The Dangers of Mixing Antidepressants and Alcohol

Updated 10/16/2024

Most people are unfamiliar with the side effects of drinking while taking antidepressants. Many misguidedly believe that the depressant effects of alcohol simply counteract the antidepressant effects of SSRIs, SNRIs, and MAOIs. Nothing could be further from the truth. Understanding why the combination of antidepressants and alcohol is harmful to your physical and mental health begins with understanding the mechanism of action for both these substances.

Alcohol Is a Powerful Nervous System Depressant

Two beers or one mixed drink is enough to alter brain levels of serotonin, dopamine, and other neurotransmitters involved in mood, motivation, and inhibition. A lesser neurotransmitter called glutamate is responsible for increasing brain activity levels. Alcohol interferes with glutamate release, causing a drastic slowdown of all brain regions.

Alcohol also increases the inhibitory effects of GABA, a neurotransmitter implicated in decreasing energy and calming the nervous system. Similar to anti-anxiety prescription drugs like Valium and Xanax, which increase GABA levels to produce sedation, alcohol works to cause slurring speech, loss of coordination, drowsiness, and other signs of intoxication.

Understanding the Mechanism of Action of Antidepressants

The most common type of antidepressants prescribed are called selective serotonin reuptake inhibitors (SSRIs). Lexapro, Prozac, Paxil, and Zoloft are the most well-known SSRIs and are taken by millions of people in the U.S. for depression, anxiety, obsessive-compulsive disorder, PTSD, and panic disorder.

SSRIs increase serotonin levels in the brain by blocking the reuptake (reabsorption) of serotonin by brain cell receptors. Serotonin is a neurotransmitter that controls mood, motivation sleep, appetite, and libido. People with depression and anxiety have lower than normal levels of serotonin in their brain. SSRIs effectively raise serotonin to improve mood and relieve depression.

Some SSRIs also increase norepinephrine, a neurotransmitter that plays an important role in mood and cognition. People are prescribed serotonin norepinephrine reuptake inhibitors (SNRIs) when SSRIs do not provide enough relief from depression and anxiety.

Drinking and Antidepressants: What Happens When You Mix Zoloft and Alcohol?

When you drink alcohol and take Zoloft or another SSRI, you will likely feel more depressed, anxious, and impaired than if you were drinking alcohol by itself.

In addition, alcohol directly counteracts what SSRIs are formulated to do–moderate brain chemistry to make you feel better. Although mixing alcohol with antidepressants may significantly improve your mood at the time, alcohol inhibits the ability of SSRIs to produce long-term, therapeutic benefits.

Signs of alcohol intoxication, such as impaired thinking and judgment, delayed reaction time, loss of coordination and motor skills, and sedation, can significantly intensify when you mix antidepressants and alcohol. Doctors call this condition “pathological intoxication,” a type of markedly severe intoxication that involves a person behaving in an uncharacteristically violent or aggressive manner. Combining antidepressants like Prozac and alcohol have been known to cause people to become pathologically intoxicated, even though they may have had only one or two drinks.

Serotonin Syndrome and the Dangers of Mixing Alcohol and Antidepressants

Drinking alcohol causes a temporary boost in serotonin. People taking SSRIs undergo continual release of extra serotonin in the their brain to maintain mood improvement. Combing alcohol and Prozac or other antidepressants can cause serotonin syndrome, a potentially life-threatening condition resulting from too much serotonin in the brain.

Symptoms of serotonin syndrome after drinking alcohol while taking antidepressants include:

• Feeling restless, agitated and extremely nervous
• High blood pressure
• Muscle twitching/muscle spasms
• Stomach cramps, diarrhea, nausea and vomiting

If a person develops a high fever, heart arrhythmia/irregular heartbeat, seizures or unconsciousness following an emergence of initial symptoms, they should be taken to an emergency room for treatment.

Wellbutrin and Alcohol

What makes Wellbutrin different from other antidepressants is that Wellbutrin is formulated to provide more stimulating effects than the moderating effects of traditional antidepressants like Prozac or Zoloft. Instead of increasing serotonin levels, Wellbutrin raises norepinephrine and dopamine levels in the brain.

Dopamine is a neurotransmitter produced in the ventral striatum, a brain area regulating motivation, reward, and how we experience pleasure. While dopamine can help improve mood and relieve depression, this same neurotransmitter is largely responsible for the process of becoming addicted to alcohol and drugs. Hundreds of research studies using neuroimaging techniques show that within a short time of drinking alcohol, most adults have twice as much dopamine in their brain as they did prior to drinking.

When Wellbutrin and alcohol are mixed together, dopamine can flood the brain, potentially causing symptoms resembling psychosis, a serious mental condition that requires hospitalization. If you combine Wellbutrin and alcohol, you could experience auditory and sensory hallucinations, paranoid or grandiose delusions, an inability to distinguish what’s real from what’s not real, and an inability to speak coherently.

Are There Any Alcohol-Safe Antidepressants?

All antidepressants react similarly to alcohol by worsening side effects of both substances. The National Alliance on Mental Illness reports that some physicians allow patients taking antidepressants to have one drink per day, such as a five-ounce glass of wine or a 12-ounce beer. The NAMI also states you should eat food with an alcoholic drink to reduce the affects of alcohol.

However, the psychological health problems of mixing alcohol and antidepressants remain. For people struggling with mental health conditions including major depression or anxiety disorder, drinking while taking antidepressants increases their risk for developing a drug or alcohol addiction. Once the mood-improving effects of alcohol fade away, they are left with nothing but the dulled effects of their antidepressant. This is why drinking while taking SSRIs or SNRIs can lead to worsening symptoms of  depression and anxiety that may ultimately result in suicidal thoughts and behaviors.

One meta-review study found that combining antidepressants and alcohol is “likely to lead to deaths related to antidepressant use.” Researchers further report that nearly 80 percent of antidepressant-related deaths were suicides. This is not surprising since mixing alcohol and antidepressants is known to have the potential of inducing violent behavior and aggression by dramatically reducing judgment and inhibitions.

If You are Deliberately Combining Antidepressants and Alcohol, It Could Be Time to Seek Professional Help

Drinking alcohol while taking antidepressants because you feel more depressed and anxious could mean you are becoming dependent on alcohol. Withdrawal symptoms such as nausea, vomiting, muscle tremors, headache, and aching joints are signs of a possible, growing alcohol dependence that demands medical treatment as soon as possible.

If you or someone you know is mixing antidepressants and alcohol, FHE can help. We offer individualized addiction and mental health treatment programs to address each person’s unique needs and would be glad to answer any questions.