At the age of 23, Jane* was an introverted, almost painfully shy young woman. ‘I was a well-behaved child and teenager, with good academic grades,’ she tells me.
Then, in her early twenties, a period of anxiety and continually feeling highly strung led her to seek help from her GP. She was prescribed Aropax, an antidepressant that contains selective serotonin reuptake inhibitors (SSRIs). Aropax helps to control mood and is typically prescribed for people who suffer from depression, anxiety or panic disorders.
‘I wasn’t told to abstain from alcohol, although it does state it clearly on the packet.’
Now 47, she believes that the antidepressants led to a period of wild behaviour and an unhealthy dependency on alcohol. ‘While the tablets helped take away my anxiety, they also removed my inhibitions,’ she says.
‘Before taking the antidepressants I was drinking fairly regularly, but sensibly: it helped relieve the stress I was experiencing as I had debilitating anxiety in every aspect of my life, including terrible social anxiety. But once I was on the tablets, I felt elated, almost manic.’
Taking prescribed SSRIs and drinking heavily led to a period of her life that Jane describes as ‘debauched’. She says drinking large amounts of alcohol – typically two bottles of wine a night – was ‘uplifting’ for her after a period of anxiety and darkness.
During this time, Jane moved to Japan to work as an English teacher, living in shared accommodation with other expats. ‘The antidepressants helped me overcome the shyness I would have normally felt in this sort of situation. And expat life is pretty crazy – there’s a lot of drink and drugs. I threw myself into partying. I was having such a great time. The tablets removed my inhibitions and I would drink almost every night. I’d buy two bottles of Prosecco on the way home and that would just be for starters. We’d drink at home, then go out for more drinks and, sometimes, drugs.’
Jane says the mix of alcohol and antidepressants left her with ‘boundless confidence. I was just super happy and open to all experiences.’ However, as the months went by, her behaviour became even more manic, in all areas of her life.
At 23, Jane* was an introverted, shy young woman – but she claims the antidepressant Aropax completely altered her personality and made her a ‘debauched’ heavy drinker (stock image)
‘I didn’t have a “stop” button,’ she says. ‘That was completely removed. But otherwise I was healthy, although perhaps I should say addicted to a high. I’d drink and party all night, then get up in the morning and head to the gym. Even here I would overdo it – I’d do hundreds of sit-ups, not stopping to catch my breath. I just couldn’t get enough of that “high” that alcohol or exercise gave me. People would tell me that I’d done enough, but it never felt like I’d reached my limit.’
Before taking the SSRIs, Jane ‘drank as much as her friends, perhaps a little less. At high school I’d have a drink with friends, but I certainly didn’t go overboard or crave alcohol.’ Now, almost twenty years later she realises that she was on a spiral towards alcohol dependency.
Jane is not alone. According to Dr Cathy Andronis, Chair of Psychological Medicine at the Royal Australian College of General Practitioners, alcohol dependency can develop while you’re on antidepressants. ‘Antidepressants are a large group, the majority prescribed is the group SSRIs, but there are some other, small groups of antidepressants which are prescribed, and people may have different reactions to when mixing with alcohol.’
Dr Andronis says different antidepressants can react in various unpredictable ways to food or other medications, and can cause health issues such as high blood pressure. ‘We can’t assume it’s safe or unsafe to use alcohol with antidepressants; this has to be an individual’s decision made with that patient’s doctor.’
So, what does happen to your brain when you mix alcohol with your medication? ‘When people drink, they get variable effects,’ says Dr Andronis. ‘At a lower level, most people will get disinhibition or a sense of social connection because it decreases anxiety at lower levels. At higher levels, or after prolonged use of alcohol, it’s a depressant, which is why you may fall asleep or feel tired after drinking.’
According to a 2014 paper in the International Journal of Risk and Safety Medicine that looked at 200 cases of people who’d reported increased alcohol consumption as a result of taking SSRIs, ‘multiple lines of evidence amplify a thus far barely recognized signal of interactions of SSRI and related antidepressants with alcohol’.
Dr Andronis finds that genetics can play a role in your reaction or growing dependence on alcohol when mixed with antidepressants. ‘Genetically, people metabolise alcohol differently. For instance, in Asian cultures where people drink much less, they’re very sensitive to alcohol because of their enzyme patterns and the way they metabolise alcohol in their liver. So even a small amount can cause disinhibition.’
