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Using Drugs on Antidepressants: What Is and Isn’t Safe

Antidepressants work by changing the chemistry in your brain. They adjust your balance of hormones and decrease symptoms of depression.

However, many antidepressants have dangerous side effects, especially when taken with certain foods, substances, or over-the-counter medications. 

Different Categories of Antidepressants

Antidepressants are classified into different groups, depending on how they change the way chemical messengers pass along your nerves and brain. 

The reason for the availability of so many kinds of antidepressants is that not everyone responds well to the same type of antidepressant. All antidepressants work similarly, but their molecular structure is what changes how people metabolize, tolerate, and absorb them. 

Along with main classes of antidepressants, there also are other medications that do not fit into the main group. Most antidepressants work by influencing three chemical messengers, including:

Along with main classes of antidepressants, there also are other medications that do not fit into the main group. Most antidepressants work by influencing three chemical messengers, including:

  • Dopamine — This plays a role in motivation, making decisions, and signifying rewards.
  • Serotonin– This is a neurotransmitter involved in mood regulation, sleep, memory, and sexual arousal.
  • Norepinephrine — This isa chemical messenger involved in the body’s fight-or-flight response by regulating heart rate and blood pressure. It also assists with alertness.

Many antidepressants have side effects. Combining them with alcohol or other substances can have harmful effects. 

Different antidepressants may even be dangerous when taken with certain over-the-counter medications or even foods.

Most Common Types of Antidepressants

Antidepressants are separated into five major types, each of which you will respond to differently, depending on your particular chemical imbalance. The types include:

Mayo Clinic reports that this kind of antidepressant was the first developed. It works by blocking the activity of an enzyme called monoamine oxidase. This allows more chemical messengers to be available for work.

TCAs stop the reabsorption of norepinephrine and serotonin. An increased level of these hormones can help to combat symptoms of depression.

These also are called dual-acting antidepressants or dual reuptake inhibitors. SNRIs work by preventing serotonin and norepinephrine from being absorbed into your system, per Healthline.

According to Mayo Clinic, SSRIs affect only the reabsorption of serotonin in the body.

 Atypical antidepressants affect chemical messengers in ways that do not fit with the main classifications above. Some of these are:

    • Wellbutrin, which mostly works on blocking dopamine reuptake.
    • Symbyax, which can assist people with bipolar disorder.
    • Remeron, which blocks the effects of adrenaline.

Different types of antidepressants will interact with substances of abuse differently. The variations in interactions can vary widely.

Co-Occurring Disorders

The Substance Abuse and Mental Health Services Administration (SAMHSA) explains that substance use disorders and mental health issues that occur together are referred to as co-occurring disorders

The organization states that these occur when:

  • A person uses substances in a way that causes them difficulty meeting responsibilities at school, work, or home. 
  • Mental health issues get in the way of those under the age of 18 functioning in their community, school, or family.
  • A person over the age of 18 has suffered diagnosable symptoms of a mental health condition within the past year that gets in the way of their ability to function or meet major responsibilities. 

A 2013 case study published by the Journal of Substance Abuse Treatment states that depression complicates the treatment of substance use disorders. The study found that co-occurring disorders are associated with increased costs, more difficulty obtaining good results during treatment, and an increased likelihood of relapse. The case study also found that people generally had mental health issues before misusing substances. 

In addition, people with co-occurring disorders usually did not receive treatment for even one of the present disorders. Only 11 percent of people received proper treatment for co-occurring disorders, per data from the study. 

Co-occurring disorders can complicate interactions between antidepressants and other drugs.

Rates of Co-Occurring Disorders

A 2011 study published in Comprehensive Psychiatry found that rates of co-occurring disorders differ among ethnic and racial groups:

  • Asian: 2.1 percent
  • Latino: 5.8 percent
  • African American: 5.4 percent
  • Caucasian: 8.2 percent

The study looked at depression and anxiety as well as the differences in the onset of substance misuse. It found that Caucasian interviewees with an alcohol use disorder had higher incidences of depressive disorders than African American interviewees.

Substances Not to Mix With Antidepressants

Each type of antidepressant has its own sets of side effects and interactions.

The United Kingdom’s National Health Service provides a general list of things that you should not take along with antidepressants. This list includes:

 

You should not take two kinds of antidepressants, such as an SNRI with an MAOI unless your doctor has approved of this first. Some combinations of antidepressants could have unwanted side effects or cause you to feel sick.

Many antidepressants can interact with dextromethorphan, an ingredient found in most cold medicines. You also should not take any over-the-counter cold medication with MAOIs.

NHS states that St. John’s wort is a popular natural herbal remedy for depression, but it should not be mixed with other antidepressants.

