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Antidepressants and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 22, 2022.

Introduction

Antidepressants are a large group of medications used to treat many different mental health conditions. Some of the more common conditions that antidepressants treat include:

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 targeted by antidepressants include serotonin, dopamine, gamma-aminobutyric acid (GABA) or norepinephrine.

Many manufacturers recommend you avoid or limit alcohol, or use caution if you're taking an antidepressant and drink. Depression medication and alcohol may also increase central nervous system (CNS) side effects such as:

  • Dizziness
  • Drowsiness
  • Confusion
  • Difficulty concentrating

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 depression, anxiety, mood or behavior.

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 (Wellbutrin XL, Forfivo, others), a common oral antidepressant, should NOT be combined with alcohol due to the risk for seizures.
  • Certain antidepressants, such as duloxetine (Cymbalta) 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 any medicine with alcohol. 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:

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. Always check with your pharmacist for herbal supplement and other dietary supplement drug interactions.

Some liquid medications, such as cough syrups or NyQuil, may also contain alcohol.

Learn More: Review your medications with the Drugs.com Drug Interactions Checker

Table 1. Common Antidepressants

Generic Name Brand Name
aripiprazole Abilify
amitriptyline Elavil*
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
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
Rexulti (brexpiprazole) is an antipsychotic medication but is used together with other medicines to treat major depressive disorder in adults.

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

Sources

  1. 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
  2. Emsam (selegiline) transdermal patch. Product Information. Accessed Jan. 5, 2020 at https://www.drugs.com/pro/emsam.html
  3. Antidepressants and alcohol: What's the concern? Drugs.com. Accessed Jan. 5, 2020 https://www.drugs.com/mcf/antidepressants-and-alcohol-what-s-the-concern
  4. 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.

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