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Clinical resource

Mirtazapine and Alcohol

Most experts strictly advise against combining mirtazapine and alcohol, as they may bring on a range of negative and severely debilitating consequences. Some of these mirtazapine and alcohol side effects include

Clinically reviewed byDr. Sarah Boss, MD
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Quick Summary

  • Combining mirtazapine with alcohol can intensify drowsiness and impair judgment, coordination, reaction time, concentration, and alertness. The prescribing information advises avoiding alcohol.
  • Alcohol may counteract mirtazapine’s intended benefits, temporarily altering mood before potentially worsening symptoms of depression or anxiety.
  • Mirtazapine can also interact with several prescription medicines, causing excessive sedation, serotonin toxicity, seizures, or impaired motor coordination. Suspected overdose needs immediate poison-service or urgent medical assessment; collapse, seizures, breathing trouble, or inability to wake requires emergency services.

Antidepressants and alcohol are the two most widely used substances across the world. Both are legal, relatively affordable, and easy to acquire but alcohol is not a treatment for major depressive disorder. Mirtazapine, in particular, is a popular antidepressant that alters the brain chemicals to uplift mood and control depressive thoughts. Combining it with alcohol can increase drowsiness and impair thinking and coordination. The prescribing information advises avoiding alcohol; taking the two at different times does not reliably prevent an interaction.

Most experts strictly advise against combining mirtazapine and alcohol, as they may bring on a range of negative and severely debilitating consequences. Some of these mirtazapine and alcohol side effects include:

Impairment of Thinking and Alertness

A combination of alcohol and antidepressants like mirtazapine can severely affect an individual’s judgment, motor skills, reaction times, and coordination. The effects are much more intense than the ones experienced with alcohol consumption alone. Some users also report experiencing impairment in the ability to perform tasks that require attention and focus by inducing drowsiness.

Sleepiness

Mirtazapine and other antidepressants can cause sedation in the users, similar to alcohol. Hence, taking them together can intensify this side effect, making it impossible for the user to carry on with the day.

Heightened Anxiety or Depression

Drinking alcohol sometimes counteracts the benefits of mirtazapine and other antidepressants, making the symptoms of depression worse and much more challenging to control. Some people may report improvement in mood shortly after drinking alcohol; however, these effects are temporary and are soon replaced by worsening anxiety.

In addition to alcohol, several medicines interact with mirtazapine. Some combinations are contraindicated, while others require an individual prescribing decision and monitoring. Discuss routine medication changes with your prescriber; suspected serotonin syndrome needs immediate action as described below. Medicines to review include the following:

Zolpidem

Zolpidem is commonly prescribed to individuals with sleeping difficulties. Belonging to the drug class of sedative-hypnotics, it works by slowing the brain’s activities to make sleep easily achievable. Combining zolpidem with mirtazapine can bring several side effects, including confusion, dizziness, and drowsiness.

Duloxetine

Duloxetine is another type of antidepressant medication prescribed to deal with depressive thoughts. It improves the levels of norepinephrine and serotonin in the brain to improve its functionality. Combining duloxetine with mirtazapine increases the risk of serotonin syndrome and requires prescribing review and monitoring. Possible signs include fever, confusion, marked agitation, muscle rigidity, tremor, and seizures. If serotonin syndrome is suspected, stop mirtazapine and seek emergency medical care.

Trazodone

Tradozone is a serotonin modulator that works by improving the levels of this neurotransmitter in the brain to combat anxiety and depression. Taking trazodone and mirtazapine together can increase the risk of serotonin syndrome. Other side effects of this combination may include excessive sweating, increased heart rate, shivering, and seizures. Any combined prescription needs individual assessment and monitoring; a low dose does not eliminate the interaction risk.

Lexapro

As a selective serotonin reuptake inhibitor (SSRI), Lexapro can also lead to serotonin toxicity when combined with mirtazapine. Serotonin toxicity includes symptoms like fever, muscle rigidity, extreme changes in blood pressure, and headache. Without urgent treatment, it may prove fatal.

