August 22, 2025

Can I mix antidepressants or anxiety medications with alcohol and other drugs?

young woman at a festival

Anxiety and depression are common in Australia. At some stage in their life, almost one in three people will be impacted by anxiety, and one in six will be impacted by an affective disorder such as depression.1

Each year, millions of people are prescribed medications, most commonly antidepressants, to help manage these conditions.2

But many are unaware of the risks of mixing some medications with alcohol or other drugs (AOD).

Here, we look at some key interactions to be mindful of, particularly when it comes to AOD, antidepressants and benzodiazepines.

Please note that mixing mental health medications and AOD can greatly increase your risk of experiencing dangerous effects - especially if multiple substances are used around the same time.4

The information provided here is not medical advice, and there may be other interactions between drugs that aren’t listed in this article.

Talk to your doctor, pharmacist or call Medicines Line on 1300 633 424 for information and advice.

What is a drug interaction?

Drugs can interact in the body in many ways.

Two of the main types of interaction to be aware of are:

  1. When one substance changes how another is absorbed in the body or cleared from the body. It can impact how strong the effects are or how long the drug stays in your system. This is known as a pharmacokinetic interaction.3
  2. When two substances have similar or opposite effects on the body. This can make effects either stronger, weaker or even cancel out one of the drugs. This is known as a pharmacodynamic interaction.3

When to call an ambulance

Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide instructions over the phone):

  • passed out or non-responsive
  • spasms or seizures
  • difficulty breathing
  • vomiting
  • choking or gurgling sounds
  • skin colour changes, especially lips and fingernails:
    • typically bluish-purple skin for people with lighter complexions
    • or greyish or ashen skin for people with darker complexions
  • sharp pain/discomfort in chest, arm, shoulder, back, neck or jaw
  • racing heartbeat, or slow/no heartbeat
  • severe agitation, confusion or panic. 5,17,18

Stay with the person, follow instructions from emergency services and put the person in the recovery position until help arrives.

Provide as much information as possible about the drug taken, the amount, timing, other substances involved, and any pre-existing medical conditions.

Types of antidepressants

There are many types of antidepressant medications, some of the most prescribed ones are:

  • SSRIs (selective serotonin reuptake inhibitors), they include:
    • escitalopram (Cipralex, Lexapro)
    • sertraline (Zoloft, Lustral)
    • fluoxetine (Prozac, Sarafem, Rapiflux, Selfemra)
    • citalopram (Celexa, Cipramil)
    • paroxetine (Paxil, Paxil CR, Pexeva, Brisdelle)
    • fluvoxamine (Luvox, Luvox CR).5,6
  • SNRIs (serotonin and norepinephrine reuptake inhibitors), they include:
    • venlafaxine (Effexor)
    • duloxetine (Cymbalta, Yentreve)
    • desvenlafaxine (Pristiq).6
  • TCAs (tricyclic antidepressants), they include:
    • amitriptyline (Endep)
    • nortriptyline (Allegron, NortriTABS, Pamelor, Aventyl HCL)
    • clomipramine (Chemmart Clomipramine Tablets)
    • dothiepin (DOTHEP)
    • doxepin (Deptran)
    • imipramine (Tofranil).6-13
  • MAOIs (monoamine oxidase inhibitors), which were once commonly used to treat depression but are no longer the first choice for most people, they include:
    • isocarboxazid (Marplan)
    • phenelzine (Nardil)
    • selegiline (Emsam)
    • tranylcypromine (Parnate).6

They all have different side effects and are prescribed depending on a person’s medical history, age, symptoms and the other medications.6

One of the main risks to be aware of when mixing antidepressants and AOD is ‘serotonin syndrome’.14

What is serotonin syndrome?

Serotonin is a chemical in the body that helps to regulate mood. Some antidepressants and other drugs (like MDMA) increase the levels of serotonin within the brain.14,15

Mixing these types of drugs together can cause a dangerous build-up of serotonin – this is known as serotonin syndrome.5

Symptoms can include:

  • confusion
  • agitation
  • fever
  • shivering
  • muscle stiffness
  • excessive sweating
  • racing heart
  • diarrhoea
  • seizures.5,16

Mild forms of serotonin syndrome may go away within one to two days after someone stops taking the drug that caused it. But severe serotonin syndrome can be life threatening, and needs medical attention.5

Types of benzodiazepines

Benzodiazepines are depressant drugs, which means they slow down the messages travelling between the brain and the body.

