Amitriptyline and Alcohol: A Risky Combination

In his novel It's Kind of a Funny Story, author Ned Vizzini captures the exhausting reality of depression: "I didn't want to wake up. I was having a much better time asleep. And that's really sad. It was almost like a reverse nightmare, like when you wake up from a nightmare you're so relieved. I woke up into a nightmare."

For many people, antidepressants provide crucial relief. But what happens when alcohol enters the picture? Specifically, is it safe to drink alcohol while taking amitriptyline (sold under the brand name Elavil)? The straightforward answer is no—mixing amitriptyline and alcohol can be dangerous. Here's what you need to know.

Understanding Amitriptyline

Amitriptyline is a tricyclic antidepressant primarily used to treat mood disorders like depression. It works by increasing certain brain chemicals that help regulate mood.

The medication prevents the reabsorption of serotonin and norepinephrine, which enhances their mood-stabilizing effects. It also influences other neurotransmitter systems, providing pain relief and improving sleep. Additionally, amitriptyline blocks sodium channels and specific receptors (such as muscarinic receptors), contributing to both its therapeutic benefits and side effects.

The Dangers of Mixing Amitriptyline and Alcohol

Scientific and medical evidence strongly advises against combining amitriptyline with alcohol. Here's why:

1. Enhanced Side Effects

Amitriptyline comes with several side effects that alcohol can worsen:

• Sedation and drowsiness: Both substances cause drowsiness. When taken together, this effect intensifies, making activities like driving or operating machinery extremely dangerous.
• Cognitive difficulties: Alcohol can amplify amitriptyline's side effects of dizziness, confusion, and poor concentration. This combination may impair thinking, judgment, and coordination.
• Gastrointestinal issues: Amitriptyline can slow digestion, leading to constipation. Alcohol may cause stomach pain, acid reflux, nausea, or diarrhea. Together, they disrupt digestive function significantly.
• Dry mouth: Amitriptyline can cause dry mouth, and alcohol's dehydrating effects make it worse by increasing fluid loss.
• Blurry vision: Both substances can cause vision problems. Alcohol affects eye muscle coordination, leading to temporary blurriness, and long-term use may contribute to permanent vision issues due to nutrient deficiencies.
• Headaches: Both amitriptyline and alcohol can trigger headaches. Alcohol may also cause "cocktail headaches" during drinking sessions.

2. Increased Overdose Risk

Combining amitriptyline with alcohol raises the risk of overdose:

• Higher blood levels: Alcohol interferes with the liver's ability to process amitriptyline, causing the medication to build up to dangerous levels.
• Amplified effects: Alcohol intensifies amitriptyline's side effects, particularly sedation, dizziness, and low blood pressure.
• Slower elimination: Both substances compete for processing by liver enzymes, slowing down amitriptyline's breakdown and potentially straining the liver over time.
• Masked symptoms: Alcohol can make it harder to recognize overdose signs like confusion, extreme sleepiness, hallucinations, seizures, breathing difficulties, or irregular heartbeat. Seek immediate medical help if these occur.

3. Alcohol Worsens Depression

Alcohol can undermine amitriptyline's antidepressant benefits. As a depressant, alcohol slows the nervous system and may worsen depression and anxiety symptoms. While some people use alcohol to temporarily feel better, it often backfires, leading to dissatisfaction and hindering genuine social connections.

How Long Should You Wait to Drink After Taking Amitriptyline?

Amitriptyline has a half-life of 10 to 28 hours, meaning it takes up to a day for your body to eliminate half the dose. Its active metabolite, nortriptyline, extends these effects. To minimize interaction risks, wait at least a few days after your last dose before considering alcohol. However, since alcohol can worsen depression, it's best to avoid drinking entirely during treatment.

Is Occasional Drinking Okay?

No amount of alcohol is safe while taking amitriptyline. The combination stresses the liver and counteracts the medication's mood-stabilizing effects, making recovery more challenging.

Safety Tips During Treatment

• Avoid mixing: Steer clear of alcohol entirely while on amitriptyline to protect your health and treatment effectiveness.
• Eat well: Fuel your body with whole grains, proteins, healthy fats (like salmon and avocados), and plenty of fruits and vegetables for essential nutrients.
• Prioritize sleep: Aim for at least 8 hours of quality sleep nightly in a distraction-free environment.
• Boost mood naturally: Increase dopamine and serotonin through exercise, outdoor activities, or gentle walks.

Conclusion

In Moab Is My Washpot, Stephen Fry reflects on his depression: "It's not all bad. Heightened self-consciousness, apartness, an inability to join in, physical shame and self-loathing—they are not all bad. Those devils have been my angels. Without them I would never have disappeared into language, literature, the mind, laughter, and all the mad intensities that made and unmade me."

Similarly, choosing to avoid alcohol during treatment can be empowering. By focusing on your health and well-being, you can achieve a level of wellness you might not have thought possible. Quitemate is here to support you every step of the way!