The Psychiatric Cocktail

For anyone who has ever googled something like, “will combining lithium and alcohol kill me?” -we know drinking alcohol while taking psychiatric drugs isn’t reccomended, but is it “safe”?

I realize this is a bit of an odd topic, but it is something I’ve never seen anyone else talk about. I know plenty of people who drink alcohol while taking psychiatric medications for various mental illnesses, and even though doctors always seem to say that we shouldn’t combine these things, they never seem to say outright (at least to me) that we can’t.

Before I dive into this, I know that there are plenty of reasons not to combine alcohol and mental disorders (let alone the medications prescribed for them). I know that for me, alcohol has triggered depression on and off -which (surprise) never quite helps make one the life of the party. Folks with mental illness are also  more prone to develop substance abuse problems, so avoiding drinking might mean avoiding an addiction. Some people use alcohol like an additional medication because of its relaxing/numbing abilities, but these “positives” can quickly be surpassed by such negative effects as liver failure and acting like an all around asshole.

However, some people don’t use alcohol as an escape, and I think it is fair to want to enjoy, say, a flute of champagne at a cousin’s wedding, or a glass of wine at ladies night, or a beer with your woodfired pizza at happy hour. These are the primary reasons I had for searching out this information.

The first time this concern really came up for me was when I began taking lithium at the beginning of last year. I’d taken a couple medications before that, but I was not yet 21 at the time so despite being young, alcohol had not yet made something of a permanent presence within the structure of my social life.

I was overwhelming careful when I began taking lithium, I measured out the amount of water I needed to drink, I documented what happened as the dosage grew higher, and as soon as I could really confirm that the lithium itself wasn’t going to kill me (immediately), I wanted to know if a glass of wine or a beer with the lithium would. 

Again, it wasn’t that I was planning a binge or anything, but as an individual with bipolar disorder who can be impulsive at times (to say the least) I was hoping that planning ahead (or at least having some idea of whether or not this was a terrible idea) would help me out a bit.

The trouble is, each medication acts differently for each person. And alcohol can act differently for each person. And though I quickly concluded that I probably wouldn’t die, my google search revealed little more than the fact that there are a LOT of people out there mixing alcohol with their psychiatric medications.

I think it is really important to be careful, especially when attempting to combine any two substances within the body. I realize that many people would consider me to be overly careful, but I have lost someone in my life due to the grossly twisted painkiller/alcohol beast. NEVER combine alcohol with painkillers or sleeping pills, and I would go so far as to say ALWAYS talk to your doctor or pharmacist before combining any drug with alcohol.

It is also a good idea to:

1. Check the warning label on the medication, some explicitly say, “do not mix with alcohol,” which I would definitely follow. Others say, “alcohol may cause extreme drowsiness,” or “may cause drowsiness, alcohol may intensify this effect,” which could mean any number of things. Alcohol may cause you to black out, become extremely fatigued, or feel more intense than it normally would.

2. Limit the number of drinks you partake in. Some medications, as I will describe below, actually make alcohol quite a bit less fun and relaxing, so it gets really easy (really fast) to drink only one or two drinks.

3. Don’t drink alone. Even if you’ve talked to your doctor about drinking while on your medication, it is a good idea to have another person around in case you have an unexpected reaction, at the very least the first couple times you try it.

4. Do not attempt to drive. Even after one drink, driving is a bad idea since drowsiness can be increased rapidly by many psychiatric medications.

5. Expect the experience to be different. The effect alcohol has on me is almost the opposite as it had before psychiatric medications, and I found the reaction to be very confusing the first few times I had a drink. If the reaction you have is that nothing happens, trying to drink a lot more to counterbalance it is not recommended.

My own experiences have been pretty interesting, and though the following is what I have experienced, I would not expect to experience things the exact same way. Again, medications all act differently for us, so it is very likely that the combination of alcohol with that mix will be quite different as well.

For me, combining alcohol and lithium has been one of the reasons I don’t drink much anymore (for better or worse). Basically, for every one drink I have, I have to drink at least 3 glasses of water. Dehydration and lithium do not mix, so even after one single drink (and the water described) I will wake up with a hang over. The hang over will intensify exponentially with each drink I have, basically, which is a giant bummer. I also feel less intoxicated than I normally would with each drink, which means a much bigger hangover for very little “fun”.

For a time I was taking Lamictal with the lithium, and in conjunction to alcohol the effects from what I experience with the lithium were intensified. I felt quite intoxicated after a single drink, but if I went on to drink anything more I felt absolutely nothing. The hangover was enormous (even after just 1), so I concluded it really wasn’t worth the trouble.

I don’t expect this to inspire anyone to begin drinking, but after looking I know there are a lot of people already out there looking for answers on this topic. Really, I am just hoping to inform people so that whatever decision they make is done in a safe, smart way.

