What have your experiences been with antidepressants and alcohol?
August 17, 2017 11:32 AM   Subscribe

The manufacturer's leaflet says to avoid alcohol altogether with citalopram; the UK NHS website says you can consume alcohol with it. What are your experiences? Including people who had not very many side-effects, please.

So I've just been prescribed citalopram 20mg per day for bereavement and loneliness-related depression that's lasted for a few years. During that time, I've been having about 4 pints of beer a day, supplemented by a couple of martinis per day at the weekend. I know the leaning on alcohol has to be tapered down at some point, but I don't feel like tackling it at the same time as tackling my first ever psychiatric medicine. The manufacturer's leaflet says to avoid alcohol altogether; the UK NHS website says you can consume alcohol with it.

What are your experiences? Including people who had not very many side-effects, please.

Needless to say, also: massive blush.
posted by paperpete to Health & Fitness (19 answers total)
It's tricky. People have different reactions, depending on how their bodies process alcohol and how effective citalopram is. The main caution is that, even in isolation, citalopram can exacerbate liver problems. That's the doctor's notes version.

The reason you'll want to taper down drinking when starting, and possibly in an ongoing way, is it can completely with the way you perceive alcohol's effect on your body. I took citalopram daily for a number of years, and it was probably months (if not a year) before I really had a handle on what a certain number of drinks felt like. In the beginning, I screwed up once or twice, because it went like this: one drink felt like two, two felt like two, three felt like two, and the point where it felt like I'd had more than two drinks was not a healthy level of drinking. But the reasons I felt like drinking so much, regularly, were to deal with social anxiety and as an escape. As a social lubricant, alcohol lost some of its charms because the ups and downs became a little leveled out.

The one thing I had to be careful with, and isn't mentioned too much, was leaning on the drug as a drinking enabler once I was used to its effects. Because some of the after-effects of drinking too much for me were anxiety, depression, and the common hangover headache. Citalopram helped all of those. Somehow, even the headache.

The end game for me, with the acknowledgment I might need a SSRI or different depression/anxiety treatment in the future, was using the drug as a cushion for the situations that would trigger negative states of mind, and as a stepladder to stay out of the muck as I stabilized the things in my life my anxious, depressed mind would not let me deal with.
posted by mikeh at 11:53 AM on August 17, 2017

Caveat: not a big drinker.

That said, I take an SSRI and find that if I stick to one to two drinks (usually jack and ginger for me), and put at least a few hours between the drinking and the medication, I'm fine. I wouldn't say you have to taper off completely, but you probably need to decrease by about half.
posted by catwoman429 at 11:59 AM on August 17, 2017 [2 favorites]

Not citalopram, but with Prozac (also an SSRI) my tolerance for wine really dropped - I'd feel tired and depressed very quickly. Beer and spirits not so much. But I also can't overemphasise how powerful a depressant alcohol is in the long term. I didn't mind drinking less because it seemed ridiculous to have got so ill that I was taking medication to counter depression, and at the same time to be taking a known depressant. Just in case you're at all persuadable on the cutting-back-on-alcohol side of things - it can only help what you're trying to do, rather than making it more difficult.
Best of luck.
posted by penguin pie at 12:16 PM on August 17, 2017 [1 favorite]

I take 20 mgs of citalopram daily for seasonal affective disorder. I limit my alcohol intake to two or three drinks a week; not because of any drug interaction, but because alcohol aggravates my restless leg syndrome, for which I take *another* medicine. But sometimes you have to throw up your hands and say, "dammit, it's summer; I'm having a gin and tonic."
I told my internist just that and he said "go right ahead; you won't drop dead" (that's not a verbatim quote.)
The upshot was/is: you're an adult; you can work a drink in here and there.
posted by BostonTerrier at 12:23 PM on August 17, 2017

I've taken escitalopram and other SSRIs in the past, though never citalopram specifically. I never changed my moderate alcohol intake, and I never noticed a problem. In general, I personally have had few side effects from antidepressants.

However, people's responses to these drugs vary widely
posted by Anticipation Of A New Lover's Arrival, The at 12:25 PM on August 17, 2017

I took citalopram my senior year of college, drank probably 6-8 drinks per week, and lived to tell the tale. It definitely lowered my alcohol tolerance, so I felt tipsy sooner.
posted by coppermoss at 12:31 PM on August 17, 2017

I take citalopram and drink (albeit no more than maybe two in an evening). The biggest issue, as others have stated, is that alcohol is a depressant. If you're depressed, adding a drug that increases depression can make the struggle harder. If I drink more than the 2, I feel pretty blue the next day or so. Citalopram can only do so much to battle depression if you're adding to it on your own. You're trying to dig out of a hole and also digging back down at the same time.

