Tricyclic Antidepressant + Alchohol = BAD

[BluMac81]

Okay so today I headed off in good spirits to the renissance festival. Naturally at such a festival i tend to consume some wine and beer here and there.

LITTLE DID I KNOW that the warning of 'don't drink alchohol while on this medication' in the TRI-CYCLIC antidepressant Desipramine is MUCH MORE SEVERE and DISTINGUISHABLE from the same such warning on SSRI antidepressants.

I had been a nearly a dozon SSRI antidepressants and drank alchohol with no noticable difference from when off the the SSRI. But with tri-cyclics??? Completely different story apparently because I am typing this now, having been at the ren fair, drinking my usual amount (5 beers 2 wines), the same amount as I had the last time I was there (but not on antidepressants), when suddenly that alchohol sickness becomes greater than usual, I, in the middle of crowds (how embarassing) start vomiting and the world is spinning (in horrible dizzyness) and it was just a world of hell. Soon the police/medics came by me and ushered me off to the medic unit, where I waited for hours to sober up (took much longer than usual!) and finally got my sister's husband to pick me up around 6:30.

Boy did he give me a talkin to, apparently worrying my sister so much with my call for help. My dad died of alcholism (offical diagnosis) and my brother in law said i'll kick you're ass if you pull this again.

Anyway I've learned my lesson and here this all too:
TRICYCLIC ANTIDEPRESSANTS = DO NOT DRINK ALCHOHOL WHILE ON (SEVERE LIVER IMPAIRMENT)

Phew what a day.

 

[peter_m]

Re: Tricyclic AD + Alchohol = BAD

Dude, 5 beers and 2 wines sounds like you really wanted to have a good time... sorry it didn't workout that way. Most medication, even if mild, will usually reduces your capacity "hold" your liquor. Having said that, 5 beers and 2 wines in how many hours?

Peter

 

[BluMac81]

Re: Tricyclic AD + Alchohol = BAD

Dude, 5 beers and 2 wines sounds like you really wanted to have a good time... sorry it didn't workout that way. Most medication, even if mild, will usually reduces your capacity "hold" your liquor. Having said that, 5 beers and 2 wines in how many hours?

Peter

Oh I chugged em as per normal. Was in a matter of 2 hours. Thats what I typically do though and with no issues like this, my point is... are tricyclic antidepressants really THAT worse than ssri's when comibining with alchohol?

 

[Daniel E.]

Re: Tricyclic AD + Alchohol = BAD

my point is... are tricyclic antidepressants really THAT worse than ssri's when comibining with alchohol?

Yes, it seems there is a very significant difference:

It used to be axiomatic to warn patients about the dangers of drinking alcohol while taking antidepressants. While it is still wise to advise patients against drinking alcohol when clinically depressed, the reason is no longer because the antidepressant will necessarily cause serious potentiation of the central nervous system (CNS) depressant effects of alcohol and other CNS depressants such as benzodiazepines. Such potentiation occurs when TCAs and alcohol are taken together due to the antihistaminic effects of TCAs, particularly tertiary amine TCAs. Since SSRIs have been designed to avoid blocking the histamine receptor, they do not pharmacodynamically potentiate the effect of alcohol or other CNS depressants. Instead, they either do nothing or may mildly antagonize the depressant effects of alcohol. This change is just one example of the reduced risk of serious pharmacodynamic drug interactions due to the more focused pharmacology of SSRIs.


Clinical Pharmacology of SSRI's: How SSRIs as a Group Differ From TCAs

 

[BluMac81]

Re: Tricyclic AD + Alchohol = BAD

Yes, it seems there is a very significant difference:
Such potentiation occurs when TCAs and alcohol are taken together due to the antihistaminic effects of TCAs, particularly tertiary amine TCAs. Since SSRIs have been designed to avoid blocking the histamine receptor, they do not pharmacodynamically potentiate the effect of alcohol or other CNS depressants.

