Will a break from Prozac keep me awake when I drink?

Dear perplexed about prozac,

Thanks for reaching out — hopefully after this response, you may feel more prepared than perplexed! Prozac (generic name: fluoxetine) is an antidepressant that falls into a family of drugs called selective serotonin reuptake inhibitors (SSRIs). These types of medications are used to treat depression because they affect how the brain absorbs serotonin (a chemical that transmits impulses between nerves and regulates emotions, mood, and behavior). While it's understandable for you to be interested in minimizing the sleepy effects of mixing the two, the short answer to your question is that fluoxetine stays in the body much longer than one or two days, so stopping right before you want to drink alcohol is unlikely to prevent you from feeling extremely sleepy. It also means taking it again after drinking doesn't start you back at the beginning. Additionally, not maintaining a consistent and daily dose of fluoxetine (or other SSRIs) may lead to less effective care of your mental health. Still perplexed? Read on!

Folks with depression, anxiety, and obsessive-compulsive disorder have a decreased amount of serotonin that is secreted by nerve cells, so SSRIs stop the cells from reabsorbing extra serotonin released by nerve cells in the brain. Maintaining a consistent dose of antidepressants help serotonin do its job, but may also worsen the effects of alcohol, such as impaired judgment, coordination, motor skills, sedation, drowsiness, and reaction time. In addition, many health care providers also recommend against drinking alcohol while taking SSRIs because alcohol, a depressant, may interfere with the medicine's therapeutic benefits. This doesn't mean that someone taking SSRIs can't drink alcohol, but rather they may find that minimizing the amount they drink helps their mental health symptoms and alleviates the side effects of combining both substances.

Missing a few doses doesn't start you back at "square one," but it may make you more vulnerable to side effects in the form of withdrawal symptoms from fluoxetine, such as dizziness, nausea, fatigue, and more. In addition, because fluoxetine and other antidepressants take time to show their effects, they stay in the body for much longer than a day or two. In fact, it takes about 25 days for 99 percent of fluoxetine to be eliminated from the body, according to experts. Therefore, this medication isn't one that may be used short-term or for convenience's sake. 

As a whole, skipping a few days of your antidepressant may not result in the desired effects with alcohol use given how long it takes to leave the body and the symptoms associated with fluoxetine withdrawal. It may be helpful for you to talk with the health care provider that prescribed the medication to create a plan together that'll help you benefit from fluoxetine, while maintaining a level of alcohol use with which you're comfortable. If still feeling perplexed, you also may be interested in the National Institute on Alcohol Abuse and Alcoholism Harmful Interactions guide or the Prescription & Over-the-Counter Drugs category of the Go Ask Alice! Alcohol & Other Drugs archives to read more about how medications interact with alcohol. 

Take care,