How does alcohol affect bipolar disorder?
Read on to find out more about the links between bipolar disorder and alcohol consumption.
Alcohol and bipolar symptoms
The effects of bipolar disorder vary between individuals and also according to the phase of the disorder that the person is experiencing.
Mania symptoms and alcohol
Alcohol can exaggerate the high mood people have with mania and add to the risk of recklessness. Bipolar disorder also carries a risk of addictive behavior.
Common symptoms of a manic episode include:
- feeling "high" or "wired"
- intense happiness and euphoria
- high self-confidence or self-esteem
- rapid thoughts and speech
- distraction and an inability to focus
- sociability and talkativeness
- rapid thoughts and speech
- impulsive behavior
- difficulty sleeping
- irritability and impatience, which can lead to aggression in some people
- psychosis, in some cases
- overindulging in pleasurable activities, such as alcohol consumption and risky sexual behavior
A person who consumes alcohol during a manic phase has a higher risk of engaging in impulsive behavior because alcohol reduces a person's inhibitions.
Depressive symptoms and alcohol
Common symptoms of depressive episodes include:
- extreme sadness or irritability
- a sense of isolation, loneliness, and despair
- feelings of guilt and anxiety
- rapid weight loss or weight gain
- inability to focus on any task at all
- depression, which may prevent the person from doing anything
- sleeping too much or too little
- suicidal thoughts
Alcohol is a central nervous system (CNS) depressant. Consuming alcohol during a depressive phase can increase the risk of lethargy and can further reduce inhibitions.
Whether a person consumes or misuses alcohol during a manic or depressive phase, it can be hazardous and possibly life-threatening for them and for those around them.
People can also experience a mixed episode, or rapid cycling, in which mood changes happen quickly, sometimes a few times in a year.
In addition, bipolar disorder can have a long-term negative impact on a person's relationships, work, and social life. When problems occur, the person may use alcohol in an attempt to alter their mood in response to these negative feelings.
In some people, a manic phase can include psychosis. The person may experience hallucinations, or they may believe that they are very important, that they are above the law, or that no harm can come to them, whatever they do.
If a person has psychosis and consumes alcohol, this can lead to both short-term and long-term complications.
Alcohol can complicate the treatment of psychosis. Combining alcohol with psychosis increases the risk of mental and physical complications.
Bipolar disorder and alcohol misuse
Addictive behavior and alcohol and substance abuse are common among people with bipolar disorder. Conditions that often happen together are known as co-morbidities.
Alcohol misuse and bipolar disorder can also produce overlapping symptoms, and they may trigger each other in some circumstances.
In the past, researchers have noted that symptoms of bipolar disorder appear as a person withdraws from alcohol dependence. Some scientists have suggested that alcohol use or withdrawal and bipolar disorder affect the same brain chemicals, or neurotransmitters.
This may cause alcohol misuse and bipolar disorder each to trigger symptoms of the other condition.
In 2006, a study of 148 people concluded that a person with bipolar disorder does not need to drink excessive amounts of alcohol to have a negative reaction.
The researchers found a direct link between alcohol consumption and the rate of occurrence of manic or depressive episodes, even when study participants drank a relatively small amount of alcohol.
Effects on diagnosis
In 2011, researchers noted that alcohol misuse can result in a misdiagnosis of bipolar disorder.
Combined with alcohol use, it can be harder for doctors to identify.
As a result, a person with bipolar disorder may not get the correct treatment that can relieve their symptoms.
Medications and alcohol
Both bipolar disorder and alcohol consumption cause changes in a person's brain.
Bipolar disorder is believed to result from imbalances in brain chemistry. Scientists believe there is a genetic component to the disorder. Alcohol is a CNS depressant that people use to relax.
People with bipolar disorder often use medications to stabilize their symptoms.
Doctors commonly prescribe:
- valproate, or valproic acid
- lithium, a mood stabilizer
- antipsychotics such as olanzapine (Zyprexa)
- antidepressants, in some cases
Mixing alcohol and drugs for bipolar disorder can lead to interactions. Some people choose alcohol over the medication because taking the drugs can be challenging.
Valproic acid is a CNS depressant that can have similar effects to alcohol. Using both at the same time can increase the effect, with potentially serious consequences.
Valproic acid can also cause liver problems, as can alcohol. If a person uses valproic acid with alcohol, this may put extra strain on the liver, increasing the risk of liver disease.
On the other hand, the person may decide to skip their medication in order to drink more "safely." However, not taking the medication can cause symptoms to return.
Lithium, too, can have side effects, including:
- weight gain
- gastrointestinal problems
The National Institutes of Health give no specific advice against using alcohol with lithium, but a doctor may provide additional information.
Challenges with taking bipolar medication
It can be difficult to get the medication right with bipolar disorder because each person is different and may respond differently to medications.
A person may need to work with their doctor for some time before they find a suitable medication and dose.
These difficulties, the possible side effects of the drugs, and the features of bipolar disorder itself can make it hard for a person to keep to a treatment plan.
Challenges include the following:
- Each individual reacts differently to the medications, and it can take time to find the right drug and dose.
- The drugs can have unpleasant side effects, especially at the beginning.
- If a person with undiagnosed bipolar disorder approaches a doctor with depression, the doctor may prescribe anti-depressants. If the person has bipolar disorder, the drugs can trigger a manic episode.
- People often enjoy the "high" times associated with mania and may miss them when they stop. They may feel that they are no longer "themselves." They also may report feeling "depressed" when in fact they are simply not feeling manic.
- If a person with bipolar disorder develops depression, they may not take their drugs because they forget or lose motivation.
- When a person starts to feel better, they may stop taking the drugs, but then the symptoms may return.
- Treatment can be expensive and time-consuming, especially if it takes time to get it right.
If people become disillusioned with their medications, some will stop using the drugs and consume alcohol as a form of self-medication. Some people use alcohol alongside their prescription drugs, adding to the risk.
When a person takes their medication, they are in a better position to manage their condition. However, adhering to treatment can be difficult for some people with bipolar disorder.
People who have a diagnosis of both bipolar disorder and alcohol dependence will need a special treatment plan.
Alternatives to alcohol
People who are trying to avoid alcohol might benefit from finding other types of pleasurable experience.
Many people see alcohol as a way to relax or socialize. A person who is avoiding or cutting down on alcohol may find it helpful to replace the habit with an alternative feel-good solution .
Alternatives may include:
- physical exertion, such as a sport or gardening
- drinking herbal teas, such as chamomile
- meditation, yoga, or tai chi
- massage therapy
- taking a warm bath
The use of alternative treatments, such as aromatherapy, may help.
The relationship between bipolar disorder and alcohol misuse is complex. There is probably not a straightforward cause-and-effect relationship. Instead, they appear to impact each other.
A person with bipolar disorder can usually remain healthy if they take their medication as a prescribed, and if they avoid alcohol.
The family and loved ones of a person with the condition can help by encouraging healthful behaviors that discourage the consumption of alcohol.