Interaction between antidepressants and alcohol: signal amplification by multiple case reports

Alcohol use and antidepressant prescription are prevalent in many countries, but little is known about their combined effects.

Having been surprised by selective serotonin reuptake inhibitor (SSRI) antidepressant-treated patients who became prone to pathological intoxication, we examined this association, searching for relevant literature and cases.

A detailed literature search showed little or no interaction between SSRIs and alcohol in laboratory studies, and inconsistent effects of these drugs in problem drinkers. We collected cases to study from our own and colleagues' practices, regulatory agencies and web-based discussion fora, and considered evidence for interactions according to standard criteria.

Pathological intoxication, characterized by unexpected and often gross disinhibition, was identified in 100 of 201 reports that provided enough detail to be evaluated. Memory impairment was prominent in just over half (53/100) of these. Outcomes included serious violence; homicide occurred in 8 cases, including two double and one triple homicide (12 deaths).

Multiple lines of evidence amplify a thus far barely recognized signal of interactions of SSRI and related antidepressants with alcohol. Systematic collection of further data is required to further characterize this syndrome, but in the meantime effective warnings must be introduced to alert prescribers and patients to the serious risk of pathological intoxication during antidepressant treatment.