especially if your intent is to manipulate the efficacy of the prescription, your ability to use alcohol, or the effects you experience when using alcohol.

What Are the Dangers of Mixing Antidepressants and Alcohol?

There may be harmful side effects of mixing drugs and alcohol, especially if you’re mixing alcohol with antidepressants.

Mild adverse effects such as the following:⁶

Nausea
Vomiting
Headaches
Dizziness
Fainting
Drowsiness
Loss of coordination
Sexual dysfunction
Weight gain
Sleep disturbances

Severe adverse effects can include:⁶

Internal bleeding
Heart problems
Breathing problems

Mixing antidepressants and alcohol, a depressant, can interfere with the intended therapeutic effects of your medicine. Factors like age, weight, the amount consumed, medical conditions, and metabolism play a role in how your body reacts when alcohol interacts with drugs like antidepressants.⁷

Mixing drugs and alcohol can affect your body in one of two types of interactions: pharmacokinetic and pharmacodynamic. Pharmacokinetic interactions occur when alcohol interferes with the metabolism of medication in your liver. Pharmacodynamic interactions occur when alcohol enhances the effects of your prescription and how it affects the central nervous system.⁸

Heavy alcohol use while on antidepressants, or any other medications, can cause minor illnesses to become chronic or create new, severe symptoms. Both physical and psychological dangers may arise. One or more of the following may be present:⁸

Sudden drops or spikes in blood pressure
Increased sedation and respiratory depression
Emergence of new clinical diagnoses, including major depressive disorder or other mood disorders
Increased anxiety or panic attacks
Alcohol-induced hypoglycemia
High blood pressure for extended periods, putting you at risk for cardiovascular disease
Severe withdrawal or discontinuation syndrome

Alcohol and Antidepressant Withdrawal

Withdrawal syndrome can be a sign of a potential polysubstance use disorder. Even when polysubstance abuse causes problems in relationships, employment, school, finances, or other areas of your life, withdrawal symptoms may be one of the reasons it is difficult to stop using alcohol without external assistance.⁹

If you have an alcohol use disorder and suddenly stop drinking, you can start to experience withdrawal symptoms as soon as 6-8 hours after your last drink.¹⁰

Alcohol withdrawal symptoms can range from mild to severe and may include any or all the following:¹⁰

Headache
Sleep disturbances
Heart palpitations
Gastrointestinal issues
Tremor
Sweating
Agitation
Anxiety
Disorientation
Hallucinations
Seizures

These alcohol withdrawal symptoms alone can be challenging. If you decide to stop taking your antidepressants—for example so that you can keep using alcohol—you can also experience withdrawals. In many cases, your doctor will not recommend that you stop an antidepressant prescription without a period of gradually decreasing the dose to minimize or eliminate these symptoms.

Antidepressant withdrawal is called discontinuation syndrome, and symptoms include the following:¹¹

Flu-like symptoms
Sleep disturbances with vivid dreams or nightmares
Nausea and vomiting
Dizziness, vertigo, and light-headedness
Sensory disorders (e.g., “burning,” “tingling,” “electric-like” sensations)
Hyperarousal (e.g., anxiety, irritability, aggression)

Is There a Risk of Overdosing on Antidepressants and Alcohol?

The Centers for Disease Control and Prevention (CDC) reports that an average of six alcohol overdose deaths occurs every day.⁸ If you, or someone you know, are mixing alcohol and antidepressants, it’s important to understand the signs of overdose so you can get help immediately if an overdose occurs.¹²

An overdose occurs when too much of alcohol or another substance enters your bloodstream and floods the brain. This flooding of chemicals affects major bodily functions. Heart rate and respiration start shutting down because the brain cannot support life-controlling functions.¹²

The following are signs of a possible overdose:¹²

Mental confusion and disorientation
Going in and out of consciousness, or becoming unable to rouse
Vomiting or dry heaving
Seizure or convulsions
Trouble breathing or stopped breathing
Slow or stopped heart rate
Clammy, pale skin, or changes in skin color
Relaxed responses such as no gag reflex, which can lead to choking if the person vomits
Dangerously low body temperature

Additional overdose symptoms specific to antidepressant toxicity include:¹³

Abnormal ECG results
Gastrointestinal problems
Involuntary muscle contractions (spontaneous clonus)
Tremors, twitching, or tics (hyperreflexia)
Extreme sweating (diaphoresis)
Serotonin syndrome

Serotonin is a chemical naturally produced in the body. The brain and nervous system need it. If your brain is producing low levels of serotonin, you may feel symptoms of depression. To help, doctors prescribe antidepressants, which boost serotonin production so that you feel happier.¹⁴

Serotonin syndrome refers to a toxic level of serotonin. It is sometimes called a toxidrome. If too much serotonin accumulates in the body, it causes mental and physical problems. Mild symptoms of serotonin syndrome include digestive problems like diarrhea, fever, chills, and shivering. More severe symptoms are seizures, delirium, agitation, and coma. It can also cause hyperreflexia, tremors, hyperactive bowel sounds, hyperthermia, tachycardia (dangerously rapid heart rate), and hypertension.¹⁴

You do not have to have a polysubstance use disorder to have an overdose. That’s why it is so important to recognize the signs and call 911 immediately.^12,13

What Is the Treatment for Polysubstance Use Disorder?

Treatment for polysubstance use disorder is a multi-layered process beginning with an extensive evaluation from a licensed polysubstance use disorder treatment specialist.¹⁵

Co-occurring or dual diagnosis treatment is the most effective approach if you are mixing alcohol and antidepressants. This type of treatment addresses both mental health and substance abuse at the same time. Because antidepressants are typically prescribed to treat mental health disorders, you need to receive the benefits of both.¹⁵

Your initial physical and mental health assessment will help your treatment team create a plan of action to help you detox from alcohol and drugs. Your team will decide if it is appropriate for you to change antidepressants based on your medical and substance use history. Treatment facilities are usually the best places to detox because you can work with an on-site psychiatrist or physician who can prescribe medicines to ease withdrawal symptoms.¹⁵

Medication management for withdrawal symptoms can continue after detox when you transition into a residential treatment program. Here you will learn relapse prevention skills through psychoeducational classes, group therapies, and 12-step groups. Your family can participate in classes that teach them how to support your recovery.

Following residential treatment, you may benefit from sober living, intensive outpatient treatment, individual outpatient counseling, community support programs, 12-step groups, and recovery support activities.¹⁵

Call our treatment specialists 24/7 at 800-681-1058 (Who Answers?) . They are eager to explain more about polysubstance use disorders and available treatments. Together, we can find the treatment program that will work for you.

Resources

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Gabriel, M., & Sharma, V. (2017). Antidepressant discontinuation syndrome. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 189(21),
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Scotton, W. J., Hill, L. J., Williams, A. C., & Barnes, N. M. (2019). Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. International Journal of Tryptophan Research: IJTR, 12, 1178646919873925.
Substance Abuse and Mental Health Services Administration. (2005). Treatment Improvement Protocol (TIP) Series, No. 42. Substance Abuse Treatment for Persons With Co-Occurring Disorders.