Antidepressants & Drug and Alcohol Abuse: What are the Risks?
Antidepressant medications make up a class of drugs that are designed to treat the symptoms of clinical depression. Even though numerous other drugs can treat depressive symptoms, antidepressant medications are designed specifically for this purpose. Other drugs are being investigated for their utility in treating depression, such as ketamine and even opiate drugs, but these drugs are not antidepressant drugs as their original manufacture and design is not to address the symptoms of clinical depression.
Recreational and prescription drugs will generally affect a person differently if they are already using an antidepressant medication. Because physicians who prescribe antidepressant medications have specific training and professional justifications for their practices, one should defer to their physician when they are prescribed an antidepressant medication and some other medication together. For further information, refer to the Handbook of Drug Interactions: A Clinical and Forensic Guide,Drug Interactions in Psychiatry, and The Evidence-based Guide to Antidepressant Medications.
Currently, there are several different classes of antidepressant drugs:
- MAO inhibitors (monoamine oxidase inhibitors): MAOs disrupt the formation of monoamine oxidase, which breaks down monoamines (neurotransmitters like serotonin, dopamine, and norepinephrine) in the brain, resulting in the availability of these neurotransmitters being extended. The theory is that these neurotransmitters are depleted in individuals with depression, and these medications can help them. Parnate and Nardil are brand names of two MAO inhibitors.
- Tricyclic antidepressants: These drugs have broad effects that also result in an increase in the availability of neurotransmitters like serotonin and dopamine. The drugs Elavil and Anafranil are brand names of two of these medications.
- Selective serotonin reuptake inhibitors (SSRIs): These drugs are a popular class of antidepressants that work via their ability to block the reabsorption of serotonin by neurons in the brain. This leaves serotonin in the brain for longer periods of time and is believed to be successful in reducing depression. SSRIs are not more effective than tricyclic antidepressants in their ability to reduce the symptoms of depression, but they have far fewer and less severe side effects; therefore, they are more commonly used. Some common SSRIs include Prozac and Paxil.
- Newer generation antidepressants (sometimes referred to as atypical antidepressants): These medications have different mechanisms of action than the other drugs mentioned above. Some of the better-known drugs in this class include Cymbalta, Effexor, and Wellbutrin.
Despite a common misconception, the use of antidepressant drugs does not make one giddy, abnormally happy, or euphoric like the “high” that one receives from other types of drugs, such as opiates or alcohol. Although there are cases of individuals abusing antidepressant drugs, these medications are not common drugs of abuse and certainly do not produce the types of psychoactive effects (euphoria) that many other drugs produce.
For some people who use antidepressants, there are unintended side effects that may weakly resemble the psychoactive effects of other drugs, such as hypomania, lethargy, and hallucinations, in rare cases; however, these are untoward effects of the drugs that occur very rarely and are not experienced by the vast majority of people using these drugs. There is a mild withdrawal syndrome associated with the discontinuation of antidepressants when a person has been using the drug for a lengthy period of time (on a continual basis for at least six weeks or more), but the withdrawal symptoms are very mild and can be controlled by the prescribing physician in most cases.
A person already abusing some other substance, such as alcohol, cocaine, heroin, etc., would not experience significant psychoactive effects as a result of combining an antidepressant medication with their drug of abuse. Moreover, there is no major street market for antidepressant drugs in the same way that opiate drugs can be sold for inflated prices on the street, indicating that these drugs are not in high demand by most drug abusers.
There are numerous medications that have the inscription on their labels, “Do not take in conjunction with alcohol,” or some other similar warning or disclaimer. The reason that alcohol use is commonly prohibited or strongly discouraged when a person is taking a prescription medicine is that alcohol typically limits the effects of the medication, results in side effects that can be serious, or the effects of the drug can be dangerously enhanced when combined with alcohol.
It is not advisable to drink alcohol when taking an antidepressant medication because alcohol use can increase the subjective feelings of depression in any individual, and this can result in the effects of the medication being significantly reduced. Moreover, the use of alcohol while one is taking antidepressant drugs may exacerbate or even result in a person experiencing significant side effects associated with antidepressants. Side effects that most often occur as a result of alcohol use in conjunction with antidepressant medications include extreme lethargy and drowsiness, dizziness, and problems with motor coordination. However, the major issue associated with the use of antidepressant medications and alcohol in conjunction is that alcohol reduces the medicinal effects of the medication.
Although MAO inhibitors are no longer commonly prescribed for depression, it should be mentioned that there is a serious potential danger in drinking certain forms of alcohol when taking an MAO inhibitor. People on MAO inhibitors are instructed to avoid eating foods or drinking beverages that contain the amino acid tyramine. Tyramine used in conjunction with an MAO inhibitor can produce a significant rise in blood pressure and increase the risk for heart attack or stroke. Alcoholic drinks, such as beer, wine (particularly red wine), and even sherry, may contain high levels of tyramine that can produce a serious interaction when a person is using an MAO inhibitor.
Opiates and Antidepressant Use
Opiate drugs include illicit drugs like heroin and prescription medications that are primarily used to control pain, such as morphine, Vicodin, OxyContin, and codeine. Individuals who suffer from chronic pain may be prescribed opiate drugs for pain control.
