- Alcohol is actually a brain depressant.
- Alcohol also interferes with the metabolism of antidepressants, leading to an increased risk of side effects.
- Minimizing or eliminating alcohol use is likely to yield the best outcome for depression treatment and recovery.
"I really don't want to give up my Friday nights. Those mean a lot to me." Chloe* is a 32-year-old social media marketer who, along with our weekly cognitive behavioral therapy sessions, has started on an antidepressant for depression. She's concerned that her usual glass (or two) of wine during weekly dinners with girlfriends will be limited by the medication. "I don't have a drinking problem so it should be fine, right?"
Alcohol is one of the most common legal, non-prescribed psychoactive substances in the U.S., with 54.9 percent of adults surveyed reporting alcohol use within the past month and 69.5 percent reporting that they drank in the past year. Use of alcohol can range anywhere from the occasional drink, to heavy drinking (more than 3-4 drinks per day), to Alcohol Use Disorder (AUD) whereby a person loses control over their intake and experiences significant negative consequences from use. According to the 2019 National Survey on Drug Use and Health, 14.5 million Americans over age 12 met the criteria for AUD that year.
Antidepressants are one of the most commonly prescribed psychoactive substances in the U.S. Eleven percent of people ages 12 and older take an antidepressant, and it is the third most commonly used prescription drug among all adults. Among the 18-44 year old age group, it is the number one prescribed drug in use.
Given the prevalence of both antidepressants and alcohol use, it's not surprising that the two often collide. To drink or not to drink while on an antidepressant—that is the question. Here are some factors that can help with an answer.
How Alcohol Affects Mood
Although the immediate effects of alcohol tend to be pleasurable and relaxing, the eventual pharmacological action of alcohol is to depress neural activity in the brain. This may seem surprising given the association between alcohol and its initial effects of disinhibition, "buzz," and fun. The depressant effect is not readily apparent at first, which can make it difficult to see the full impact alcohol has on mood.
Alcohol's sedating properties can also increase disruptions to sleep, which in turn exacerbate mood disorders. Additionally, the presence of major depression doubles the risk of alcohol use disorders, while a National Epidemiologic Survey on Alcohol and Related Conditions found that the presence of alcohol abuse increases the risk of major depression by 3.7 times.
The overall research suggests a bidirectional relationship between alcohol use and depression, whereby increased use of alcohol correlates with an increased risk for clinical depression and depression itself increases one's risk for developing an alcohol use disorder.
As a result, when evaluating patients for depression, clinicians must also assess for co-morbid substance use that could be either causing or contributing to the depressive episode. Forty to 60 percent of people with AUD will have a substance-induced depression and for some, stopping alcohol use will lift the depressive episode.
For others, alcohol abuse and depression are actually two separate diagnoses that exist at the same time (the so-called dual diagnosis), making each more complex and difficult to treat.
How Does Alcohol Affect Antidepressants?
Alcohol and some antidepressants compete for the same metabolic systems in the body—that is, they both head for the exit doors at the same time once the body has ingested them. Because of this competition, the body's levels of both the antidepressant and alcohol can be higher than with either alone. With a higher level of each in the system, potential side effects of both may be exacerbated. These can range from sedation and dizziness to falls and even fatal overdose.
Concurrent use with alcohol can also cause some antidepressants to be metabolized more extensively and become less clinically effective than usual.
Given this array of risk factors, psychiatrists are likely to encourage their patients to minimize or completely abstain from alcohol use. It gives the brain less hurdles to clear in terms of alcohol's depressant qualities, and it gives the body a break in terms of dealing with more frequent and intense side effects than needed. Not only does it makes sense for people to minimize complications during the course of antidepressant treatment but also while trying to recover from depression overall. Removing alcohol from the picture increases the opportunities for brain and body to function optimally.
Finally, if minimizing or complete cessation of alcohol is difficult, then it is possible that the issue goes beyond the occasional drink and extends into the arena of heavy drinking (more than three drinks per day for women or four drinks per day for men) or an alcohol use disorder. In such cases, the impact of alcohol on depression becomes even more significant and may warrant its own specific treatment focus.
Disclaimer: All content is for informational purposes only and is not a substitute for direct medical advice from your doctor or other qualified clinician. If you need medical or psychological help, seek guidance from your own physician, qualified mental health clinician, or call 911.
*Names and personal identifiers have been changed to protect patient confidentiality.
Revadigar, N. Gupta, V. Substance Induced Mood Disorders. StatPearls. National Library of Medicine website. Nov 2022.
Tolliver, BK, Anton, RF. Assessment and Treatment of mood disorders in the context of substance abuse. Dialogues Clin Neurosci. 2015; 17:2.
Boden, JM, Fergusson, DM. Alcohol and Depression. Addiction. 2011; 106(5): 906-914.