Is it safe to combine alcohol and antidepressants? Depends on the type of medication

I recently started taking an SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant, but I was unsure whether it is safe to drink alcohol. Some internet sources say it’s ok, others say absolutely avoid drinking.

For many healthcare professionals who treat anxiety and depression, concern about whether it’s safe — or even advisable — to drink alcohol while taking an antidepressant is common.

“Patients tell me all the time, ‘I’m having a drink with friends tonight, so I skipped a drink,'” said Sarah Ramsay Andrews, a psychiatrist at the Johns Hopkins University School of Medicine.

But skipping a dose is never a good idea, said Jody Glance, an addiction medicine specialist at the University of Pittsburgh’s Western Behavioral Health Medical Center — even if you go out for drinks with friends.

“When people stop taking their medication for a day or two, they usually don’t resume, and that can lead to a relapse of anxiety or depression.”

Also, she added, how safe it is to drink while taking antidepressants depends on the type of antidepressant you are taking. For most people who take SSRIs, an occasional drink probably won’t do much harm. There are, however, caveats to remember.

SSRI drugs — which include citalopram, sertraline and escitalopram — are the most commonly prescribed class of antidepressants. They are typically used to help treat depression and can also be effective for other conditions such as anxiety, obsessive compulsive disorder, certain phobias, and even premenstrual dysphoric disorder. They work by increasing levels of the brain chemical serotonin — which can influence your mood and emotions, among other things — and blocking its removal after carrying messages in the brain.

But unlike many other drugs used to treat mood disorders — such as the anxiety drug alprazolam or the tricyclic antidepressant amitriptyline — SSRIs are less likely to interact with alcohol than other types of drugs, Glance said.

That said, it’s still important to limit alcohol consumption while taking medication for depression or anxiety, he added.

While alcohol can temporarily relieve anxiety and lower inhibitions, it can also trigger activity in the brain that can worsen symptoms of depression or anxiety.

“If you drink a lot, you’re not going to allow the antidepressant to work as effectively,” Andrews said.

Combining alcohol with SSRIs can also amplify the drug’s side effects and intensify feelings like drowsiness, fatigue or dizziness, he added.

“I’ve had patients who say one drink feels like two. Alcohol can hit you harder, and not in that pleasant euphoric way, but in the tired, depressed way.”

Consuming more than what is recommended by current US dietary guidelines for alcohol — two drinks or less a day for men, one or less a day for women — can interfere with your goal of improving symptoms of depression or anxiety, Andrews said. .

As of now, there is little, if any, evidence that an occasional drink while using SSRIs can cause harm. But we don’t know very well that habitual drinking in larger than recommended amounts can affect you in the long run — a subject that needs more research, according to Glance.

The idea that you shouldn’t mix alcohol with antidepressants comes from previous research on older medications, which are now prescribed less frequently.

“The ‘don’t drink while you’re taking an antidepressant’ message is based on the likelihood of increased sedation, but that was based on older drugs like tricyclic antidepressants,” Glance said.

People who can’t take — or aren’t benefiting from — SSRIs can still be given tricyclic antidepressants or other classes of drugs that can interact with alcohol.

Pairing alcohol with monoamine oxidase inhibitor antidepressants, for example, can lead to dangerous spikes in heart rate and blood pressure that may require hospitalization, Glance said. “If you’re taking an MAOI, you shouldn’t drink alcohol.”

Another commonly prescribed antidepressant called bupropion can potentially increase the risk of seizures when combined with too much alcohol.

After all, said Glance, the best advice to follow is the same for any medication you’re taking: “Know what class of medication you take and talk to your doctor about drinking.”