Alprazolam

Alprazolam is the most popular medication for generalized panic disorders and anxiety. Belonging to the drug class of benzodiazepines, it enhances the binding of GABA, an inhibitory neurotransmitter, in the brain to induce a calming effect. The mirtazapine label advises avoiding benzodiazepine combinations because they increase impairment. If you already take alprazolam regularly, ask your prescriber to review the combination; do not abruptly stop alprazolam without a clinical plan.

Sertraline

Sertraline is a famous antidepressant used to manage panic attacks, anxiety, fear, and depression. As an SSRI that stops the reuptake of serotonin and accumulates it in the brain, its combination with mirtazapine requires an individual prescribing decision and monitoring for serotonin syndrome. However, side effects like blurry vision, shivering, and sweating may occur because of the possibility of interaction.

Bupropion

As an atypical antidepressant, bupropion helps in the management of mood disorders. Inside the brain, it boosts dopamine and norepinephrine levels to improve users’ focus and concentration. Using bupropion with mirtazapine can increase the risk of suffering from seizures.

Living with depression or treating it can be highly exhausting. For many, it is not unnatural to want to drink alcohol as a solution to unwind and calm down a depressed mind. Avoid alcohol while taking mirtazapine. If you are dependent on alcohol, get medical help before abruptly stopping or reducing drinking; severe confusion, hallucinations, or a seizure during withdrawal require emergency care. Mixing a new prescription with alcohol use before you are aware of the possible consequences may lead to disastrous consequences that may only leave you repenting.

If you or someone you love are fighting depression and seem to be struggling with alcohol, know that help is available. The first and the most critical step is always to acknowledge the problem and seek help from the right place. Many treatment providers and rehabilitation centers are working all across the UK to help people fight multiple psychiatric disorders simultaneously. Specialized care plans, known as dual diagnosis programs, are offered to such individuals so they can recover from alcohol addiction and depression simultaneously.

Some common elements of a dual diagnosis program include:

  • Detailed assessments, including medical, psychiatric, psychological, and pharmacogenetic evaluations to establish accurate diagnoses
  • Cognitive behavioral therapy (CBT)to address underlying alcohol addiction and associated behaviors
  • Solution-focused brief therapy (SFBT) on finding solutions tailored to your individual goals and concerns
  • Brief strategic family therapy (BSFT) to fight addictive behaviors and co-occurring psychiatric illnesses with the support and help of families
  • Eye movement desensitization and reprocessing therapy (EMDR) to deal with trauma-triggered depression and alcohol abuse
  • Psychoeducational groups enlighten patients on the nature of their underlying issues and provide them with tools to handle the stresses leading to these issues
  • Outdoor therapy to promote wellness and harmony in the mind and body
  • Neurofeedback that aims at self-regulation for better brain function and activity
  • Meditation and yoga restore the connection between the mind and the body to ensure mental healing

Help is just one click away. Give us a call to begin your journey with us today.