Cutting back might make a difference in how you feel. You can always just ratchet down slightly, from 4 to 3, if you're concerned.

Also, if you're drinking (or drinking more) because you're depressed, it's possible the citalopram will affect your mood and you'll feel like cutting back slightly anyway.

(I don't have any side effects. The first 2 weeks on it, I felt horribly anxious, but it went away as I adjusted.)
posted by Ink-stained wretch at 12:32 PM on August 17, 2017 [1 favorite]

My anecdote, data point of one:

I was a lightweight before I started SSRIs (fluoxetine for 1yr, sertraline for about 4mos) and even more so since. However, the amount you drink every day is more than I usually drink in a month, so it's really hard to make a good comparison.

I hope you don't plan on using a bunch of anecdotes from the internet to completely guide your healthcare decisions? This question should really go to your doctor, who knows your overall health picture much better than we do, and you should really be honest about extent to which you are drinking.
posted by schroedingersgirl at 12:34 PM on August 17, 2017 [1 favorite]

I'm on a low dose SNRI and I found that my alcohol tolerance dropped a lot at first -- one drink felt the same 2-3 had previously. Then it evened out, and now feels like it did before I started taking it. I'd say it took 2-3 weeks for that to settle out, though. And I'm not a heavy drinker - usually 1-2 drinks at a time. I'd say to pay attention to how you feel and take it easy until you know what the interactions are.
posted by gingerbeer at 12:54 PM on August 17, 2017 [2 favorites]

I take 20mg citalopram and have for years. I'm not a big drinker - 1-2 beers when I have a drink. The very occasional bourbon drink. I don't think I've ever noticed a side effect.
posted by jdl at 1:58 PM on August 17, 2017

low-dose escitalopram for seasonal affective disorder. I try mostly not to drink, but come on, it's about 6 months of the year! keep my "date night" to one good-sized drink (cleared by my prescribing physician), occasionally have a half glass at home with dinner. but I'm in a period of low alcohol tolerance these days due to parenthood, so I wouldn't be surprised if that amount could be scaled if your tolerance were higher.

note: my doctor said that the concern with escitalopram was that alcohol is a depressant, so you're messing up the theraputic effect you're seeking (in addition to making dosage unreliable). no mention was made of the liver, but it's a different drug. never noticed an increase in tipsiness, but again, drinking as little as I do these days, a glass is noticeable anyway.
posted by acm at 2:03 PM on August 17, 2017

I'm on citalopram and drink moderately a few times a week, which my doctor is fine with. I haven't had any problems nor have I noticed changes to tolerance or hangovers. I've also gotten drunk-drunk on occasion with no apparent change in effect.

I avoided the booze while adjusting to the meds, though, which may be advisable-- I felt weirdly high all the time already.
posted by noxperpetua at 3:02 PM on August 17, 2017

I take escitalopram 5 MG. The first month I definitely got affected way more after 1 drink, but it's now nearly two months and I pretty much am back to pre-medication levels of drinking tolerance. I like craft beer too much to stop drinking, but I only really have one or two drinks anyways.
posted by yueliang at 3:45 PM on August 17, 2017

I would talk to your doctor about this, or to whoever prescribed the citalopram. Drinking 4 pints a day, plus martinis on the weekend, is not the moderate drinking people are describing in their anecdotes. If you're concerned about the interaction between alcohol and your new medication, you need to talk to a doctor.
posted by shapes that haunt the dusk at 5:16 PM on August 17, 2017 [1 favorite]

If you are what your reportinting drinking everyday, you are at risk for problems regardless of the medication honestly. You should speak to a doctor about decreasing significantly or stopping your alcohol consumption.

You also are at risk for withdrawal symptoms if you stop suddenly.

