Is drinking alcohol while taking antidepressants a serious danger?

May 6, 2009 5:25 AM

I take prescription medication (paroxetine) in the morning and also enjoy an alcoholic beverage or two in the evening. The sticker on the medicine bottle warns me not to do this, but I do it anyway. How serious are consequences?

I take Paroxetine (Paxil) 20mg daily (in the morning). I also drink. On average 2 beers or glasses of wine after dinner - and about once a week, I go out with friends and drink more than that.

There has always been a sticker on the medicine bottle that says "Do not drink alcoholic beverages when taking this medication." That sounds more severe than warning messages on other medications that say something like "Drinking alcohol can increase the effects of drowsiness", etc.

I am trying to assess the real effects that drinking and taking Paroxetine is having on my body.

I am an otherwise healthy male in his early 30s. I am no longer depressed (I started taking the meds about 5 years ago) but I have fought depression throughout my life and do not suffer any side effects, so I've decided to stay on them.

posted by meantime to health & fitness (17 comments total)

I took Paxil briefly and had the same question. I asked a relative who is an RN and she said that the most likely issues would be that it would either make the Paxil less effective or the alcohol more effective. She basically told me to try it out and see if I had any issues.

This site supports the theory that you might just get more drunk. Obviously, IANAD, etc.
posted by thejanna at 5:53 AM on May 6

The reason alcohol and paxil can't be combined is because together they produce a synergistic effect. It's not because their interaction produces a bad reaction in your body, per se (like acetaminophen + alcohol, which together actually damage your liver). Basically, together you can overdepress your nervous system.

I am not a doctor, so I'm not going to tell you what to do. I am a pharmacology student. When we were shown the alcohol dose curves at which it produces similar effects as Paxil it was on the higher end of the dose of alcohol, so I would wager that a single drink won't harm you much. But, I am not a doctor. If you are concerned, you should ask one.
posted by sickinthehead at 5:56 AM on May 6

Not a doctor, not your doctor, but I bet a frank discussion with your doctor would be awesome.

That being said, Google Paxil and Alcohol, there's quite a bit on it. It doesn't seem... toxic, but who knows. Also, there's a bit on increasing your impairments (dizziness and drowsiness).

A lot of people say they are having an occasional drink with the Paxil and not having trouble. You're drinking daily, so YMMV.
posted by jerseygirl at 6:00 AM on May 6

IANAD; but the response to psychiatric medications is very variable between people, and the response to psychiatric medication + alcohol is even more variable. From a group of my friends on similar meds, there was everything from "fine getting absolutely wasted regularly" to "serious physical and mental effects after a couple of glasses of wine".

Talk to your doctor, but be aware of this idiosyncrasy; you may have experiences that they've not come across because brains are weird. Caution and self-monitoring are probably the way forward.
posted by Coobeastie at 6:07 AM on May 6

In my experience there have been absolutely no downsides to drinking whilst taking anti-depressants. In my time Ive taken Clomipramine (Anafranil), Venlafaxine (Effexor), Citalopram (Celexa?), Mirtazapine (Remeron), another I forget, and now Im back on Clomipramine and have been solidly for the last 6 years. Unlike antibiotics where indeed alcohol consumption can nullify the effects of the antibiotic, usually the only 'warning' as such with anti-depressants is that they 'may' cause alcohol to be more effective. I.e. You dont need to drink as much for the same buzz. However in my personal experience, its better than that. Ive always found that the drunkeness I get when drinking on AD is a much more refined experience than drinking without. I get all the sociability, fun etc, but with much more 'clarity'...(Perhaps that due also to drinking vodka-redbulls..). I first took Clomipramine seriously when I was 30 years of age and the window it opened onto how 'normal' felt, meant the very first thing I wanted to do was get out into bars and drink, meet people etc. As already said, Ive never encountered anything negative from the combination, I would say the reverse. My advice would be to drink in moderation, confident in the knowledge that you wont be doing any damage to yourself, and monitor your body's reaction. You can increase consumption from there. I wouldnt consider myself a heavy drinker, but I have certainly had periods on AD of drinking daily and certainly many single nights of drinking a fair amount. One thing I would caution against of course is taking anything in addition to your AD that might further elevate your Serotonin levels (i.e. another AD, MAOI, Ecstasy etc.). This could lead to serotonin syndrome which is very serious. Enjoy your alcohol..
posted by stumpyolegmcnoleg at 6:19 AM on May 6

The risk seems to be minor but real.

