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Zoloft and Alcohol

13 Minutes

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CONTENTS

Depression and other mental health-related problems are on the rise. According to WHO, 264 million people of all ages are affected by depression globally which is quite a significant figure. Moreover, WHO estimated the top 10 countries with the highest prevalence of depression, and the US was listed as second in the list. This signifies that most individuals in the US are diagnosed and treated for depression and do not go unnoticed as awareness about mental health improves which is not the case in most countries where the prevalence of depression is low but suicide rates are high indicating lack of awareness about mental health.

Shadows on a white wall of glasses with alcoholic beverages.

It has been observed that depression and alcohol abuse are frequently related. However, what is not known yet is which leads to the other. Does depression promote increased consumption of alcohol or is it the other way around and excessive drinking leads the person into a downward spiral in terms of mental health resulting in depression? Either way, the use of anti-depressant medication along with concomitant use of alcohol has shown negative consequences and the interaction between the two should be avoided before the adverse effects begin to manifest.

Zoloft is an anti-depressant and it shows no exception in its interaction with alcohol. Zoloft and alcohol, although studied limitedly the side effects of the two individually are enough to prohibit the use of alcohol and Zoloft together. Since Alcohol is a depressant, it can reverse the positive effects that Zoloft has on the brain resulting in detrimental consequences hence authorities such as the FDA advised against the concomitant use of Zoloft and Alcohol.

Zoloft is the brand name of Sertraline which is an anti-depressant and belongs to the class of Selective Serotonin Reuptake Inhibitors (SSRIs). The primary indication for the use of Zoloft (Sertraline) is depression. However, several other psychiatric disorders also respond favorably to SSRIs such as Zoloft (Sertraline), including obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder, posttraumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.

Did you know that there have been more than 37 million prescriptions for Sertraline in 2017, making it the 14^th most prescribed medication in the US?

Zoloft is an SSRI drug that acts by blocking the reuptake of serotonin, leading to increased concentration of the neurotransmitter in the synaptic junction. Serotonin is the principal hormone that stabilizes our mood and it promotes a feeling of well-being and happiness which is why it is commonly known as the ‘happiness hormone’.

Serotonin has an impact on not just our mood but our entire body. It improves sleep, appetite, and digestion along with enabling the brain cells to communicate with each other for a better-coordinated response system. Low levels of serotonin are associated with depressed mood and anxiety and this is when the role of SSRIs comes into play. They increase the level of serotonin in the brain by decreasing its uptake by the neurons and it results in improved mood and a generalized feeling of well-being.

Anti-depressants including SSRIs take at least 2 weeks to produce significant improvement in mood and the overall state of the body.

However, for maximum benefit, you may require to wait up to 12 weeks or more. It is also common to notice the mild side effects during the first couple of weeks of using the drug but they subside or become less apparent with regular use of sertraline.

Sertraline is available as both, a tablet and an oral solution. Tablet is the most commonly used form.

It is available in different strengths or doses. It comes in 25mg, 50mg, and 100mg tablets. The oral solution is available in 20mg/ml concentration. Sertraline is taken once a day either in the morning or night.

Take the medication as instructed by your doctor. Do not stop taking the medication abruptly due to the potential for serious withdrawal effects. Your doctor will taper the dose slowly to minimize the risk of withdrawal effects.

Although Zoloft (Sertraline) being an SSRIs drug is considered to have fewer and lesser side effects compared to other classes of anti-depressants, the SSRIs are not without adverse effects.

Some of the common adverse effects of Zoloft (Sertraline) include:

nausea
diarrhea
stomach upset resulting in indigestion
sexual dysfunction
sweating
fatigue and lethargy
dizziness
drowsiness
sleep disturbance- insomnia or somnolence

Some less common side effects of Zoloft (Sertraline) include:

rhythmic disturbance in the heart

increased risk of bleeding
anxiety
agitation
hypernatremia (low sodium levels in the blood)
serotonin syndrome
discontinuation syndrome
changes in weight

Zoloft along with other SSRIs is known to cause serotonin syndrome. Serotonin syndrome may include the symptoms of hyperthermia (increase in body temperature), muscle rigidity, sweating, myoclonus (clonic muscle twitching), and changes in mental status and vital signs such as heart rate, breathing rate, and blood pressure, etc.

Moreover, Zoloft like all other SSRIs has the potential to cause a discontinuation syndrome following their abrupt withdrawal. Possible signs and symptoms of SSRI discontinuation syndrome include headache, malaise, and flu-like symptoms, agitation and irritability, nervousness, and changes in sleep pattern. Your doctor will lower your dose timely and you are advised not to stop taking Zoloft or any other anti-depressant abruptly.

