Antidepressants and alcohol: effects and consequences of their combination

The relationship between the simultaneous use of antidepressants with other psychotropic substances, such as alcohol, Has recently been studied by various specialists. This is because frequent alcohol consumption is a common practice among people with depression, just as depression is a common occurrence among people with alcoholism.

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

    Antidepressants and alcohol: mechanisms of action

    Prescribing antidepressants is based on the fact that depression is characterized by a decrease in serotonin levels (a neurotransmitter associated with the activation of pleasant emotions).

    Thus, the main objective of antidepressants is to compensate for this decrease by means of ensure that serotonin is concentrated longer in the synaptic space. This compensation can in turn promote the concentration of other substances and, depending on what they are, the side effects of antidepressants can increase or decrease.

    The main types of antidepressants are:

    • Monoamine oxidase enzyme (MAOI) inhibitors, which may have an irreversible or reversible effect, and its use is only recommended if there is no response to other treatment. for its high health risk.

    • Tricyclic and tetracyclic antidepressants, which prevent the reuptake of serotonin, but also norepinephrine, as well as other substances such as acetylcholine.
    • Selective Serotonin Reuptake Inhibitors (SSRIs). It is the most widely used antidepressant today because its side effects are less than those of other psychotropic drugs.

    • Selective serotonin and norepinephrine reuptake inhibitors (SNRIs), which, like tricyclics, they prevent the reuptake of both neurotransmitters, And yet, they have less risk of side effects.
    • Serotonin reuptake antagonists and inhibitors (SARIs) which also have hypnotic effects.
    • Selective catecholamine reuptake inhibitors (adrenaline, norepinephrine, dopamine).

    How does alcohol work?

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

    Its main effect is central nervous system depression, as it produces neurochemical inhibition at GABAa receptors. In high consumption, and as a depressant, ethanol has consequences such as behavioral disinhibition associated with states of euphoria, drowsiness, dizziness, Weak reflexes, slow movements, reduced vision, among others.

    Its effects are very similar to those produced by psychotropic drugs such as benzodiazepines and barbiturates, as they act on the same neural receptors.

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

    Effects and consequences of their combination

    As we have seen, alcohol use in depression is common, however, its interaction with antidepressants in those diagnosed has been little studied except in those with problematic alcohol use.

    These studies have shown that the combination of antidepressants and alcohol generates a potentiation of the effects that alcohol produces by itself. For this reason, mixing alcohol with different antidepressants is contraindicated. Below we will list some of the main reasons in more detail.

    1. Promote sedative action

    The clearest and best known effect of the combination of antidepressants and alcohol is the high probability of increasing its depressant or sedative effects on the central nervous system. The latter happens so much 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 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 drowsiness.

    In addition, the combination of alcohol and SSRI antidepressants, such as venlafaxine, and related drugs, 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 accompanied by memory impairment.

    2. Interference with alcohol metabolism

    Especially with regard to MAOI-type antidepressants, alcohol is contraindicated, as these drugs inhibit the oxidative activity of hepatic microsomal enzymes, which interfere with the metabolism of chemical compounds such as ethanol; but also with the metabolism of caffeine, pain relievers, barbiturates and other antidepressants.

    In turn, it reinforces the psychotropic effects of the substance with which it is mixed (both ethanol and the drugs mentioned). Since MAOIs interact with different substances that are easily found in foods and drinks, it is important to take care with what is consumed. Improper mixing can cause high blood pressure and serious side effects.

    3. Increases the risk of adverse drug reactions

    As with many other medications, mixing antidepressants with alcohol increases the likelihood of experiencing side effects associated with the medication. For example, significant anxiety states, sleep disturbances and damage to various organs.

    4. Sleep disturbances

    Since alcohol causes drowsiness and depression is sometimes characterized by difficulty falling asleep, drinking alcohol becomes a common resource. However, this is a short-term effect, because while alcohol consumption can cause rapid sleep, it is also common to alter circadian rhythms and induce waking states at midnight.

    Use of antidepressants in the treatment of alcoholism

    As we have said, alcoholism and depression are often accompanied phenomena. Combined with this, various symptoms caused by alcoholism have been treated with pharmacological prescriptions diverse.

    While the use of anxiolytics is more common, to consider anxiety as one of the main causes of alcoholism, the use of antidepressants in the detoxification phases in alcoholism treatment has recently been studied. . This phase consists of eradicating the psychological dependence on alcohol.

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

    Bibliographical references:

    • Hall-Flavin, D. (2018). Why is it bad to mix antidepressants and alcohol? Mayo Clinic. Accessed August 15, 2018.Available at https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231.
    • Gutiérrez, JA, Torres, VA, Guzmán, JE et al (2011). Pharmacological therapy. 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. Accessed August 15, 2018. Available at https://www.pharmaceutical-journal.com/news-and-analysis/drinking-alcohol-during-antidepressant-treatment-a-cause-for-concern/11091677.article? FirstPass = false.
    • Dualde, F. and Climente, M. (2006). Chapter 03: Antidepressants, p. 93-147. In Handbook of Psychopharmacology. Retrieved August 15, 2018.Available at https://www.researchgate.net/profile/Fernando_Dualde_Beltran/publication/321997690_Antidepressivos/links/5a3d65fba6fdcce197ff7bff/Antidepresivos.pdf.
    • Rubio, G., Ponce, G., Jiménez-Arrieto, MA, et al (2002). Treatment of depressive disorders in alcohol dependent subjects. 3rd Virtual Congress of Psychiatry, Interpsychie, pp. 1-18.
    • Rubio, P., Giner, J. and Fernández, FJ (1996). Antidepressant treatment in alcoholic patients in the phase of addiction. Journal of the Chair of Medical Psychology and Psychiatry, 7 (1): 125-142.

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