If you drink alcohol with some antidepressants, the combination can lead to a dangerous situation. However, drinking alcohol with most of the available antidepressant medications on the market is not dangerous.

Antidepressants are specifically designed to treat clinically significant depression. They should not be used to manage everyday sadness.

Types of Antidepressants

Antidepressant medications are most often classified by their mechanism of action.

  • Monoamine oxidase inhibitors (MAOIs) like Nardil (phenelzine) and Parnate (tranylcypromine): These block the actions of monoamine oxidase which is a substance that breaks down neurotransmitters in the brain.
  • Tricyclic antidepressants (TCIs) like Elavil (amitriptyline) and Anafranil (clomipramine): These are believed to increase levels of serotonin and norepinephrine, and block the effectiveness of acetylcholine.
  • Selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine) and Zoloft (sertraline): These specifically increase levels of serotonin.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) like Effexor (venlafaxine) and Cymbalta (duloxetine): These increase levels of serotonin and norepinephrine.
  • Norepinephrine and dopamine reuptake inhibitors (NDRIs) like Wellbutrin (bupropion): These increase levels of norepinephrine and dopamine.

There are also atypical antidepressants that consist of several different classes of drugs that do not prevent the reuptake of neurotransmitters but seem to stop them from being released. Drugs like Remeron (mirtazapine} and even ketamine were recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression and are included in this category.

Medications formally classified as antidepressants are often prescribed for the treatment of other conditions, such as certain types of pain (tricyclic antidepressants), eating disorders (SSRIs and others), anxiety disorders (SSRIs and others), and the depression that occurs in conjunction with having some other mental health diagnosis.

Dangers of Combining Alcohol with MAOI

MAOIs are older antidepressants that are not commonly prescribed today because newer antidepressants have fewer side effects. However, some individuals may still be prescribed these drugs, especially if other drugs for depression are ineffective for them.

Combining the use of an MAOI with alcohol can result in a serious condition. If you are taking an MAOI, you should not ingest any substance that contains high levels of the amino acid tyramine.

When tyramine interacts with an MAOI, it can produce a serious cardiac-related event, potentially resulting in significantly increased high blood pressure. This can lead to a hypertensive crisis and cause a stroke or heart attack.

There are many foods that are high in tyramine, like many cured meats and types of cheese. These foods should not be consumed if you are taking an MAOI.

In Addition, High Levels of Tyramine May be Found in Certain Alcoholic Beverages:

  • Sherry or vermouth
  • Red wine
  • Beer, especially homebrewed beer, beer from a tap, and even alcohol-free beer
  • Many liqueurs

Ketamine and Alcohol

Ketamine is classified as a dissociative anesthetic and known to be a significant drug of abuse (Special K) It was recently approved for the treatment of depression that is not effectively addressed by other types of medications.

Its mechanism of action is not fully understood, but it is believed to act by reducing the effectiveness of the excitatory neurotransmitter N-methyl-D-aspirate (NMDA).

Ketamine is known to have hallucinogenic and dissociative effects. In very small doses, such as the dose being used to treat depression, these effects will most likely not occur.

Mixing Alcohol with Ketamine Can be Potentially Dangerous Due To:

  • The enhancement of disorientation and potential psychotic/dissociative experiences.
  • Continual use of both exacerbates cardiovascular damage, liver damage, and brain damage. The approved treatment of depression with ketamine is only for very small doses and very short-term applications.
  • Problems with amnesia, aggression, and muscle rigidity.

Combining Alcohol with Other Antidepressants

Other than ketamine, antidepressant medications do not produce the psychoactive effects that most drug abusers seek. However, all antidepressant medications have a side effect profile.

Side effects associated with using any antidepressant can be exacerbated by alcohol use. The medicinal effects of the antidepressant could also be reduced when you drink.

The side effects that might be exacerbated can include:

  • Sedation and drowsiness. These are common side effects of antidepressants. Drinking can increase the sedative effects of the medications and be potentially dangerous.
  • Dizziness. This may occur with the use of antidepressants. Alcohol can enhance this side effect, resulting in a potentially dangerous issue.
  • Problems concentrating. Various aspects of cognition may be impacted by some antidepressants. Drinking alcohol can further cloud thinking abilities.
  • Confusion. Confusion associated with antidepressant use is typically mild, but alcohol can enhance it, leading to a potentially dangerous situation.
  • Anxiety. Anxiety and even mania can occur with the use of some antidepressants. Alcohol may exacerbate both.
  • Suicidal thoughts. These may increase, particularly in adolescents and children, with alcohol use.
  • Liver damage. Damage to the liver after chronic use of some antidepressants like Cymbalta has been reported. Obviously, alcohol can further increase the potential for liver damage.

Only Use Antidepressants as Prescribed

The instructions on the labels of antidepressants specifically state that you should not drink alcohol when taking these medications.

The above interactions and reactions are some of the potential issues that can occur as a result of combining alcohol and antidepressants. There is also the potential for idiosyncratic effects to happen when a person combines alcohol and their antidepressant.

Thus, there are many reasons why the instructions on the labels of these medications warn against the use of alcohol. Individuals taking antidepressant medications should heed these warnings.

Alcohol Use Disorders

People who chronically abuse alcohol are very likely to also have co-occurring mental health disorders.

The most probable combination is an alcohol use disorder and a recurring major depressive disorder. If you are diagnosed with depression, your alcohol use can exacerbate your depressive symptoms. The exacerbation of depression can spur more alcohol abuse and other drug abuse.

Individuals who are taking antidepressants and chronically abuse alcohol will not receive the full benefits of their antidepressant medication. In fact, they may experience more severe levels of depression.

Even though antidepressant medications are not typically considered to be drugs at risk for serious abuse, the abrupt discontinuation of antidepressant medication can bring on a withdrawal-like syndrome known as antidepressant discontinuation syndrome.

Ensuring Your Safety

If you experience withdrawal symptoms when you stop drinking, you may find that they are significantly enhanced as a result of stopping the use of antidepressants. Consult a physician to ensure your safety before you attempt to stop drinking or using antidepressants.

If you take antidepressants, the best practice is to avoid alcohol. Talk to your doctor if you plan to drink socially while on antidepressants.

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