Bipolar Disorder and Alcohol Use Disorder: A Connection?

Bipolar II disorder and cyclothymia are even more does water flush alcohol out of urine difficult to reliably diagnose because of the more subtle nature of the psychiatric symptoms. Because of the diagnostic difficulties, it may be that this diagnostic group is often overlooked. Bipolar disorder and alcohol use disorder, or other types of substance misuse, can be a dangerous mix. Also, having both conditions makes mood swings, depression, violence and suicide more likely. About 45 percent of people with bipolar disorder also have alcohol use disorder (AUD), according to a 2013 review. For people with bipolar disorder, caution is warranted even with moderate alcohol consumption.

Analyzing the SFBN sample of the two German centers revealed a life-time prevalence of 17.8% for AUD only—compared to 33% in the whole SFBN which included four US and three European centers (two in Germany, one in the Netherlands). The transatlantic difference for illicit drug use might be even higher, as SUD other than AUD was only present in 8.5% of the German SFBN sample (37). The higher SUD comorbidity rates in the US might directly relate to the poorer prognosis and higher treatment resistance in the SFBN US compared to the European sample (38). Whereas, the incidence of BD across countries and cultures is within a similar range, reported rates for AUD differ considerably due to cultural and religious diversity. For example, a representative household survey in Iran found a 12-month prevalence of alcohol use disorders of 1% according to DSM-IV criteria and 1.3% according to DSM-5, with higher prevalence rates in urban vs. rural areas (8). For comparison, a recent US household survey reports a 12-month prevalence of DSM-5 AUD of 13.9% (9).

The medications most frequently used for treating bipolar disorder are the mood stabilizers lithium and valproate. As stated previously, preliminary evidence suggests that alcoholic bipolar patients may have more rapid cycling and more mixed mania than other bipolar patients. There is also evidence to suggest that these subtypes of bipolar disorder have different responses to medications (Prien et al. 1988), which would help provide a rationale for the choice of agents in the alcoholic bipolar patient.

Alcohol and symptoms of bipolar disorder

1. Whereas, the incidence of BD across countries and cultures is within a similar range, reported rates for AUD differ considerably due to cultural and religious diversity.
2. The World Health Organization World Mental Health Survey Initiative (2) conducted across eleven countries reported a 4.8% lifetime prevalence of all manifestations of bipolarity, including subthreshold and spectrum disorder.
3. Patients with 4 or more mood episodes within the same 12 months are considered to have rapid cycling bipolar disorder, which is a predictor of poor response to some medications.
4. In adolescents with comorbid BD and SUD, inclusion of the family appears crucial.
5. Fortunately, there are numerous resources available for individuals dealing with both bipolar disorder and alcohol use issues.
6. Early abstinence predicted later abstinence, and a significant number of those who reduced their drinking by 6 months also achieved complete abstinence after 5 years (91).

This may change figures of future epidemiological studies on SUD and BD comorbidity to some degree. If you’ve lost control over your drinking or you misuse drugs, get help before your problems get worse and are harder to treat. Seeing a mental health professional right away is very important if you also have symptoms of bipolar disorder or another mental health condition.

Understanding the Effects of Alcohol on Bipolar Disorder

The analyzed subgroup of bipolar patients was well-stabilized on different mood stabilizers (antipsychotics, antiepileptics, or lithium). Severity of depression correlated significantly with craving and drinking behavior 1 week later. The relationship between alcohol and bipolar mania is particularly concerning.

The NIH estimates that about 42% of people with bipolar disorder also have an alcohol use disorder. Living with bipolar disorder may increase the risk of having an alcohol use disorder. Also, if you have bipolar disorder, alcohol use of any amount may affect your health. There is also a greater risk of suicide in individuals who have bipolar disorder and alcohol use disorder.

Other guidelines, e.g., the Canadian Network for Mood and Anxiety Treatments (CANMAT) do not recommend CBT but rather the integrated group therapy (IGT) developed by Weiss and colleagues which includes CBT and psychoeducation components. IGT has been studied in a pilot study (92) and 2 separate RCTs (93, 94) comparing it with either group drug counseling or no treatment. This manualized program with 20 weekly group sessions demonstrated effectiveness both for the prevention of alcohol and bipolar relapses (93) even at 8-month follow-up. A slimmed version with twelve sessions, developed by the same group, also demonstrated effectiveness (94).

What Is AUD?