One of the most serious adverse effects associated with Zoloft (Sertraline) is the potential for having suicidal tendencies. FDA issued a black box warning to all anti-depressant including Zoloft for its potential to warn consumers about the suicidal thoughts and behavior associated with these drugs for people with mental health problems. You can find the warning on the bottle or package insert of the prescription medication. SSRIs should be used cautiously in children and teenagers because 1 out of 50 children reports suicidal ideation as a result of SSRI treatment. Pediatrics patients should be observed for worsening depression and suicidal thinking with dosage change of the antidepressant medication.

No, you cannot drink alcohol with Zoloft because the risk of potential side effects of both the substances increases, and the mental state of a person worsens when they take alcohol and sertraline together.

Zoloft is one of the most commonly prescribed anti-depressants and this makes people presume that it is safe to drink beer with Zoloft. Despite the fact that there have been limited studies about the interaction of alcohol and Zoloft, FDA warns about using Zoloft and Alcohol together. This is because the side effects of mixing alcohol and Zoloft can be extreme, unpredictable, and deleterious.

The Dangers of Mixing Hydroxyzine and Alcohol

Both the substances act on the neurotransmitters in the brain. While Zoloft is known to increase the levels of serotonin in the brain, alcohol acts by suppressing the central nervous system thereby, altering the therapeutic effect caused by Zoloft. A person taking an anti-depressant such as sertraline with alcohol will not experience an uplift in their mood rather they will feel more anxious and depressed as alcohol is a central nervous system depressant. This combination will lead to an increase in the suicidal tendencies in the individuals further deteriorating the mental state of a person. Hence, it is advised not to drink alcohol with Zoloft.

People with depression often use alcohol as a coping mechanism but except for providing temporary relief to some extent, it does no good to the individual. Contrarily, alcohol is known to exacerbate episodes of depression and hampers the thinking capability and judgment of the person by clouding their brain. People with depression struggle with sleeping and alcohol is known to impair the quality of their sleep.

If an individual is depressed and is taking anti-depressants, he might be facing side effects of the drug he is consuming. For instance, a patient taking Zoloft will experience an upset stomach with nausea, vomiting, and indigestion, and if such a person is to take alcohol over Zoloft the stomach problems will intensify causing difficulty for the individual. Similarly, if a person is experiencing depression and anxiety as a side effect of sertraline, this effect will enhance by many folds after a person consumes alcohol since alcohol is known to depress the central nervous system and the person will go into a downward spiral in terms of mental health as mentioned above.

Moreover, the most critical condition results when a person is fighting with suicidal tendencies as a side effect of Zoloft and after taking a drink the suicidal thoughts aggravate to such an extent that the person under the effect of the two substances tries to attempt suicide. Since the judgment and thinking capacity is impaired after consuming alcohol, such people are not able to give explanations of their deadly actions and tend to make unreasonable excuses for their impulsiveness. For all these unpleasant consequences it is advised that you should not mix alcohol and Zoloft.

People taking Zoloft and Alcohol may experience any of the following side effects:

depression
anxiety
diarrhea
nausea
vomiting
dizziness
drowsiness
headaches
suicidal thoughts

The greatest risk and danger associated with concomitant use of Alcohol and Sertraline is overdose. As per the prescription guidelines of Zoloft, the most frequent signs and symptoms linked with non-fatal sertraline overdosage include:

vomiting
nausea
somnolence
dizziness
agitation
tremors
tachycardia (increased heart rate)

However, when sertraline is combined with other drugs such as alcohol in greater dosage some fatal side effects come into view. They include:

bradycardia (decrease in heart rate)
hallucinations
delirium
hypertension
hypotension
convulsions
manic episodes
bundle branch block
QT- interval prolongation
Torsade de Pointes
serotonin syndrome
pancreatitis
stupor
syncope
coma

A frightening trend was noticed with the use of Zoloft and Alcohol that during the use of Zoloft medication, tolerance to alcohol was decreased such that people were experiencing intoxication even after taking their usual doses of alcohol that were previously harmless.

During Alcohol and Zoloft blackouts the person is intoxicated by the two substances and is unable to recall events that took place while he was intoxicated. In some situations, it can result in unusual, uncharacteristic, and violent behavior and the person may attempt unintended assaults, suicide, and even homicide.

