At the age of 23, Jane* was an introverted and almost terribly shy young woman. “I was a well-behaved girl and teenager with good academic grades,” she tells me.
Then, in her early twenties, a period of anxiety and a continued feeling of tension led her to seek help from her GP. He was prescribed Aropax, an antidepressant that contains selective serotonin reuptake inhibitors (SSRIs). Aropax helps control mood and is typically prescribed to people suffering from depression, anxiety, or panic disorders.
“I wasn’t told to abstain from alcohol, even though it clearly says so on the package.”
Now 47, she believes antidepressants led to a period of wild behavior and an unhealthy dependence on alcohol. “Although the pills helped relieve my anxiety, they also removed my inhibitions,” she says.
‘Before taking antidepressants I drank quite regularly, but sensibly – it helped relieve the stress I was experiencing as I had debilitating anxiety in all aspects of my life, including terrible social anxiety. But once I took the pills, I felt euphoric, almost manic.”
Taking prescription SSRIs and drinking heavily led to a period of her life that Jane describes as “libertinate.” She says drinking large amounts of alcohol (usually two bottles of wine a night) was “uplifting” for her after a period of anxiety and darkness.
During this time, Jane moved to Japan to work as an English teacher and lived in shared accommodation with other expats. ‘Antidepressants helped me overcome the shyness I would normally have felt in this type of situation. And expat life is pretty crazy: there’s a lot of drinking and drugs. I threw myself into the party. I was having a great time. The pills removed my inhibitions and I drank almost every night. I would buy two bottles of Prosecco on the way home and that would be just for starters. We drank at home and then went out for more drinks and sometimes drugs.
Jane says the mix of alcohol and antidepressants left her with “unlimited confidence.” “She was super happy and open to all experiences.” However, as the months went by her behavior became even more manic, in all areas of her life.
At 23, Jane* was an introverted and shy young woman, but she claims that the antidepressant Aropax completely altered her personality and turned her into a “libertinate” heavy drinker (archive image)
“I didn’t have a ‘stop’ button,” he says. ‘That was completely eliminated. But he was otherwise healthy, although perhaps I should say drug addicted. I would drink and party all night, then get up in the morning and head to the gym. Even here I went overboard: I did hundreds of sit-ups non-stop to catch my breath. I just couldn’t get enough of that “high” that alcohol or exercise gave me. “People told me I’d done enough, but I never felt like I’d reached my limit.”
Before taking SSRIs, Jane “drank as much as her friends, maybe a little less.” In high school I had drinks with friends, but I certainly didn’t overindulge or crave alcohol. Now, almost twenty years later, he realizes he was spiraling toward alcohol dependency.
Jane is not alone. According to Dr Cathy Andronis, Professor of Psychological Medicine at the Royal Australian College of General Practitioners, alcohol dependence can develop while taking antidepressants. “Antidepressants are a large group, the most prescribed are SSRIs, but there are other small groups of antidepressants that are prescribed, and people can have different reactions when they are mixed with alcohol.”
Dr. Andronis says different antidepressants can react in various unpredictable ways to foods or other medications and can cause health problems such as high blood pressure. ‘We cannot assume that it is safe or dangerous to consume alcohol with antidepressants; This has to be an individual decision made with that patient’s doctor.’
So what happens to your brain when you mix alcohol with your medications? “When people drink, they get varying effects,” says Dr. Andronis. ‘At a lower level, most people will feel disinhibition or a sense of social connection because it decreases anxiety at lower levels. At higher levels, or after prolonged alcohol consumption, it is a depressant, so one may fall asleep or feel tired after drinking.’
According to a 2014 article in the International Journal of Risk and Safety Medicine that analyzed 200 cases of people who had reported increased alcohol consumption as a result of taking SSRIs, “multiple lines of evidence amplify a heretofore barely recognized signal of interactions between SSRIs.” and alcohol-related antidepressants’.
Dr. Andronis discovers that genetics can influence the reaction or increasing dependence on alcohol when mixed with antidepressants. ‘Genetically, people metabolize alcohol differently. For example, in Asian cultures where people drink much less, they are very sensitive to alcohol because of their enzyme patterns and the way they metabolize alcohol in the liver. Therefore, even a small amount can cause disinhibition.’