The above quote is especially useful in solving this issue, thanks Daniel. It may explain why I, still here at T+5 hours since my last alchoholic drink, feel the effects of alchohol (feel fairly buzzed).

Four questions:
1. In the above quote, what classifies as a "tertiary anime TCA", would Desipramine classify as one?
2. I only started on TCA's because none of the dozen SSRI's I tried had any positive effect on my depression, should I stop (taper off) this old-school type antidepressant? (I left a message with my psychiatrist about this but he tends to not respond)
3. My brother-in-law scolded me, since he works as a manager at walgreens and knows his pharmaceuticals, that combining this drug with alchohol could have killed me. Was he right?
4. I also take sleeping meds, typically: 3 pills of temazapam, 2 pills of ambien, and 3-4 xanax. In this current 'buzzed' state would it be advisable to reduce those sleeping meds? I'm out of temazapam anyway and have hydroxizine (which I didn't quite like, odd sensations with it).... Anyway should I wait until I'm completely sober until I take a sleeping pill such as ambien?

 

[ladylore]

Re: Tricyclic AD + Alchohol = BAD

Drinking alcohol with any anti-depressant is not a good idea. Alcohol is a depressant so what your doing is cancelling out the benifits of the anti-depressant.

 

[BluMac81]

Re: Tricyclic AD + Alchohol = BAD

Drinking alcohol with any anti-depressant is not a good idea. Alcohol is a depressant so what your doing is cancelling out the benifits of the anti-depressant.

Ya but essentially in big social situations like that I really don't have "fun" unless I drink. The whole point in today was to have a break in my life to have fun. And it is ruined. Why do I need alchohol to enjoy life? Why???
And now I feel like SI'ing because I worried my sister so and disappointed my borther in law. Why can't I be normal??! And enjoy life like the rest of humanity seems to?
Maybe... I should give up now. End it all. I'm destined to sorrow regardless it seems. Just as my father...

 

[Daniel E.]

I also take sleeping meds, typically: 3 pills of temazapam, 2 pills of ambien, and 3-4 xanax. In this current 'buzzed' state would it be advisable to reduce those sleeping meds?

If you need advice regarding your medications, it is always advisable to either leave a message with your doctor's answering service or to call your pharmacy (or a 24-hour pharamcy). Having said that, I would certainly want to give my liver a break tonight if I had taken what you did earlier today. But I really don't know anything about alcohol/liver metabolism.

BTW:

Nonhabituated patients metabolize ethanol at 13-25 mg/dL/h. In persons with alcoholism, this rate increases to 30-50 mg/dL/h. Metabolism rates vary greatly between individuals and cannot be predicted.


Ethanol effects at various BAC levels for nonhabituated drinkers are as follows:

* 20-50 mg/dL – Decreased fine motor function

* 50-100 mg/dL – Impaired judgment and coordination

* 100-150 mg/dL – Difficulty with walking and balance

* 150-250 mg/dL – Lethargy

* 300 mg/dL – Coma

* 400 mg/dL – Respiratory depression

* 500 mg/dL – Potential death

http://www.emedicine.com/EMERG/topic19.htm

Ethanol is cleared from the blood at about 1/2 ounce/hr (15 mg/dL per hour). Liver metabolism accounts for more than 90% of ethanol clearance from the blood ...

Source: Marks' Basic Medical Biochemistry: A Clinical Approach


Retrieved from: mg/dl ethanol clearance - Google Search

As a rule of thumb, a person will eliminate [metabolize] one average drink or .5 oz (15 ml) of alcohol per hour

Physiology / Alcohol and the Human Body / Alcohol Properties

 

[ladylore]

Re: Tricyclic AD + Alchohol = BAD

Ya but essentially in big social situations like that I really don't have "fun" unless I drink. The whole point in today was to have a break in my life to have fun. And it is ruined. Why do I need alchohol to enjoy life? Why???
And now I feel like SI'ing because I worried my sister so and disappointed my borther in law. Why can't I be normal??! And enjoy life like the rest of humanity seems to?
Maybe... I should give up now. End it all. I'm destined to sorrow regardless it seems. Just as my father...

