Drug interactions are an important public health topic. That is because the effects of combining certain drugs and substances can be harmful, even leading to addiction, and because many people are unaware of the risks and dangers of such combinations. Two drugs that, when used in combination, can cause potentially risky interactions are alcohol and anxiety medications. In fact, antidepressants and alcohol are especially dangerous when combined.
How Commonly Are Antidepressants and Alcohol Combined?
Research published in the Canadian Journal of Public Health found that among adults in Ontario, Canada, who participated in a repeat, cross-sectional telephone survey, in 2017, about nine percent reported using antidepressants in the past year. The research found that, overall, problem drinkers were 1.5 times more likely to drink and use antidepressants in the past year. The multi-year study also found that antidepressant use in the past year increased from 1999 to 2017. Interestingly, researchers noted that problem drinking in the past year among women (but not men) is associated with antidepressant use in the past year.
Anxiety Medication Is a Catch-All
It’s common to refer to the term anxiety medication when talking about prescription medicine that a doctor orders for someone living with anxiety. However, in society today, there isn’t a single medication for anxiety treatment. Doctors prescribe medication depending on the type of anxiety disorder. Also, the doctor may prescribe a medication intended to manage the anxiety, or as a cure. Someone with anxiety may be prescribed distinct types of medication to treat the disorder. The use of the term “anxiety medication,” then, is a catch-all. Among the groups of anxiety treatment medications, the effects of each are quite different.
Antidepressants are the most common anxiety medication prescribed by doctors. They are believed to work by increasing specific neurotransmitters like serotonin in the brain. Serotonin levels affect how a person feels.
Antidepressants typically include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), and tricyclic antidepressants. Lexapro, Paxil, Zoloft, and Celexa are brand names of SSRIs prescribed in the treatment of chronic anxiety. Effexor and Cymbalta are SNRI brand names. SNRIs work to slow the breakdown of the brain chemicals serotonin and noradrenaline. In tricyclic antidepressants, the main working mechanism is a three-ring chemical structure.
These anxiety medications are taken daily whether there are symptoms or not. Temporary side effects include restlessness, nausea, headaches, disturbances in sleep, and some sexual issues.
Antihistamines and Beta-Blockers
A doctor may prescribe an antihistamine such as hydroxyzine for mild anxiety, or a beta-blocker such as propranolol. These anxiety medications may also be prescribed to treat a form of social anxiety known as performance anxiety. They are taken only as needed, not daily.
Medications such as gabapentin and pregabalin (Neurontin and Lyrica, respectively) are also prescribed to treat some forms of anxiety. Research shows they are beginning to hold promise as an effective anxiety treatment.
Buspirone is a non-benzodiazepine drug in a class called anxiolytics that may be prescribed as a short-term treatment to reduce the symptoms of anxiety. While Buspirone is not addictive like benzodiazepines, the drug’s side effects can include headache, numbness, nervousness, nausea, diarrhea, dizziness, excitement, feelings of anger and hostility, lightheadedness, weakness, and increased sweating. Serious side effects include hallucinations, irregular heartbeat, uncontrollable shaking, hives, rash, blurred vision, twitching, seizures, allergic reactions, loss of coordination, and vomiting.
When someone has been prescribed a benzodiazepine to treat acute anxiety, the medication may produce side effects that can be debilitating. Since benzodiazepines (“benzos” for short) slow down the brain’s neural activity, they may reduce the anxiety condition but initiate undesirable effects in the process. These include memory loss and difficulties with cognitive function, confusion, depression, drowsiness, fatigue, impaired coordination, irritability, and slurred speech. Xanax, Ativan, Klonopin, Valium, and Librium are brand names of benzodiazepines.
Can You Drink on Anxiety Meds?
After popping a prescription pill meant to address diagnosable anxiety, many people casually chase it with alcohol. They never give thought to the serious question of “can you drink on anxiety meds?”
Does alcohol help anxiety? In the short term, alcohol helps dull anxious thoughts and feelings. That’s because alcohol is a depressant. The use of the substance slows down racing thoughts and makes worries seem less urgent. It does nothing to eliminate the source of the anxiety, however, and once the effects of the alcohol dissipate, the anxiety returns with a more pronounced effect.
Some people who repeatedly use alcohol to help cope with anxiety experience more anxiety when they know that the effects of the alcohol are wearing off.
Alcohol’s Effects on Anxiety
Research shows that alcohol tends to worsen existing symptoms of anxiety. That’s because alcohol changes levels of serotonin and other brain chemicals (neurotransmitters). Once the effects of the alcohol begin to wear off, and the blood alcohol content (BAC) drops, an individual’s anxiety can start to increase with the result that they feel more anxious than before drinking. This state of alcohol-induced anxiety, sometimes called “hangxiety,” can persist from several hours to a whole day following drinking. Thus, alcohol can either increase or cause anxiety both during its withdrawal from the body and within the time period that the person is drinking.
How Anti-Anxiety Meds and Alcohol May Interact
If alcohol increases anxiety, how do anti-anxiety medications combined with alcohol interact? There are significant dangers in combining alcohol and anxiety medication. Here is a look at some of the interactions.
Antidepressants and Alcohol
People prescribed antidepressants are urged to avoid drinking or limit alcohol intake when taking the drug. The combination of antidepressants and alcohol can increase the side effects affecting the central nervous system such as confusion, difficulty concentrating, dizziness, and drowsiness. Anyone taking antidepressants and drinking should not drive a vehicle or operate heavy machinery. Some antidepressants combined with alcohol increase seizure risk, cause liver damage, unconsciousness, or high blood pressure.
Anxiolytics and Alcohol
Taking alcohol and an anxiolytic such as Buspirone compounds the drowsiness effect of the drug. For this reason, people taking Buspirone are cautioned not to drink alcohol.
Antihistamines and Alcohol
Mixing antihistamines and alcohol can cause drowsiness, loss of coordination, headaches, nausea, and vomiting. Reduction in awareness and alertness can also occur. There is also an increased overdose risk from combining antihistamines and alcohol.
Anticonvulsants and Alcohol
Anticonvulsants mixed with alcohol tend to enhance the effects on the central nervous system, specifically increasing drowsiness. Other negative side effects may occur from the combination of the drug with alcohol, depending on the anticonvulsant used.
Benzodiazepines and Alcohol
During stressful times, it’s common for people who’ve had problems managing stress to take a prescribed benzodiazepine like Xanax to relax and help them deal with insomnia associated with stress. But Xanax, like other benzodiazepines, is a psychoactive sedative that slows down the body’s central nervous system and lowers brain activity. Benzodiazepines are often prescribed to treat anxiety, insomnia, and sometimes seizures.
Mixing benzodiazepines and alcohol can prove to be a deadly combination. Both are depressants and synergistically work to depress or slow down the central nervous system. Taken together, there’s a greater likelihood of impairment with memory. Individuals taking high doses of benzos or who continue to take the medication for a long time run the risk of significant memory impairment as well as mood swings and changes in behavior.
Long-time benzodiazepine users develop a tolerance for the drug, meaning they must take more of it more often to achieve the desired effects. Tolerance can lead to benzodiazepine addiction. Combining alcohol with benzos makes the serious side effects of each more pronounced.
When It May Be Time to Seek Help
Are you mixing antidepressants and alcohol, either purposefully or to self-medicate? If so, it may be time to seek help. At FHE Health, we’re experts at treating anxiety disorders and alcohol addiction, either alone or as a co-occurring mental health disorder and substance use disorder. For trusted and confidential information about treatments that can help you reclaim a healthy and productive life, contact us today.