Alcohol and Antidepressants: Why Mixing Them Is Dangerous and What to Do if You’ve Been Drinking

Why Alcohol and Antidepressants Should Not Be Combined

Ethanol acts on the same brain systems that antidepressants and other psychotropic medications affect: the GABA, glutamate, serotonin and dopamine systems. In small amounts it brings brief relaxation, but this is followed by a rebound — increased anxiety, low mood and irritability, and worse sleep. That is why, in depression, alcohol works against treatment: a person takes medication to stabilize their mood, and alcohol knocks it off balance.

The second reason is pharmacological interaction. Alcohol and many antidepressants are metabolized in the liver, and taking them together can change the concentration of the drug in the blood, strengthen or weaken its effect, and increase the strain on the liver. Most antidepressants cause some degree of drowsiness or dizziness, and alcohol amplifies these effects. The patient information leaflets for antidepressants almost always advise avoiding alcohol.

Alcohol Makes Depression Worse

Regular drinking is one of the factors that keep depression going, make it resistant to treatment and increase the risk of relapse. Sleep is disrupted, energy drops and feelings of guilt intensify. Many patients notice that after giving up alcohol their mood becomes noticeably more stable and the effect of their medication becomes clearer.

Risk of Suicidal Behavior

Intoxication reduces self-control and increases impulsivity. In depression, especially during the first weeks of treatment, this combination is dangerous: thoughts that a person could manage while sober may turn into actions under the influence of alcohol. That is why avoiding alcohol during treatment for depression is a matter not only of effectiveness but also of safety.

The Dangers of Combining Alcohol With Different Classes of Antidepressants

The risks vary depending on the class of medication, the dose, how much is drunk and the person’s health. General patterns are listed below, but only your doctor can tell you the specific restrictions for your treatment. Do not conclude that if your medication belongs to a “safer” class, you can drink without consequences: alcohol’s effect on depression remains the same with any treatment.

• Selective serotonin reuptake inhibitors (SSRIs): increased drowsiness, dizziness and anxiety, worsening mood
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): extra strain on the liver, blood pressure fluctuations
• Tricyclic antidepressants: marked sedation, drop in blood pressure, heart rhythm disturbances
• MAO inhibitors: risk of a hypertensive crisis with drinks containing tyramine, such as some types of beer and wine
• Antidepressants with a sedative effect: severe drowsiness, impaired coordination, suppressed breathing with large amounts of alcohol
• Combination with tranquilizers and sleeping pills: dangerous suppression of consciousness and breathing

What to Do if You Have Been Drinking While Taking Antidepressants

If you have had a small amount of alcohol and feel fine, do not panic, but take note: do not skip your next dose or double it, do not take any extra sleeping pills or sedatives, and avoid driving and hazardous activities. Drink water, rest and, if possible, do not stay alone. Be sure to tell your doctor what happened at your next appointment: this is important information for adjusting your treatment.

If after drinking you develop marked drowsiness, confusion, severe dizziness, a racing or irregular heartbeat, a sudden severe headache, high blood pressure, difficulty breathing, seizures or thoughts of not wanting to live, this is an emergency. Call 103 or 112 and tell them which medication you take and how much you drank. Do not stay alone until the medical team arrives.

1. Do not skip or double your antidepressant dose on your own
2. Do not take extra sleeping pills, sedatives or painkillers
3. Do not drive or do hazardous work
4. Drink water and rest; if possible, stay with someone close to you
5. Tell your doctor what happened at your next consultation
6. If you have worrying symptoms, call 103 or 112

Why You Should Not Stop Antidepressants in Order to Drink

Sometimes people skip a dose before a celebration or stop treatment altogether so they can “drink in peace.” This is a mistake with a double risk. Stopping many antidepressants abruptly causes discontinuation syndrome: dizziness, nausea, irritability, sleep problems, “brain zaps” (electric shock–like sensations) and anxiety. In addition, a break in treatment increases the risk of depression returning, and alcohol on top of that destabilizes mood even more.

Many antidepressants work cumulatively, and skipping a single dose does not “clear” your system by the evening. If you have an event coming up where it will be hard to turn down alcohol, discuss it with your doctor in advance. The specialist will advise you on how to stay safe and help you prepare what to say to others. The decision to stop treatment is made only together with your doctor, with the dose reduced gradually.

If It Is Hard to Go Without Alcohol: Depression and Addiction Together

Depression and problem drinking often go hand in hand. A person drinks to drown out sadness, anxiety and insomnia, and over time alcohol makes exactly these symptoms worse. ICD-10 and DSM-5 distinguish both alcohol-induced depression and the combination of independent depression with an alcohol use disorder. A doctor can tell them apart by assessing when the symptoms appeared and how they change during periods of sobriety.

If you notice that you cannot give up alcohol for the duration of treatment, drink more than you planned, or drink to fall asleep or calm down, tell your psychiatrist honestly. In such cases, treatment is more effective when both a psychiatrist and an addiction specialist are involved: depression is treated at the same time as the addiction is addressed, including, if necessary, safely stopping drinking. Psychotherapy, especially cognitive behavioral therapy, helps with both conditions.

How Psychiatry Online Helps With Depression and Alcohol Problems

During an online consultation, the psychiatrist assesses the course of depression and the effect and tolerability of medications, and honestly discusses alcohol use with the patient without judgment. If needed, an addiction specialist joins in to assess the pattern of drinking and withdrawal risks and propose a plan. This coordinated approach avoids treating depression and addiction separately and reduces the risk of dangerous combinations.

The online format is convenient for regular follow-up: you can quickly tell your doctor about side effects, a relapse or a worsening of mood. If binge withdrawal treatment, an IV drip or tests are needed, the doctors will arrange a home visit or a hospital referral. Consultations are anonymous, and information is protected by medical confidentiality. We are honest about what can be handled online and what requires an in-person examination.

When to see a doctor

• You are taking antidepressants and cannot give up alcohol
• After drinking during treatment, your mood has worsened or your anxiety has increased
• You skipped or stopped your medication on your own in order to drink
• You have developed marked side effects after combining alcohol and medication
• You drink to fall asleep, calm down or drown out sadness and anxiety
• Your loved ones say you have started drinking more since your depression and treatment began

Questions and answers

Reviewed by

Assel Omarova, MDPsychiatrist and addiction specialist

Addiction combined with depression and anxiety, crisis states, online consultations for families.