How to navigate college life with antidepressants

Editor’s note: Dr. Jill Grimes is author of “The Ultimate Health Handbook for Students: Your guide to everything from hangovers to homesickness.” Grimes has more than 30 years of experience in private practice and academic medicine, and shares her medical wisdom on social media platforms such as The College Doc.

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Is it safe to drink alcohol while taking antidepressants? What about using marijuana? What happens if I miss a dose of my medicine so I can drink at a party? Are over-the-counter medications prohibited if I get sick?

As a primary care physician who focuses on college health, I am asked these questions all the time. The stressful atmosphere and dense living quarters on college campuses often create the perfect storm for potential health complications. Sleepless nights, substance use, and widespread respiratory viruses make it important to understand how these medications interact with daily habits and illnesses.

According to the Health Minds Study 2023-204, more than a third of students today suffer from moderate to severe anxiety and depressive symptoms, and it’s good that many are getting help. About 1 in 5 students, or 22%, report using prescription antidepressants in the past year, the study found, and about 1 in 3 students, or 36%, have received professional counseling.

At the same time, students study through the night, shifting their sleep schedules to balance different class times, going to weekend parties and more. Those parties tend to serve alcohol, and social drinking and even binge drinking are part of college culture. All-day tailgates increase the chance of excessive intake, even for those who try to drink in moderation.

The best medical recommendation, of course, is to avoid alcohol and drugs if you are taking a prescription antidepressant. Ideally, students taking these medications should also attend counseling, get consistent sleep, and commit to good nutrition and daily exercise to improve their mental health.

But these are not always easy to do in college. So here’s what you need to know about combining your legal antidepressant prescriptions with other drugs.

What is the difference between anxiety medications and antidepressants?

Traditional anxiety medications have been tranquilizers (benzodiazepines), which certainly reduce immediate anxiety but can quickly become physically addictive. Today, doctors have many alternative medication choices with little or no addictive potential.

The treatment of choice for most anxiety disorders is a selective serotonin reuptake inhibitor, or SSRI, or a serotonin and norepinephrine reuptake inhibitor, or SNRI. These medications typically must be taken every day to be effective.

Beta blockers, such as propranolol, are blood pressure medications that can be used in low doses to slow your heart rate, which directly calms the physical symptoms of stress and indirectly leads to mental relaxation. Hydroxyzine is a prescription antihistamine that calms anxiety through sedation. These two medications can be taken “as needed.”

SSRIs and SNRIs increase levels of neurotransmitters in the brain and have proven clinical efficacy in treating both anxiety and depressive disorders, but they are categorized as antidepressants.

Interestingly, many people are prejudiced against taking an antidepressant, but are okay with taking prescription medications for their anxiety. That is why it is important to make it clear what we are treating.

How does alcohol affect anxiety and depression?

First of all, remember that alcohol is a sedative, a central nervous system depressant. Yes, you may initially feel stimulated as your brain is flooded with a bath of short-term dopamine, serotonin, and gamma-aminobutyric acid, or GABA, but the subsequent drop in neurotransmitter levels can suppress your mood and increase the likelihood of you having negative intrusive thoughts , anger and fear.

Students often think that alcohol improves their sleep because it makes them drowsy and falls asleep faster. However, alcohol disrupts your sleep quality by decreasing restorative rapid eye movement, or REM, sleep and increasing wakefulness, making your brain more tired and prone to emotional problems.

Alcohol obviously impairs your judgment, which can lead to embarrassing, harmful, or dangerous actions, conversations, and drunken texting.

Antidepressants work by slowly and steadily building up neurotransmitters such as serotonin and dopamine. Drinking alcohol, which ultimately depletes these chemicals, therefore creates more work to improve your mental health, which is the main reason not to drink while taking antidepressants.

Antidepressants can greatly enhance the effects of alcohol, causing more central nervous system depression, increasing sedation, and further impairing your judgment, reaction time, and coordination.

Many people find that their alcohol tolerance decreases significantly while taking these medications.

No doctor, including myself, will ever recommend drinking alcohol while taking antidepressants. However, the medical risks of drinking one or possibly two standard, measured drinks a few times a month are low in otherwise healthy young adults who take SSRIs or SNRIs and are not taking additional medications.

However, the typical college drink poured freely into a cup is more than two standard drinks, and the impaired judgment of one drink often leads to a second drink, despite initial intentions to keep it to one drink.

That’s why I answer ‘maybe’.

The main exception to this low risk is monoamine oxidase inhibitors, or MAOIs, which should never be mixed with alcohol because they can cause a serious, potentially fatal sudden increase in blood pressure. MAOIs are a unique class of antidepressants that are typically only used in patients who have not responded to other treatments.

The worst is death from alcohol poisoning. A much more common problem is seizures. Antidepressants lower the seizure threshold slightly, meaning it’s easier to have a seizure. Alcohol on its own can cause seizures, and combining it with these medications increases your risk.

Absolutely not. Antidepressants don’t go in and out of your system in just a few hours. It takes many days or weeks. Skipping a dose will not reduce your risk of interacting with alcohol and may cause you to experience headaches, nausea, and increased anxiety or flu-like symptoms due to antidepressant discontinuation syndrome.

Like alcohol, the immediate effect of cannabis tends to be mood enhancing or sedative, leading many students to self-medicate with these products. The social convenience and discretion of vaping or consuming edibles (compared to alcohol) makes it tempting to over-rely on quick hits throughout the day. This can contribute to its addictive potential, especially in people under the age of 25. According to the U.S. Centers for Disease Control and Prevention, an estimated 10% of adults who use cannabis will become addicted.

Inconsistent THC concentrations and unique individual responses can cause even a single dose to produce randomly increased anxiety, paranoia, irritability, and/or nausea. Illegally produced THC products may be enriched with other psychoactive substances.

Cannabis affects liver enzymes, raising blood levels of antidepressants and increasing side effects, according to a 2021 study in the Journal of Personalized Medicine. And of course, there are legal issues depending on what state you live in and how old you are.

They are legal medications, strictly regulated by the U.S. Food and Drug Administration. Every over-the-counter drug label should contain warnings about important drug interactions.

In this case, there may be a risk of serotonin syndrome, a rare but serious drug reaction usually caused by multiple medications and other substances interacting and causing serotonin levels to rise abruptly.

Which medications increase serotonin? Antidepressants, migraine and nausea medications, street drugs, herbal remedies, and dextromethorphan increase serotonin. Cold medications get their warning because they typically contain dextromethorphan to help suppress coughs.

Although increasing the dosage of a certain serotonin-enhancing drug can cause serotonin syndrome, the most common scenario is someone who regularly takes two or more of these medications (especially at higher doses).

If you are taking one of these medications and want or need to add another one, check with your doctor or pharmacist before adding it.

You may feel like your antidepressant isn’t helping enough, so you supplement with other drugs. Instead, consult your doctor about increasing your dose, changing prescriptions, or combining it with a complementary medication to increase effectiveness.

And if you have to do mental gymnastics to guess whether you can combine partying and your daily medications, that’s a good sign that you should skip the alcohol or THC in favor of your prescription.