18 responses to “The Psychiatric Cocktail

  1. Hey, thanks for the info! I don’t take lithium, but the dehydration thing really hit me. That is probably why despite how little alcohol I drink, I always end up with a vicious hangover. I have an issue where I’m very dehydrated, nearly all of the time. I never did find a reason why, but you’ve hit the nail on the head with providing me with an answer for that age old question.

    I have one thing to say. Drinking is probably a bad idea. Maybe there are people out there with mood disorders that can get drunk one night, and get away with it. But for me, if I go beyond buzzed, not only will I end up with a vicious hangover, but I’ll usually have some kind of awful mood swing to contend with. That’s to say that I don’t get into a nasty state when I am drunk.

    Thanks for this. It’s really inspired me to get working on the alcoholism post I’ve been working on.

  2. I am not much of a drinker anyway, but on meds I generally don’t drink at all. Maybe the occasional social glass of wine, but I am not a very social person so that doesn’t come up very often:)

    A very interesting article with lots of things to think about, for anyone contemplating the idea of drinking while on meds.

  3. I certainly wouldn’t recommend drinking and medicating, but I know people do it all the time (including myself). I guess people can test a little at a time to see what their body can tolerate. I don’t think most liquor/rx cocktails will kill a person, unless they are binge drinkers. Benzodiazepines (like ativan) and other sedating drugs (such as seroquel) could be a very big problem … excess alcohol plus excess benzos might equal a trip to the hospital, or worse.

  4. Good tips.

    When I was taking the Lamictal, even at a low dose, I went out to dinner with a friend and had a hard cider. Normally, that would not affect me at all. But that night I introduced myself twice to the same person one time after the other (“hello, how are you” I’m fine how are you” “hello, how are you. Oh I just said that didn’t I?”) and missed my mouth completely when drinking a glass of water. Increased drowsiness indeed!

  5. bravingbipolar

    I haaaaaaaate how when you’re out with friends who don’t know you’re on some serious medication and after my my personal 2 drink limit, out come the slew of one liners calling me a lightweight, etc etc. I actually felt compelled to come out to a set of friends that way. They weren’t taking my limit seriously.
    So yeah, I’m on lithium and drink maybe twice a month, and I stick to my limit.

  6. Reblogged this on Disorderly Chickadee and commented:
    A very nice discussion of alcohol + psych meds. The more meds I have in the mix, the more cautious I am about adding in alcohol.

  7. I’ve never had adverse effects or even really noticed a difference when drinking with Wellbutrin, stimulants, Lamictal, or SSRIs – individually or in pairs, that is. However, now that I’m taking a combination of all of the above (plus the occasional benzo PRN) I’m thinking that any alcohol at all is a really bad idea.

    But I’ve never had a real hangover. Maybe it’s because I slurp down at least a pint of water per drink. Maybe I’m just lucky?

    • Sarah @ bi[polar] curious

      Hangovers are an odd science, hydration, age, amount of sleep, and type of drink are all variables that can come into play. Maybe you just consistently hit a home run in at least two out of the four every time?

  8. I’m a recovering alcoholic with over 20 years’ sobriety; I’m also bipolar. And, as an RN, I’d caution *anyone* on psychiatric medications NOT to use alcohol—period! It’s too easy to damage your liver, and in addition you’re at risk of decompensation. That’s bad news for us BPers who like to stay in control of our illness as much as possible. We are also more apt to do foolish and dangerous things than the average Joe who routinely consumes a six-pack on Saturday nights. Please…THINK, don’t drink!

  9. The Quiet Borderline (back in hospital)

    From my own experiences, I’d say to avoid drinking alcohol with psych meds. When I have drank and mixed with meds, it’s been a pretty unpleasant experience. My anxiety has skyrocketed, heart pounding and I’ve felt more drunk than usual with the room spinning and also experiencing disassociation.

    Now I don’t have even one drink as I’m on meds.

    That’s personally from me.

  10. Wow – great topic.

    I sat at the computer after I finished your post, wondering why I never thought of writing on this subject. I realized It’s because I am pretty reckless when it comes to psyc meds and alcohol consumption. Even I know what I do is bad & therefore should not be spoken of. LOL.

    • Sarah @ bi[polar] curious

      Thanks! And I feel ya, there are a lot of things I haven’t written about yet just out of pure guilt around my own behavior, really, but if the information is helpful to someone I guess I might as well just throw it out there!

  11. Reblogged this on bravingbipolar and commented:
    Here’s a great post and discussion about mixing alcohol with our mental Meds. Love her blog!

  12. This is really useful information. I have just started on Lamictal and although the decision not to drink is mine (ie nobody has explicitly told me I can’t, I just decided it would be better for now) I feel a little resentment at the idea that I can never enjoy the odd glass of wine with friend’s if I wanted to. I guess it’s just a case of taking it slow and seeing how things go. At the moment I don’t particularly feel like drinking anyway!

    Thank you for such an informative post :-)

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