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Some groups need to be especially careful: People early in treatment or after a dose change, when side effects like grogginess and dizziness may already be present Young adults under 25, who have an elevated suicidality monitoring concern early in SSRI treatment People with alcohol use disorder or a pattern of binge drinking People with PTSD, trauma histories, or complex psychiatric diagnoses People taking multiple medications, where alcohol may amplify sedation or serotonin burden People with liver disease or other significant medical conditions VA research found that about 41% of Veterans reported lifetime signs of AUD, and AUD was associated with higher rates of psychiatric disorders and suicidal behavior, with risk increasing alongside severity

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Thiamine-responsive megaloblastic anaemia syndrome (TRMA) resembles B12 deficiency