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PaperclipPerfector  8mo ago (text post)   3779 thread views

Small-Scale Question Sunday for February 25, 2024

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

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Does anyone have direct experience mixing alcohol with SSRIs, or medical experience treating people who have?
I'm asking in SSQ rather than WW because it's tangential to a red hot culture war question circa 2015: drink spiking.

The percentage of women taking antidepressants has doubled or tripled in the last decade, but there's been no decrease in drinking to compensate. I think Scott may have briefly tangled with this during the feminism wars of the 10s when Vox and Jezebel revived earlier panics, but afaik nobody's actually looked at the likelihood that a lot of the self-reported symptoms you see on reddit are real, but caused by interactions with other drugs.

Apparently there was a recent hysteria in europe about men injecting women with drugged needles in bars which eventually died down after the claims got too wild. The wikipedia article is very carefully written not to call it a social panic, but the writer obviously wishes he could just say it.

I'm worried we're going to keep getting mass panics like this fueled by social media, activists, and a dysfunctional drinking and drug culture that people are unwilling to own up to. But since I don't have any experience with SSRIs, drinking, or european party culture, I'm probably not the right person to make an argument about it.

Apparently there was a recent hysteria in europe about men injecting women with drugged needles in bars which eventually died down after the claims got too wild.

This headline is very striking: https://www.irishexaminer.com/news/arid-40792437.html

For ~6 months or so. I felt they made me a cheap date, in that I would feel the effects of alcohol quicker and more pronounced for a given volume of drink.

I have an EXTENSIVE experience with alcohol combined with SSRIs, and the only time it went into any WTF territory was with one particular one out of half a dozen, mixed with alcohol AND Xanax. Otherwise, alcohol plus SSRI is absolutely the same as alcohol on its own.

I have had plenty of drinks while on SSRIs, and I can't say it made a difference.

From what I'm aware of in the literature, the risk is minimal, and primarily due to alcohol worsening symptoms of depression rather than a significant interaction.

I do, however, lean towards it being hysteria that so many women confuse being "blackout drunk" with being roofied. Like, drink enough alcohol and that just happens, including waking up in an unfamiliar place feeling like shit. It's just not probably due to SSRIs making it worse, women have a lower alcohol tolerance in the first place.

I do, however, lean towards it being hysteria that so many women confuse being "blackout drunk" with being roofied. Like, drink enough alcohol and that just happens, including waking up in an unfamiliar place feeling like shit.

I've always been confused by the American tendency to conflate being blackout drunk with being passed out, completely helpless or doing things you'd otherwise never do even while drunk. All it means is that you drank enough for your brain to not store new memories (or store them very poorly) during that time (which could range anywhere from 30 minutes to many hours). There are many factors that can influence getting a blackout, such as how fast you get drunk (even if the level of drunkenness is the same), whether you ate anything, how tired you are, genetic factors etc, all without implying that you've lost control, are helpless or will pass out.

When I was much younger it wasn't that unusual for me to get blackouts when going out with friends to get properly drunk. It never worried me since I knew that my behavior didn't change all that much when drunk (other than being more talkative than usual and starting to tell really shitty jokes at some point) nor would I be any more helpless than normal. These days I skip the "getting very drunk" part and just progress to feeling like shit if I drink much. I guess that's age for you.

I had a bit hard time believing blackouts were a real thing rather than an excuse before experiencing one.

I don't seem to be able to get blackouts on alcohol alone, I can pass out but not blackout, I always remember everything regardless of whether I'm drunk or not. Then one night I had taken a combination of morphine, caffeine and a lot of alcohol and that made me both black out and act very out of character, not just lacking inhibition like when you're drunk but like a different person.

It made me have a bit more sympathy for people not remember things and acting out while drunk, but only a little. I was surprised and if that was the consequence of me getting drunk I wouldn't drink.

It really differs hugely on a person to person basis. I used to get blackouts quite easily but they would never last all that long - at the very least I'd have memory of finding myself at the entrance to my home. I've passed out exactly once in my life (some 20 years ago). I'd always puke my guts out much before I got that drunk (except for that one time). OTOH, I've never once felt drinker's remorse. Like sure, sometimes I felt slight embarrassed afterwards but that was always a rational reaction, never the kind of "OMG I want to kill myself because I was such an idiot" neurotransmitter imbalance that some people get from drinking (it probably helped that I learned in my late teens that no matter how much I drank, I never started acting much out of character).

It's not like being drunk and having patchy memories, or remembering the dumb things you did and wishing you couldn't remember, or needing to be prompted and then remembering. All three times it's happened to me the last thing I remember is taking my nth shot of vodka in x minutes on an empty stomach. Then waking up.