According to the National Health Service, it is generally advised to abstain from alcohol when taking antidepressants. Alcohol could worsen depression or intensify certain side effects, such as dizziness. You should not stop taking your prescription just so you can drink alcohol.

Below are some precautions organized by type of antidepressant.

  • MAOIs: Alcohol use can be dangerous, especially if you drink wine, beer, or other alcoholic beverages that contain tyramine. This component is known to increase blood pressure quickly. 
  • TCAs: Major side effects of TCAs include sleepiness and difficulty with coordination, especially when you initially take the antidepressant. It may be safe to have small amounts of alcohol once you have gotten used to TCAs but ask your doctor before you drink. 
  • SSRIs: NHS says that drinking alcohol while taking SSRIs might be safe, but alcohol can increase drowsiness. Talk to your doctor first.
  • Other antidepressants: It may not be classified as dangerous to drink alcohol with different types of antidepressants, but it is still best to avoid it because alcohol could make you feel drowsy.

 

A 2017 article on VICE mentions that some SSRI users may not be able to get high when taking ecstasy (MDMA). Like SSRIs, MDMA also affects your levels of serotonin. 

Taking MDMA along with SSRIs often causes each substance to cancel the other one out. 

In a 2015 article, The Fix stated that, although it is hard to recognize how antidepressants may interact with street drugs like amphetamine, methamphetamine, and cocaine, both antidepressants and stimulants carry the risk of seizure. Taking both of these at the same time increases your risk. The risk is higher with TCAs or other antidepressants, such as bupropion. 

Amphetamines could increase your blood pressure levels when they are taken with antidepressants. 

The National Health Service states that marijuana could have adverse effects when taken with TCAs. Both TCAs and cannabis cause your heartbeat to increase, and they can both cause hypertension or high blood pressure. 

You may also suffer from side effects, such as changes in mood, hallucinations, restlessness, and confusion. 

More data is needed to determine whether or not marijuana can worsen symptoms of depression. 

In addition to the substances and medications mentioned above, you may need to avoid certain foods, such as aged cheeses or soy products, if you take certain antidepressants, such as MAOIs. 

Because of the variety of antidepressants on the market, it is important that you discuss any potential interactions with your prescribing doctor so you can stay safe.

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Sources

(March 2016) Can I drink alcohol if I'm taking antidepressants? National Health Service. Retrieved March 2019 from https://www.nhs.uk/common-health-questions/medicines/can-i-drink-alcohol-if-i-am-taking-antidepressants/

(July 2017) Everything You Need to Know About Mixing MDMA and Antidepressants. VICE. Retrieved March 2019 from https://www.vice.com/en_uk/article/padgjm/everything-you-need-to-know-about-mixing-mdma-and-antidepressants-safe-sesh

(March 2015) Ask an Expert: Which Street Drugs Don't Mix With Antidepressants? The Fix. Retrieved March 2019 from https://www.thefix.com/content/ask-expert-which-street-drugs-dont-mix-antidepressants

(March 2018) Does cannabis interact with antidepressants or lithium. National Health Service. Retrieved March 2019 from https://www.nhs.uk/common-health-questions/medicines/does-cannabis-interact-with-antidepressants-or-lithium/

(November 2018) Cold Medicine Interactions With Antidepressants and Bipolar Medication. Verywell Mind. Retrieved March 2019 from https://www.verywellmind.com/cold-medicine-interactions-with-bipolar-medication-380344

(August 2018) Antidepressants: Cautions. National Health Service. Retrieved March 2019 from https://www.nhs.uk/conditions/antidepressants/considerations/

(March 2019) The 5 Major Classes of Antidepressants. Verywell Mind. Retrieved March 2019 from https://www.verywellmind.com/what-are-the-major-classes-of-antidepressants-1065086

(January 2019) Mental Health and Substance Use Disorders. Substance Abuse and Mental Health Services Administration. Retrieved March 2019 from https://www.samhsa.gov/find-help/disorders

(May 2018) Selective serotonin reuptake inhibitors (SSRI’s). Mayo Clinic. Retrieved March 2019 from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

(November 2018) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). Healthline. Retrieved March 2019 from https://www.healthline.com/health/depression/serotonin-norepinephrine-reuptake-inhibitors-snris

(December 2018) Overview of Tricyclic Antidepressants. Verywell Mind. Retrieved March 2019 from https://www.verywellmind.com/tricyclic-antidepressants-379652

(June 2016) Monoamine oxidase inhibitors (MAOIs). Mayo Clinic. Retrieved March 2019 from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992

(September 2013) Treating depression and substance use: A randomized controlled trial. Journal of Substance Abuse Treatment. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345298/

(December 2011) Prevalence, Patterns, and Correlates of Co-Occurring Substance Use and Mental Disorders in the US: Variations by Race/Ethnicity. Comprehensive Psychiatry. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327759/


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