Can you drink on mirtazapine? (3+ reasons why you shouldn’t) 

In this blog post, we are going to answer the question, “Can you drink on mirtazapine?”. Mirtazapine is an antidepressant which is used to treat a variety of mental health conditions. 

However, this medicine should be used properly in order to minimise the side effects and maximise the beneficial effects. This blog will cover the safety related to the concomitant use of alcohol and mirtazapine. 

Can you drink on mirtazapine?

Yes, you can drink on mirtazapine, but you should not. It is a known fact that antidepressants don’t work that well with alcohol. This can be even more dangerous for a new mirtazapine user. For such people, it is recommended to not drink at all, until you know how mirtazapine makes you feel. 

Mirtazapine belongs to the tetracyclic antidepressants. It has a dual mode of action. Mirtazapine is believed to be responsible for the activation of 5-HT1 receptors, which are one of the serotonin receptors. This antidepressant also acts on the noradrenergic system. 

Experts believe that mirtazapine enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin. It also prevents the inhibitory action of the noradrenergic system which hinders the release of serotonin. 

This way, it actively increases the amount of this excitatory neurotransmitter in your system. Mirtazapine can be used to treat the following health conditions:

• Depression 
• Anxiety 
• Treatment resistant depression 
• Depression in elderly patients
• Post-operative nausea
• Alcohol dependence
• Insomnia or inability to fall asleep 
• Neuropathic pain
• Inability to feel hungry/hunger suppression

This antidepressant also inhibits H1 (Histamine 1) receptors, which is the biggest reason why mirtazapine is responsible for making you sleepy. Alcohol and mirtazapine together can dangerously enhance this effect. 

Why should you cut back on alcohol while you’re taking mirtazapine? 

You should cut back on alcohol as much as you can while you are being treated with mirtazapine or any other antidepressant. The combination may cause disturbing consequences, some of which include:

Risk of serotonin syndrome

Serotonin syndrome is a big risk when it comes to the use of alcohol and mirtazapine together. Both of these chemicals have an effect on your brain and the neurotransmitters it releases. 

Serotonin syndrome is a troublesome condition, which usually comes with excessive amounts of mirtazapine. It causes following sign and symptoms:

• Excessive sweating 
• Restlessness and fatigue
• Headache, which often feels like your head is pounding
• Changes in blood pressure and/or temperature
• Nausea
• Vomiting
• Diarrhoea
• Bradycardia
• Tremors
• Muscle twitching and muscle pain

Serious side effects include:

• High fever with chills
• Seizures
• Arrhythmia 
• Unconsciousness

Now, the intensity of these side effects totally depend on the amount you have taken. People who get drunk usually get carried away and end up consuming dangerously high amounts. This could result in life threatening symptoms and may require hospitalisation. 

Sensory and motor coordination impairment

Alcohol and mirtazapine work in opposite ways. Alcohol acts as a central nervous system suppressant and dulls down your brain. It clouds your thinking, judgement, decision making ability, speech and a couple of other functions. 

Mirtazapine, on the other hand, enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin. It also prevents the inhibitory action of the noradrenergic system which hinders the release of serotonin. 

This increases the amount of active serotonin which binds to its receptors present throughout the body. When these two are used together, your brain is subjected to a number of effects. 

One slows it down while the other enhances its functions. This creates a number of sensory and motor disturbances, including impaired senses, impaired ability to identify threats, abnormal jerks, tremors, and inability to maintain balance. 

Blackouts

Both alcohol and mirtazapine have tiredness, fatigue, dizziness and drowsiness as common symptoms. When these two are taken excessively together, they cause extreme sedation, which could result in blackouts or unconsciousness. 

The blackout could last for hours and it dangerously slows your heart rate, blood pressure, breathing, and every other metabolic function in your body. 

Suicidal behavior 

The combination of alcohol and mirtazapine is dangerous in more ways than you can imagine. Mirtazapine is usually given for depression, which is a heart-sinking condition. 

Alcohol, on the other hand, tends to accelerate depression induced heart-sinking feelings, along with hopelessness, worthlessness, and a will to give up on everything. 

When these two chemicals are consumed together, they completely mess up your system. It’s like a fight within your brain. It clouds your judgement and messes up your decision making ability. 

Various studies suggest that mirtazapine and alcohol overdose have resulted in a number of people trying to take their life. This effect is much more pronounced in people younger than 24 years of age, as mirtazapine itself can cause suicidal behavior in younger individuals. 

Mirtazapine and Alcohol toxicity

The overdose of mirtazapine and alcohol can have a drastic effect on your liver, an organ chiefly responsible for performing metabolic activities. It converts harmful active substances into their harmless inactive metabolites. Liver damage results in accumulation of these chemicals in your body which causes toxicity. 

Excessive vomiting

Throwing up uncontrollably is one of the most common hangover effects of alcohol, but it is also a side effect of mirtazapine. By combining these two together, you’re subjected to excessive gut-wrenching vomiting. 

This condition can take a serious turn as this kind of hangover makes your mind dull and causes sedation. If you throw up under such circumstances, you’re at higher risk of aspiration.

In this condition, your gastric content along with acid, food and bacteria enter into your lungs by accident. This is most common in people who throw up while being unconscious. 

What are the common side effects associated with the use of mirtazapine and alcohol?