I've drunk the same amount of alcohol on an empty stomach many times, often much more. I think the critical factor is drinking high strength alcohol much too quickly. Much easier to do when it's just a little shot instead of a big glass of cold gassy beer.

I also used to think blue balls and jaw-dropping were merely colourful euphemisms for sexual frustration and surprise.

I think the critical factor is drinking high strength alcohol much too quickly.

From the few news clips I've read about the topic, I recall that how fast you got drunk is usually more important than how drunk you end up being when it comes to alcohol induced memory loss. Too fast and your brain can't keep up with the result that new memories aren't properly transferred from short term memory to longer term memory.

I think the problem is that people react differently to alcohol/drugs in general. I, for example, tend to get sleepy very fast from alcohol but never outright passed out, likewise I only threw up quite rarely, and by my own recollection and those of my friends I also never did anything I substantially regretted (and being religious country-side hicks, we drank A LOT). Which reflects my admittedly overall bias towards inaction. Other people seem to not get sleepy but quickly do stupid things they regret later, yet others seem mostly fine but throw up relatively quickly, and so on.

Though in agreement, I've seen quite a few cases where someone did something very much out of their own volition they later regretted, but being blackout drunk as well, they instead attributed it to another person taking advantage of them (it's a good way to conserve your own self-image, I admit).

You have summoned a crankier doctor than the one I think you are looking for but I'm sure he will chime in at some point.

Some thoughts:

-It's generally standard of care to recommend that patients on psychiatric medication (or just cross through that and make it just meds in general) abstain from alcohol use. This is for a variety of reasons, chronic and acute alcohol use both have impacts on certain kinds of drug metabolism. Some medications have specific interactions with alcohol (ex: Benzos). Alcohol and Marijuana appear to have a problematic effect on underlying conditions (no shit booze is a downer). This also applies to non-psych things. We are going to suggest you stop drinking.

-Just because it's standard of care doesn't mean it's mandatory, but again if we are speaking in official capacity we are going to tell you not to do it.

-SSRIs are (with some exceptions) pretty fucking safe. Older antidepressants have some issues. We have mostly switched for a reason.

-Alcohol is a poison with a very variable effect on the human body. Sick? Tired? Just worked out? Empty or full stomach? Haven't drank in a while? Random luck of the draw nonsense? You'll have a bad time. Easy to blame on the social boogieman if you do two doubles on an empty stomach.

-Personal anecdote: I've run into a "date rape" drug level alcohol response in settings where I know nobodies shit is tampered with, so I'm certain this class of thing exists, including one time where it was me and my own bottle of rum (and I later connected the dots that I recently had diarrhea and that may have been responsible for my bad time...).

-People are variable (duh) and have variable responses to things AND also variable awareness. There are a lot of people in this world who struggle to realize they are drunk until they are absolutely obliterated. You can easily see how those types (or other adjacent groups) might feel they were drugged if they got really drunk secondary to some other non-sketchy circumstance.

-Mixing uppers and downers is a huge problem and a lot of young people don't take the combination of stimulants (including all that Starbucks) and alcohol seriously. That combo can cause severe reactions and more people abuse those things now.

You have summoned a crankier doctor than the one I think you are looking for but I'm sure he will chime in at some point.

My general sunny disposition has been severely tarnished of late. The schadenfreude from seeing the nurses being chewed out after a patient lodged a formal complaint when they woke him up for his sleeping pills has yet to outweigh the far more numerous times I've been woken up to prescribe them to someone enjoying a far more restful night than I have.*

Personal anecdote: I've run into a "date rape" drug level alcohol response in settings where I know nobodies shit is tampered with, so I'm certain this class of thing exists, including one time where it was me and my own bottle of rum (and I later connected the dots that I recently had diarrhea and that may have been responsible for my bad time...).

I can handle an ungodly amount of liquor (a terrible thing for my bank balance if I were to indulge it), but I remember accepting a single shot of local moonshine at a girl's birthday party and then poof, total anterograde amnesia, with me waking up next morning with a pounding hangover in my knickers.

In her bed.

I'm told that I was uh, talked into crossdressing, and someone has a video of it, which I must figure out a way to delete. Then again, if I ever become cancel-worthy for my many online crimespeeches, it offers a convenient retreat into Protected Characteristic territory. I'm just grateful I didn't go blind, the fucking thing smelled like hand sanitizer and tasted like coconut.

*Urine output on an intensive care unit: case-control study :

Objective To compare urine output between junior doctors in an intensive care unit and the patients for whom they are responsible.

Design Case-control study.

Setting General intensive care unit in a tertiary referral hospital.

