David Baxter PhD
Late Founder
Alcohol: How much is bad for you?
by Chris Ballas, M.D.
Tuesday, March 6, 2007
I am often asked if a glass of wine is ok if you are on medications. My standard answer--you shouldn't do it--isn't rigorous, and a better answer might be that alcohol's effects are magnified.
Part of the problem is that a "drink" isn't the same to everyone. Different countries have different "standard drinks" ranging, usually, from 10g to 14g per drink. As a reference point, there are about 14g in a 12 oz beer (5% alcohol by volume) and 77g in a bottle of wine (13% alcohol by volume.) So there are about six "drinks" in a bottle of wine.
Let's leave aside the impact of alcohol on psychiatric illness, and focus only on its effects on medications.
Surprisingly little formal study has been done on the interaction between alcohol and SSRIs. One study found that Prozac's inhibitory effect on liver enzymes doesn't necessarily translate to an increase in alcohol or its effects. Another study found that SSRIs did not diminish the intoxicating effects of alcohol (in mice), but did reduce the relaxing effects of alcohol. However, a handful of studies found that SSRIs don't magnify the cognitive effects of alcohol.
Another way of looking at this is to ask if it is recommended for psychiatrists to alter the doses of SSRIs in alcoholic patients. The answer: No. Generally, we dose SSRIs the same in current drinkers as in anyone else (though of course we caution our patients not to drink.) There is also enough evidence showing that treatment of depression reduces alcohol consumption (in people trying to get clean.)
I don't mean to imply that it is now okay to drink while on an SSRI; I mean that drinking is not a reason not to start one, if it is indicated. Check with your doctor.
I should point out that organ damage due to alcohol is a reason to change the dose of SSRIs. For example, someone with cirrhosis should probably get a lower starting dose, and then of only certain SSRIs with less liver metabolism.
Finally, other depression medications--for example benzodiazepines--are definitely risky with alcohol. In all of these situations, it is best to be completely upfront with your doctor and so the safest and most effective treatment plan can be initiated.
by Chris Ballas, M.D.
Tuesday, March 6, 2007
I am often asked if a glass of wine is ok if you are on medications. My standard answer--you shouldn't do it--isn't rigorous, and a better answer might be that alcohol's effects are magnified.
Part of the problem is that a "drink" isn't the same to everyone. Different countries have different "standard drinks" ranging, usually, from 10g to 14g per drink. As a reference point, there are about 14g in a 12 oz beer (5% alcohol by volume) and 77g in a bottle of wine (13% alcohol by volume.) So there are about six "drinks" in a bottle of wine.
Let's leave aside the impact of alcohol on psychiatric illness, and focus only on its effects on medications.
Surprisingly little formal study has been done on the interaction between alcohol and SSRIs. One study found that Prozac's inhibitory effect on liver enzymes doesn't necessarily translate to an increase in alcohol or its effects. Another study found that SSRIs did not diminish the intoxicating effects of alcohol (in mice), but did reduce the relaxing effects of alcohol. However, a handful of studies found that SSRIs don't magnify the cognitive effects of alcohol.
Another way of looking at this is to ask if it is recommended for psychiatrists to alter the doses of SSRIs in alcoholic patients. The answer: No. Generally, we dose SSRIs the same in current drinkers as in anyone else (though of course we caution our patients not to drink.) There is also enough evidence showing that treatment of depression reduces alcohol consumption (in people trying to get clean.)
I don't mean to imply that it is now okay to drink while on an SSRI; I mean that drinking is not a reason not to start one, if it is indicated. Check with your doctor.
I should point out that organ damage due to alcohol is a reason to change the dose of SSRIs. For example, someone with cirrhosis should probably get a lower starting dose, and then of only certain SSRIs with less liver metabolism.
Finally, other depression medications--for example benzodiazepines--are definitely risky with alcohol. In all of these situations, it is best to be completely upfront with your doctor and so the safest and most effective treatment plan can be initiated.
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