The common side effects of mirtazapine include:

• Sleepiness or drowsiness 
• Excessive tiredness or fatigue 
• Dizziness or lightheadedness 
• Xerostomia or dry mouth 
• Anxiety 
• Agitation 
• Confusion 
• Gain of appetite
• Weight gain 
• Gastrointestinal side effects including nausea, vomiting and diarrhoea/Constipation 

Mirtazapine is also associated with some serious side effects, which may include:

• Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
• Convulsions 
• QT prolongation 
• Pain and tightness in chest
• Arrhythmia 
• Flu like symptoms 

The common side effects associated with the use of alcohol include:

• Drowsiness 
• Nausea
• Vomiting
• Euphoria
• Impaired judgement
• Loss of appetite 
• Inability to make decisions 
• Inability to speak or walk properly 
• Blackouts 
• Motor impairment 
• Dizziness
• Tremors
• Severe headache

Depression and alcohol itself is a dreadful combination. Depression is a condition associated with hopelessness, worthlessness, and sadness. This condition impairs your normal brain function and slows it down. Alcohol produces the same kind of effects. 

It suppresses your brain and your thinking capability. In short, alcohol enhances the symptoms associated with depression and gives rise to a life threatening mental health condition. 

What to do if you are an alcohol addict? 

If you are an alcohol addict, there are a few things you can try to get rid of this nerve-racking addiction. These include:

• Detoxification is just a technique to completely remove the effects of alcohol from your system. It is not a treatment plan, just a way to detoxify your system. 

• There are a few medications which are used to help cut back on alcohol, usually antagonists which help to counteract the effects of alcohol. These include Naltrexone, Topiramate, Disulfiram, gabapentin, and Acamprosate. 

• Counselling helps to mentally prepare you to stop drinking. Psychologists lay down all the side effects and consequences associated with alcoholism. This can help you understand how it can ruin your life and is capable of taking you to the point of no return. 

• You can try to be a part of a support group. Such groups provide a platform for people to come out in the open. You can listen to other people’s stories and can realise how alcoholism has been ruining lives for decades now. 

Conclusion 

In this blog post, we have talked about the concomitant use of mirtazapine and alcohol. Alcohol can contribute to depression and suicidal behavior. This effect is more common in younger individuals.

Mirtazapine and alcohol together can cause extreme sedation which can slow down your heart rate, breathing rate, blood pressure and your several other metabolic functions. Make sure you try to cut back on alcohol and avoid using it with your antidepressant. 

Make sure you use this medication or any other medication only when your doctor has advised it. Using medications which can affect your brain is not something ideal and should not be encouraged unless it is absolutely necessary to do so. 

FAQs: can you drink on mirtazapine 

What will happen if I drink alcohol while taking mirtazapine?

Both alcohol and mirtazapine have tiredness, fatigue, dizziness and drowsiness as common symptoms. When these two are taken excessively together, they cause extreme sedation, which could result in blackouts or unconsciousness. 

The blackout could last for hours and it dangerously slows your heart rate, blood pressure, breathing, and every other metabolic function in your body. 

What should you not mix mirtazapine with?

• Monoaminoxidase inhibitors (MAOIs). The combination use can increase the risk of serotonin syndrome. 
• Non-steroidal anti-inflammatory drugs (NSAIDS). The combination use can increase the risk of bleeding. 
• Pimozide. The concomitant use can increase the plasma concentration(availability of a drug in the blood) of pimozide to much higher levels. It can result in life-threatening arrhythmia.
• Controlled substances, including all narcotic analgesics. The concomitant use can cause severe psychological side effects. 
• Mood stabilisers 
• Alcohol 

What can happen if you drink while on antidepressants?

• Serotonin syndrome is a big risk when it comes to the use of alcohol and antidepressants together. Both of these chemicals have an effect on your brain and the neurotransmitters it releases. 
• The concomitant use can cause a number of sensory and motor disturbances, including impaired senses, impaired ability to identify threats, abnormal jerks, tremors, and inability to maintain balance. 
• The overdose of antidepressants and alcohol can have a drastic effect on your liver, an organ chiefly responsible for performing metabolic activities

Is mirtazapine a strong antidepressant?

Yes, mirtazapine is a strong antidepressant. It enhances the stimulatory action of the noradrenergic system which increases the secretion of serotonin. It also prevents the inhibitory action of the noradrenergic system which hinders the release of serotonin. This way, it actively increases the amount of this excitatory neurotransmitter in your system.

Is mirtazapine more effective at lower doses?

Mirtazapine is effective at lower doses only for the treatment of insomnia. However, the more complex mental health conditions require a proper dosage schedule in order to get better. 

References 

• Antidepressants and alcohol: What’s the concern? https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231
• National Institute on Alcohol abuse and Alcoholism – Mixing Alcohol With Medicines https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
• David B Menkes et al. Int J Risk Saf Med. (2014) – Interaction between antidepressants and alcohol: signal amplification by multiple case reports https://pubmed.ncbi.nlm.nih.gov/25214162/
• Nadia Iovieno et al. J Clin Psychiatry. (2011) – Antidepressants for major depressive disorder and dysthymic disorder in patients with comorbid alcohol use disorders: a meta-analysis of placebo-controlled randomized trials https://pubmed.ncbi.nlm.nih.gov/21536001/
• Niladri Banerjee – Neurotransmitters in alcoholism: A review of neurobiological and genetic studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065474/
• Joseph M Boden, David M Fergusson (2011)  – Alcohol and depression https://pubmed.ncbi.nlm.nih.gov/21382111/