Antidepressant use is on the rise. In fact, in examining the prescriptions of all ages of Americans, it was found that at least one in every nine people have taken an anti-depressant medication in the last month.
That’s up from thirty years ago, when only one out of 50 people took them.
This data, collected through the National Health and Nutrition Examination Survey (NHANES) and conducted by the Centers for Disease Control (CDC), also showed that antidepressant use in people over 65 has increased from 3 percent in 1988 to over 19 percent in 2014.
It may be that the widespread use of antidepressants has caused people to ignore the contraindications of using alcohol with this class of drugs, but it’s important not to misunderstand the dangers of mixing antidepressants and your evening glass of merlot.
Why You Should Not Mix Antidepressants and Alcohol
There are two simple reasons why you shouldn’t mix antidepressants and alcohol. First, the mixture can worsen your depression symptoms and, second, it’s just plain dangerous.
Let’s take a look at some of the issues surrounding alcohol’s interaction with antidepressants.
The last thing you want is for your depression to get worse.
But research shows that patients who drank alcohol during pharmacological treatment for depression tended to have worse outcomes and were less likely to get relief from their depression.
Furthermore, the level of drinking strongly corresponded to the level of depressive symptoms. Simply put, those who drank more felt more depressed.
Worsened Side Effects
Many people who suffer from depression also take medication for other disorders, most often sleep, anti-anxiety, or pain medications.
These medications often react with alcohol, as do most antidepressants. This means if you’re taking both an antidepressant and another medication that is contraindicated with alcohol, you can double your risk of side effects or make the side effects you’re experiencing twice as serious.
Additionally, some medications — even over-the-counter varieties like NyQuil and other cough and allergy medications — already contain alcohol.
If you’re taking an antidepressant along with an alcohol-containing drug and then you drink on top of that, you’re getting a lot more alcohol than you may think. Given that most antidepressants interact with alcohol, this double dose can boost your risk of adverse side effects.
Dangerous Spikes in Blood Pressure
If you’re taking a special kind of antidepressant known as a monoamine oxidase inhibitor, or MAOI, you’ll definitely want to avoid alcohol.
MAOIs work by reducing the effect of monoamine oxidase on the neurotransmitters in your brain to help you feel more well-adjusted and function more normally.
Examples of MAOIs are:
The problem is monoamine oxidase also helps to regulate your blood pressure by controlling tyramine. When you inhibit monoamine oxidase, you’ll naturally have higher concentrations of tyramine in your blood, which can lead to high blood pressure.
Many forms of alcohol have tyramine present in them, and alcohol has been found to increase tyramine absorption in your body.
The combination of your MAOI antidepressant’s action on tyramine coupled with added tyramine from a source of alcohol plus alcohol’s ability to increase absorption of tyramine can lead to a sudden, dangerous spike in blood pressure.
In fact, so many foods contain a high level of tyramine that doctors recommend people taking a MAOI for depression also follow a low-tyramine diet for extra protection from problems with blood pressure.
Aside from alcohol, examples of foods high in tyramine include:
- Cured meats
- Aged cheese
- Dried fruits
- Processed meats
- Pickled foods
- Sauces like soy and miso
It would not be far-fetched to think that one or more of these foods would be present in your diet along with any alcohol you may consume, increasing the tyramine levels in your body.
It’s no surprise that drinking alcohol can affect your coordination, judgement, and ability to think clearly and rationally.
When you combine antidepressants and alcohol, this increases alcohol’s ability to affect your motor coordination, focus, and rationality.
In some cases, the mix can cause dizziness and sleepiness, while in others, an inability to react quickly in situations that require it, such as driving a motor vehicle or avoiding obstacles while performing daily activities.
Alcohol is well-known to cause sleepiness or drowsiness, and many antidepressants are known to have soporific effects as well.
In fact, several antidepressant medications are used to help people with sleep problems get more restful slumber. They are:
- Trazodone (Desyrel)
- Amitriptyline (Elavil)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
- Trimipramine (Surmontil)
Also, every person has different levels of sensitivity to certain drugs, so what may not cause overwhelming drowsiness in one person may cause another person to be overly sleepy.
The Link Between Antidepressants and Alcohol
Depression itself can be a precursor to alcohol addiction. Studies have found that depressed people tend to drink more and more often than non-depressed individuals.
This means that if you suffer from depression, you could be at risk to develop alcohol dependence. In some cases, alcohol is the depression sufferer’s attempt to self-medicate.
Also, many antidepressants such as Lexapro have been found to contribute to the development of alcoholism. In fact, alcoholism is listed as a side effect for many of these drugs.
If you have a family history of alcoholism or are considered at high risk for developing alcohol dependence, you should seek an antidepressant that does not put you at higher risk for this disorder.
Staying away from alcohol while on an antidepressant will also lower your chances of falling prey to substance abuse.
Sleep and Alcohol
Many depression sufferers also have trouble sleeping at night, and some use alcohol to help them fall asleep. Although alcohol can help you fall asleep, it also contributes to wakefulness later in the night.
In fact, people who consume large amounts of alcohol often struggle with sleep issues, including insomnia.
This is because alcohol interferes with rapid eye movement (REM) sleep, the sleep closely associated with dreaming, increased breath, and rapid pulse.
Alcohol suppresses REM sleep early on, causing you to fall into a deep sleep initially. Later in your sleep cycle, an alcohol-induced sleep results in increased REM, which contributes to broken, non-restorative sleep and even full wakefulness.
In addition, alcohol usage is associated with a higher incidence of sleep apnea, a disorder that causes an obstruction in your breathing passage that causes you to awaken many times during the night. Other studies confirm that alcohol use can cause snoring, which contributes to poor sleep quality.
Paradoxically, poor sleep quality is associated with a higher incidence of depression and anxiety, which is then associated with a tendency toward alcohol dependence.
Antidepressant Types and Alcohol
Different categories of antidepressants react differently with alcohol. Here are some general guidelines.
Selective serotonin reuptake inhibitors (SSRIs)
This group of antidepressants is not usually problematic when combined with small amounts of alcohol, although there are some exceptions, like Lexapro.
Monoamine oxidase inhibitors (MAOIs)
This category of drugs increases the circulation of tyrosine in your body and should not be taken with alcohol. Alcohol contains tyrosine and can increase the effectiveness of tyrosine already present in your body. Increased tyrosine is associated with high, sometimes dangerous, spikes in blood pressure.
Tricyclic antidepressants (TCAs)
TCAs often make patients feel drowsy and uncoordinated, particularly in the first weeks of usage.
You should avoid alcohol while your body gets acclimated to the drug, and you should probably not drink alcohol at all with these.
However, you may be able to tolerate alcohol in small amounts if your health care provider is in agreement.
Putting It All Together
In general, it’s not a good idea to mix alcohol with antidepressant medications.
However, you may be safe to have an infrequent drink while taking antidepressants if you’re not at risk for alcohol dependency and if you aren’t taking other medications that may react poorly with alcohol.
Remember, as your body ages and changes, the way that you metabolize and react to medications can change along with it.
You may need to revisit your use of alcohol when new medications are added to your schedule, when current medication dosages are changed, or if a new medication contains added alcohol.
Before consuming any amount of alcohol, you should always talk to your health care provider to determine if there are side effects or interactions associated with alcohol use and the medications you’re taking.
Keeping your primary doctor informed of changes in your health, medication changes that may have been prescribed by another physician, or even concerns about alcohol dependency is of utmost importance.
Your doctor is best qualified to guide your actions regarding the use of antidepressants and alcohol as it fits your individual lifestyle and health profile.