While alcohol can have an initial, temporary, positive impact on our mood, in the longer term it can cause serious problems for our mental health. Drinking slows down messages within your brain. It can cause fatigue, anxiety, depression, impaired motor skills and poor decision making. Drinking alcohol while taking antidepressants is generally advised against, since alcohol can make depression worse. It can also increase the side effects of some antidepressants, such as drowsiness, dizziness and co-ordination problems.
Alcohol alters your brain chemistry
Our brains rely on a delicate balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting our thoughts, feelings and actions – and sometimes our long-term mental health. This is partly down to ‘neurotransmitters’; chemicals that help to transmit signals from one nerve (or neuron) in the brain to another.
The relaxed feeling you can get when you have that first drink is due to the chemical changes alcohol has caused in your brain. For many of us, a drink can help us feel more confident and less anxious. That’s because it’s starting to depress the part of the brain we associate with inhibition.
But, as you drink more, more of the brain starts to be affected. It doesn’t matter what mood you’re in to start with, when high levels of alcohol are involved, instead of pleasurable effects increasing, it’s possible that a negative emotional response will take over. Alcohol can be linked to aggression, anxiety, depression and suicide.
You should be wary of drinking alcohol if you’re taking anti-depressants, as alcohol is itself a depressant and drinking alcohol can make your symptoms worse.
Commonly used antidepressants such as Fluoxetine (brand-name Prozac) and Citalopram belong to a class of drugs called ‘selective serotonin reuptake inhibitors’ (SSRIs). These anti-depressants work with neurotransmitters in the brain to help people with depression and anxiety. Mixing SSRIs with brain-altering substances like alcohol can be harmful. The ingredients in SSRIs are designed to help calm your mood. One of the side effects of the drug is tiredness and interference with co-ordinated movement and alertness (similar to alcohol). Combining SSRIs with alcohol can quickly lead to increased drowsiness and can lead to dizziness, poor decision-making, increased risk of falls and injuries, feelings of hopelessness and suicidal thoughts.
There are different categories of antidepressant: ‘serotonin and norepinephrine reuptake inhibitors’ (SNRIs) such as Venlafaxine; ‘tricyclic antidepressants’ such as amitriptyline, and ‘monoamine oxidase inhibitors’ (MAOIs) such as phenelzine. Each category has different possible side effects and different contraindications. Always follow the manufacturer’s guidelines and precautions.
How alcohol can interfere with medication
There are two main reasons why doctors advise people not to drink with anti-depressants:
- Alcohol is a depressant, it affects the way your brain works, numbing your senses so they don’t operate properly. Some types of medication also affect the way your brain works, and if you’re drinking alcohol there will be a conflict. Alcohol can cause sleepiness and dizziness, and also changes the way the brain responds to the medication, thus making it less effective.
- Alcohol can affect the way drugs are absorbed by the body and broken down in the liver. If you drink alcohol regularly, especially in excessive amounts, your liver produces more enzymes so that it can get rid of the alcohol more quickly. Those same enzymes might break down the anti-depressant you are taking so it no longer has the same effect. So, you are not getting the best from your anti-depressant, and it may actually make your condition worse.
It’s important to note that the effects of combining alcohol with anti-depressants can happen even if you don’t drink at the same exact time you take the drug. Certain anti-depressants stay active in your body for some time, depending on your dosage and how long you’ve been taking it.
Anxiety and depression
Anxiety is different to depression. Depression is considered to be a low mood that lasts for a long time. It can range from low spirits to feeling suicidal. But depression and anxiety often go together. Feeling anxious and worrying constantly can make you feel low, and about half of people who suffer from depression also get attacks of anxiety.
Effects of alcohol on depression
Alcohol is a depressant, so drinking it when you have depression can make the symptoms of your condition worse. It can even cause signs of depression in people who don’t have clinical depression. Symptoms of depression can include frequent sadness, feelings of worthlessness, loss of interest in activities you used to enjoy, unusual tiredness and suicidal thoughts.
If you’re tempted to drink when you feel depressed, try not to. Instead, speak to a professional as there are many safe, effective ways to treat depression.
Alcohol and anxiety – the vicious circle
If you suffer from anxiety, you might think that a couple of drinks will help you relax. In fact, alcohol can heighten the anxiety. Here’s an example of a typical cycle:
You drink alcohol. You initially feel calm as the alcohol affects your brain. You then feel anxious as a symptom of alcohol withdrawal as your body processes the alcohol, and interacts with your anti-depressant. You will likely want to drink again to try to relieve your anxiety.
Remember, the more alcohol you drink, the greater your tolerance will be. Over time you may need to drink more alcohol to experience the ‘feel good’ effects. Over time, this will likely negatively affect your mental health.
Taking control of your alcohol intake
If you think you may be struggling with anxiety then you should consider cutting back on the amount of alcohol you drink:
- Step 1: Track how much you’re drinking to help spot patterns so you can avoid triggers – the Drinkaware: Track and calculate units app or MyDrinkaware online tracker can help.
- Step 2: If you’re drinking more than the UK Chief Medical Officers’ low risk drinking guidelines, (no more than 14 units a week for both men and women) try to cut down. Here are some useful tips and advice on how to take a break from alcohol. If you’re worried you may be dependent on alcohol talk to your GP or contact an alcohol support service.
- Step 3: Once you’ve cut down your drinking (or stopped drinking altogether), keep going like this for a couple of weeks. Most people can expect to see an improvement in their anxiety symptoms in this time as the brain’s balance of chemicals and processes start to return to normal and you experience better quality sleep.
- Step 4: If you’re still feeling anxious after three weeks you should speak to your GP. Talking therapies like CBT (cognitive behavioural therapy), can help you learn to spot unhelpful patterns of behaviour. Your GP should be able to tell you about local services.