Prozac for Alcoholism
Alcoholism is often not an isolated struggle. It can come with a whole host of other problems, especially anxiety and depression. As many as one-third of people who suffer from major depression also struggle with alcohol issues.1 Whether these psychological conditions influence a person’s addictive behavior or if the addiction itself leads to such conditions is not wholly understood, and the directionality likely differs on an individual case basis. Encouragingly, treatment attention directed at both issues — termed dual diagnosis treatment — can help patients to recover.
Some people who suffer from depression may begin to drink alcohol as a means of coping with negative emotions. Conversely, the depressive symptoms associated with alcohol-use disorders may first arise as a result of the temporary, albeit profoundly impacting, negative effects of intoxication and withdrawal.2 In the case of co-morbid depression and alcoholism, it’s not always certain which disorder came first, but the fact remains that the two often co-occur together.
Combined with behavioral therapy and other lifestyle treatments, medication, such as antidepressants, can help a person along the road to recovery. While antidepressants treat the depression itself (which alone might facilitate the course toward abstinence), they may also decrease cravings for alcohol, leading to reduced drinking behaviors.4
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The prescription drug fluoxetine, most commonly known under the brand name Prozac, is typically prescribed to treat depression, anxiety, and obsessive-compulsive disorder. There is some research evidence to suggest that it has a marked effect on decreasing alcohol intake and, additionally, may be moderately effective in treating alcohol withdrawal syndrome.5 It cannot reduce the effects of alcohol alone, but it may be a helpful therapeutic addition to address the emotional distress often associated with addiction.
It is dangerous to mix Prozac and alcohol, so any attempt to use Prozac or any other medication to treat alcoholism should be a joint decision between an individual and his or her doctor.
According to the CDC, roughly 1 in 5 adults in the U.S. experience some form of depression or anxiety.7 If you have suffered from the following symptoms before developing an alcohol addiction, you may have experienced depression and/or anxiety.2
Prozac is a trade formulation of the antidepressant fluoxetine. Fluoxetine is available as a tablet, a delayed-release capsule, and an oral solution, and the frequency of use depends on the form in which the medication comes in. It is most often taken once or twice a day, but the delayed-release dose is taken once a week.6 Prozac, like many antidepressants, is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs).
SSRIs are antidepressants that increase the levels and activity of serotonin, a key neurotransmitter in the brain. Serotonin affects a number of different neural functions, such as:8
Normally, serotonin is released by the presynaptic neuron into the synaptic space and elicits its regulatory effects, then is reabsorbed by the neuron. Prozac works by inhibiting this reuptake, or reabsorption, in serotonin-deficient brains, thus effectively increasing active serotonin levels. When levels of this neurotransmitter are low, it can negatively impact mood, causing feelings of sadness, restlessness, anxiety, and depression. Taking an SSRI like Prozac can increase the amount of serotonin in the brain and effectively regulate mood.
Common Uses for Fluoxetine
The National Library of Medicine lists fluoxetine (the generic name for Prozac) as an effective treatment for the following conditions:9
- Obsessive-compulsive disorder
- Eating disorders
- Panic attacks
- Premenstrual dysphoric disorder
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Alcohol increases the release of serotonin in your brain. This might explain, in part, why alcohol intoxication can lead to feelings of euphoria that some drinkers attempt to repeat with frequent and excessive drinking. While it’s uncertain why it occurs, research has suggested that those suffering from an addiction to alcohol may have lower serotonin levels than non-alcoholics.10 Put simply, while a moderate amount of alcohol consumed by a non-addict can result in feelings of euphoria, the ability to achieve that same high disappears when excessive consumption becomes an everyday habit. Alcoholics may be chemically incapable of feeling joy the way non-alcoholics do.
Chronic alcohol use results in adaptive changes in the brain and serotonergic system. These changes are the body’s attempts to maintain homeostasis, or stable conditions, while adjusting to long-term alcohol exposure and increased serotonin release. Some withdrawal symptoms, such as anxiety, are thought to be partially due to this constant increase in serotonin in alcohol abusers. 10
According to the Journal of the American Medical Association, antidepressants can have a moderate effect in treating alcoholism.11 The ability of Prozac to regulate the body’s serotonin levels may have two positive effects in the treatment of alcoholism.
First, Prozac can address the serotonin depletion in the brain that has resulted from chronic alcohol abuse. It won’t increase the amount of serotonin, but it will allow the body to make more efficient use of the small amount of serotonin it already has. Over time, the body will start to produce more serotonin on its own, so the elevation in mood and impulse stability can make the recovery process less strenuous, while also reducing the desire to seek out the long-lost high of excessive alcohol consumption.
Second, Prozac can manage the underlying psychological stressors that might otherwise influence a person’s desire to escape through intoxication. Many untreated individuals with severe depression or anxiety may be attempting to “self-medicate” with alcohol, though medicines like the SSRIs would actually be much more effective and far less harmful. Prozac can help to manage these underlying problems and, with behavioral therapy and lifestyle changes, ultimately reduce their contribution toward sustained alcohol dependency.
