Antidepressants and Alcohol Interactions
Introduction
You should usually avoid or limit alcohol use if you're taking an antidepressant. Depression medicines mixed with alcohol may increase central nervous system (CNS) side effects, like dizziness, drowsiness, confusion and trouble concentrating. Check with your healthcare provider before you mix the two.
When taking an antidepressant you should avoid activities that requiring mental alertness, such as driving or operating hazardous machinery, until you know how the antidepressant affects you. Alcohol use may also worsen your depression, anxiety, mood or behavior.
Why are antidepressants prescribed?
Antidepressants are a large group of medications used to treat many different health conditions. Not all of these conditions are mental health conditions.
Some of the more common conditions treated by antidepressants include:
- Major depressive disorder
- Generalized anxiety disorder
- Seasonal affective disorder
- Social anxiety or social phobias
- Obsessive-compulsive disorder
- Post-traumatic stress disorder (PTSD)
- Eating disorders like bulimia
- Panic attacks
- Diabetic nerve pain
- Muscle and joint pain (like back pain or osteoarthritis)
Antidepressants work by altering levels of neurotransmitters in the brain to cause an enhanced effect on depressed mood and symptoms such as anxiety, insomnia (sleep problems), and suicidal thoughts. Neurotransmitters (brain chemicals) targeted by antidepressants include serotonin, dopamine, gamma-aminobutyric acid (GABA) or norepinephrine.
Some drugs used for depression may lead to serious side effects when combined with alcohol, for example:
- Zulresso is used for severe postpartum depression. It should NOT be used with alcohol due to a risk for dangerous sedation or unconsciousness.
- When antidepressants from the monoamine oxidase inhibitors (MAOIs) class are combined with alcoholic beverages high in tyramine, serious heart-related effects, such as dangerous high blood pressure can occur.
- Bupropion (Aplenzin, Forfivo XL, Wellbutrin XL), a common oral antidepressant or treatment for seasonal affective disorder, should NOT be combined with alcohol due to the risk for seizures.
- Certain antidepressants, such as duloxetine (Cymbalta, Drizalma Sprinkle) may cause liver damage, and taking it with alcohol may increase that risk.
Always check the warnings and interactions in the labeling for your antidepressant. You can always ask your pharmacist if you can take your medicine with alcohol if you aren't sure. And never abruptly stop taking an antidepressant unless directed to do so by your doctor.
There are several types (classes) of antidepressants, but they all work a bit differently:
- Tricyclic antidepressants (TCAs)
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Monoamine oxidase inhibitors
- Phenylpiperazine antidepressants
- Tetracyclic antidepressants
- Miscellaneous antidepressants
It’s important to remember that certain dietary supplements like St. John’s wort, an over-the-counter herbal supplement often used for symptoms of depression, may have drug interactions as well. Side effects such as dizziness, drowsiness, and difficulty concentrating can occur when mixed with alcohol. Avoid or limit the use of alcohol while being treated with St. John's Wort.
Some liquid medications, such as NyQuil or other cough syrups, may also contain alcohol. Review the ingredient labels on OTC products to see active and inactive ingredients.
Always check with your healthcare provider or pharmacist for possible drug interactions.
Learn More: Review your medications with the Drugs.com Drug Interaction Checker
Table 1. Common Antidepressants
| Generic Name | Brand Name |
|---|---|
| aripiprazole | Abilify |
| amitriptyline | not available |
| brexanolone | Zulresso |
| bupropion | Aplenzin, Forfivo XL, Wellbutrin XL, Wellbutrin SR |
| citalopram | Celexa |
| clomipramine | Anafranil |
| desipramine | Norpramin |
| desvenlafaxine | Pristiq |
| duloxetine | Cymbalta |
| escitalopram | Lexapro |
| esketamine | Spravato |
| fluoxetine | Prozac |
| fluvoxamine | Luvox |
| levomilnacipran | Fetzima |
| mirtazapine | Remeron, Remeron SolTab |
| nefazodone | not available |
| paroxetine | Paxil |
| risperidone | Risperdal |
| sertraline | Zoloft |
| St. John’s wort | Dietary Supplement / Herbal Product |
| trazodone | Desyrel |
| venlafaxine | Effexor, Effexor XR |
| vilazodone | Viibryd |
| vortioxetine | Trintellix |
MAOIs
Monoamine oxidase inhibitors (MAOIs) are a class of antidepressants typically reserved to treat depression that is not responding to other medications, but they can cause serious interactions. MAOIs are not frequently prescribed, but can be important treatments for patients who fail other treatments for depression.
During and within two weeks after treatment with MAOIs, you must NOT consume any foods or beverages that are high in tyramine content. When MAOIs are combined with alcoholic beverages high in tyramine, serious heart-related effects, such as dangerous high blood pressure (called a hypertensive crisis), may occur. Many foods may be high in tyramine as well, like such as aged cheeses and cured meats.
Alcoholic beverages that are high in tyramine content include:
- red wine
- beer, especially tap or home-brewed
- sherry, vermouth
- liqueurs
- alcohol-free and reduced-alcohol beer can even have small amounts of tyramine
Learn More: MAOIs and diet: Is it necessary to restrict tyramine?
Common Monoamine Oxidase Inhibitors (MAOIs)
| Generic Name | Brand Name |
|---|---|
| isocarboxazid | Marplan |
| phenelzine | Nardil |
| tranylcypromine | Parnate |
| selegiline | Emsam |
*Note: These tables may not be complete lists; always check with your pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the other medications you use including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products.
Types of Drug Interactions With Alcohol
- ADHD Medications and Alcohol
- Allergies, Cough/Cold Medications and Alcohol
- Antibiotic Medications and Alcohol
- Antipsychotic Medications and Alcohol
- Anxiety Medications and Alcohol
- Bipolar Medications and Alcohol
- Birth Control Pills and Alcohol
- Blood Thinners and Alcohol: A Dangerous Mix?
- Caffeine, Energy Drinks and Alcohol
- Can You Mix Weight Loss Drugs and Alcohol?
- Cholesterol Medications and Alcohol
- Diabetes Medications and Alcohol
- Enlarged Prostate (BPH) Medications and Alcohol Interactions
- Erectile Dysfunction Medications and Alcohol
- Heart Medications and Alcohol
- Herbal Supplements and Alcohol
- Illicit Drugs and Alcohol Interactions
- Is it safe to drink alcohol with acne medicines?
- Motion Sickness Drugs and Alcohol Interactions
- Pain / Fever Drugs and Alcohol Interactions
- Seizure Medications and Alcohol Interactions
- Should you mix muscle relaxants with alcohol?
- Stomach / Heartburn Medications and Alcohol
- What are the dangers of mixing sleeping pills with alcohol?
Learn more
Treatment options
Care guides
Symptoms and treatments
Medicine.com guides (external)
Sources
- Herxheimer A, Menkes D. Drinking alcohol during antidepressant treatment — a cause for concern? https://www.pharmaceutical-journal.com/news-and-analysis/drinking-alcohol-during-antidepressant-treatment-a-cause-for-concern/11091677.article
- Emsam (selegiline) transdermal patch. Product Information. Accessed Jan. 5, 2020 at https://www.drugs.com/pro/emsam.html
- Antidepressants and alcohol: What's the concern? Drugs.com. Accessed Jan. 5, 2020 drugs.com/mcf/antidepressants-and-alcohol-what-s-the-concern
- Menkes DB, Herxheimer A. Provocation by alcohol of violence as a side-effect of antidepressants. Drug Safety 2009;32:948–9.
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
