Alcohol and Effexor

Effexor, or ‘Venlafaxine’, is an SNRI used to treat mental health disorders such as depression and anxiety. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are anti-depressants; SNRIs work to block the reabsorption of released serotonin and norepinephrine from nerve cells.

By blocking the reabsorption, the levels of serotonin and norepinephrine are increased. [1]

Serotonin is a chemical that carries messages from the brain to around the body. Serotonin plays a vital role in mood, sleep, and sexual desire, all required for a happy and healthy life.

Without accurate levels of serotonin, individuals are likely to suffer from anxiety and depression, along with other mental health conditions and mood disorders.

Norepinephrine is another neurotransmitter, important for ‘fight or flight’. Norepinephrine also plays a part in mood and the ability to concentrate.

Those with low levels of norepinephrine are more likely to suffer from ADHD (attention deficit hyperactivity disorder), depression, and low blood pressure.

Effexor is an immediate-release formula and Effexor XR is an extended-release formula. By its general name, venlafaxine works on the brain to treat major depressive disorder, generalised anxiety disorder, panic disorder, and social anxiety disorder (social phobia). [2]

In order to be prescribed the correct dose for the right amount of time, there are plenty of things you must discuss with your chosen healthcare provider:

• All the symptoms of the condition
• Past medication that has had negative effects
• Side-effects of medication
• All psychiatric and medical issues
• Whether you are taking other medication or treatment
• If you are pregnant, breastfeeding, or plan to become pregnant
• If you use drugs
• If you drink alcohol

The reason it is important to disclose whether you drink alcohol and how much you consume is that medication and alcohol interact in the body.

These interactions can alter the metabolism of the medication and alcohol and alter their effects. These interactions can even occur during moderate alcohol intake but are most harmful if you drink in excess.

Interactions Between Medication and Alcohol

Research has shown that 2 types of interactions take place between medication and alcohol. The first type of interaction is called a pharmacokinetic interaction, where alcohol prevents the proper metabolism of alcohol.

This usually occurs in the liver, where most of the alcohol we consume is metabolised by enzymes such as alcohol dehydrogenase (ADH) and cytochrome P450. The second type of interaction is pharmacodynamic interaction. Alcohol enhances the effects of medication, specifically on the nervous system. [3]

Alcohol is first metabolised in the gastrointestinal tract (GI tract) and stomach, called the ‘first-pass’ metabolism. This ‘first-pass’ metabolism has remained controversial, as research has found that it is more likely in men than in women, and more likely in those that have consumed very low alcohol doses. [4]

For example, the stomach is more likely to metabolise alcohol if it is consumed with a meal, rather than binge drinking on an empty stomach. Research suggests that only around 10% of alcohol is metabolised during this stage; the more alcohol that is consumed, the less alcohol is metabolised in the stomach.

Some researchers have suggested that alcohol may block this first-pass metabolism, leading to higher blood alcohol levels (BALs) and meaning people are more intoxicated. Age, gender, and body fat also have an effect on BALs, which is why women’s ‘safe alcohol intake’ is lower than men’s.

The rest of the alcohol is absorbed into the bloodstream and transported to the liver. This is where the primary alcohol metabolism takes place, broken down by ADH and cytochrome P450.

ADH converts alcohol into acetaldehyde through oxidation. Acetaldehyde is then broken down further by the enzyme aldehyde dehydrogenase (ALDH), which is rare amongst Asians and causes the common ‘flushing reaction’.

Many forms of medication can inhibit ALDH, causing interactions such as flushing and nausea in those taking medication. Along with influencing the metabolism of medication, alcohol and medication can affect the liver’s ability to remove toxic substances from the body.

Both alcohol and medication are metabolised in the liver, which may cause the liver to struggle.

Further, alcohol and medication often have similar side effects such as sickness, flushing, nausea, and drowsiness. Drinking whilst on medication may exacerbate these side effects, causing a more intense reaction.

Side Effects of Mixing Effexor and Alcohol

Mental Health

People often use alcohol to relax, but sometimes people drink alcohol to aid the symptoms of depression and anxiety. However, alcohol is a depressant and will make mental health conditions worse in the long run.

If you are taking medication for depression, and drink alcohol which is a depressant, then you are negating and counterbalancing the effects of the medication.

Not only will you make the depression worse, but you will risk health side effects by mixing medication and alcohol that will interact in your body.

This interaction may cause:

• A feeling of sadness
• A feeling of loneliness or emptiness
• Paranoia and anxiety
• Irritability and mood swings
• Decreased or increased appetite

Health Risks: Bleeding

The occasional drink whilst taking Effexor may not be dangerous, but it is still highly recommended that you abstain from alcohol when you are taking medication.

Antidepressants such as Effexor can risk internal bleeding. These types of medication often extend the time it takes for platelets to form their usual clots, so any cuts or wounds (external or internal) may bleed excessively.

Alcohol thins the blood by reducing the number of platelets in the blood, interfering with blood cell production. Therefore, combining antidepressants such as Effexor with alcohol can significantly increase the risk of bleeding. This may be indicated by bleeding internally, bruising easily, or nosebleeds.

Mixing antidepressant medication with alcohol can have dangerous adverse effects, both with matching common side effects.

Feelings of depression and generalised anxiety disorder are likely to remain and get worse, even when you are taking the medication because alcohol will exacerbate these symptoms.

If alcohol use is not identified or treated, it may develop into a substance use disorder. Alcohol use disorders often present in those with psychiatric disorders such as bipolar disorder, as patients aim to self-medicate their symptoms.

Serotonin-norepinephrine reuptake inhibitors are antidepressant drugs, which, by themselves, can have severe side effects. Alcohol is a blood thinner, and mixing this with medication that prevents clotting can have fatal outcomes.

The interaction between prescription medication and alcohol may:[5]

• Exacerbate depressive symptoms and feelings of sadness
• Exacerbate feelings of anxiety
• Cause cognitive impairments such as dizziness and loss of consciousness
• Reduce motor skills and reaction times
• Cause abdominal pain
• Cause chest pain
• Cause internal bleeding
• Cause abnormal bleeding
• Damage brain cells
• Cause shortness of breath
• Cause hot flashes
• Cause shorter attention spans

Treating alcohol use disorders (AUDs) is critical if you are suffering from medical conditions or need to take medication.

The first step is identifying whether you have an issue with cutting down on alcohol, by taking a self-assessment quiz such as the AUDIT.

This will give you an indication regarding your alcohol habits, and whether you should talk to someone and seek medical attention. If a home-detox is deemed safe, think about following this up with group therapy such as Alcoholics Anonymous.

References

[1] Shelton RC. Serotonin and norepinephrine reuptake inhibitors. Handb Exp Pharmacol. 2019;250:145-180. doi:10.1007/164_2018_164

[2] https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Venlafaxine-(Effexor)

[3] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54. PMID: 10890797; PMCID: PMC6761694.

[4] Thomasson HR. Gender differences in alcohol metabolism. Physiological responses to ethanol. Recent Developments in Alcoholism. 1995;12:163–179

[5] https://uhs.umich.edu/combine

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