It isn’t effective for everyone, though; it largely depends on the individual and his or her body chemistry and addiction. Furthermore, it cannot be used as the sole treatment for alcoholism, but rather as a supplementation to a treatment program. 10
Abusing alcohol while taking Prozac is never a good idea. While a moderate amount of alcohol (one serving) will not result in adverse interactions with antidepressants like Prozac, higher-than-moderate amounts of alcohol mixed with antidepressants can be very dangerous.12
The primary concern with interactions between alcohol and antidepressants is the marked increase in drowsiness the two substances produce. Both alcohol and SSRI antidepressants create a drowsy or sluggish sensation, and when taken together, this mental and physical slow-down is essentially doubled. As few as two drinks with Prozac can cause drowsiness equal to four or more drinks, making it incredibly ill-advised to drive, operate machinery, or do anything else that requires fine motor skills and full attention.
The impact of alcohol on serotonergic neurotransmission may also be a concern while taking Prozac. Instead of regulating mood, as it does when taken alone, the antidepressant can be rendered ineffective when mixed with alcohol, potentially leading to a feeling of acute depression.
Some incidents of pathological intoxication have been reported in those who combine the medication with alcohol. Pathological intoxication is described as a severe disinhibition and loss of self-control when even a small amount of alcohol has been consumed. Some of the reports outline memory loss and violence as two results of pathological intoxication. 13
Antidepressants will not treat the symptoms of alcohol withdrawal, especially severe symptoms such as delirium tremens. Instead, sedative medications (in general, relatively long-acting benzodiazepines) are relied on to preclude against the potential dangers associated with acute alcohol withdrawal.
When there is a suspected risk of severe withdrawal, judicious use of benzodiazepines and close patient monitoring will be very important, since convulsions and delirium tremens are responsible for the deaths of as many as 10% of withdrawal sufferers.14 Similarly to alcohol, benzodiazepine medications influence inhibitory gamma-aminobutyric acid (GABA) neurotransmission in the brain, mediating their effectiveness in treating alcohol withdrawal syndrome.
Fluoxetine is a preferred antidepressant for ongoing addiction recovery because of its low likelihood of leading to a secondary dependence and substance abuse behavior. Fluoxetine has a long half-life, meaning it takes a long time to break down once released into the body. This avoids the sudden need for more once the body has become accustomed to it, since the amounts of the drug in the bloodstream diminish slowly. Prozac withdrawal is mild and often unlikely to occur at all, especially when the dose is gradually scaled down with a physician’s help.
Prozac and other antidepressants can be highly effective tools for combating alcoholism and its underlying motivations, but they are far from a miracle cure. Like every aspect of the recovery process, it is important to seek help from qualified professionals and other support structures when adding a medication to your treatment.
Everyone responds differently to various types of treatment, but for those who suffer from a dual diagnosis such as depression and alcoholism, specialized inpatient or residential treatment can be effective.
Two types of inpatient treatment facilities include:
Traditional inpatient: You are required to live at the facility while receiving alcohol addiction treatment. This provides you with the opportunity to escape your everyday drinking environment and triggers in order to focus solely on your recovery process. While at the inpatient center, a treatment team will devise an individualized program that caters to your unique needs. Some services offered may include:
- Medically monitored detoxification.
- Individual therapy.
- Group counseling.
- Family therapy.
- Relapse-prevention education.
- Medical maintenance.
- Aftercare planning.
Luxury inpatient: These facilities are typically set in beautiful, vacation-like destinations. They offer all the same services as traditional centers with many added amenities such as:
- Horseback riding.
- Spa treatments.
- Private rooms.
- Gourmet cooking.
- Massage therapy.
Substance abuse treatment professionals will work closely with you to determine if Prozac would be helpful to your long-term recovery.
- National Alliance on Mental Illness. (2016). Dual Diagnosis.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C.: American Psychiatric Publishing.
- Cavanaugh, S. E. (2014). Alcoholism and mental illness: Overlapping diseases requiring a renewed focus. Mental Health and Substance Use, 7(4), 487-496.
- Dongier, M. (2005). What are the treatment options for comorbid alcohol abuse and depressive disorders? Journal of Psychiatry & Neuroscience, 30(3), 224.
- Naranjo, C. A., Poulos, C. X., Bremner, K. E., & Lanctot, K. L. (1994). Fluoxetine attenuates alcohol intake and desire to drink. International Clinical Psychopharmacology, 9(3), 163-172.
- U.S. National Library of Medicine: Medline Plus. (2014). Fluoxetine.
- Centers for Disease Control and Prevention. (2012). Treatment Works: Get Help for Depression and Anxiety.
- Scripps Research Institute. (2010). How serotonin works: Findings point to new treatments for schizophrenia and depression.
- U.S. National Library of Medicine: PubMed Health. (2016). Fluoxetine (by mouth).
- Lovinger, D. M. (1997). Serotonin’s Role in Alcohol’s Effects On the Brain. Neurotransmitter Review, 21(2), 114-120.
- Nunes, E.V. and Levin, F.R. (2004). Treatment of Depression in Patients with Alcohol or Other Drug Dependence. The Journal of the American Medical Association, (291)15, 1887-1896.
- Mayo Clinic. (2014). Depression (major depressive disorder): Why is it bad to mix antidepressants and alcohol?
- Menkes, D. and Herxheimer, A. (2014). Interaction between antidepressants and alcohol: Signal amplification by multiple case reports. The International Journal of Risk and Safety in Medicine, 26(3), 163-170.
- Schaefer, T.J. and Hafner, J.W. (2013). Are Benzodiazepines Effective for Alcohol Withdrawal? Annals of Emergency Medicine, 62(1), 34-35.