By: Adria Pratt-Forte, LMHC

The holidays are here and, let’s face it, they can be stressful for the happiest of folk.  The change in seasons can bring on, or enhance, bouts of depression and anxiety.  If the thought of getting dressed up for a holiday party is causing you to hide in your office with your stash of chocolate or having dinner with family has your anxiety sky high, then having a drink or two to relax almost seems necessary, right?  Whether you are feeling overwhelmed by too many social obligations, finances, or feeling lonely there is no better time to talk about the effects of drinking while taking psychiatric medications than now.

It seemed so harmless at the time.  Just a few drinks at a holiday party or a night out with friends that are in town for the weekend.  You may say to yourself, “What’s a few drinks?”  What starts out as a simple party can be a slippery slope that leads to some serious consequences.  Unfortunately, I understand those consequences from a very personal and clinical perspective.  While in graduate school to become a mental health therapist, I lost a teenage brother to an accidental overdose.  He had struggled with ADHD and depression as a child and adolescent.  Although I don’t know exactly how and when his substance abuse started, I feel pretty strongly that it was directly related to the enhanced sedation that he felt when combining alcohol with his prescribed medication.  Once he enjoyed that feeling, he began mixing different substances resulting in a fatal combination at a party on Halloween night.

Alcohol is a known depressant of the central nervous system (CNS) that is known to interact with many drugs. A significant number of drugs can affect the effects, absorption, and metabolic breakdown of alcohol and vice versa. In some case, the interaction between alcohol and antidepressants can occur even after drinking a small amount.

So, what happens to your body when mixing alcohol and psychiatric medication?  In some cases the alcohol can enhance the effects of your medication resulting in a relaxed, sedated feeling.  Most people who drink alcohol while taking medication notice that the drugs enhance the effect of alcohol. In other words, someone who wasn’t taking psychiatric medication may feel a buzz while you are already pretty drunk.  Since the liver is responsible for breaking down most medications as well as alcohol, it is working overtime when you mix the two.  This can mean that one, or both, don’t get processed properly and can cause liver damage.  When a person drinks alcohol, serotonin levels in the brain significantly increase. Alcohol tends to modify serotonin activity throughout the brain in regards to both signaling and neurotransmission. If you are taking an antidepressant medication (SSRI) that prevents reuptake of serotonin, it may lead to elevated levels of serotonin, which could cause manic symptoms, risky behavior, and dangerous mood swings.

What are the side effects that can occur when mixing alcohol and psychiatric medication?

In some cases, alcohol can interact with psychiatric medication and lead to unpredictable adverse effects such as seizures, drowsiness, dizziness, and/or fainting. Your chances of experiencing adverse or rare side effects is thought to increase if you consume alcohol while on a psychiatric medication. Under various circumstances, people have died from mixing alcohol with antidepressants and other psychiatric medications.

This is more common if a person is combining alcohol with an antidepressant and another pharmaceutical drug, particularly if the drug is a depressant (e.g. analgesic or anxiolytic). Although it is not common for someone to die from this interaction, it has happened.

Even though alcohol can sometimes help temporarily improve depressive or anxious symptoms, once a person sobers up, their depression or anxiety may be worse than it was before they drank. This could be due to the fact that alcohol consumption can affect neurotransmission and is thought to lower serotonin levels over time. Additionally, some people may notice worsened mood swings and increased depression when they take consume alcohol while on antidepressants or other psychiatric medications.  It is already documented that alcohol consumption slows reaction time and judgment. This means that you will not be able to make good decisions and/or react well when operating heavy machinery or a motor vehicle. Combining alcohol with psychiatric medication is thought to intensify the impairment of cognitive function and mental processing speed.

Group A: Anti-Anxiety and Sedating Drugs	Group B: Tricyclic Antidepressants	Group C: SSRI and SNRI Antidepressants	Group D: Atypical Antidepressants
Ativan (generic lorazepam) Klonopin (clonazepam) Serax (oxazepam) Valium (diazepam) Xanax (alprazolam) Ambien (zolpidem) Lunesta (eszopiclone) Rozerem (ramelteon) Restoril (temazepam)	Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin)	Celexa (citalopram) Prozac (fluoxetine) Lexapro (escitalopram) Zoloft (sertraline) Luvox (fluvoxamine) Paxil (paroxetine) Effexor (venlafaxine)	Wellbutrin (generic bupropion) Trazodone (brand name Desyrel) Serzone (nefazodone) St. John’s Wart (herbal)

Interactions and Medication Groups
Drowsiness, dizziness	All groups
Increased risk of overdose	Groups A, B & C
Slow breathing or Difficulty breathing	Groups A & D
Impaired motor control	Groups A & D
Unusual behavior	Groups A & D
Problems with memory	Groups A & D
Increased depression Loss of effectiveness of antidepressant	Groups B & C
Hopelessness, increased risk of suicide or suicidal ideation in adolescents and young adults	Groups B & C
Convulsions, disturbance in heart rhythm	Group B