If your doctor is aware if your drinking, it may be the benefits if the antidepressants outweigh the potential risks in terms of behavior and risk for self harm or suicide.
posted by AlexiaSky at 7:37 PM on August 17, 2017 [2 favorites]

I am not a super regular drinker, but even then I've never been a lightweight until I got on a combo of an SSRI and an NDRI. I would say drinks hit me between 2 and 4 times harder than they would have before, depending on the circumstances. I recently made the super, super dumb decision of upping my dosage a week before my birthday & had my first-ever blackout drunk experience, which resulted in me getting admitted to the hospital for the night (I went from fine to unconscious extremely rapidly). I do not regularly consume alcohol on a more casual basis, but I would maybe suggest trying to cut down what you're regularly drinking by a half or more. Your body is going to be reacting stronger to it & all the general wear & tear on your system that comes with alcohol...& it may even mess up the effectiveness of the medication you're on in the first place, impeding your long-term recovery. I'd also suggest trying to find a beer you like with a lower alcohol content & maybe experimenting with more diluted mixed drinks. Ultimately, you really gotta be kind to your body through this, because starting an anti-depressant can often be a rollercoaster just on its own.
posted by giizhik at 8:53 PM on August 17, 2017

...agreed that there is a discrepancy between OP and others' "moderate" drinking, but I do not think OP is risk of withdrawal at four beers a day. (IANAD, but I don't think anyone else in this thread is, either.)

Do try asking pharmacists -- in a perfect world, a psychopharmacologist. I find a good pharmacist tends to be more skilled with answering drug questions than an average doctor; they certainly seem to consult more sources and generally be more up-to-date. I also suspect it doesn't hurt that they spend their entire day talking to people about drugs. My GP deals with all sorts of fusses from me, but my pharmacist only hears the "OMG, this is a magical drug" and "Okay, so I am now off the X because I could not take the headaches and acne it gave me." If it is a reasonably busy pharmacy and lots of customers discontinue drug X mentioning that, or they stay on it buying acne cream and a bottle of Aleve with it, there's a nice little database for them to draw upon and note.

(I went on two antidepressants, the very similar escitalopram included, after my brain crapped the bed along with my body apropos of a vitamin deficiency. Noted changes in reaction to alcohol: absolutely none. I went through all sorts of testing then and in the aftermath, and I drank, not daily but often a robust amount of lower-alcohol beers {"session ale"!} on Fridays, and my liver is apparently enjoying itself and performing exactly as it should be, even after a year of giving it pills and beer while not physically well.)

Please do not be embarrassed. Adult life can be messy and difficult and we all use crutches at times.
posted by kmennie at 6:16 PM on August 18, 2017

My experiences are mixed, partly depending on how heavy my drinking was. Overall I've had little-to-no purely physical side effects, but at heavier drinking levels have found mental health effects.

I've been on antidepressants, on and off, for 15+ years, due to recurrent & treatment-resistant depression; and have been a drinker most of the time too. When I first started taking antidepressants I found it gave me a lower booze tolerance , but after a month or two that was back to usual. I didn't have any other physical side-effects. This was while drinking maybe 4-5 units of alcohol at a time, 3-4 days per week.

Over time my drinking became heavier and eventually problematic - I had maybe five years of drinking at the level you are (about 8 units a day, most days), and another year or so of double that. I decided to stop drinking for a while, and found that within a few weeks my mood was noticeably better. It surprised me how clear the effect was - I knew intellectually that alcohol was a mood depressant, but always found the immediate high of drinking enjoyable and even necessary for coping with my depression (... self-medication), and thought the two factors would balance out more evenly.

Of course YMMV, and I'm sure the effects vary by level of drinking, I was drinking an awful lot. Also, at the time I was taking a different antidepressant (duloxetine), for which there is clearer evidence that alcohol directly interferes with the effectiveness of the drug. I don't think that's the case for citalopram.

I was unsure whether to post this, because your question is very clear that you don't feel in a place to be able to tackle your drinking at the moment. I get this - this was me for many years, and who knows what will happen in my future (it's only been a few months since I reduced my drinking). But I wanted to share my experience that, while you're fine to drink from a purely physical perspective, I expect your mood will ultimately benefit from it if/when you are able to reduce the amount.

Good luck with it all, and like kmennie said no blushes, so many of us grapple with the same stuff.
posted by yesbut at 8:03 PM on August 18, 2017

I think you'll likely be okay as long as you take it slow at first. But drinking alcohol while taking antidepressants is going to reduce their ability to help your depression.

When you decide to tackle your drinking I wholeheartedly recommend Naltrexone. I used to drink as much and often more than you. Naltrexone has almost completely eradicated any desire to drink. It works by blocking your opioid receptors so you don't feel pleasure from drinking. You still feel the other effects of alcohol, and you can still enjoy yourself if you are with good company, but you won't get any buzz from the alcohol. If you take the medication at least 1-2 hours before drinking every time you drink you can sort of re-wire your brain so it won't crave alcohol anymore.

Good luck. :)
posted by blackzinfandel at 11:06 AM on August 19, 2017

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