Tips on How to Stop Taking Psychiatric/Neurological Drugs | Common Crazy Med Crap Index | Common Side Effects

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 drinking.

  • 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.

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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.
    • Lamictal is notorious for causing multiday hangovers after drinking minimal amounts of alcohol.
    • A reason for AEDs causing such epic hangovers 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.

There was no evidence that AE[adverse effects]s of aripiprazole and topiramate are additive and can, therefore, be administered safely together with a modest amount of alcohol.

They start with heavy drinkers and find it’s safe to give to people who drink a “modest” amount of alcohol. When used to help them to quit drinking. I’m sure that makes sense to someone.
  • In Effects of Alcohol Dependence Comorbidity and Antipsychotic Medication on Volumes of the Thalamus and Pons in Schizophrenia the researchers found that alcoholism shrinks those two areas of the brain more than schizophrenia does, and antipsychotics help to prevent that - mostly in the thalamus - for both alcoholism and schizophrenia. So while the booze is messing with the immediate effects of the AP, the AP is still able to do some good in the long run.
  • As long as you manage to stay medication compliant.
  • Which isn’t easy when drinking interferes with how your meds are working.
  • Then again, if the meds make you more drunk that might be an incentive to be med complaint.
  • So even if the data are contradictory regarding your brain when mixing booze and APs, various other internal organs will hate you for doing so.

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Tips on How to Stop Taking Psychiatric/Neurological Drugs | Common Crazy Med Crap Index | Common Side Effects

1 This isn't about how some people are born to be alcoholics and others have alcoholism thrust upon them. Long-term use of any drug, from coffee to Zyprexa, will change how your brain reacts to other drugs. If you were born with one of several known genetic predispositions to substance abuse and had the misfortune of getting sucked into that particular hell, there are plenty of crazy meds to help you. They just won't act the same way as they do for everyone else. At least not at first.

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.

Can You Drink Alcohol While Taking Crazy Meds? by Jerod Poore is copyright © 2011 Jerod Poore

Last modified on Monday, 18 April, 2016 at 00:16:22 by JerodPoorePage Author: Jerod PooreDate created: 13 August 2011

All drug names are the trademarks of someone else. Look on the appropriate PI sheets or ask Google who the owners are. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of any trademarks may have changed without my noticing.

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‘Everything is true, nothing is permitted.’ - Jerod Poore

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 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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