Health and Psychology

"What do you mean I shouldn't drink if I take a stimulant? Doesn't alcohol and a stimulant like Ritalin just cancel each other out?"

I was advising a client that taking a stimulant medication with alcohol can pose some significant health risks.  While not all medications for ADHD are stimulants a number of them are.  Many of these medications are prescribed by general practitioners or family doctors without a cardiac workup prior to the prescription.  Minor structural abnormalities in the heart are intensified when given a stimulant type of medication.  So minor heart valve problems that may cause a heart palpitation on occasion, may get intensified with the use of a stimulant medication.  Some heart rhythm problems may also intensify. Psychiatrists will generally require an electrocardiogram (EKG) prior to prescribing a stimulant medication just to be on the safe side.

Combining a stimulant medication with alcohol makes more problems because alcohol is a depressant. The impact of the stimulant isn't to "cancel out" the effects of alcohol, but to lessen the awareness of the effects of intoxication.  That will allow someone to become more intoxicated than they would be in general, all the way to alcohol poisoning levels.  They don't recognize how drunk they are getting.  It also raises the risk of heart attack or sudden cardiac arrythmia.  This happens because the heart is slowed down and the breathing is slowed down by the alcohol and sped up by the stimulant.  The same can be true when you mix energy drinks in quantity with alcohol.  

Sudden death has been reported in association with stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Although some serious heart problems alone carry an increased risk of sudden death, stimulant medications generally should not be used in children or adolescents with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the effects of a stimulant drug.  Children who develop symptoms such as exertional chest pain, unexplained dizziness or fainting, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.

Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD. Adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs.  Adults show an increase in blood pressure and heart rate with stimulants. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent heart attack, or ventricular arrhythmia.