Can You Drink Alcohol While Taking Crazy Meds?

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The question of drinking alcohol - along with some other vices - while taking neurological / psychiatric medications comes up all the time. It’s a confusing issue. On one hand crazy meds are used all the time to treat alcoholism, and some of them show a lot of promise (especially Topamax), on the other it will say in the patient information leaflet/handout (PIL) not to drink (e.g. Topamax’s PIL specifically warns you not to drink when taking it).

The simplest thing to do is not drink at all, but simple, being mentally interesting, and reality rarely go together.

1.  Keep it Simple, Stupid

OK, a couple things are simple.

• If you have a substance abuse problem, don’t drink, take drugs you haven’t been prescribed, or take anything illegal. Duh.
• Lots of meds make it easier to not drink. We’ll be getting to those a bit later.
• And some meds make it a lot harder to not drink.
• The brains of long-term, heavy drinkers react to meds differently than those of people who aren’t¹.
  • And that’s not even taking into consideration what has happened to your liver and kidneys.
  • What this means is: this article is for people who drink socially, moderately, or have yet to make a career of their heavy drinking (i.e. 5 years or less).
  • If you’ve been a daily, heavy drinker for longer than five years this article doesn’t apply to you because either:
    • You’re taking one or more crazy meds in order to stop drinking, so there’s no point in worrying about short- and long-term interactions of meds & booze
    • You’re not going to stop, so it doesn’t matter - except for the one bit about antipsychotics

1.1  I Told You it’s Complicated. Really Complicated.

Some, like Effexor, actually make it more difficult to abstain from drinker.

• So whether or not you’re still drinking - in which case we hope you’re using a med to help you stop drinking (or smoking pot, or snorting cocaine, or a few other things ²) - if you’ve been a heavy drinker for however long it takes to have messed with your body and mind (5–10 years on average), you and your doctor are going to have to talk about it in detail.

2.  Geez You’re Moody when You Haven’t Had a Drink

Unless you’re taking these meds as part of a treatment plan to stop drinking, you normally shouldn’t drink alcohol if you are taking any type of mood stabilizer, either an anticonvulsant/anti-epileptic drug (AED) or an antipsychotic (AP). Why?
Alcohol + bipolar = trouble.
If you can honestly look back at your life you’ll find that will be true far more often than for those who are not bipolar. Alcohol may or may not have been trouble 100% of the time. Booze may be something you never had a problem with. But things are different now.