Hey Blu,
Its ok. Don't give up. So you thought that having a few beer would help you relax and have fun. Now you know that when your on SSRIs you can't do that. Lesson learned - nothing big.

I am in recovery myself, and I also use to think that drinking was the only way I could have fun. I know different now since I have been in recovery for almost 2 yrs now. When I was in my 20's I couldn't fathom not drinking to be a part of the crowd, but now its different.

The goal here is your health and to keep yourself safe.

Take care.

 

[Daniel E.]

I'm destined to sorrow regardless it seems. Just as my father...

Of course, such hopelessness is a common symptom:

You feel convinced that your problems will go on forever and that things will never improve. "I'll never get over this depression," or "I just can't lose weight and keep it off," or "I'll never find a good job," or "I'll be alone forever."

Feelings and the Thoughts That Control Them - Psychlinks Psychology Self-Help & Mental Health Support Forum

Similarly:

The Ten Forms of Twisted Thinking - Psychlinks Psychology Self-Help & Mental Health Support Forum

Just a little bit of hope can mean a big difference since part of enjoyment/engagement/meaning is anticipation.

 

[BluMac81]

Thank you everyone for your great information and support. I did end up getting to sleep last night with my regular sleep med combo, and woken up today by my loving sister and her husband who drove me to my truck 40 miles away to pick it up. I'm so lucky to have loving family in my life, and you guys!

Today I'm mostly in a fog, the aftershocks of guilt/shame/depression from last nights events leaving me in a down state. But not TOO down. I wonder... is getting through your 20's this hard for a lot of people? I heard that as you age, you become more mentally stable and happy.

 

[ladylore]

My 20's were hard but at the same time fun. The part that was hard is that I suffered complex PTSD - depression and anxiety along for the ride, but I didn't know it. I thought this is the way everyone felt so I just had to get use to it. A big secret that no one talked about. It wasn't till a few years ago I finally figured out that something was wrong and that life didn't have to be like the way I was experiencing it. It took me another year to do anything about it.

On the up side, my 20's is when I did most of my travelling. I haven't been out of N. America but I have been coast to coast in Canada and a few places in the U.S.

The 20's is also the decade where people discover what they want in life (sometimes), try new things out. A time to explore.

What I can say Blu is that I am glad your doing something about the depression now. I don't recommend waiting another decade to do something about it, like I did. I think that your courageous for tackling these issues. It isn't an easy road, but your not alone on it either.

Hope some of this helps.

 

[Daniel E.]

I wonder... is getting through your 20's this hard for a lot of people?

BTW:

Many College Students have Self-Injured
Negative Emotions Mellow with Age
Mental Health Through the Lifespan

 

[BluMac81]

Thanks Ladylore

And Daniel that's what I kind of figured, and the suicide rates I imagine are highest among the 20's. I was contemplating it last night, suicide that is, as you saw from my posts, but what keeps me going is for one, my wonderful family, my sister told me today.... "You have to live, for us... because we love you", and that reminded me that if my self-inflicted death would severely hurt others that are close to me. So that's why I gotta stay alive, no matter what.

That and I'm coming to realize that everything changes, nothing stays the same, in fact the only thing certain in life IS change. So if you don't like the way you feel now, just wait. Let life happen.

I hope that someday I can give back to those going through what I have been going through, help them in some way. Working on a bio degree so that's a step in the right direction, but firstly I have to get myself under control, been a mess as of late.

 

[Daniel E.]

the suicide rates I imagine are highest among the 20's.

BTW, that's more the case in Brazil, where old people and the unemployed are not in a high risk group for suicide. In the US and I assume Canada, it's elderly white men who have the highest rate. But it's certainly true that for young adults living in good neighborhoods (where homicide rates are relatively low), it's car accidents and suicide that are the leading causes of death.