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 different specialists. This is so because the frequent use of alcohol is a common practice in people who have diagnosis of depression, as well as depression is a frequent phenomenon in people who have alcoholism.

In this article we will see 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 is based on the consideration that depression is characterized by a decrease in serotonin levels (neurotransmitter associated with the activation of emotions pleasant).

Thus, antidepressants have the main objective of compensating for this decrease by ensure that serotonin is concentrated longer in the synaptic gap

. 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:

• Monoamine Oxidase Enzyme Inhibitors (MAOI), which can have an irreversible or reversible effect, and whose use is recommended only in cases where there is no response to other treatment, due to 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 currently the most widely used antidepressant because its adverse effects are less than in other psychoactive drugs.
• Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), which, like tricyclics, prevent reuptake of both neurotransmitters, and yet have less risk of adverse effects.
• Antagonists and Inhibitors of Serotonin Reuptake (AIRS) that also have hypnotic effects.
• Selective Catecholamine Reuptake Inhibitors (adrenaline, norepinephrine, dopamine).

How does alcohol work?

On the other hand, alcohol is a chemical substance 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 alcoholic beverages for recreational use, such as wine, liquor or beer.

Its main effect is the depression of the central nervous system, since it produces an inhibition neurochemistry at GABAa receptors. In high consumption, and as a depressant, ethanol has consequences like 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 produced by psychotropic drugs such as benzodiazepines and barbiturates, since they act on the same neuronal receptors.

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

Effects and consequences of their combination

As we have seen, alcohol consumption 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 beverages alcoholic.

In these studies it has been seen that the combination of antidepressants and alcohol generates a potentiation of the effects that alcohol produces on its own. For this reason, mixing 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 depression symptoms in the medium term, as well as a prolonged decrease in alertness, coordination, motor skills, and a significant increase in drowsiness.

Likewise, 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 behaviors together with impaired memory.

2. Interfere with alcohol metabolism

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

At the same time, this causes the psychotropic effects to be potentiated of the substance with which it is mixed (both ethanol and the drugs mentioned). Because MAOIs interact with a number of substances that are easily found in food and drink, it is important to be careful with what you consume. Inadequate mixing can cause increased blood pressure and severe adverse reactions.

3. Increases the risk of adverse drug effects

As with many other medications, mixing antidepressants with alcohol increases the chance of experiencing drug-associated side effects. For example, important states of anxiety, sleep disorders, and damage to different organs.

4. sleep disturbances

Because alcohol causes drowsiness, and depression is sometimes characterized by difficulty falling asleep, drinking alcoholic beverages becomes a resource common. However, this is a short-term effect, since although alcohol consumption can cause rapid sleep, it is also common that it alters circadian rhythms and provoke states of vigil at midnight.

Use of antidepressants in the treatment of alcoholism

As we have said, alcoholism and depression are phenomena that often accompany each other. Added to this, different symptoms caused by alcoholism have been treated by pharmacological prescriptions various.

Although the use of anxiolytics is more frequent, considering anxiety as one of the main causes of alcoholism, the use of antidepressants in withdrawal phases in alcoholism treatments has recently been studied. alcoholism. This phase is the one that consists of eradicating psychological dependence on alcohol.

For example, trazodone, which is a serotonin reuptake inhibitor and antagonist used for the treatment of chronic alcoholism. Likewise, venlafaxine (sometimes combined with fluoxetine), which are selective serotonin reuptake inhibitors, 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 in https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231.
• 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 PharmaceuticalJournal. Retrieved August 15, 2018. Available in 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, pp. 93-147. In Manual of Psychopharmacology. Retrieved August 15, 2018. Available in https://www.researchgate.net/profile/Fernando_Dualde_Beltran/publication/321997690_Antidepresivos/links/5a3d65fba6fdcce197ff7bff/Antidepresivos.pdf.
• 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 Fernandez, F.J. (nineteen ninety six). Antidepressant treatment in alcoholic patients in the withdrawal phase. Journal of the Chair of Medical Psychology and Psychiatry, 7(1): 125-142.