Why Alcohol and Antidepressants Don’t Mix

If you take antidepressants, you may have been advised to avoid alcohol.

But why? Is a glass of wine really all that bad? What about just one night of heavy drinking?

Psychiatrist and substance use disorder specialist David Streem, MD, shares the trouble with mixing alcohol and antidepressants.

The risks of drinking alcohol while on antidepressants

Antidepressants help manage depression by making small, steady changes in your brain chemistry. But alcohol can undo all that work.

“Alcohol causes very large changes in how your brain functions,” Dr. Streem explains. “Alcohol is like a tidal wave that wipes out that quiet stream of progress made with antidepressants.”

Alcohol can keep your medication from working properly, affect your sleep and, in rare cases, lead to dangerous spikes in blood pressure.

Let’s look at some of the specifics.

Lowers the effectiveness of your medication

Drinking is counterproductive to treating depression.

Alcohol is a depressant. It slows down your central nervous system. That’s why alcohol affects your judgment and coordination and makes you sleepy and relaxed.

Similar changes can happen when you have depression.

Antidepressants aim to undo the effects of depression. But their work gets canceled out when your system is flooded with alcohol.

“Alcohol does the opposite of what antidepressants are trying to achieve,” Dr. Streem confirms.

And the effects can linger. Depending on how much you drink, alcohol can affect your system days after you put down your glass. Even when you stop feeling the effects, alcohol still affects your brain chemistry.

Going back to Dr. Streem’s tidal wave example, there’s a significant amount of cleanup your body has to do after it gets pummeled with alcohol.

Disrupts your sleep

Sure, having a few drinks can make you extra sleepy. But alcohol doesn’t encourage quality sleep. And when you’re managing depression, getting good sleep (and plenty of it) is important.

Depression is often associated with sleep disorders.

And alcohol can further disrupt your sleep cycles. Drinking suppresses REM sleep, which is important for regulating mood, memory and brain function. And alcohol can keep you from sleeping through the night.

“People will say, ‘I drink, and then I fall asleep.’ That’s true — alcohol is a sedative,” Dr. Streem acknowledges. “But often, within a few hours, they wake up and can’t get back to sleep.”

That means fewer ZZZs that your body and your brain need to help manage depression.

“If you’re further disrupting your sleep cycles with alcohol, that complicates our efforts to normalize your sleep and your brain function,” he points out.

Potential for dangerous interactions

It’s generally recommended to limit alcohol if you take any kind of antidepressant. But if you take MAOIs (monoamine oxidase inhibitors), the effects of alcohol can be especially dangerous.

“MAOIs have become rarer because they have many dangerous drug interactions,” Dr. Streem reports. “But for anyone who does take them, avoiding alcohol is very important. Alcohol can cause your blood pressure to spike dangerously high when you take an MAOI.”

The risks of drug interactions between alcohol and newer classes of antidepressants, like SSRIs (selective serotonin reuptake inhibitors), aren’t as dramatic. But it’s still not a good mix.

Is any amount of alcohol OK on antidepressants?

You shouldn’t drink any alcohol if you take an MAOI or if your provider has told you it’s not safe for you to drink.

Dr. Streem also recommends abstaining from drinking when you first start taking SSRIs.

“It’s best to avoid all alcohol and other habit-forming substances for at least the first four to six weeks,” he advises. “During that time, you’re trying to figure out whether the medication even works for you. You don’t want to muddy the waters by introducing the effects of alcohol.”

Beyond that, how much is too much?

“One heavy drinking episode per month isn’t going to have a significant impact on most modern antidepressants,” Dr. Streem says. “But drinking once a week or drinking every day — that could cause problems.”

And if you’re planning to have a drink, don’t skip taking your medication. Antidepressants rely on consistent daily use to keep your brain chemistry balanced. Missing doses can undo your progress.

If you’re finding it difficult to curb your drinking or stop altogether, or if you’re concerned about your relationship with alcohol, help is available. Talk with a healthcare provider, local resources, family and friends, or reach out to the 988 crisis lifeline (U.S.).