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Tuesday, April 4, 2017

Drinking on Anti-Depressants

By STEVEN PETROW DEC. 20, 2016

Credit Tony Cenicola/The New York Times

“So why did you stop drinking?” my friend Brad asked recently when we were out for dinner. “You never seemed to have a drinking problem.”

The question surprised me, coming as it did a full two years after my decision to take a “break” from alcohol. He was scanning the wine list, and I sensed he was hoping I’d share a bottle of French rosé with him. So I decided to tell him the truth.

“To get my depression back under control.”

In my late 50s, my longstanding depression had started to deepen, albeit imperceptibly at first. I continued drinking moderately, a couple of glasses of wine most days of the week, along with a monthly Manhattan.

Then two dark and stormy months really shook me up, leaving me in a black hole of despair as depression closed in. At my first therapy appointment, the psychopharmacologist listened to me attentively, then said bluntly: “Stop drinking for a month.”

The shrink wanted to know whether I was in control of my drinking or my drinking was in control of me. He explained that we become more sensitive to the depressant effects of alcohol as we age, especially in midlife, when our body chemistry changes and we’re more likely to be taking various medications that can interact with alcohol and one another.

On doctor’s orders, I went cold turkey off alcohol. When I returned a month later and volunteered that I hadn’t touched a drink since our last visit, he was satisfied that I didn’t have “an active alcohol problem” and told me I could drink in what he considered moderation: No more than two glasses of wine a day, and never two days in a row. He also suggested I keep a log.

More Americans than ever are taking antidepressants. The prevalence nearly doubled between 1999 and 2012, increasing to 13 percent from 6.9 percent, a study in JAMA found. Antidepressant use increases with age, with more than one in six of those over 60 taking a drug for depression.

Drug companies err on the side of caution, warning those taking the drugs to “avoid alcohol.” Alcohol is itself a depressant and may worsen depression, though few studies have explored the clinical implications of mixing it with antidepressants. Dr. Daniel Hall-Flavin, an associate professor of psychiatry at the Mayo Clinic who studies addiction, said: “While select individuals may be able to have an occasional drink without complications, that cannot be generalized to an entire population, some of whom may have drug interactions.”

Andrew Solomon, a professor of clinical psychology and among the world’s best-known depressives thanks to his book “The Noonday Demon: An Atlas of Depression,” couldn’t provide much more guidance. “It definitely varies by how I’m feeling over all,” he told me when I asked about his personal habits. “When I’m in good spirits — no pun intended — I am easier about this; when I feel more fragile, I’m more cautious.”

“People just don’t know,” said Dr. Richard A. Friedman, a professor of clinical psychiatry and director of the psychopharmacology clinic at Weill Cornell Medicine in New York and occasional contributor to The New York Times. “There simply aren’t any good studies of whether there’s a safe amount to drink while taking antidepressants, which is why you have such variable opinions from doctors, ranging from none to modest, whatever that is.”

Dr. Friedman pointed out one thing we do know: “The risk of alcohol abuse and dependence problems for those who suffer from depression is about double the risk of people who don’t.” And if you have an accompanying psychiatric condition like bipolar disorder, he said, the risk of an alcohol use disorder is six to seven times higher.

He noted that some medications may be more dangerous than others when combined with alcohol. Specifically, he warned me away from Wellbutrin, preferred by many patients because it has virtually no sexual side effects; unfortunately that antidepressant, when combined with alcohol, can increase the likelihood of a seizure. Lexapro, the antidepressant I take, belongs to a widely prescribed class of antidepressants known as selective serotonin reuptake inhibitors and is no better or worse when it comes to drinking than other S.S.R.I.s.

Dr. Friedman added that an older type of antidepressants known as monoamine oxidase inhibitors Dr. Friedman added that an older type of antidepressants known as monoamine oxidase inhibitors, or MAOIs, could be particularly dangerous when combined with alcohol. Alcohol contains variable amounts of tyramine, a natural substance also found in certain foods like aged cheese and cured meats that, when combined with these drugs, could cause blood pressure levels to skyrocket.

So what to do? Dr. Friedman suggested an experiment: Try having one drink a couple of times a week or less. If no problems arise, such as the return of feelings of depression or anxiety, or a disruption in sleep, you can maintain that level of very moderate drinking. Such side effects may become apparent the next day or take days or weeks to develop, he cautions, especially with higher levels of alcohol intake.

“Many people don’t recognize and make those connections,” he said, so they think that they can continue drinking — or drink more. They can’t. The bottom line is that anyone taking an antidepressant should first speak with a doctor before drinking any alcohol.

As for me, my experiment about how much to drink has been unambiguous: Even a half glass of wine opens the trap doors to depression in my head. Abstaining keeps those doors closed, and my depression at bay. At least for now.

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