From Stockley's interaction alerts:

Studies have found that paroxetine with alcohol decreased attentiveness and increased reaction time. (In other words, sluggishness.)

From rxlist.com

Since the introduction of immediate-release paroxetine hydrochloride in the United States, 342 spontaneous cases of deliberate or accidental overdosage during paroxetine treatment have been reported worldwide (circa 1999). These include overdoses with paroxetine alone and in combination with other substances. Of these, 48 cases were fatal and of the fatalities, 17 appeared to involve paroxetine alone. Eight fatal cases that documented the amount of paroxetine ingested were generally confounded by the ingestion of other drugs or alcohol or the presence of significant comorbid conditions.

I doubt talking to a doctor would help. They don't have time to memorize all the drug interactions and would give you a fuzzy answer like, better safe than sorry (which is about what the manufacturer says). A really diligent doctor might try to run down such info as I presented above.
posted by dances_with_sneetches at 6:49 AM on May 6

IANAD, but here's a really simplistic explanation I was given once: Paxil (all SSRIs, really) is an antidepressant. Alcohol is a depressant. If you're going to drink while taking SSRIs, you'll be cancelling out some or all of their positive effects. Hence, the warning on the bottle.
posted by chez shoes at 6:50 AM on May 6 [1 favorite]

Presumably you're on the Paxil for a reason. Why not just let it do its job? Even if you notice no deleterious effects, wouldn't you like to know that your medication is working at full strength?

By the way, alcohol is a depressant. Consuming regular amounts of a depressant daily during a time when you're also taking an anti-depressant seems like a conflict of interest in your well-being. We're not talking about a drink here and there to be social: you are a moderate drinker.

It may not seem like much fun to have to interrupt your lifestyle and mostly abstain from alcohol in order to let your medicine do its work, but I recommend you do that.
posted by hermitosis at 7:12 AM on May 6

"In retrospect, it was a bad idea to screw with my brain chemistry and possibly inflict lifelong damage just for the sake of experiment. I would not do something like this again. At the height of my withdrawal I was seriously terrified, thought it might never end, and repeatedly cursed my own stupidity. The fact that I considered a wholesale career change under the drug's effects, and couldn't complete any work, is alarming. Also, the zaps are for real. Fear them.

At the same time, I admit it was fascinating to try out a different personality. He only came out when I drank, but I caught a glimpse of an alternate me, and he wasn't such a bad guy—if a little gabby. I think I gained some empathy for other types of folk, and maybe got an idea of how alcohol can mean different things to different people. I also sort of discovered what emotions are for and decided being shy isn't so bad after all. Thanks, Paxil!"
posted by Jaltcoh at 7:34 AM on May 6 [1 favorite]

Last year about this time, I started to realize that - even when the medicine bottle said, "don't drink when you're taking this medicine, asshole" - I couldn't stop drinking. I'm not saying you are an alcoholic; I am. And what any good alcoholic will tell you is that nobody but YOU can determine if you've got a drinking problem.

I had a constant headache. My brain didn't work like it used to. I didn't sleep particularly well (not that I ever do, but this was extreme). And eventually, I devolved into a puddle of depressed, suicidal, loser. Over a couple months, I slowly ticked off all of the signs you might have a drinking problem. I withdrew from the world with cheap white wine and public television. And I slowly fell apart.

I went to bed every night praying to a God I didn't believe existed that he would just let me die in my sleep so that I wouldn't have to wake up and think about killing myself all day. I recently found a stash of papers from that time, ridiculous and sad and barely lucid scrawlings from that time when I was crazy. It was very hard to read how out of it I was. (Along the lines of, "They're watching me" tinfoil hat stuff.) And through it all, the only thing that kept me from slipping in front of the train I rode every day to and from work, or from jumping off the overpass I walked across to get to my office, or slicing myself open with whatever sharp object I could find...was my dog. Who would feed my dog? Would he go back to my ex's family, where he was mistreated? Would he protect my body or eventually give in and eat it when he realized he wasn't going to be fed otherwise? And would that mean he would be put down. My ridiculous devotion to my dog saved my life.

So what can you take away from my experience? Only a warning: that the combination can be dangerous. Whether it is because one impedes the progress of the other, or because they interact poorly, or maybe there IS no causality and the issues are totally independent. But my mental health took a very serious backslide when I started drinking regularly after starting the medicine and trying to limit my consumption. (Just for a point of reference, when I started taking the medicine I had a few drinks A WEEK; and at the height of my drinking I wasn't consuming more than four drinks a night. Though as I'm sure you're aware, mileage varies greatly where alcohol consumption is consumed.)