• The effects of mixing booze with AEDs are completely unpredictable.
  • You may get way more drunk on surprisingly less alcohol.
  • You may not feel drunk no matter how much you drink.
• Your meds may suddenly stop working.
• The one thing that is relatively consistent is the hangover will be worse and last longer.
  • Which may be because you had a seizure when you were asleep.
  • Because alcohol is, oddly enough, an AED of sorts³. It’s just not a very good one.
  • Good AEDs don’t fry your brain the way chronic, heavy drinking does.
  • And having too many AEDs, especially ones with different ways of working (mechanisms of action) that aren’t particularly compatible, can cause seizures.
    • So whenever an epileptic mentions “seizure hangover,” they aren’t kidding.
  • Alcohol + AP = I used to think really fucking stupid, no matter what you’re taking it for. Now it’s unpredictable in different ways, but still really fucking stupid if you’re bipolar.
    • You can get higher off of the combination of booze and APs.⁴
    • Alcohol is definitely a serotonergic drug, and possibly a dopaminergic drug.
    • So in addition to being a crappy AED, it’s an antidepressant (AD) of sorts, which is why people self-medicate with it for depression.
    • Which means you’d be taking an AP and AD at the same time, which can act either as a souped-up AD, or effectively negate some of the actions of your AP.
    • And that means you’re wasting money and side effects as your symptoms get worse instead of better.
• In spite of, or maybe because it is a crappy AED, mixing alcohol and epilepsy is generally a bad idea.
• Alcohol + benzodiazepines = dying like a rock star.
• Alcohol + stimulants = You have no idea how drunk you really are.
• Alcohol + hypnotics (Ambien, Lunesta, etc.) = Sleep driving? How about sleep DUI!
• Alcohol + antidepressants = here we go with it getting complicated again
  • SSRIs are one of the few drugs where it is relatively safe to drink a moderate amount of alcohol. “Moderate” meaning a beer or two, or a glass of wine, two or three nights a week. Just one more reason why they are so popular.
  • But you shouldn’t drink when taking SNRIs like Effexor and Cymbalta. As mentioned above, Effexor has this weird side effect of turning people into alcoholics. It goes away when you stop taking the drug, and it’s uncommon (fewer than 1%, more than 0.1% of people have had some kind of bad drug-drug interaction of alcohol and Effexor), but when it does happen, it can get really bad really fast. Cymbalta has a minutely small chance of causing liver problems. Cymbalta + alcohol turns that into a slight chance. I haven’t got a feel for Pristiq yet, but as it’s a derivative of Effexor, you should probably avoid it.
  • The interaction of TCAs and alcohol is potentially fatal. You don’t need to use a lot of booze to wash down much more than a week’s worth of a TCA to be at the low end of a lethal amount.
  • With MAOIs it depends on what you’re drinking. You still shouldn’t drink that much, and to be absolutely safe you need to stick to things like white wine (but not vermouth), crappy beer, and vodka. I.e. avoid anything with actual flavor.
    • OK, most red wines are safe. You need to avoid Chianti and probably some other good ones.
    • By “crappy beer” I mean any beer that is available in a “Lite” form. You don’t need to drink the “Lite” flavor. If you can see through it, it’s safe. It also has to come out of a bottle or can and not a keg or a tap.
    • The only difference between almost all gins and vodkas these days is the name. Most distilled liquor is safe from a drug-drug interaction standpoint. Quantity is the issue. One shot/mixed drink is your new limit.
    • You can tell I used to be such a booze snob.
    • The restrictions aren’t as bad with the Emsam patch. You just have to avoid anything that undergoes fermentation in the bottle/container, like good beer and good sake.
    • Talk to your pharmacist and read the PI sheet (and not just the patient hand-out, if you get one) for more, and probably better information.
  • As for everything else, it’s a crap shoot.
    • Wellbutrin + booze is mostly benign, with a couple provisos. Some people will feel less inebriated than they actually are, and it’s an ersatz epilepsy test - because too much booze and Wellbutrin both lower your seizure threshold, so you really need a way to get home that does not involve you driving.
    • Remeron will make you more drunk, but liquor as no effect upon Remeron. That’s from the Remeron PI sheet.
• But wait, aren’t crazy meds used to treat alcoholism? Aren’t they given to people who are still drinking?
• Yes. As I wrote above, chronic use of alcohol changes how your brain works.
• And we get into “Which sucks less?” territory.
  • Here’s a study on using Topamax and Abilify to treat alcoholism. I like this part

‹ < Tips on How to Stop Taking Psychiatric/Neurological Drugs | Common Crazy Med Crap Index | The Differences Between Brand Name and Generic Medications ›

² Except smoking tobacco. The long-term neurological effects and drug-drug interactions on that particular vice are really well known. It may still get a section of a page, or even an entire page of its own Real Soon Now.

³ Which is why heavy drinkers go into seizures when they suddenly stop drinking.

⁴ Now I know why Seroquel and other antipsychotics are so popular in prisons: so the inmates can get higher off of their toilet wine! Those who get the APs from prison doctors are artificially inflating the percentage of mentally interesting in the prison population, making it appear as if there are more of us locked up for various crimes than there actually are. Which just feeds the stereotype that we're all a bunch of psychokillers waiting explode.

Page created by: Jerod Poore. Date created: 13 August 2011 Last edited by:

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¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]