Benzodiazepines can come in three types: short-acting, intermediate and long-acting.

Short-acting benzodiazepines can have a stronger withdrawal or ‘come down’ effect.

Common types of benzodiazepines include:

  • diazepam (Valium, Ducene)
  • alprazolam (Xanax, Kalma, Alprax)
  • temazepam (Euhypnos, Normison)
  • oxazepam (Alepram, Murelax, Serepax)
  • nitrazepam (Alodorm, Mogadon)
  • lorazepam (Ativan).

Mixing benzodiazepines with other depressant drugs, such as alcohol, is unsafe and increases risk of overdose.

Mental health medications and their AOD interactions are listed below, click on a category to expand the information.

SSRIs are the most prescribed antidepressant. They can help reduce symptoms of depression and anxiety by increasing the activity of serotonin within the brain.2,5,22,23

Can I drink alcohol with SSRIs?

Check with your doctor or prescriber about how alcohol can interact with your medications.24,25

SSRIs can increase the negative effects of alcohol, such as:

  • drowsiness
  • impaired judgement
  • impaired thinking and motor skills.25,26

How do SSRIs interact with other drugs?

Higher risk:

  • Cannabis and SSRIs: can increase the risk of side effects, such as cough, diarrhoea, dizziness and fatigue.27
  • Cocaine and SSRIs: can increase the risk of serotonin syndrome.28
  • MDMA (ecstasy) and SSRIs: can increase the risk of serotonin syndrome. SSRIs may also decrease the effects of MDMA.29,30
  • Opioids and SSRIs: some opioids mixed with SSRIs have a high level of risk. Tramadol, pethidine, and dextromethorphan can increase the risk of serotonin syndrome. Some SSRIs can also increase the risk of overdose with opioid-based painkillers such as oxycodone.31,32

Lower risk:

  • Ketamine and SSRIs: generally, no major adverse effects.33
  • Psilocybin (magic mushrooms) and SSRIs: generally, no major adverse effects.34

Unknown risk:

  • LSD and SSRIs: there isn’t enough evidence on LSD and SSRI interactions.35

SNRIs affect the levels of serotonin and norepinephrine within the brain. These chemicals regulate mood.22,36

SNRIs aren’t prescribed as often as SSRIs, but they’re still widely used to manage depression and anxiety. SNRIs can also be used for treating some chronic pain conditions, such as fibromyalgia.36,37

Because SNRIs and SSRIs work in similar ways, some of their interactions with AOD are likely to be similar.36,38

Can I drink alcohol with SNRIs?

Check with your doctor or prescriber about how alcohol can interact with your medications.

SNRIs can increase the negative effects of alcohol, such as:

  • drowsiness
  • impaired judgement
  • impaired thinking and motor skills.39

How do SNRIs interact with other drugs?

Higher risk:

  • Cocaine and SNRIs: can increase the risk of serotonin syndrome.40
  • MDMA (ecstasy) and SNRIs: based on the interaction between SSRIs and MDMA, mixing SNRIs and MDMA may also increase the risk of serotonin syndrome.14
  • Opioids and SNRIs: some opioids combined with SNRIs have a high level of risk. Tramadol, pethidine, and dextromethorphan can increase the risk of serotonin syndrome.31

Lower risk:

  • Ketamine and SNRIs: generally no major adverse effects.33

Unknown risk:

TCAs affect the levels of serotonin and norepinephrine within the brain. These chemicals regulate mood.42

TCAs can be effective, especially for people with severe or hard-to-treat depression - but they’re usually not the first treatment option as they can be more likely to cause side effects.

TCAs can also be prescribed for other symptoms or conditions such as migraines, anxiety, sleep problems, and long-term nerve pain.42,43

Can I drink alcohol with TCAs?

Check with your doctor or prescriber about how alcohol can interact with your medications.

Some TCAs can increase the negative effects of alcohol, which may lead to:

  • drowsiness
  • dizziness or feeling lightheaded
  • sudden drop in blood pressure when standing up (orthostatic hypotension). 44-46

Extra care may be needed when taking TCAs like doxepin, clomipramine, or imipramine with alcohol as they can increase the risk of these side effects.8-10 Some TCAs, such as amitriptyline and doxepin, may make drinking unsafe as they lower the amount of alcohol needed to cause an overdose.44,45

How to TCAs interact with other drugs?