Jane recognised she was engaging in risky behaviour after several ‘blackouts’, when she was found unconscious on the side of the road. ‘I decided to take myself off the antidepressants – I put two and two together and realised my heavy drinking had coincided with beginning the course of tablets.’ However, going cold turkey meant she endured three days of detoxification symptoms, ranging from insomnia, racing heartbeat and feeling chronically overwhelmed.
‘I felt paranoid and even though I’ve never been suicidal, I did feel that the world was caving in on me. Thankfully a flatmate found me and helped me through the worst of it. I began my antidepressants again and this time, took myself off them in a slower, more controlled manner, cutting down my dose gradually.
‘I then moved from Japan to Seville, Spain, and while my drinking slowed down a little, I would still easily drink a bottle of wine a night. When I returned to Australia, the drinking ramped up again.’
Jane admits her family drink heavily, and there is a history of alcoholism. ‘We all drink more than we probably should,’ she tells me.
At age 36, Jane began experimenting sexually – which she believes was caused by another antidepressant, Zoloft – and had a compulsion to drink
David Godden, a psychologist and director of The Bay Addiction Centre in Byron Bay, says that in his experience, an increase in a reliance on alcohol and the link with antidepressants isn’t necessarily genetic. ‘I do believe it’s a reaction between the individual, the alcohol and the antidepressants,’ he says. ‘Most people who are starting antidepressants probably already self-medicate with alcohol, to a large extent or not, regardless of whether they were told to stop drinking when they were prescribed alcohol. I don’t think antidepressants make people uninhibited, but the combination of an [antidepressant] which can increase people’s energy and mixing these with alcohol, can make people potentially feel euphoric.’
Dr Godden says that many don’t stop drinking on SSRIs due to the side effects of alcohol withdrawal. ‘They may then drink to manage those feelings,’ he adds.
The recognised physical symptoms of the interaction between antidepressants and alcohol can include a worsening of depression, low mood, agitation, headache and electrical shock sensations in the brain, known as ‘brain zaps’.
With 14 per cent of the Australian population now on antidepressants, SSRI-induced alcoholism could potentially be a relatively common problem yet is largely unrecognised.
Jane’s return to the Gold Coast coincided with another period of depression and anxiety, brought on by a new, demanding job. ‘I was quite healthy, although extremely stressed. Then I met someone and together we began to drink heavily.’ The end of this relationship and continuing work pressures led to nervous breakdown, after which she was prescribed anther SSRI, Zoloft. She abstained from drinking on this course of tablets, under the advice of her GP.
‘When I felt stronger, I moved to Melbourne – but began drinking again.’
The move to Melbourne coincided with Jane once again entering another ‘manic period of her life, with no inhibitions.’ Now 36, she began experimenting sexually – which she believes was caused by the Zoloft – and had a compulsion to drink.
What followed was several years of high-risk drinking, during which time she suffered from alcohol poisoning. With her then-relationship at risk, she decided it was time to finally address her health issues.
‘I was in my late thirties by then and I needed to take care of my health. I realised I wanted to have a child. I had some of my eggs frozen when I was about 38 years old but I didn’t cut back on my drinking.’
Jane met her now-partner when she was 40 and decided she wanted to go ahead with an embryo transfer. ‘I continued to egg harvest and attempt embryo transfer, but I think the alcohol and subsequent inflammation in my body affected my ability to falling pregnant.’
There’s a happy ending to the story: Jane and her partner moved back to the Gold Coast where they were able to have a child – a daughter who is now five.
She is no longer on SSRIs and drinks just a few glasses of wine or beer on the weekend. She recently had several health issues which she suspects are related to her years of alcohol abuse combined with taking antidepressants. She now suffers from fibromyalgia and memory loss, and continues to have fertility challenges.
‘Without a doubt antidepressants caused me to drink heavily and removed my inability to say “enough”. I feel lucky that I’m on the other side of those chapters of my life and just hope that my past doesn’t affect my health in the future.’
The RACGP recommends avoiding alcohol entirely when taking antidepressants. ‘Alcohol can counteract antidepressants’ benefits, worsening depression and anxiety,’ says Dr Andronis. ‘There are not many positive effects of alcohol and once we take away mind-altering experience we’re after, it is a poison. Small quantities of alcohol may be okay for some people, sometimes, but there is not really a positive.’
She points to research that shows consuming large amounts of alcohol are linked to health problems such as cancer, high cholesterol levels and mental health issues. ‘Alcohol is a depressant in the brain, it affects sleep patterns, causing broken and poor-quality sleep,’ she adds. ‘The effects of poor sleep can exacerbate mental health issues and other symptoms of depression, such as overeating and lower inhibitions.’
*Name has been changed
