Can You Drink on Antidepressants? Medication and Alcohol

The holiday season brings a question many people on medication never quite ask out loud: can I have a drink at the party? If you’ve typed “Lexapro and alcohol” or “Zoloft and alcohol” into a search bar, you’ve probably found conflicting answers. The place to start is what your medication’s own instructions say.

Here’s the short answer on antidepressants and alcohol. The Zoloft and Lexapro Medication Guides say not to drink, and no label we reviewed sets a safe amount. The specific risks depend on which medication you take, so this post goes through them drug by drug. Ask your provider or pharmacist before drinking any amount.

What Can Happen If I Drink?

• Drowsiness and judgment. The Zoloft and Lexapro labels say the medication can cause sleepiness or affect decisions and reaction time. NIAAA, the federal alcohol research institute, notes that alcohol can intensify these effects when combined with medicines, and that even small amounts of alcohol can make it dangerous to drive.
• Mood. NIAAA lists increased feelings of depression or hopelessness as a possible reaction when alcohol is mixed with depression medications. If you’re in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.
• Worse side effects. MedlinePlus tells people taking sertraline or escitalopram to ask their doctor about alcohol, because it can make side effects worse.
• Problems specific to your medication. Depending on what you take, the labels warn about seizures, liver injury, a dangerous rise in blood pressure, or dangerously slowed breathing. The next sections go through them.

For why alcohol affects mood in the first place, see how alcohol actually affects anxiety and depression.

What the Zoloft and Lexapro Labels Say

The Medication Guide in the sertraline (Zoloft) label, the handout written for patients, tells people not to drink alcohol while taking it.

The escitalopram (Lexapro) label says alcohol isn’t recommended for people taking it, and its Medication Guide says not to drink during treatment. No label we reviewed gives a safe amount.

Liquid sertraline (the oral solution) contains 12% alcohol. It’s mixed with one of the liquids the label lists, such as water or orange juice, right before you take it, and it must not be taken with disulfiram (Antabuse).

Which Antidepressants Carry the Most Specific Warnings?

Some antidepressants have different, more specific alcohol warnings.

• Bupropion (Wellbutrin): seizures. The label says excessive alcohol use, or suddenly stopping after heavy use, can raise seizure risk, and bupropion must not be used during abrupt alcohol discontinuation. It also describes rare reports of reduced alcohol tolerance and says to minimize or avoid alcohol.
• Duloxetine (Cymbalta): the liver. The label says heavy drinking with duloxetine may be associated with severe liver injury, and that it shouldn’t be prescribed to people with substantial alcohol use or chronic liver disease. Its Medication Guide says to avoid heavy drinking and to talk with your provider about how much you drink.
• Mirtazapine (Remeron): added impairment. The label found that mirtazapine’s effect on thinking and movement adds to alcohol’s. It says to avoid alcohol.
• Trazodone: a stronger reaction. The label warns that it may strengthen the response to alcohol, and it tells patients not to drink until they’ve talked with their provider.
• Venlafaxine (Effexor XR): serious side effects. The label says the risk of combining it with alcohol hasn’t been systematically studied and advises avoiding alcohol. Its Medication Guide says not to drink during treatment, because drinking can increase the risk of serious side effects.
• MAOIs, an older antidepressant group: blood pressure. Tyramine, a substance in some aged and fermented foods and drinks, can cause a dangerous rise in blood pressure. The tranylcypromine (Parnate) label doesn’t recommend alcohol, and its Medication Guide says not to drink while taking it. It names tap beer and unpasteurized beer as the tyramine concern, and says bottled and canned beer and wine contain little or no tyramine. The phenelzine (Nardil) label goes further. Separate from tyramine, it says phenelzine shouldn’t be combined with alcohol, because alcohol slows the brain and nervous system. It also lists beer and wine, and alcohol-free and reduced-alcohol versions of both, among drinks to avoid.

Other Psychiatric Medications

Many people take more than one medication, so the answer has to cover all of them.

