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Antidepressants and alcohol: effects and consequences of their combination

Antidepressants and alcohol: effects and consequences of their combination

June 17, 2024

The relationship between the simultaneous use of antidepressants with other psychotropic substances, such as alcohol , has been recently studied by different specialists. This is because the frequent use of alcohol is a common practice in people who have a diagnosis of depression, as well as depression is a frequent phenomenon in people who have alcoholism.

In this article we will see what are the mechanisms of action of both antidepressants and alcohol, as well as some of the effects and consequences of combining both substances.

  • Related article: "Types of antidepressants: characteristics and effects"

Antidepressant drugs and alcohol: mechanisms of action

The prescription of antidepressant drugs starts from considering that depression is characterized by a decrease in the levels of serotonin (neurotransmitter associated with the activation of pleasurable emotions).

Thus, antidepressants have the main objective of compensating for this decrease by means of ensure that serotonin concentrates longer in the synaptic space . This compensation can in turn favor the concentration of other substances and, depending on what they are, the adverse effects of antidepressants can increase or decrease.

The main types of antidepressants are the following:

  • Inhibitors of the enzyme MonoAmino Oxidase (MAOI), which may have an irreversible or reversible effect, and whose use is recommended only in cases where there is no response to another treatment, because of its high risk to health .
  • Tricyclic and Tetracyclic antidepressants, which prevent the reuptake of serotonin, but also of noradrenaline, as well as other substances such as acetylcholine.
  • Selective Inhibitors of Serotonin Recapture (SSRI). It is the most used antidepressant currently because its adverse effects are less than in the other psychotropic drugs.
  • Selective Inhibitors of Reuptake of Serotonin and Noradrenaline (ISRN), such as tricyclics, prevent the recapture of both neurotransmitters , and yet have less risk of adverse effects.
  • Antagonists and Inhibitors of Serotonin Reuptake (AIRS) that also have hypnotic effects.
  • Selective Inhibitors of Catecholamines Reuptake (adrenaline, noradrenaline, dopamine).

How does alcohol work?

On the other hand, alcohol is a chemical substance that has different uses and that is present in several organisms and natural compounds. Ethyl alcohol, also known as ethanol , is the psychoactive substance found in alcoholic beverages for recreational use, such as wine, liquor or beer.

Its main effect is central nervous system depression, since it produces a neurochemical inhibition in GABAa receptors. In a high consumption, and as a depressant, ethanol has consequences as behavioral disinhibition combined with states of euphoria, drowsiness, dizziness , low reflexes, slow down movements, decreased vision, among others.

Its effects are very similar to those that produce psychotropic drugs such as benzodiazepines and barbiturates, since they act on the same neuronal receptors.

That said, we can describe some of the main effects that can cause the combination of antidepressant drugs with alcohol consumption .

Effects and consequences of their combination

As we have seen, the consumption of alcohol in depression is common, however, its interaction with antidepressants in people who have the diagnosis has been little studied, except in those who have a problematic consumption of alcoholic beverages.

In these studies it has been seen that the combination of antidepressants and alcohol generates an enhancement of the effects that alcohol produces on its own. For this reason, the mixture of alcohol with different antidepressants is contraindicated . Below we will list in more detail some of the main reasons.

1. Enhance the sedative action

The clearest and best known effect of the combination of antidepressants with alcohol is the high probability of increasing its depressant or sedative effects on the central nervous system. The latter occurs both in the case of SSRIs (for example, duloxetine, floxamine, fluoxetine or citalopram), as in the case of tricyclic and tetracyclic antidepressants (such as imipramine or mirtazapine).

The consequence of the above is an increase in the experience of symptoms of depression in the medium term, as well as a prolonged decrease in alertness, coordination, motor skills, and a significant increase in sleepiness.

Also, the combination of alcohol and SSRI antidepressants, such as venlafaxine, and related medications, has been associated with a change in alcohol tolerance , and with the exacerbation of the behavioral effects that the latter produces, such as the disinhibition of violent and sexual behavior together with a deteriorated memory.

2. Interfere in the metabolism of alcohol

Especially when it comes to MAOI antidepressants, alcohol is contraindicated, because these drugs inhibit the oxidative activity of hepatic microsomal enzymes, which interfere in the metabolization of chemical compounds such as ethanol; but also with the metabolism of caffeine, analgesics, barbiturates and other antidepressants.

At the same time, this makes psychotropic effects potentiate of the substance with which it is mixed (both ethanol and the aforementioned drugs). Because MAOIs interact with different substances that are easily found in food and beverages, it is important to take precautions with what is consumed. Improper mixing can cause increased blood pressure and severe adverse reactions.

3. Increase the risk of adverse effects of the drug

As with many other medications, mixing antidepressants with alcohol increases the likelihood of suffering the adverse effects associated with the medication. For example, important states of anxiety, sleep disorders, and damage to various organs .

4. Sleep disturbances

Because alcohol causes drowsiness, and sometimes depression has as a characteristic difficulty in falling asleep, drinking alcoholic beverages becomes a common resource. However, it is a short-term effect, because although alcohol consumption can cause a rapid sleep, It is also common to alter the circadian rhythms and provoke waking states at midnight.

Use of antidepressants in the treatment of alcoholism

As we have said, alcoholism and depression are phenomena that are often accompanied. In addition to this, Different symptoms caused by alcoholism have been treated by pharmacological prescriptions diverse

Although the use of anxiolytics is more frequent, considering that anxiety is one of the main causes of alcoholism, the use of antidepressants in phases of detoxification in alcoholism treatments has recently been studied. This phase is what is to eradicate the psychological dependence on alcohol.

For example, trazodone, which is an antagonist and inhibitor of serotonin reuptake It is used for the treatment of chronic alcoholism . Likewise, venlafaxine (sometimes combined with fluoxetine), which are selective inhibitors of serotonin reuptake, is used to treat different types of alcoholism.

Bibliographic references:

  • Hall-Flavin, D. (2018). Why is it bad to mix antidepressants and alcohol ?. Mayo Clinic Retrieved August 15, 2018. Available at //
  • Gutiérrez, J.A., Torres, V.A., Guzmán, J.E. et al (2011). Pharmacological Therapeutics Antidepressants Aten Fam 18 (1): 20-25.
  • Herxheimer, A. and Menkes, D. (2011). Drinking alcohol during antidepressant treatment- a cause for concern ?. The Pharmaceutical Journal. Retrieved August 15, 2018. Available at // .
  • Dualde, F. and Climente, M. (2006). Chapter 03: Antidepressants, pp. 93-147. In Manual of Psychopharmacology. Retrieved August 15, 2018. Available at //
  • Rubio, G., Ponce, G., Jiménez-Arrieto, M.A., et al (2002). Treatment of depressive disorders in alcohol dependent subjects. 3rd Virtual Congress of Psychiatry, Interpsiquis, pp. 1-18.
  • Rubio, P., Giner, J. and Fernández, F.J. (nineteen ninety six). Antidepressant treatment in alcoholic patients in the phase of detoxification. Journal of the Chair of Medical Psychology and Psychiatry, 7 (1): 125-142.

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