Alcohol and Antidepressants: A Mixture That Deceives the Brain

In recent decades, the use of antidepressants has grown significantly, alongside a very common cultural habit: the consumption of alcoholic beverages. This combination often occurs because anxiety and depression coexist with substance use, creating a cycle in which the patient seeks immediate relief from emotional distress through alcohol.¹ However, studies show that this interaction is far more complex and dangerous than simply reducing the medication’s effectiveness.²

One of the most intriguing findings about this combination is how the interaction between alcohol and antidepressants alters the perception of pleasure.² When a person consumes alcohol while taking certain antidepressants, such as selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, and escitalopram), they may not experience the typical euphoria or relaxation associated with intoxication. This phenomenon, known as “blunted pleasure,” is a dangerous trap.² Because the individual does not feel the expected effects of drinking, they may consume much larger quantities in an attempt to achieve the desired sensation. The result is a greater risk of intoxication and health damage, often without the person immediately recognizing the danger, since discomfort does not always appear right away.

Beyond subjective sensations, the body experiences silent and profound physical impacts.¹ The liver, responsible for metabolizing both medication and alcohol, may show signs of overload. In addition, alcohol can increase the side effects of antidepressants on the central nervous system, such as drowsiness and dizziness.³ Alcohol may also reduce response to antidepressant treatment and adherence, while promoting impulsivity, which can increase the risk of suicide.

Biology and behavior also show different nuances between men and women. Among women, depression is often associated with higher alcohol consumption, regardless of whether they are taking medication.⁴ Among men, antidepressant use appears to help reduce the desire to drink, suggesting a positive response to treatment or to medical guidance. Nevertheless, the golden rule for both is the same: medical supervision and  honesty about one’s treatment. Hiding drinking habits makes dose adjustments more difficult and puts the effectiveness of psychiatric treatment at risk, making an integrated approach that cares for both mind and body essential.

Note: This text is for informational purposes and is based on scientific studies. It does not replace professional medical advice.

References

1. Mușat MI, Militaru F, Udriștoiu I, Mitran SI, Cătălin B. Alcohol Consumption Is a Coping Mechanism for Male Patients with Severe Anxiety Disorders Treated with Antidepressants Monotherapy. J Clin Med [Internet]. 2024;13(9):2723. Disponível em: https://doi.org/10.3390/jcm13092723
2. Helle AC, Wycoff AM, Griffin SA, Fleming M, Freeman LK, Vebares TJ, et al. Co-use of medication and alcohol: The influence on subjective effects of intoxication and affect. Personal Disord [Internet]. 2022;;13(1):75–83. Disponível em: https://doi.org/10.1037/per0000480
3. Antidepressants and Alcohol Interactions. Drugs.com. Accessed November 2, 2021. https://www.drugs.com/article/antidepressant-medications-alcohol.html
4. Graham, K., & Massak, A. (2007). Alcohol consumption and the use of antidepressants. CMAJ : Canadian Medical Association journal=journal de l'Association medicale canadienne, 176(5), 633–637. https://doi.org/10.1503/cmaj.060446