Chronic use of alcohol results in irreversible liver injury. As a person consumes more than the suggested amount of alcohol it destroys the liver cells impairing their ability to metabolize substances including drugs. Sertraline is extensively metabolized in the liver and alcoholic liver damage hinders the metabolism of Sertraline resulting in the accumulation of the drug. Consequently, drug doses are reduced in people having a compromised liver either due to alcoholic liver disease or due to other reasons.

On the contrary, liver test abnormality has been associated with up to 1% of patients on Sertraline, and elevation was usually modest and it was reported that infrequent dose adjustments and discontinuation of the drug were required. Hence, it shows that sertraline is not associated with liver damage but is the chronic use of alcohol that impairs the functioning of the liver.

Combining Alcohol and Zoloft results in a myriad of side effects that are unwelcome and detrimental. One of the reasons that doctors advise avoiding alcohol and Zoloft is that Alcohol is known to acts on the GABA receptors in the brain and increase its release. The neurotransmitter, GABA, has an inhibitory action on the brain. As a result, if a person overdoses on alcohol it causes depression of the respiratory system which decreases the oxygen supply to vital organs including the brain and the heart.

In the chain of events, brain damage ensues due to decreased oxygen and the heart rate slows down and blood pressure drops, and all these events to enter the result in coma or death of an individual. Along with alcohol the sedative property of Zoloft also results in coma or death after a serious overdose due to exacerbation of the side effects of the two substances.

You can drink alcohol, 5 to 6 days after your last dose of Zoloft since it is the time required by the drug to leave your system. You should not drink alcohol on a day you have skipped the dose of Zoloft assuming that it would not lead to serious consequences, since your last dose would still be in the system and it has the potential to interact with alcohol and cause fatal side effects.

Yes, like any other medication Zoloft too poses the potential for overdose and significantly so when combined with alcohol. The most common symptom of sertraline overdose includes nausea, vomiting, increased in the heart (tachycardia), fever and tremors.

When you combine Zoloft (sertraline) with alcohol or other drugs in increased doses it may potentiate the side effects resulting in fainting, delirium, heart problems, serotonin syndrome, and coma.

You should not take Zoloft more than prescribed by your doctor. If you miss a dose do not take two tablets rather take one dose at a time this will prevent the potential overdose situation. Moreover, if you overdose on Sertraline and alcohol such that it results in serious side effects then call medical emergency without further delay.

Zoloft has an elimination half-life of about 26 hours. Half-life is the time required for the drug to reduce to half its dose. It roughly takes 5 half-lives to remove the drug out of your system. In the case of sertraline, it takes 5 to 6 days to be eliminated from the system. However, you need to know that the time needed for elimination of the drug varies from person to person and it depends on several factors. For instance, younger individuals remove the drug faster from their bodies as compared to the geriatric population. Moreover, the health status is pivotal to calculate the time needed by the drug to be removed completely since people with impaired functioning of liver and kidney may eliminate the drug at a slower rate compared to those who have both the organs optimally working.

Suicidal thoughts and behavior in pediatric and young adult population-
Serotonin Syndrome
Increased risk of bleeding
Discontinuation Syndrome
Activation of Mania or Hypomania
Seizures
Angle-closure glaucoma
False-positive effects on a screening test for Benzodiazepines

FAQs

Can you have an occasional drink while taking Zoloft?

Unfortunately, we do not have the data to prove what amount of alcohol is safe to drink with Zoloft since the research has been limited.
But it is advised to avoid taking alcohol even occasionally since you do not know if this little amount of alcohol may wreak havoc in your system due to its potential to interact negatively with Zoloft. Hence, it is best to avoid drinking while taking Zoloft.

What is the effect of mixing sertraline and alcohol on the liver?

Too much alcohol can impair the ability of your liver to function properly. This happens because each time your liver filters alcohol, some of the liver cells die but the liver has the potential to regenerate. But with excessive use of alcohol over a long period, the regeneration capacity of the liver is impaired resulting in permanent liver damage. As sertraline is metabolized in the liver and so is alcohol, the concomitant use of both the substance should be avoided to prevent hepatotoxicity.

Why should you not take sertraline on a night?

Many people experience decreased sleep after taking SSRIs such as sertraline so it is suggested that one should not take it at night as it aggravates insomnia. Other conditions that promote the use of Sertraline in the morning are urinary problems and sexual dysfunction. Zoloft is known to cause urinary incontinence so to avoid frequent breaks in sleep at night and bedwetting in children many people take Zoloft in the morning. Moreover, Sertraline causes sexual dysfunction, and to mitigate this effect one should take the drug in the morning.

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