In reality, though, many people taking psych meds drink anyway. They have various reasons: not wanting to curtail their fun, not putting much stock in the warnings, or simply thinking it’s easier to take a proffered drink than explain why they’re turning it down.
Doctors oftentimes don’t bother to talk to patients about potential dangers. Or they tell patients not to drink, but don’t explain why. To make matters worse, because of a lack of studies on the subject, patients inclined to do their own research will have a hard time just how risky it is to drink while taking various kinds of psychiatric medications (I’ve written elsewhere about this troubling lack of evidence).
A widely publicized study that came out last month in the journal Neurology underscores the problem. The findings, which pooled data from 16 studies, showed that people taking SSRI antidepressants like Zoloft or Celexa were 40 percent more likely to suffer a type of stroke caused by bleeding in the brain and 50 percent more likely to suffer any bleeding in the skull.
The overall risks remained tiny (this kind of rare stroke occurs in just 26 out of every 100,000 people in a given year, and taking SSRIs could be expected to increase the likelihood by about 1 person out of 10,000).
But in the journal article itself and in multiple news articles, the study’s authors cautioned that people who drink heavily might want to talk to their doctors about switching to a different antidepressant. That’s because numerous studies have shown that drinking heavily also increases the risk of this kind of stroke.
As a journalist, I’m skeptical of exaggerating dangers – especially since this study didn’t even look at at alcohol use directly, and because the risk of suffering brain hemorrhages is so low overall.
But as someone who has taken SSRIs for many years and done my fair share of college and post-college heavy drinking, I have to confess to being slightly unsettled by these warnings.
I also didn’t find it particularly reassuring that the lead author suggested that heavy drinkers might want to switch to a different kind of antidepressant, such as Wellbutrin or an older tricyclic drug like Pamelor or Elavil. Both Wellbutrin and alcohol increase the likelihood of seizure, which makes combining them extra-risky (something I only learned after years of doing just that). And tricyclics carry their own risks when combined with alcohol.
The obvious answer, you might say, is simply to be safe, not sorry. In the absence of studies examining the relationship between alcohol, particular psychiatric medications and specific negative health outcomes, it’s probably wiser to abstain from drinking if the drug you’re taking warns against it.
But that’s easier said than done, especially for young people. Teens and young adults face significant peer pressure to drink – and drink heavily.
Binge drinking – defined as four or more drinks in one sitting for a female and five or more for a male – runs rampant in this age group. More than forty percent of 18 to 25-year-olds report binge drinking at least once a month, with rates declining as people age, according to U.S. government statistics.
Even for young people taking psychiatric meds who don’t want to drink (and many do), it’s tough to invoke medication as an excuse without raising eyebrows as to what kind of medication. At this age, it’s rare to take meds regularly for anything other than a psychiatric condition.
So, given these realities, what should young people – or older ones, for that matter – do when it comes to mixing meds with alcohol?
Should they trust the warnings, despite a lack of evidence as to specific risks, and abstain? If so, how should they explain their choice to people who want to know why they’re not drinking?
Or should they just throw caution to the wind, drink like they would if they weren’t taking meds, and hope nothing bad happens?
Feel free to share your own experiences. And for more on this particular dilemma – especially as it relates to college students – check out my column on the subject here.