Bipolar I disorder is the most severe; it is characterized by manic episodes that last for at least a week and depressive episodes that last for at least 2 weeks. Patients who are fully manic often require hospitalization to decrease the risk of harming themselves or others. People can also have symptoms of both depression and mania at the same time. This mixed mania, as it is called, appears to be accompanied by a greater risk of suicide and is more difficult to treat. Patients with 4 or more mood episodes within the same 12 months are considered to have rapid cycling bipolar disorder, which is a predictor of poor response to some medications. Bipolar II disorder is characterized by episodes of hypomania, a less severe form of mania, which lasts for at least 4 days in a row and is not severe enough to require hospitalization.

The only exception was aripiprazole which reduced significantly number of drinks and heavy drinking days in one study (116). Carbamazepine has been traditionally used in acute alcohol withdrawal to reduce the risk of seizures and ameliorate physical symptoms. However, there are no reliable data whether it is of any usefulness in the long-term treatment of BD + AUD. Carbamazepine is metabolized by the liver and can, by itself, induce an increase in liver transaminases (ALAT, ASAT, γGT) and, in rare cases, cause liver failure.

A controlled study suggested a reduction of alcohol consumption with ondansetron (126). The use or digital media and “blended care” is likely to increase in the future across treatment settings and will facilitate diagnosis and treatment of mental disorders including comorbid conditions. It’s usefulness in BD patients comorbid with AUD, however, still needs to be further investigated. Are you or a loved one struggling with addiction to alcohol and bipolar disorder?

Genetic differences may affect the brain reward system making people with bipolar disorder more vulnerable to alcohol and drug addiction. The dangers of angel dust drug wiki drinking with bipolar disorder extend far beyond the immediate effects on mood and behavior. Alcohol use can significantly complicate the course of bipolar disorder, leading to more frequent hospitalizations, increased suicide risk, and poorer overall outcomes.

The short answer is yes, alcohol can significantly exacerbate bipolar symptoms and interfere with treatment efficacy. Still, alcoholic patients going through alcohol withdrawal may appear to have depression. Depression is a key symptom of withdrawal from several substances of abuse, and studies have demonstrated that symptoms of withdrawal-related depression may persist for 2 to 4 weeks (Brown and Schuckit 1988). Because of this phenomenon, it is likely that observation during lengthier periods of abstinence (i.e., continued observation following the withdrawal stage) is important for the diagnosis of depression as compared with mania. In BD, comorbid SUD and especially AUD are rather the rule than the exception. Pharmacological and integrated psychotherapeutic approaches that give equal weight to both disorders, while still scarce, are recommended.

Of the 228 Bipolar probands, 75.4% (74% in bipolar I patients and 77% in bipolar II patients) fulfilled criteria for DSM-IV life time alcohol dependence. In younger patients, it appears that alcohol use and bipolar symptoms are more likely to increase or decrease in unison (64). An exploratory sub-analysis (65) examined the impact of depressive symptoms on craving and drinking behavior in 30 comorbid patients participating in a 8-week, placebo-controlled relapse prevention study (acamprosate vs. placebo).

Does alcohol interact with bipolar disorder medications?

Alcohol is a depressant that disrupts chemical messengers in the brain, which may drinker nose lead to worsened depressive symptoms or trigger hypomania or mania. Understanding this relationship is crucial for both individuals with bipolar disorder and their loved ones. It’s important to recognize that alcohol use can significantly complicate the course of bipolar disorder, interfering with treatment efficacy and potentially leading to more severe symptoms and poorer outcomes. However, with proper support and treatment, many individuals with bipolar disorder can successfully manage their condition and achieve long-term sobriety. One of the most pressing questions for individuals with bipolar disorder and their loved ones is whether alcohol makes bipolar disorder worse.

Available research on the use of lithium, valproate, and naltrexone for comorbid patients is reviewed below. O’Sullivan and colleagues (1988) found that alcoholics with bipolar disorder functioned better during a 2-year followup period than did primary alcoholics (i.e., those without comorbid mood disorders) or alcoholics with unipolar depression. This suggests that bipolar patients may use alcohol primarily as a means to medicate their affective symptoms, and if their bipolar symptoms are adequately treated, they are able to stop abusing alcohol. Hasin and colleagues (1989) found that patients with bipolar II disorder were likely to have an earlier remission from alcoholism compared with patients with schizoaffective disorder or bipolar I disorder. Researchers have also proposed that the presence of mania may precipitate or exacerbate alcoholism (Hasin et al. 1985).