Can I Drink Alcohol With Antidepressants Like Cymbalta or Amitriptyline?

Kevin Le, PharmD, BCPS, BCPPS
Published on May 27, 2021

Key takeaways:

  • Alcohol slows down chemical signals within the brain and can worsen depression.

  • Mixing antidepressants and alcohol can have severe side effects, such as liver damage with Cymbalta and blackouts with amitriptyline.

  • Drinking alcohol with antidepressants can be more dangerous for certain people. Make sure to discuss your risks with your provider before drinking.

Red pill spilled from a prescription bottle

Alcohol has been consumed for centuries, dating back to prehistoric eras. People drink alcohol for many reasons, such as celebrating with others or as a means to lower their stress. However, alcohol has various health risks including high blood pressure, liver disease, cancer, and mental health conditions. 

Over 10% of adults in the United States report taking antidepressant medications. And people taking them often ask if they can be safely combined with alcohol. But there are a few things to keep in mind before mixing the two together. 

In this article, we will discuss the impact of alcohol on depression and its interactions with antidepressants like Cymbalta (duloxetine) and amitriptyline.

How does alcohol affect people with depression?

While drinking alcohol may temporarily distract from feelings of sadness, its use can worsen depression in the long run. Alcohol disrupts the communication pathway between brain cells, which may negatively affect people’s thoughts, emotions, and behaviors. Studies have shown that drinking more alcohol is linked to a higher chance of developing depression. 

Alcohol acts as a depressant on the brain, and it can worsen mood and elevate feelings of anxiety. It can also make it more difficult for you to get a good night’s sleep, which may worsen depressive feelings.

What’s more, people with alcohol dependency have a higher risk of developing depression. And treating the dependency is key in successfully managing depression symptoms. This is why the American Psychiatric Association strongly recommends that people are educated on the benefits of lowering alcohol use in treating depression. 

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How does alcohol affect people treated with antidepressants for other conditions?

While Cymbalta and amitriptyline are more commonly used to treat depression, they can also be used for other conditions. 

Cymbalta is sometimes used to treat neuropathic pain, a form of shooting or burning pain caused by nerve damage. Nerves are important in transporting signals from the brain and spinal cord throughout the body. Drinking alcohol, especially in large amounts, can damage nerves and cause people to feel more pain and tingling. 

Although amitriptyline was originally developed to treat depression, it is also used off-label to treat migraines. Amitriptyline may help prevent the throbbing pain caused by migraine headaches. On the flip side, drinking alcohol — such as red wine — may trigger even more migraines.

Can I take medications like Cymbalta or amitriptyline with alcohol?

Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI) that works by raising levels of brain chemicals called serotonin and norepinephrine to improve mood and treat depression. Examples of other SNRIs include venlafaxine ER (Effexor XR) and desvenlafaxine ER (Pristiq). 

Amitriptyline is a tricyclic antidepressant that also works by raising the levels of serotonin and norepinephrine available for chemical signals between brain cells. Other tricyclic antidepressants include nortriptyline (Pamelor), imipramine (Tofranil), and doxepin.

Because of how these medications affect your central nervous system (CNS) and other organs in your body, Cymbalta and amitriptyline (and others within their classes) should not be taken with alcohol. Combining these antidepressants with alcohol can have very serious effects on your health. 

Is having one or two drinks OK?

People often ask if having an occasional drink is safe while taking antidepressants. Unfortunately, there is no information to show exactly how much alcohol is safe to drink when taking these medications. 

Although it may be possible to drink an occasional beverage, this is dependent on various factors, including the dose you’re taking, as well as your age and medical history. Therefore, make sure to talk to your healthcare provider before drinking alcohol while taking antidepressants.

What’s more, you should not skip a dose of your antidepressant to drink alcohol. Doing so can worsen depression or lead to withdrawal symptoms including confusion, irritability, and exhaustion.

Are certain people more at risk when combining alcohol and antidepressants?

Combining alcohol with antidepressants may be more dangerous for certain people. 

For example, people with alcohol dependency may experience more severe depressive feelings. Older people are also at a higher risk for complications since their bodies don’t process alcohol and medications as effectively as younger people. Similarly, liver disease slows down how alcohol is cleared from the body, which can be very unsafe. 

How does alcohol interact with Cymbalta and amitriptyline?

