Substance Abuse

Substance Abuse

Q. May I drink alcohol while taking antidepressants?
There are a number of problems with the mixture of alcohol and antidepressants. First, antidepressants may make you especially susceptible to the intoxicating effects of alcohol. Second, if you drink more than three or four drinks a week, the effects of alcohol may prevent the antidepressants from working. Many people who seem not to benefit from antidepressants, do so, if they reduce or eliminate their intake of alcohol. Third, you may be taking along with the antidepressant a drug such as clonazepan (Klonopin) with which one should not drink at all.

Q. If I plan to drink alcohol while on medication, what precautions should I take?
There is much misinformation about drinking while on anti- depressants. Alcohol can prevent antidepressants from being effective. This is not so much because it interferes with the absorption of antidepressants, it is because of the effects of alcohol upon brain chemistry. Antidepressants can also increase one’s susceptibility to the intoxicating effects of alcohol. Also, both alcohol and some anti- depressants (especially Wellbutrin) increase the possibility of seizures.

If you are determined to drink despite taking antidepressants you should discuss the matter with your psychiatrist. If you get permission you might want to determine the extent to which the medication has made you more sensitive to the alcohol. You might start by seeing what are the effects of half a glass of wine. You might then experiment with a full glass. Remember, a 4 oz glass of wine, a 12 oz bottle of beer, and 1 oz of “hard stuff” all contain the same amount of alcohol.

Q. What’s the relationship between depression and recovery from substance abuse?
It is not unusual for people who have recently been withdrawn from alcohol, or other abusable drugs to become depressed. These depressions are often self-limited, and clear in about 8-weeks. If depression has not cleared by the end of that period, anti-depressant therapy should be started.

Q. What does the term “dual-diagnosis” mean?
Dual-diagnosis is a phrase used to indicate the combination of substance abuse and a psychiatric disorder. A path to alcohol or other substance abuse is an attempt to self- medicate uncomfortable symptoms such as depression, anxiety, agitation or feelings of emptiness. The psychiatric disorders that cause such symptoms are often diagnosed in substance abusers.

Q. Is it safe for a person recovering from substance abuse to take drugs?
People recovering from substance abuse can safely take many kinds of psychiatric drugs. Most psychiatric drugs are unable to be abused. The best evidence for this is that there are not street markets for such drugs. On the other hand, The benzodiazepines (diazepam [Valium], lorazepam [Ativan], alprazolam [Xanax], etc.) and the psycho-stimulants (dextroamphetamine [Dexedrine], methamphetamine [Desoxyn], and Ritalin [methylphenidate]) are quite abusable.

For people active in AA please read the pamphlet “The AA Member–Medications & Other Drugs.” This outlines AA’s official attitude toward medication–that it is necessary for certain illnesses including depression. Too many depressed people who have been talked out of taking antidepressants by members of their AA groups have killed themselves as a result.

Q. How do you know when depression is severe enough that help should be sought?
Professional help is needed when symptoms of depression arise without a clear precipitating cause, when emotional reactions are out of proportion to life events, and especially when symptoms interfere with day-to-day functioning.. Professional help should definitely be sought if a person is experiencing suicidal thoughts.