Higher risk:

  • Cocaine and TCAs: can increase the risk of serotonin syndrome, and may also lead to irregular heartbeat, and increase blood pressure, anxiety and agitation.47
  • MDMA (ecstasy) and TCAs: can increase the risk of serotonin syndrome.47
  • Opioids and TCAs: some opioids combined with TCAs have a high level of risk. Tramadol and fentanyl can increase the risk of serotonin syndrome when combined with TCAs.48

Unknown risk:

  • Ketamine and TCAs: there isn’t enough evidence on ketamine and TCA interactions.
  • Cannabis and TCAs: there isn’t enough evidence on cannabis and TCA interactions.49
  • Psychedelics and TCAs: there isn’t enough evidence on the interaction between psychedelics such as LSD or psilocybin (magic mushrooms) and TCAs.35

MAOIs are an older type of antidepressant. They aren’t widely used anymore but are still prescribed when other medications haven’t been effective.50

MAOIs can have dangerous interactions with certain foods, medications, alcohol and other drugs.50

Check with your doctor before taking any medication while on MAOIs, including over the counter drugs.

Can I drink alcohol with MAOIs?

Mixing MAOIs with alcohol is unsafe.

This combination can cause dangerous spikes in blood pressure.26,39

Many alcoholic drinks contain a chemical called tyramine, which when combined with MAOIs can have life threatening consequences.26

How do MAOIs interact with other drugs?

Higher risk:

  • MDMA and MAOIs: greatly increases the risk of serotonin syndrome. Compared to other antidepressants MAOIs have a much higher risk of harm when mixed with MDMA. MAOIs can last up to two weeks within the body after stopping treatment. This means taking MDMA within this period can be potentially life threatening.51
  • Opioids and MAOIs: opioids such as tramadol, methadone, dextromethorphan and propoxyphene, combined with MAOIs can result in life threatening complications and greatly increase the risk of serotonin syndrome.26, 52
  • Cocaine and MAOIs: increases the risk of serotonin syndrome. It can also cause a build-up of the chemical noradrenaline in the brain which can dangerously increase blood pressure.53
  • Ketamine and MAOIs: potentially dangerous. This combination may increase blood pressure. MAOIs may also increase the potency of ketamine.26,54

Unknown risk:

Benzodiazepines are usually prescribed to relieve anxiety and to help with sleep. They’re also used to manage alcohol withdrawal and epilepsy.19

Using benzodiazepines can lead to dependence and withdrawal symptoms, so they’re usually prescribed for a very short amount of time.20

Benzodiazepines can have dangerous effects when combined with AOD.

Can I drink alcohol on benzodiazepines?

Mixing alcohol and benzodiazepines is unsafe.

Taken together, these drugs increase the risk of overdose, unconsciousness and can dangerously affect breathing – putting someone at risk of death due to asphyxiation (choking).55,56

People may also experience blacking out (temporary loss of consciousness) from mixing alcohol and benzodiazepines, which can result in memory loss.26,57

How do benzodiazepines interact with other drugs?

Higher risk:

  • Opioids and benzodiazepines: greatly increase the risk of overdose and death. Both drugs affect breathing and brain function. This can be fatal unless medical attention is provided.56
  • Ketamine and benzodiazepines: increases sedative effects. This can lead to unexpected loss of consciousness, causing problems with breathing and/or blocked airways (from inhaling vomit).56
  • Cocaine and benzodiazepines: can increase the harms associated with both drugs. It can make it difficult to tell the effect that each drug is having on a person, increasing the risk of overdose.58,59
  • MDMA and benzodiazepines: can increase the harms associated with both drugs. It can make it difficult to tell the effect that each drug is having on a person, increasing the risk of overdose.56

Lower risk:

  • LSD and benzodiazepines: may reduce some of the unpleasant effects of LSD. Taking more than a prescribed dose of benzodiazepines is dangerous and not advised if you are experiencing negative effects of LSD.60

Unknown risk:

  • Cannabis and benzodiazepines: there isn’t enough evidence on cannabis and benzodiazepine interactions.

More information and advice

Talk to your doctor, pharmacist or call Medicines Line on 1300 633 424 for information and advice around medications. For in-depth information on common medications and their interactions with different drug types, the Queensland Network of Alcohol and Other Drug Services (QNADA) have a range of resources available:

For more general information on drug combinations check out the resources below:

This article has been reviewed by the Victorian Poison Information Centre (VPIC).

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Last updated: 27 Aug 2025