There is also a very strong relationship between chronic pain and significant symptoms of depression. In some cases, psychiatrists or other physicians may diagnose a person who is taking an opiate medication for pain with a major depressive disorder and prescribe the person an antidepressant medication. Again, physicians have a thorough understanding of the interactions that can occur with these drugs. Based on the needs of the individual, they may prescribe an antidepressant medication that should be appropriate for the specific case. The real problem occurs when an individual who is taking antidepressant medications abuses an opiate drug.
Use of opiate drugs when they are not prescribed is extremely dangerous. A person who was on an antidepressant medication may already be experiencing a mild level of central nervous system depressant effects, and taking an opiate drug, particularly in the types of doses that abusers use, can exacerbate these effects because opiate drugs are powerful central nervous system depressants. Most readers are acutely aware of the dangers associated with opiate abuse and overdose, including the potential for death. Using opiate drugs that are not prescribed and while on antidepressant medications can lead to significant problems with lethargy, respiratory suppression, and alterations in judgment and thinking that can be potentially serious and even fatal.
Moreover, an individual who has chronically abused opiate drugs and is undergoing opiate withdrawal may experience an exacerbation of withdrawal symptoms if they also stop using their antidepressant medications. This can lead to potentially dangerous issues with dehydration or judgment and reasoning that can lead to accidents or even intentional self-harm.
Antidepressants and Benzodiazepines
Benzodiazepines include familiar drugs like Valium and Xanax. They are central nervous system depressants that are designed to treat anxiety or seizures. Because depression and anxiety are common bedfellows, it might not be unusual for a person with an atypical form of depression who has strong feelings of nervousness, jitteriness, etc., to receive a prescription for a benzodiazepine from their treating psychiatrist. In addition, certain anxiety disorders, such as panic disorder and agoraphobia, often have associated depressive symptoms, and a psychiatrist might describe both an antidepressant (most likely an SSRI) and a benzodiazepine. However, it is known that use of benzodiazepines can inhibit the effects of the transmission of serotonin in the brain, and using benzodiazepines while one is on antidepressant medications could reduce the effects of the antidepressant.
Moreover, benzodiazepines are central nervous system depressants like alcohol and opiate drugs. When the substances are combined, it could lead to increased side effects, increased issues with lethargy, and/or an increased potential for overdose.
Suicidality and CNS Depressants
Suicidality, Antidepressants, and Central Nervous System Depressants
Abuse of central nervous system depressants, such as alcohol, opiate drugs, and benzodiazepines, may be associated with individuals who exhibit suicidal thoughts or suicide attempts. Using a central nervous system depressant while on an antidepressant medication may or may not increase the potential for suicidality over the use of the central nervous system depressant alone. However, when one abuses any central nervous system depressant drug, they experience a sharp reduction in judgment, impulse control, and emotional distress that could lead to the potential for self-harm in individuals who are already prone to hurting themselves intentionally.
Stimulants and Antidepressants
Stimulants include drugs like cocaine, methamphetamine, Ritalin, Concerta, and substances that are found over the counter like caffeine and dietary aides. Most stimulant drugs increase the available levels of the neurotransmitters dopamine and norepinephrine in the brain. Rising levels of dopamine inhibit the release of serotonin, and it is conceivable that using or abusing stimulant medications by someone who is taking an antidepressant medication could seriously interfere with the effectiveness of the antidepressant medication. Moreover, the use of stimulant drugs in conjunction with antidepressant medications would be expected to increase the potential for the development of side effects to either drug that can include lethargy, drowsiness, problems with motor control, and even the potential for hallucinations.
In general, use of cannabis products produces central nervous system effects. In some individuals, an increase in anxiety and even hallucinations may occur. There is little research devoted to understanding the effects of cannabis in conjunction with being prescribed antidepressant medications. This means that there is potential for unpredictable interactions between these two drugs to occur. Moreover, chronic cannabis use is often associated with problems with motivation, and the use of cannabis products while on antidepressants may lead to the person stopping their use of the antidepressant. This might trigger what is known as an antidepressant discontinuation syndrome, a mild form of withdrawal that occurs in some people when they stop using antidepressant medications.
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Side Effects of Antidepressant Medications That Could Be Exacerbated by the Abuse of Other Drugs
There is quite a varied side effect profile that is associated with the use of antidepressant medications in general.
Some of the more common side effects that occur over all different types of antidepressant medications that may be exacerbated by the use and abuse of other drugs include:
- Tachycardia or an abnormally increased heart rate
- Anxiety, nervousness, feelings of panic, and even manic behavior
- Lethargy, dizziness, and drowsiness
- Problems with motor functioning and motor coordination
- Nausea, stomach cramps, and even vomiting
- Confusion and problems with judgment
Any person who is taking an antidepressant medication should consult with their physician before using alcohol or any other drug. Physicians may prescribe other medications to individuals who are already taking antidepressant medications. Each patient should carefully follow the prescribing physician’s instructions and report any unusual symptoms or reactions to their physician as soon as possible. A person should never discontinue an antidepressant medication unless told to do so by their physician.
It is not advisable that any person using antidepressant medications for any reason use any type of prescription medication, illicit drug, or alcohol unless they are instructed to do so by their physician. Any person who believes that they have a substance use disorder should consult with a licensed mental health professional.
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