The liver’s function is to detoxify and filter waste from the body, which includes the processing of alcohol. Especially when large amounts are consumed over a long period of time, alcohol can be very harmful, causing damage and inflammation. This can result in scarring to the liver, which is also known as cirrhosis

Both Cymbalta and amitriptyline are cleared from the body through the liver. As described above, drinking alcohol can cause liver damage, slowing down how these medications are processed. This may result in people experiencing worse and more dangerous side effects from these medications.

What are the typical side effects of these medications?

As with most medications, you may experience some side effects while taking them. However, some of the medication’s side effects may get worse if you are taking them with alcohol.

The common side effects of Cymbalta include:

  • Nausea

  • Headache

  • Tiredness

  • Trouble sleeping

  • Dry mouth

  • Constipation or diarrhea

  • Dizziness

  • Stomachache

  • Loss of appetite

People taking amitriptyline may experience side effects including:

  • Sleepiness

  • Dizziness

  • Headache

  • Blurry vision

  • Constipation

  • Dry mouth

  • Weight gain

Are there any serious side effects or risks of combining alcohol with these medications?

Aside from worsening depression, drinking alcohol while taking Cymbalta raises the risk of liver damage. Both alcohol and Cymbalta can cause liver injury on their own. However, the risk goes up when they are taken together — especially if you have multiple drinks at a time.

Since alcohol slows down communication between your brain cells, it can make you feel drowsy and negatively affect your judgment and coordination. Amitriptyline can also make you feel drowsy and dizzy on its own. When combined, they can cause extreme drowsiness and fatigue and may result in passing out or blackouts. If you are drinking alcohol while taking amitriptyline, you should avoid driving, operating heavy machinery, or other activities that require alertness. 

When should I get medical attention?

You should immediately notify your healthcare provider if you notice any signs of liver damage including the following:

  • Pain in the upper right abdomen

  • Fatigue and tiredness

  • Nausea and vomiting

  • Yellow skin and/or eyes

  • Bleeding or bruising

  • Dark urine

  • Confusion

  • Hand tremor

  • Swelling

  • Itching

Other symptoms that require immediate medical attention include:

  • Extreme confusion or drowsiness

  • Chest pain or palpitations

  • Seizures

Antidepressants also have a warning for raising thoughts of suicide, especially among children and adolescents. Notify your provider right away if you notice any behavior changes or sudden changes in feelings or emotions.

When can I start drinking if I’m no longer taking these medications?

Since alcohol may worsen depression, make sure to talk to your healthcare provider first before drinking or stopping these medications.

Antidepressant doses are usually lowered over a period of time before being stopped completely. Abruptly stopping antidepressants may result in a “discontinuation syndrome” involving:

  • Nausea

  • Vomiting

  • Dizziness

  • Tremors

  • Difficulty sleeping

  • Abnormal heart beats

  • Behavior or mood changes 

How long do they stay in your body?

Cymbalta is mostly cleared from the body after about 3 days, while amitriptyline takes longer to be cleared at approximately 1 week. However, this can be influenced by a number of factors, like the dose you’re taking, as well as your age and medical history.

Because of this, it’s best to talk to your provider about when it’s safe to have a drink after you’re no longer taking your medication.

Are there are any antidepressants that aren’t affected by alcohol?

Mixing alcohol with antidepressants can create harmful effects in the brain since they both alter chemical pathways between brain cells. There are no antidepressants that are completely safe when taken with alcohol. 

Some providers may say that light to moderate drinking is OK while taking certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro). SSRIs work by raising serotonin levels in the brain. 

However, drinking alcohol also temporarily raises serotonin levels, which may be dangerous when these levels become too high. This can result in serotonin syndrome which can result in dangerously high blood pressures, muscle twitching, and agitation. 

It’s important to note that some antidepressants — like monoamine oxidase inhibitors (MAOIs) — have more dangerous interactions than SSRIs. 

Since risks vary among people, you should thoroughly discuss with your provider before drinking alcohol with your antidepressants.

The bottom line

People taking antidepressants should be careful when considering drinking alcohol. Alcohol works as a depressant on the brain and can worsen depression long-term. 

All antidepressants can have negative effects when mixed with alcohol. In mild cases, alcohol may cause antidepressants to work less effectively. In severe cases, serious health problems, including liver damage, can occur while taking medications like Cymbalta. And drinking alcohol with tricyclic antidepressants like amitriptyline may result in blackouts. 

Your healthcare provider can thoroughly discuss the risks that drinking alcohol may have while you are taking antidepressants. 

If you or someone you know struggles with alcohol dependency, you can get help by calling the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

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