Alcohol can interact with many psychiatric medications, and the risk ranges from extra drowsiness to life-threatening breathing problems, depending on the drug. Cannabis is less well studied, but it can add to sedation, CBD can change how some medications are processed, and THC can worsen some psychiatric conditions. The safest plan is to tell your prescriber exactly what you use and ask about your specific medications.
Part of our guide: A Patient’s Guide to Psychiatric Medication
If you drink or use cannabis regularly, do not skip your medication to make room for it, and do not stop your medication on your own because of this article. If you drink heavily every day, do not stop suddenly without medical advice either, since alcohol withdrawal can be dangerous. Make any change with your prescriber.
If you are thinking about suicide or self-harm, or are worried about someone else: call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.
This is relevant because the National Institute on Alcohol Abuse and Alcoholism lists increased feelings of depression or hopelessness among the effects of mixing alcohol with depression medications, and because antidepressants carry an FDA boxed warning about increased suicidal thoughts and behavior in pediatric and young adult patients.
Call 911 if someone is very hard to wake, is breathing slowly or has stopped breathing after mixing alcohol, cannabis or other substances with a sedating medication.
Alcohol: what the sources say by medication type
The NIAAA notes that alcohol can make a medication less effective or even useless, and that alcohol and medicines can interact harmfully even if they are not taken at the same time. FDA labels for specific drugs are often more direct:
| Medication type | Examples | What the source says |
|---|---|---|
| Benzodiazepines | Alprazolam, lorazepam, clonazepam | The FDA says not to drink alcohol while taking benzodiazepines because it can increase the risk of life-threatening side effects. NIAAA lists slowed or difficult breathing. |
| SSRIs | Sertraline | The Zoloft Medication Guide says: "Do not drink alcohol while you take ZOLOFT." NIAAA lists drowsiness, dizziness and increased overdose risk across its depression medication group. |
| Bupropion | Wellbutrin | The label reports rare neuropsychiatric events or reduced alcohol tolerance and says alcohol should be minimized or avoided. It is contraindicated in people abruptly stopping alcohol, and the label lists this among situations that raise seizure risk. |
| Mirtazapine | Remeron | The label says alcohol should be avoided with it. |
| MAOIs | Phenelzine, tranylcypromine | NIAAA warns of serious heart-related effects and dangerously high blood pressure when MAOIs are mixed with tyramine, which it notes is present in beer and red wine. |
| Valproate | Depakote | The Medication Guide says: "Do not drink alcohol while taking Depakote." NIAAA lists possible liver damage. |
| Lithium | Lithobid | The Lithobid label does not address alcohol. NIAAA lists drowsiness, dizziness, tremors and increased risk of side effects. |
| Olanzapine | Zyprexa | The label says alcohol may worsen the drop in blood pressure on standing. |
This table is a starting point. It is not a list of what is safe, and absence from it does not mean no interaction exists. NIAAA also warns that older people are at particularly high risk for harmful alcohol and medication interactions, and that women, in general, have a higher risk for problems than men.
Cannabis: what is known and what is not
Direct information on cannabis with most psychiatric medications is limited. The FDA says unapproved cannabis products have not been evaluated for how they could interact with other drugs. So the honest answer for many combinations is that nobody can give you a precise answer. Here is what sources do say.
CBD
CBD is not automatically harmless. NCCIH, part of the National Institutes of Health, says CBD use has been associated with liver injury, male reproductive harm and interactions with other drugs, and that over-the-counter products may contain more or less CBD than stated on their labels, and may contain contaminants such as THC.
The prescription CBD medication Epidiolex, approved for certain seizure conditions, gives the clearest data. Its label says:
- It can raise liver enzymes, and taking it with valproate, along with higher Epidiolex doses, increases that risk.
- It can cause sleepiness and sedation, and alcohol and other sedating drugs could add to that effect.
- Cannabidiol is a moderate inhibitor of an enzyme called CYP2C19, which helps process some other medications.
- Like other antiepileptic drugs, it carries a warning about suicidal thoughts or behavior.
These findings come from a pharmaceutical product and may not translate directly to store-bought CBD, so ask your prescriber or pharmacist about your exact medications. If you take valproate, mention any CBD use.
THC
The closest FDA labeling for THC is dronabinol (Marinol), a prescription synthetic form used for specific medical purposes. Its label says it has been reported to exacerbate mania, depression or schizophrenia and advises screening for these conditions and avoiding use in people with a psychiatric history where possible. It also warns that other sedating drugs, including benzodiazepines, alcohol, lithium and buspirone, may add to its effects on dizziness, confusion and sleepiness, and it names tricyclic antidepressants among drugs that may add to these effects and that have similar effects on the heart. The label does not specifically address SSRIs. Dronabinol is a controlled pharmaceutical product, so effects with cannabis may differ.
Cannabis and the condition being treated
NCCIH says cannabis use, especially frequent use, has been linked to a higher risk of developing schizophrenia or other psychoses in people predisposed to these illnesses. NIDA adds that cannabis intoxication can induce a temporary psychotic episode in some people, especially at high doses, and that some research shows increased risk of depression in people who use cannabis during adolescence. NIDA also notes that how often someone uses is the strongest predictor of cannabis use disorder, and that higher THC concentrations have been associated with a greater likelihood of progression. These are associations, and much of this research cannot show cause. For background, see cannabis and mental health.
Why this can look like the medication is failing
Regular drinking or cannabis use can blur the picture, because symptoms may overlap with those of mental health conditions. If your prescriber does not know about your use, they may read poor sleep, low mood or anxiety as treatment failure and change your medication. That is one of the best reasons to be honest, even if it feels uncomfortable. Telling your prescriber lets them make better decisions. This article on what to do if medication isn't working describes other things a review can cover.
Practical next steps
- List what you use. Include alcohol, cannabis, CBD, edibles and vapes, plus how much and how often.
- Ask specific questions. "I have two drinks on weekends and use an edible some nights. Is this a concern with my medications?"
- Ask your pharmacist too. They can check your full medication list for interactions.
- Do not drive until you know how a combination affects you, or if you feel impaired. The alprazolam label cautions against driving, and NIDA says cannabis may affect a person's ability to drive.
- Do not stop drinking abruptly if you drink heavily. NIAAA says sudden stopping after prolonged heavy drinking can be painful or even potentially life-threatening, and advises seeking medical help to plan a safe recovery.
- Get support if cutting back is hard. SAMHSA's National Helpline, 1-800-662-HELP (4357), is a free, confidential treatment referral and information service, open 24/7. NIMH notes integrated care combines mental health and substance use treatment.
Mind Body Seven has information on addiction treatment and medication management. This article on medications in addiction treatment may also help. You can request a consultation, and the intake team confirms fit, scheduling and costs.
FAQs
Is one drink okay on my medication?
There is no single answer for all medications. Some Medication Guides say not to drink at all. Others advise minimizing or avoiding alcohol. Ask your prescriber about your specific medication and be honest about your usual amount.
Should I skip a dose if I plan to drink?
Do not change your doses on your own. NIAAA says alcohol and medicines can interact even if they are not taken at the same time, so skipping may not remove the risk, and it can create other problems. Ask your prescriber what to do.
Is medical cannabis safer with psychiatric medication?
Not necessarily. A medical card does not mean an interaction has been studied. The FDA notes that unapproved products have not been proven to be safe or effective. Tell every prescriber what you use, including products from a dispensary.
Will my prescriber judge me for telling them?
They need the information to treat you safely, and a good clinician will treat it as medical information. If you do not feel comfortable with a provider, that is a reason to look for another one, not to hide what you use.
