Bipolar Disorder and Alcohol Use

Drug interactions and alcohol abuse are common

woman with depression

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Doctors will commonly advise you to avoid alcohol while taking certain medications, particularly those used to treat mental health disorders. While it would be fair to assume that drowsiness is the main concern, there may be other, more serious consequences of mixing alcohol with bipolar drugs. Whether you are a heavy or occasional drinker, alcohol can undermine your therapy and increase your risk of drug toxicity, side effects, and even suicide.

Bipolar Disorder and Alcohol Use

Bipolar disorder and substance use disorders often go hand in hand. According to a 2014 survey from the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorders occur more frequently in people with mental health disorders than the general population.

This is largely due to the fact that co-occurring conditions like substance abuse and bipolar disorder (BP) are often treated as a single problem rather than as separate entities. As such, symptoms suggestive of bipolar depression or mania may actually be related to a drinking problem and go untreated. The opposite also holds true.

Research published in the Journal of Affective Disorders concluded that alcohol abuse was the single most prevalent substance use disorder in people with bipolar I and bipolar II disorders. According to an analysis of 22 multi-center studies and 56 individual studies, no less than 30 percent of bipolar people met the clinical definition of substance abuse disorder (SUD).

Of these, 42 percent were classified as having an alcohol abuse disorder (AUD).

Cannabis abuse was seen in 20 percent of people with BP, followed by cocaine and methamphetamine at 11 percent. Men with BP were two to three times more likely to have AUD than women with BP.

Complications of BP and AUD

Alcohol abuse can complicate the management of bipolar disorder.

Not only does drinking impair your judgment and make you more impulsive, but it also increases your risk of suicide, injury, hospitalization, and sexually transmitted infections like HIV.

According to research from the Medical University of South Carolina, the risk for attempted suicide is nearly twice as high in people with BP and AUD as it is in those with BP alone. Moreover, the effect alcohol has on a person's moods and judgment can make adherence to drug therapies all the more difficult, undermining the very goals of treatment.

Due to these inherent risks, it is best to abstain from alcohol completely if you have bipolar disorder. Not only can drinking make your BP symptoms worse, achieving sobriety may be far more difficult when faced with the dual diagnosis.

Medication Groups

These following groups of psychotropic drugs used may have serious interactions with alcohol, ranging in severity from mild to life-threatening:

Group A: Anti-Anxiety and Sedating Drugs

This group of drugs includes benzodiazepines and certain prescription sleep aids such as:

  • Ativan (lorazepam)
  • Klonopin (clonazepam)
  • Valium (diazepam)
  • Xanax (alprazolam)
  • Ambien (zolpidem)
  • Lunesta (eszopiclone)
  • Prosom (estazolam)
  • Restoril (temazepam)
  • Sominex (diphenhydramine)

Group B: Tricyclic Antidepressants

Tricyclic antidepressants are an older class of drug used to treat severe mood disorders and include:

  • Elavil (amitriptyline)
  • Anafranil (clomipramine)
  • Norpramin (desipramine)

Group C: SSRI and SNRI Antidepressants

Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants include:

  • Celexa (citalopram)
  • Prozac (fluoxetine)
  • Lexapro (escitalopram)
  • Zoloft (sertraline)
  • Luvox (fluvoxamine)
  • Paxil (paroxetine)
  • Effexor (venlafaxine)
  • Cymbalta (duloxetine)

Group D: Atypical Antidepressants

Atypical antidepressants are a newer class of antidepressant which include:

  • Wellbutrin (bupropion)
  • Desyrel, Oleptrol (trazodone)
  • Serzone (nefazodone)
  • Remeron (mirtazapine)

St. John's Wort, an herbal supplement believed to have antidepressive effects, is also included in this drug group and has many other potentially dangerous interactions.

Group E: Anticonvulsants

Anticonvulsants used as mood stabilizers in people with BP include:

  • Tegretol (carbamazepine)
  • Lamictal (lamotrigine)

Group F: Mood Stabilizers

Other commonly prescribed mood stabilizers include:

  • Lithobid, Eskalith (lithium)
  • Depakene, Depakote (valproic acid)

Group G: Antipsychotics

Examples of antipsychotics used in bipolar therapy include:

  • Zyprexa (olanzapine)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Abilify (aripiprazole)
  • Geodon (ziprasidone)

Possible Interactions With Alcohol by Medication Group

InteractionGroups
Drowsiness or dizzinessAll groups
Increased risk of overdoseGroups A, B, C, & G
Slowed breathing or difficulty breathingGroups A & D
Impaired motor controlGroups A, F, & G
Unusual behaviorGroups A, D, & F
Problems with memoryGroups A & D
Increased depressionGroups B, C, F, & G
Loss of effectiveness of antidepressantGroups B & C
Increased risk of suicide or suicidal ideation (most especially in adolescents and young adults)Groups B & C
Convulsions and heart rhythm disturbancesGroup B
Liver damageGroups C (duloxetine) & F (valproic acid)
Increased effect of alcoholGroup D (bupropion)
TremorsGroup F
Upset stomachGroup F
Muscle or joint painGroup F
RestlessnessGroup F
Appetite lossGroup F

A Word From Verywell

Some over-the-counter products, especially cough syrup and laxatives, may contain enough alcohol to interact with your medications. Ask your doctor or pharmacist if they are safe to use.

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