Questions

Frequently Asked Questions

What is the association between alcohol abuse and depression?
Depression is a debilitating psychiatric disorder characterized by low moods, loss of interest in usual hobbies, and hopelessness. In some individuals, these symptoms become so intense that they may resort to using alcohol as self-medication to fight them. Alcohol can worsen depression, and heavy use can lead to alcohol use disorder; even occasional drinking can interact with mirtazapine. This combination of issues can prove dangerous due to the severe problems of mixing alcohol with antidepressants.
Is mirtazapine a benzodiazepine?
No. Mirtazapine is an antidepressant with a tetracyclic structure, not a benzodiazepine or a tricyclic antidepressant. Its antidepressant mechanism is not fully understood; its actions include blocking alpha-2 adrenergic and certain serotonin receptors.
Is mixing alcohol with mirtazapine a sign of alcohol addiction?
Mixing alcohol with mirtazapine can sometimes indicate a much deeper problem. People with untreated depression are at a heightened risk of indulging in alcohol addiction or abuse. Such people may be tempted to mix their medications, such as mirtazapine, with alcohol to escape the emotional pain or simply get high and enjoy it. Do not stop mirtazapine simply to drink alcohol. Routine discontinuation should be planned with your prescriber because abrupt stopping can cause withdrawal symptoms. New or worsening suicidal thoughts need urgent clinical help; call emergency services if there is immediate danger.
Who is at the most risk of combining mirtazapine and alcohol?
An individual with untreated depression or substance abuse is at an exceptionally high risk of abusing alcohol alongside taking mirtazapine and other prescription medication. Because this combination can make the user sleepy, people with insomnia and other sleep-related difficulties may also use the two substances together to find quick relief. However, indulging in this potentially dangerous habit can lead to more intense problems in the long run.
When should I seek help with mixing mirtazapine and alcohol?
For suspected overdose, contact a poison service or urgent medical care immediately; collapse, a seizure, breathing trouble, or inability to wake requires emergency services. For repeated mixing or problems controlling drinking, seek a clinical assessment. This determines whether outpatient care or an inpatient rehabilitation center is appropriate. Such centers provide people with easy access to trained and highly-qualified therapists, doctors, and other staff members to monitor their mirtazapine use and help them manage depression and alcohol addiction side by side. This integrated care plan often continues after your treatment tenure finishes at a rehab.
Is it always dangerous to mix alcohol and antidepressants?
Risk varies with the medicine and individual circumstances. For mirtazapine, the prescribing information advises avoiding alcohol because the combination increases impairment. Do not skip or stop mirtazapine to drink; discuss alcohol use and any planned medication changes with your prescriber.
Can you overdose on mirtazapine with alcohol?
Taking too much mirtazapine can cause serious poisoning; alcohol can add to impairment. Contact a poison service or urgent medical care immediately if an overdose is suspected, even without symptoms. Possible symptoms and emergency warning signs include:
Drowsiness
Disorientation
Memory problems
Fast heartbeat
Collapse: call emergency services immediately
Seizure: call emergency services immediately
Breathing trouble: call emergency services immediately
Cannot be awakened: call emergency services immediately
Do not wait for these signs before seeking help

Editorial evidence

Evidence & sources

Selected clinical guidelines, peer-reviewed research, and public-health sources used in this article.

01National Institute on Drug Abuse. (2022). Benzodiazepines and opioids. National Institutes of Health.View source
02StatPearls. (2025). Mirtazapine. National Center for Biotechnology Information.View source
03StatPearls. (2025). Serotonin syndrome. National Center for Biotechnology Information.View source
View all 16 sourcesShow fewer sources
04U.S. Food and Drug Administration. (n.d.). Lexapro (escitalopram) tablets/oral solution: Prescribing information. FDA.View source
05American Psychiatric Association. (2022). What is depression? Psychiatry.org.View source
06MedlinePlus. (2024). Mirtazapine. National Library of Medicine.View source
07National Health Service. (2023). Common questions about mirtazapine. NHS.View source
08National Institute of Mental Health. (2024). Depression. National Institutes of Health.View source
09National Institute on Alcohol Abuse and Alcoholism. (2024). Harmful interactions: Mixing alcohol with medicines. National Institutes of Health.View source
10U.S. Food and Drug Administration. (2016). Remeron (mirtazapine) tablets: Prescribing information. FDA.View source
11World Health Organization. (2023). Alcohol. WHO.View source
12Substance Abuse and Mental Health Services Administration. (2023). National Helpline. SAMHSA.View source
13National Institute on Drug Abuse. (2022). Substance use and mental health. National Institutes of Health.View source
14National Institute of Mental Health. (2024). Major depression. National Institutes of Health.View source
15Centers for Disease Control and Prevention. (2022). Alcohol use and your health. CDC.View source
16American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Psychiatry.org.View source
What this includes
01

Clinical context

Clear information is framed around complex and co-occurring presentations.

02

Individual factors

Assessment remains essential because needs and risks differ from person to person.

03

Next steps

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Jil MooreClient Relations Director
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