Mixing Antidepressants with Alcohol: Dangers, Risks, and Effects

What Are Antidepressants?

Antidepressants are a type of medication typically prescribed to help treat depressive disorders, including (but not limited to) major depressive disorder, obsessive-compulsive disorder, and generalized anxiety disorder.⁵ It had been thought that antidepressants worked by exclusively targeting certain chemicals (neurotransmitters) in the brain and changing the way the brain used them to better regulate an individual’s mood and behavior. However, more recent research indicates that antidepressants also induce neuroplasticity, a process that allows the brain to restructure itself by incorporating and adapting to environmental stimuli and then making appropriate adaptive responses to it.⁶

Types of Antidepressants

There are several different types of antidepressants available to help treat depression. Some common antidepressants include:^3,7,8

• Selective serotonin reuptake inhibitors (SSRIs). SSRIs, the most widely prescribed class of antidepressants, include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are also commonly prescribed in the United States for the treatment of depression and anxiety and include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
• Atypical antidepressants. Atypical antidepressants, which are generally prescribed for individuals who have had an inadequate response to first-line SSRIs or SNRIs, include bupropion (Wellbutrin) and mirtazapine (Remeron).
• Serotonin modulators. Serotonin modulators include trazodone, vilazodone (Viibryd), and vortioxetine (Trintellix) and offer another alternative to SSRIs and SNRIs.
• Tricyclic and tetracyclic antidepressants (TCAs). Not commonly prescribed, TCAs are associated with worsening of cardiovascular conditions in individuals with heart disease. TCAs include nortriptyline (Pamelor) and desipramine (Norpramin).
• Monoamine oxidase inhibitors (MAOIs). MAOIs are not typically prescribed as a first-line treatment for depression because of adverse side effects and drug interactions. MAOIs include isocarboxazid (Marplan), moclobemide (Manerix), phenelzine (Nardil), selegiline (Emsam patch), and tranylcypromine (Parnate).

Always consult with your doctor to determine which antidepressant is right for you.

Alcohol Addiction and Depression

Depressive disorders are among the most prevalent mental health conditions to co-occur with alcohol misuse. In fact, research indicates that individuals diagnosed with alcohol use disorder are 2.3 times more likely than individuals without alcohol use disorder to also have major depressive disorder. Additionally, individuals diagnosed with alcohol dependence—wherein their body and brain become so used to having alcohol present that when drinking stops, withdrawal symptoms surface—are 3.7 times more likely to have major depressive disorder and 2.8 times more likely to have persistent depressive disorder than individuals who are not alcohol dependent.⁹ While alcohol dependence can lead to alcohol addiction, the two are not the same. Alcohol use disorder is a chronic, relapsing brain disease in which a person has lost control of their alcohol use; they continue to drink despite the significant consequences it has their lives.¹⁰

Furthermore, research indicates that individuals with co-occurring alcohol use and depressive disorders have a higher likelihood of experiencing outcomes that are more severe and worse than each of the conditions alone. This includes an increased risk of suicidal behavior.⁹

This co-occurrence of alcohol use and depressive disorders may be, in part, genetic. One study found that comorbid alcohol use disorder and depression occurred substantially more often in the parents, siblings, and children of study participants who had an alcohol use disorder compared to those who did not.¹¹

These co-occurring conditions can also result in a maladaptive cycle of compulsive alcohol use, which can then worsen depression symptoms and lead to drinking larger amounts and/or more frequent consumption.¹²

Mixing Alcohol and Antidepressants

Mixing alcohol with antidepressants can exacerbate the side effects of the medication—such as drowsiness, dizziness, and impaired motor control—and also increase the risk of overdose.⁴

When specific MAOIs, like tranylcypromine and phenelzine, are combined with alcohol, the result can cause hypertensive stroke, heart palpitations, and changes in blood pressure.³ There is a risk of dangerously high blood pressure when MAOIs mix with tyramine, a byproduct in beer and wine.⁴

Drinking alcohol while taking antidepressants can also make the symptoms associated with depression worse and interfere with the treatment and potentiate suicide risk.^13,14 Research indicates that even low levels of alcohol consumption, by individuals being treated for depression, may reduce the antidepressant effectiveness, decrease the individual’s adherence to taking the medication, and increase their impulsivity—all of which can increase the risk for suicidal behavior.¹⁴

Treatment for Co-Occurring Depression and Alcohol Addiction

The treatment for co-occurring depression and alcohol use disorder often includes an integrated approach to simultaneously address both disorders. Interventions utilized may include:

Medical detox. Medically managed detox may be the first step in a comprehensive treatment plan. Detox allows the body rid itself of alcohol safely and as comfortably as possible under the supervision of healthcare professionals.⁹

Antidepressants and other medications. Research suggests that for individuals with co-occurring alcohol use and depressive disorders, antidepressants can help reduce the symptoms of depression. Other medications used for the treatment of alcohol use disorder include naltrexone, which diminishes the rewarding effects of alcohol and helps prevent relapse; acamprosate, a drug that aids in maintaining abstinence from alcohol; and disulfiram, which acts as a deterrent to drinking since taking it in combination with alcohol causes severe nausea, flushing, and heart palpitations.^9,15

Additionally, studies of patients with co-occurring alcohol use disorder and depressive disorders have demonstrated that treatments using medications for alcohol use disorder are safe and effective for reducing drinking and depression symptoms.⁹

Behavioral therapies. The behavioral therapies that may be used include:¹⁶

• Motivational enhancement therapy.
• Cognitive-behavioral therapy (CBT).
• Contingency management.
• 12-step mutual-help groups.

If you or a loved one are ready to seek treatment for co-occurring alcohol use and depressive disorders, American Addiction Centers (AAC) can help. With facilities nationwide that are staffed with doctors, therapists, and other addiction treatment professionals, your treatment team can assess your comorbid conditions and tailor a comprehensive, integrated treatment plan that is unique to your needs and addresses both your alcohol use and mental health disorders at the same time.

Reach out by calling to speak to one of our compassionate and knowledgeable admissions navigators, who can answer your questions, explain your options, and help you get started on your road to recovery today.