Alcohol and mental health medicines interact in three ways: alcohol adds to sedation, it works against what the medicine is treating, and with one group it can be genuinely dangerous.
The dangerous combination is alcohol with benzodiazepines, sleeping tablets or opioid painkillers. Both suppress breathing, and together the effect is greater than either alone. This combination is a recognised cause of preventable deaths, and it is the one point on this page that is not a matter of degree.
Common side effects and early adjustment effects
With most antidepressants and antipsychotics, alcohol mainly amplifies effects you would get anyway: drowsiness, dizziness, poor coordination and slowed thinking. The practical consequence is that a familiar amount of alcohol can affect you noticeably more than it used to, which matters for driving in particular.
Alcohol also disrupts sleep quality even when it helps you fall asleep, which works directly against treatment for depression and anxiety.
Serious mood, behaviour or physical symptoms to take seriously
Get emergency help for very slow or shallow breathing, someone who cannot be roused, or extreme drowsiness after alcohol combined with a sedative or opioid.
Alcohol raises risk in a way worth being direct about. It lowers inhibition and worsens low mood, and the combination of alcohol and suicidal thoughts is particularly dangerous. If your mood drops when drinking, or you find yourself drinking when you feel at your worst, that is worth telling someone, and it is a common enough pattern that nobody will be surprised by it.
Contact a doctor or emergency services urgently for thoughts of self-harm.
Sexual, sleep, weight and emotional side effects
Alcohol and several mental health medicines both affect sleep architecture, sexual function and weight, so the two together can make it hard to tell what is causing what. If you are trying to work out whether a medicine is responsible for an effect, a period without alcohol makes the picture considerably clearer.
Interactions, alcohol, pregnancy and other risk factors
- Benzodiazepines and sleeping tablets. The combination to avoid entirely. See sleeping tablets and alcohol and anxiety medication and alcohol.
- Antidepressants. Added drowsiness, and alcohol works against the treatment. Tricyclics such as amitriptyline are particularly sedating in combination.
- Antipsychotics. Added sedation and dizziness, raising fall risk.
- Lithium. Alcohol contributes to dehydration, which raises lithium levels. See lithium side effects.
- Sodium valproate and some others add liver strain alongside alcohol.
Binge drinking is riskier than the same total spread out, both for sedation and for medicines whose levels depend on hydration.
What to ask your doctor before changing dose or stopping
Be honest about what you actually drink. Prescribers ask in order to choose safely, not to judge, and an accurate answer changes what they prescribe. Understating it can lead to a combination that would otherwise have been avoided.
- Is any alcohol safe with this specific medicine?
- Am I safe to drive after a drink while taking this?
- Does anything else I take add to the sedation?
- Is my drinking making the condition harder to treat?
- If I want to cut down, what support is available?
Do not stop a mental health medicine in order to drink. If that trade-off is one you find yourself weighing, it is worth discussing directly. See should I stop my mental health medication.
Related mental health medication guides
- Mental health medication side effects
- When to call a doctor
- Chronic medication and alcohol
- Report a side effect in South Africa
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.