Q: I recently started taking an S.S.R.I. antidepressant, but I have been confused about whether it’s safe to drink alcohol. Some internet sources say it’s fine, others say to avoid drinking completely. Help!
For many health care providers who treat anxiety and depression, the concern about whether it’s safe — or even advised — to drink alcohol while taking an antidepressant is a common one. “Patients tell me all the time, ‘I’m going to be drinking with friends tonight, so I skipped a dose,’” said Dr. Sarah Ramsay Andrews, a psychiatrist at the Johns Hopkins University School of Medicine.
But skipping a dose is never a good idea, said Dr. Jody Glance, an addiction medicine specialist at the University of Pittsburgh Medical Center Western Behavioral Health — even if you’re going out for cocktails with friends. “When people stop taking their medicines for a day or two, they often don’t resume, and that can lead to a relapse of anxiety or depression.”
Besides, she added, how safe it is to drink while on antidepressants depends on the kind of antidepressant you’re taking — and for most people taking selective serotonin reuptake inhibitors (or S.S.R.I.s), an occasional drink likely won’t do much harm. There are, however, caveats to keep in mind.
S.S.R.I. medications — which include citalopram (Celexa), sertraline (Zoloft) and escilatopram (Lexapro) — are the most commonly prescribed class of antidepressants. They are typically used to help treat depression, and can also be effective for other conditions like anxiety, obsessive compulsive disorder, certain phobias and even premenstrual dysphoric disorder. They work by increasing the levels of the brain chemical serotonin — which is thought to influence your mood and emotions, among other things — by blocking its removal after it carries messages in the brain.
But unlike many other medications used to treat mood disorders — like the anxiety medication alprazolam (Xanax) or the tricyclic antidepressant amitriptyline (Elavil) — S.S.R.I.s are less likely to interact with alcohol than other kinds of drugs, Dr. Glance said.
That being said, it’s still important to limit your drinking while taking medications for depression or anxiety, she added.
While alcohol can temporarily ease anxiety and lower inhibitions, it can also trigger activity in the brain that can worsen symptoms of depression or anxiety.
“If someone is drinking heavily, it’s not going to allow the antidepressant to work as effectively,” Dr. Andrews said.
Combining alcohol with S.S.R.I.s can also amplify the medication’s side effects and intensify sensations such as drowsiness, fatigue or dizziness, she added. “I’ve had patients who said one drink feels more like two. Alcohol might hit you harder, and not in that pleasant euphoric way, but in that tired mopey way.”
Consuming more than is recommended by the current U.S. dietary guidelines for alcohol — two drinks or less per day for men, one drink or less per day for women — might interfere with your goals of improving your depression or anxiety symptoms, Dr. Andrews said.
As of now, there isn’t much evidence, if any, that an occasional drink while on S.S.R.I.s can cause harm. But we know less about how regularly drinking more than recommended amounts can affect you in the long run — a subject that needs more research, Dr. Glance said.
The idea that you shouldn’t mix alcohol with antidepressants comes from past research on older antidepressants that are now prescribed less frequently. “The message of, ‘Don’t drink while taking an antidepressant,’ is based on the odds of an increase in sedation, but this was based on older medicines like tricyclic antidepressants,” Dr. Glance said.
People who can’t take — or who aren’t benefiting from — S.S.R.I.s might still be prescribed tricyclic antidepressants or other classes of antidepressant drugs that may interact with alcohol. Drinking on monoamine oxidase inhibitor antidepressants (or MAOIs), for instance, can lead to dangerous spikes in heart rate and blood pressure that could require hospitalization, Dr. Glance said. “If you’re taking an MAOI, you shouldn’t be drinking alcohol at all.”
Another commonly prescribed antidepressant called bupropion (Wellbutrin) can potentially increase the risk of seizures when combined with too much alcohol.
In the end, Dr. Glance said, the best advice to follow is the same for any medication you might be taking: “Know what class of medication you’re taking, and talk to your doctor about alcohol use.”
Jyoti Madhusoodanan is an independent journalist based in Portland, Ore.
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