Regular, heavy drinking interferes with chemicals in the brain that are vital for good mental health. So while we might feel relaxed after a drink, in the long run alcohol has an impact on mental health and can contribute to feelings of depression and anxiety, and make stress harder to deal with.
The brain relies on a delicate balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting our thoughts, feelings and actions – and sometimes our long-term mental health. This is partly down to neurotransmitters, which are chemicals that help to transmit signals from one nerve (or neuron) in the brain to another.
For example, the relaxed feeling we can experience if we have a drink is due to the chemical changes alcohol has caused in the brain. A drink can make some people feel more confident and less anxious, as the alcohol begins to suppress the part of the brain associated with inhibition.
As we drink more, the impact on our brain function increases. And regardless of the mood we’re in, with increasing alcohol consumption, it’s possible that negative emotions will take over, leading to a negative impact on mental health. Alcohol can be linked to aggression and some people report becoming angry, aggressive, anxious or depressed when they drink.
For someone experiencing anxiety, a drink might help them feel more at ease, but this feeling is short-lived. The so-called ‘relaxed’ feeling somebody may say they experience after having a drink is due to the chemical changes alcohol causes in the brain. But these effects wear off fast. Relying on alcohol to mask anxiety could also lead to a greater reliance on it to relax. A likely side-effect of this is the increased risk of build uping up a of tolerance to alcohol. Over time you will need to drink more alcohol to get the same feeling. And, in the medium to longer term, this pattern often leads to alcohol dependence.
Feelings of anxiety can happen with a hangover, too. As we process alcohol, we can begin to experience psychological symptoms, such as feeling depressed, anxious or agitated. For some, these feelings are barely noticeable. But if anxiety is already an issue, the hangover effect can make those symptoms worse.
Drinking alcohol can also make a person feel more anxious in certain situations. When we drink, we don’t always respond to all the cues around us. If we’re prone to anxiety and notice something that could be interpreted as threatening in the environment, there is a tendency to focus on that and miss the other less threatening - or neutral - information.
To reduce stress or anxiety without alcohol, try exercise or relaxation methods, such as meditation or yoga. Or try breathing techniques when you feel worried or anxious. Talking to somebody you know about how you’re feeling is also a positive thing to do.
Drinking heavily and regularly is associated with symptoms of depression, although it can be difficult to separate cause and effect. This means it’s not always clear whether drinking alcohol causes a person to experience symptoms of depression. What we do know is that alcohol affects several nerve-chemical systems within our bodies which are important in regulating our mood.2 Studies show that depression can follow on from heavy drinking.3 And that reducing or stopping drinking can improve mood.4,5,6,7,8
Medications prescribed for depression should not be mixed with alcohol.9 Some commonly prescribed anti-depressants tend to increase the risk of relapse to heavy drinking in people who are trying to cut down or abstain from alcohol, so antidepressants should be only taken with great caution and only when prescribed by your doctor.10,11,12
Alcohol can cause people to lose their inhibitions and behave impulsively, so it can lead to actions they might not otherwise have taken – including self-harm and even suicide.13 There is a strong association between drinking heavily (either chronic or acute alcohol misuse) and suicidal thoughts, suicide attempts, and death from suicide.
Extreme levels of drinking (such as drinking more than 30 units per day for several weeks) can occasionally cause psychosis, which is a severe mental illness where hallucinations and delusions – of persecution, for example – occur. Psychoses can be caused by both acute intoxication and withdrawal, and can be more common in cases when drinkers who are dependent on alcohol suddenly stop drinking.
If you’re experiencing feelings of distress or despair, including those which could lead to suicide, Samaritans provides confidential, non-judgemental emotional support, 24 hours a day. You can call them on 116 123 or email them at jo@samaritans.org. It is best to call them when you are able to have a conversation and have not been drinking.
The UK’s Chief Medical Officers advise that, in order to keep the health risks from alcohol to a low level, men and women should not regularly drink more than 14 units a week – this equivalent to six pints of average strength beer or six medium (175ml) glasses of average strength wine. If you regularly drink as much as this, it’s safest to spread your drinking evenly over three or more days.
The risk of developing a range of serious mental and physical health problems increases the more you drink on a regular basis.
A good way to cut down the amount you drink is to have several drink-free days each week. And avoid binge drinking.
If you’re worried about your drinking - or someone else’s - and want to talk with someone confidentially, we can help. Drinkchat is a confidential online web chat service, available weekdays 9am to 2pm. Alternatively, you can call Drinkline confidentially on 0300 123 1100 weekdays 9am to 8pm and weekends 11am to 4pm.
[2] Sari, Y. (2017). Commentary: Targeting NMDA receptor and serotonin transporter for the treatment of comorbid alcohol dependence and depression. Alcoholism, Clinical and Experimental Research, 41(2), 275.
[3] Boden, J.M. and Fergusson, D.M. (2011). Alcohol and depression. Addiction, 106(5), 906-914.
[4] Cordovil De Sousa Uva, M., Luminet, O., Cortesi, M., Constant, E., Derely, M. and De Timary, P. (2010). Distinct effects of protracted withdrawal on affect, craving, selective attention and executive functions among alcohol-dependent patients. Alcohol and Alcoholism, 45(3), 241-246.
[5] Craig, M., Pennacchia, A., Wright, N.R., Chase, H.W. and Hogarth, L. (2011). Evaluation of un-medicated, self-paced alcohol withdrawal. PloS One, 6(7).
[6] Potamianos, G., Meade, T.W., North, W.R.S., Townsend, J. and Peters, T.J. (1986). Randomised trial of community-based centre versus conventional hospital management in treatment of alcoholism. The Lancet, 328(8510), 797-799.
[7] Shaw, G.K., Waller, S., Latham, C.J., Dunn, G. and Thomson, A.D. (1998). The detoxication experience of alcoholic in-patients and predictors of outcome. Alcohol and Alcoholism, 33(3), 291-303.
[8] Driessen, M., Meier, S., Hill, A., Wetterling, T., Lange, W. and Junghanns, K. (2001). The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders. Alcohol and Alcoholism, 36(3), 249-255.
[9] British National Formulary, Section 4.3 BMJ Group and RPS Publishing.
[10] Charney, D.A., Heath, L.M., Zikos, E., Palacio-Boix, J. and Gill, K.J. (2015). Poorer Drinking Outcomes with Citalopram Treatment for Alcohol Dependence: A Randomized, Double‐Blind, Placebo‐Controlled Trial. Alcoholism: Clinical and Experimental Research, 39(9), pp.1756-1765.
[11] Kranzler, H.R., Burleson, J.A., Korner, P., Del Boca, F.K., Bohn, M.J., Brown, J. and Liebowitz, N. (1995). Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics. The American Journal of Psychiatry, 152(3), 391–397.
[12] Chick, J. (2019). Unhelpful prescribing in alcohol use disorder: risk and averting risk. Alcohol and Alcoholism, 54(1), 1-4.
[14] Edwards, A.C., Ohlsson, H., Sundquist, J., Sundquist, K. and Kendler, K.S. (2020). Alcohol use disorder and risk of suicide in a Swedish population-based cohort. American Journal of Psychiatry