Participants 18 junior doctors responsible for clerking patients on weekday day shifts in the unit from 23 March to 23 April 2009 volunteered as “cases.” Controls were the patients in the unit clerked by those doctors. Exclusion criteria (for both groups) were pregnancy, baseline estimated glomerular filtration rate <15 ml/min/1.73 m2, and renal replacement therapy.

Main outcome measures Oliguria (defined as mean urine output <0.5 ml/kg/hour over six or more hours of measurement) and urine output (in ml/kg/hour) as a continuous variable.

Results Doctors were classed as oliguric and “at risk” of acute kidney injury on 19 (22%) of 87 shifts in which urine output was measured, and oliguric to the point of being “in injury” on one (1%) further shift. Data were available for 208 of 209 controls matched to cases in the data collection period; 13 of these were excluded because the control was receiving renal replacement therapy. Doctors were more likely to be oliguric than their patients (odds ratio 1.99, 95% confidence interval 1.08 to 3.68, P=0.03). For each additional 1 ml/kg/hour mean urine output, the odds ratio for being a case rather than a control was 0.27 (0.12 to 0.58, P=0.001). Mortality among doctors was astonishingly low, at 0% (0% to 18%).

Conclusions Managing our own fluid balance is more difficult than managing it in our patients. We should drink more water. Modifications to the criteria for acute kidney injury could be needed for the assessment of junior doctors in an intensive care unit.

(This is why I avoid ICU work like the plague, and if you think medical oncology discharges are bad..)

That is an amazing confidence interval.

At least you can be sure that you won't have more doctors at the end of the study!

It's both a numbers game in terms of having your own personal random bad experience and in terms of meeting people who have zero insight into and understanding of their drinking, but if you expand that to a whole population you are going to catch some weirdness.

It's okay to just ping @self_made_human; he's cool.

A brief search suggests that SSRIs are generally safe with alcohol (IANAMD; please update your will and assign medical power of attorney before mixing any drugs with alcohol based on my advice) but the combination can still "lead to more pronounced effects of drunkenness", which sounds like it could be enough all alone, especially to new users who think they know their limits. And with MAOIs (are these still used often?) interactions range from "you may become drowsy and dizzy" to "dangerous spikes in blood pressure that may require immediate medical attention".

There are far more senior and qualified doctors here, but if you want cheap free medical advice and random bullshit, I'm always on call heh. Anyone is free to ping me, it beats the nurses waking me up at 1 am to write a prescription for Xanax to a patient who is already asleep (this is not a joke, it legitimately happened to me on multiple occasions).

On the topic of MAOIs, can't recall seeing one prescribed recently but I'm not working in pscyh or neuro. My understanding is that, in India at least, they're used far more for Parkinsons than depression, and that seems to be true in the UK.

Can't remember the last time I saw an MAOI (for Psych use anyway, you see them in Neuro). I think Phenelzine is around a bunch still.

The TCA's have broader use, Doxepin is legitimately an excellent choice as a sleep aid.

It's important to keep in mind that SSRIs are safer but not necessarily better - it's a good guess that David Foster Wallace killed himself because his doc insisted on stopping his MAOI for "safety" reasons.

Thanks. I hate pinging people, and use the ol' "indirectly reference them and assume they must hate you forever if they don't reply to it right away."

I've had long periods of taking ssris, and have (and against explicit medical advice) consumed alcohol during those times. I don't know what symptoms you're talking about. SSRIs have not really made me sleepy, in my experience, only other, similar drugs, like SARIs (often presecribed off-label for insomnia) have done that. Maybe the hangovers have been worse. But I can't disentangle that from just the fact that I'm older now.

My gut-level guess has always been that there are theoretical interactions, but most of the "don't mix this with alcohol" advice is based on alcohol causing problems for depression anyway. But I'm also not a doctor, so I don't know what the possible interactions between alcohol and SSRIs are.

Are European women taking SSRIs at similar rates to American women?

Are European women taking SSRIs at similar rates to American women?

Good question. I've found some stats suggesting the increase in Sweden has been similar, but having trouble finding hard data outside the anglosphere.

Huh, I hadn't even considered interactions. That's entirely plausible to add in. My impression was that pretty much all cases of claimed "drink spiking" are basically just people that drank more than they realized and don't have the tolerance to hang. Even as a (too) experienced drinker, I have had mornings where I woke up and thought, "what the fuck, this hangover is bullshit, I didn't even drink that much", so it's entirely plausible to me that someone at a party having mixed drinks with unknown quantities of alcohol could wind up completely hammered and being genuinely surprised by it.

Even as a (too) experienced drinker, I have had mornings where I woke up and thought, "what the fuck, this hangover is bullshit, I didn't even drink that much"

This is the worst, particularly when you know for a fact that you were never even above the legal limit at any point the previous night.

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