Ultimately, when I stopped drinking, things got better. Much much better.
posted by greekphilosophy at 8:27 AM on May 6

The information you're looking for is probably in the fine print that comes with your Paxil. You can find that in the links on this page (look for "information sheet", and more if you poke around the site some. (I realize it looks kind of scattershot and crazy, but that's the most helpful site I know of for official + anecdotal info about antidepressants, and I did a bunch of research when I started mine [not Paxil].)

The effects of SSRIs are pretty idiosyncratic. That's why a given drug is awesome for one person's depression and sucks for another. Ditto the combination of SSRI + alcohol. Some people don't notice a difference, some people binge or get cravings for alcohol. I turn into kind of a lightweight, so I have to be careful doing anything that exceeds regular social drinking or I might find myself accidentally shitfaced. In the end, you're probably the best judge of how much you can drink; if you have a psychiatrist they might be helpful, but a GP, not so much, like dances_with_sneetches says above.
posted by clavicle at 8:30 AM on May 6

You seem to be asking about physical effects, but I have found that there are emotional/behavioral aspects to this combination that are worth considering. This might sound weird, but if you are in a relationship with someone (especially if it is a romantic relationship but really anyone who has occasion to be around you when you drink) ask that person this question. Bonus if this person was regularly with you when you were drinking before you started taking Paxil. Although I have never taken Paxil, I have some anecdotal experience being around folks in three different states of being: just drunk, drunk on antidepressants, and drunk on Paxil. The "drunk on Paxil" state was by far the most unpleasant due to the behaviors that the person exhibited.
posted by jennyb at 9:23 AM on May 6

Paxil (all SSRIs, really) is an antidepressant. Alcohol is a depressant.

Alcohol isn't a mood depressant, it's a central nervous system depressant. Two different meanings of "depressant".
posted by mendel at 12:06 PM on May 6 [1 favorite]

(And as a data point I find my alcohol tolerance the same on Lexapro as not.)
posted by mendel at 12:06 PM on May 6

Effexor + alcohol makes me weirdly drunk very quickly. Usually I'm on top of my actions when drinking but when I'm on effexor and drink I get... weavy... a few sips in. I don't like it much so I rarely drink, not really a big deal for me. ymmv.
posted by Billegible at 12:52 PM on May 6

I'm going to mostly echo what others have already said. fwiw, I've talked over this question with multiple physchiatrists and pharmacists, tho for different antidepressants than paxil.

the main danger is that combining alcohol and an ssri can overwork your liver (which is trying to process both of them at the same time) and thus can increase the effects of *both* the alcohol and the ssri. so you can (1) get drunker off the same amount of alcohol, and (2) be in danger of overdosing on serotonin, which can in rare instances cause serotonin syndrome (unfortunately, it doesn't just make you happier and happier :-P).

I'd talk to your pharmacist about your dosage of paxil in relation to how worried you need to be about the serotonin syndrome. from what I gather, it's not very common and is more likely if you're on multiple antidepressants and/or other psychotropic meds and add a bunch of alcohol. but it wouldn't hurt to be aware of the symptoms on the off chance of it happening.

so given that you're already used to having a few drinks while on the paxil, it doesn't seem like you need to worry about the paxil making you a lightweight. though, if for any reason you change the time of day you either take your pills or are drinking, I'd keep an eye out.
posted by ahimsa at 8:52 PM on May 6

As mendel points out, people are confusing the issue of alcohol being a CNS 'depressant', and Paxil's 'anti-depressant' qualities. This isnt an dark cancels light situation. Alcohol doesnt cancel the anti-depresssant effects of Paxil. For a start, the mechanism(s) by which SRIs and SSRIs have their anti-depressive effects on mood are not fully understood even by the researchers, and alcohol, whilst being a CNS depressant, usually elevates 'mood' by reducing inhibition. As I advised in my earlier comment, simple gradual experiment will show what effect the combination of SSRI and alcohol will have for any given individual. It is easy when researching online for anecdotal evidence re. medications to fall prey to all manner of scare stories. Just take a look at the advice slip that comes with any SSRI and read the 'possible' side effects listed. Invariably you will see just about every possible reaction from dizziness, itchy feet, to heart attack and sudden inexplicable death. Everything and anything at any time reported during all clinical trials are noted even if they happened to a single solitary patient who also had 2 heads and lived solely on kidney beans. For the vast majority of patients the effects both intended and side will be the more run of the mill.
posted by stumpyolegmcnoleg at 6:13 PM on May 8