• Benzodiazepines, such as alprazolam and clonazepam. This is a dangerous combination. The alprazolam and clonazepam Medication Guides warn that taking one with alcohol can cause severe drowsiness, breathing problems, coma and death. Their boxed warnings, the FDA’s strongest label warning, add that misuse often involves alcohol and is tied to more serious outcomes. NIAAA lists slowed or difficult breathing with opioid pain medicines and prescription sleep medicines too. Shallow or slowed breathing is an emergency: call 911.
• Mood stabilizers. The divalproex (Depakote) Medication Guide says not to drink, since the two can cause sleepiness and dizziness. NIAAA also lists lithium and lamotrigine among medicines that can cause drowsiness or dizziness with alcohol. The lithium label warns that dehydration can raise the risk of toxicity. It doesn’t name alcohol, but alcohol increases fluid loss, so it’s worth asking.
• Antipsychotics. The quetiapine (Seroquel) Medication Guide says not to drink, and the label reports that quetiapine made alcohol’s effects on thinking and movement stronger in a clinical trial.
• Buspirone and hydroxyzine. The buspirone label calls avoiding alcohol the prudent choice. The hydroxyzine label cautions that alcohol’s effects may be increased.

What If I Already Drank?

Try not to panic. Don’t drive and don’t drink more.

• If you take an antidepressant, keep taking it as prescribed and mention it to your provider.
• If you take an MAOI, such as phenelzine (Nardil) or tranylcypromine (Parnate): if you get a sudden, severe headache, a pounding or fast heartbeat, a stiff or sore neck, chest pain, nausea and vomiting, or any other sudden, severe symptoms after drinking or eating a tyramine-rich food, call 911 and say you take an MAOI.
• If you take a benzodiazepine, sleep medication or another sedating medication, don’t take your next dose while alcohol is still in your system without asking first; call your provider, your pharmacist or Poison Control at 1-800-222-1222.
• If someone is very sleepy and hard to wake, or breathing slowly or shallowly, call 911.

Don’t Skip a Dose to Make Room for a Drink

NIAAA notes that alcohol and medicines can interact even when they aren’t taken at the same time, so skipping a dose doesn’t clear the way. Please don’t stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.

Planning Ahead for a Party

Most of this comes down to deciding before you’re standing at the drinks table.

• Ask your provider or pharmacist before drinking any amount. They can answer for your exact list of medications.
• Have your “no, thanks” ready. NIAAA’s advice is to have a polite answer prepared, since hesitating leaves time to think of excuses to go along.
• Choose a non-alcoholic drink. On phenelzine, check the mocktail too: alcohol-free beer and wine are on that label’s avoid list.
• Check what else you’ve taken. NIAAA notes that many cough, cold and allergy remedies contain ingredients that react with alcohol.

If You Drink Most Days

If you drink heavily and often, please don’t stop suddenly on your own. Alcohol withdrawal can range from uncomfortable to life-threatening, so talk with a medical provider first. Call 911 or go to the nearest emergency room for seizures, fever, severe confusion, hallucinations or an irregular heartbeat. If you take bupropion, mention it right away, because of its seizure warning.

If alcohol is part of the picture, your provider can talk with you about options, which may include non-controlled medications such as naltrexone tablets or acamprosate when appropriate. We don’t offer injectable naltrexone (Vivitrol) or detox. Our substance use and mental health page explains more.

When to Talk With Your Provider

Bring up alcohol before you start a medication, whenever you’re unsure about a drink, and if a medication doesn’t seem to be helping. The amounts people report tend to run low: in U.S. public health surveys, self-reported drinking covers only 30% to 60% of alcohol sales. But the real number changes decisions. The duloxetine and bupropion labels both make alcohol part of the choice of medication. MedlinePlus also lists anxiety, low mood and insomnia among the symptoms of alcohol withdrawal, so drinking can blur the picture of how you’re doing.