Jane recognized that she was engaging in risky behavior after several “blackouts” when she was found unconscious on the side of the road. “I decided to stop taking antidepressants; I put two and two together and realized that my excessive alcohol consumption had coincided with starting pill treatment.” However, quitting cold turkey meant she endured three days of detox symptoms, ranging from insomnia, tachycardia and feeling chronically overwhelmed.
‘I felt paranoid and, although I have never been suicidal, I felt like the world was collapsing before me. Fortunately, a roommate found me and helped me get through the worst. I started my antidepressants again and this time weaned them off in a slower, more controlled manner, reducing my dose gradually.
‘Then I moved from Japan to Seville, Spain, and although my alcohol consumption decreased a little, I was still easily drinking a bottle of wine a night. When I returned to Australia, alcohol consumption increased again.”
Jane admits that her family drinks a lot and that she has a history of alcoholism. “We all drink more than we probably should,” he tells me.
At age 36, Jane began experimenting sexually – which she believes was caused by another antidepressant, Zoloft – and had a compulsion to drink.
David Godden, a psychologist and director of the Bay Addiction Center in Byron Bay, says that in his experience, an increase in alcohol dependence and the link to antidepressants is not necessarily genetic. “I think it’s a reaction between the individual, the alcohol and the antidepressants,” he says. “Most people who start taking antidepressants are probably already self-medicating with alcohol, to a large extent or not, regardless of whether they were told to stop drinking when they were prescribed alcohol. I don’t think antidepressants make people disinhibited, but combining an (antidepressant) that can increase people’s energy and mixing it with alcohol can make people feel potentially euphoric.’
Dr. Godden says many don’t stop drinking on SSRIs because of the side effects of alcohol withdrawal. “Then they can drink to control those feelings,” he adds.
Recognized physical symptoms of the interaction between antidepressants and alcohol may include worsening depression, low mood, agitation, headache, and sensations of electrical shocks in the brain, known as “brain zaps.”
With 14 per cent of the Australian population now taking antidepressants, SSRI-induced alcoholism may be a relatively common problem, although it is largely unrecognized.
Jane’s return to the Gold Coast coincided with another period of depression and anxiety, brought on by a demanding new job. ‘He was quite healthy, although very stressed. Then I met someone and together we started drinking a lot. The end of this relationship and continued work pressures caused a nervous breakdown, after which she was prescribed another SSRI, Zoloft. He abstained from drinking during this tablet treatment, following the advice of his GP.
“When I felt stronger, I moved to Melbourne, but I started drinking again.”
The move to Melbourne coincided with Jane once again entering another “manic, uninhibited period of her life.” Now 36, he began experimenting sexually, which he believes was caused by Zoloft, and had a compulsion to drink.
What followed were several years of high-risk drinking, during which time he suffered alcohol poisoning. With her then relationship at risk, she decided it was time to finally address her health issues.
“By then I was already in my thirties and I needed to take care of my health. I realized that I wanted to have a child. I had some of my eggs frozen when I was about 38, but I didn’t stop drinking.’
Jane met her current partner when she was 40 and decided she wanted to go ahead with an embryo transfer. “I continued collecting eggs and trying to transfer embryos, but I think the alcohol and subsequent inflammation in my body affected my ability to get pregnant.”
The story has a happy ending: Jane and her partner returned to the Gold Coast, where they were able to have a daughter, who is now five years old..
He no longer takes SSRIs and only drinks a few glasses of wine or beer on the weekends. He recently had several health problems that he suspects are related to his years of alcohol abuse combined with taking antidepressants. She now suffers from fibromyalgia and memory loss, and continues to have fertility problems.
‘No doubt the antidepressants made me drink a lot and eliminated my inability to say “enough.” I feel lucky to be on the other side of those chapters of my life and I just hope that my past doesn’t affect my health in the future.’
The RACGP recommends avoiding alcohol completely when taking antidepressants. “Alcohol can counteract the benefits of antidepressants, making depression and anxiety worse,” says Dr. Andronis. ‘There aren’t many positive effects of alcohol and once we remove the mind-altering experience we seek, it becomes a poison. Sometimes small amounts of alcohol may be okay for some people, but it’s not really a positive thing.’
She points to research showing that drinking large amounts of alcohol is linked to health problems such as cancer, high cholesterol levels and mental health problems. “Alcohol is a brain depressant, it affects sleep patterns, causing interrupted and poor quality sleep,” he adds. “The effects of poor sleep can exacerbate mental health problems and other symptoms of depression, such as overeating and lowered inhibitions.”
*Name has been changed