Amitriptyline and alcohol - how dangerous is it?

introduction

In connection with antidepressants, accompanying alcohol consumption is generally not recommended.

Psychotropic drugs and alcohol also do not get along very well.

Especially with active ingredients that have an additional sedating, i.e. calming property, additional doses of alcohol can intensify this effect.
In addition, there is a reduced ability to react, as the mental and motor performance is limited.
Driving a motor vehicle and using machines, for example, are strictly prohibited in this case.
Antidepressants with a sedating component are the tricyclic antidepressants (NSMRI) amitriptyline, trimipramine and doxepin as well as the tetracyclic antidepressants (? 2 antagonists) mianserin and mirtazapine. Soothing active ingredients are particularly helpful in the treatment of agitated, restless depression and sleep disorders.

What happens in the brain after consuming alcohol?

Under the influence of alcohol, various messenger substances and receptor systems in the brain are modulated.
The dopamine concentration is increased, for example, which has a central influence on people's emotions.
You feel more disinhibited and your mood improves as the body's own reward system is increasingly activated.
The result is a desire for more alcohol to maintain this condition. The sedative effect is mediated via GABA receptors, GABA is the strongest inhibitory transmitter in the CNS. Its concentration is indirectly increased and motor function impairments and physical slowdown occur.
Memory performance also declines; this is triggered by a reduced glutamate receptor function. Glutamate is the most important excitatory transmitter in the CNS.
Northern adrenaline and serotonin, two other important central transmitters, are reduced in their concentration, which explains the aggressive and depressive behavior of alcoholics.
In addition, more enkephalins and endorphins are released, these promote addictive behavior and have a pain-suppressing effect.

Amitriptyline and alcohol

If alcohol is taken together with an antidepressant such as amitriptyline, one can unmistakable interactions determine.
These are dependent on Drinking behavior of the person (immediate or chronic alcohol abuse), of Age, gender and how quickly people can break down drugs in the body.
Pharmacodynamically one comes up mutually reinforcing effect of both active ingredients (ethanol and amitriptyline).
As a result, those affected experience a strong sedationthat of Drowsiness up to dangerous coma states can be enough. They also have to reckon with considerable psychomotor restrictions.
Other side effects to be observed are one increased susceptibility to seizures (especially when withdrawal symptoms occur), decreased blood pressure and Cardiac arrhythmias.
Gastrointestinal complaints such as constipation up to Intestinal obstruction are one of the side effects of therapy with tricyclic antidepressants or? 2 antagonists and can also become worse with simultaneous alcohol consumption.
At a acute alcohol poisoning According to some studies, one must expect the Duration of action of amitriptyline in the body is extended. So-called cytochromes are responsible for the breakdown of tricyclic antidepressants in the organism; Alcohol is also partly broken down via this enzyme system. By excessive acute consumption of alcohol are the cytochromes therefore for the Amitriptyline degradation inhibited.

Regular alcohol consumption in lower doses, however, shows a different picture: there is increased cytochrome formation, since the organism has adjusted to having to break down more alcohol via the cytochrome system. This also leads to one accelerated dismantling of amitriptyline and other psychotropic drugs that are metabolized via cytochromes. The duration of action of the drug is shortened and there are as a result higher doses necessaryto be able to achieve the same therapeutic effect.

Amitriptyline and alcohol addiction

Sometimes it happens that Depressed people are also addicted to alcohol (Comorbidity), in this case the depressive phases of the patients last longer than normal and in dry alcoholics the depressive phases increase the Risk of relapse. The effectiveness of various antidepressants in the context of alcohol dependency has not yet been adequately researched; However, good approaches succeed with a combination therapy consisting of sertraline, a selective serotonin reuptake inhibitor (SSRI) and naltrexone, an opioid antagonist.
For the treatment of mild withdrawal symptoms, low-dose tricyclic antidepressants are occasionally used, but here is Doxepin to be preferred to therapy with amitriptyline.