For adults in South Jersey and across New Jersey, this is an ordinary thing to raise with your provider, who would rather know, because it can change which medication fits you best. Looking for a psychiatrist in New Jersey? Our providers are board-certified psychiatric nurse practitioners (PMHNPs), who provide psychiatric evaluation and medication management.

What About Studies That Found No Interaction?

You may read that some antidepressants “don’t interact with alcohol.” That idea comes from small, short experiments in healthy volunteers (people without depression), who took the medicine, had a drink, and then did tests of reaction time, memory and coordination. The Zoloft label describes this kind of experiment in healthy people; the Lexapro, Cymbalta, Effexor XR and buspirone labels report similar “no added impairment” results.

These experiments were short and small and used healthy people, so they don’t show that drinking on an antidepressant is safe. They also say nothing about what regular drinking does to sleep or mood over weeks. That’s why the same labels still say not to drink or advise avoiding alcohol.

One point is debated. A 2014 report collected case reports of unexpected disinhibition and memory loss in people drinking while on SSRIs, and its authors called for stronger warnings. Case reports can raise a concern, but they can’t prove the medication was the cause.

Does Drinking Stop an Antidepressant From Working?

You’ll often read that it does. The evidence is less settled than that.

NIAAA says in general that alcohol can make a medication less effective. A systematic review found that alcohol problems go along with worse depression outcomes. But that review also found antidepressants can still be effective when someone has alcohol dependence, and a Cochrane review rated similar evidence as low quality, with a possibly modest benefit. Our depression guide covers treatment more broadly.

This research focuses almost entirely on alcohol abuse or dependence, mostly in psychiatric inpatients, so nobody can honestly say how many drinks undo how much benefit. That gap isn’t evidence that even drinking at levels often called moderate is safe. If a medication doesn’t seem to be helping, alcohol is worth looking at along with everything else.

Frequently Asked Questions

Can you drink on Lexapro?

The label says alcohol isn’t recommended, and its Medication Guide says not to drink during treatment. Lexapro can also make you drowsy, and alcohol can make side effects worse. A short experiment in healthy volunteers didn’t find that Lexapro increased alcohol’s effects on thinking and coordination, but that doesn’t show that drinking on Lexapro is safe. Your provider can talk through what this means for you.

Can you drink on Zoloft?

The Medication Guide says not to drink alcohol while you take it. Short experiments in healthy volunteers didn’t find that Zoloft added to alcohol’s short-term effects on thinking and coordination, but that doesn’t show that drinking on Zoloft is safe, and it says nothing about regular use over time. Liquid sertraline contains 12% alcohol and must not be taken with disulfiram (Antabuse).

Is one glass of wine okay on antidepressants?

The antidepressant labels we reviewed advise against alcohol or say not to drink. (Cymbalta’s label specifically warns against heavy drinking because of the risk of liver injury; none of the labels we reviewed sets a safe amount of alcohol.) Follow your medication’s instructions, and ask your provider before drinking any amount.

Should I skip my antidepressant if I’m going to drink?

No. Alcohol and medicines can interact even when they aren’t taken at the same time. Please don’t stop a medication on your own; some can cause withdrawal symptoms or a return of symptoms if stopped suddenly.

Is a psychiatric nurse practitioner the same as a psychiatrist?

No. Psychiatrists are medical doctors (MD or DO) who complete a residency in psychiatry. Psychiatric nurse practitioners are advanced practice registered nurses with graduate training in psychiatric care, and ours are board-certified (PMHNP-BC). In New Jersey, both can evaluate, diagnose and prescribe psychiatric medication. Our providers focus on careful evaluation and medication management.

If you’re unsure how alcohol fits with what you take, medication management gives you regular follow-ups to talk it through and adjust the plan as you go.

This article is for general educational purposes only. It does not constitute medical advice, does not establish a provider-patient relationship, and is not a substitute for individual evaluation, diagnosis, or treatment by a qualified clinician. If you’re in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.