More than 100 medications list interactions with alcohol, including some over-the-counter drugs. Even mixing allergy medication with alcohol increases the risk for overdose.
Psychiatric drugs are no exception.
In fact, they make up a good portion of the list. This is one reason professionals suggest some people with bipolar disorder avoid alcohol. Another is that it’s possible for alcohol to trigger symptoms, and one more is that almost 30% of patients also experience alcohol dependence. What happens when individuals mix their medications with alcohol?
There are several categories of psychiatric medications. There are medications for anxiety disorder, ADHD, bipolar disorder, depression, psychosis and sleep problems. All of these are relevant to bipolar disorder patients as 95% of those with bipolar disorder have at least one other psychiatric illness. Add to this that half of patients take more than one medication just for their bipolar disorder. That’s a lot of pills, and a lot of opportunity for interactions.
Alcohol is a drug, and it works remarkably similarly to the drugs used to treat psychiatric illnesses. It affects brain chemistry, most notably glutamate, dopamine, and GABA, which are a large part of the brain’s reward system.
Among other roles, glutamate increases brain activity. It’s excitatory. Dopamine makes you feel good, and GABA acts as a calming agent on your central nervous system. The increased activity caused by glutamate is suppressed by alcohol. Alcohol also increases the effects of GABA, and the release of dopamine. That’s why alcohol is satisfying, but meanwhile it’s wreaking havoc on the rest of you when it’s abused.
That’s what happens in the brain when no other drugs are present that affect brain chemistry. Now, let’s see what happens when alcohol interacts with the most common bipolar disorder medications.
These are medications such as lamotrigine (trade name Lamictal), quetiapine (Seroquel), olanzapine (Zyprexa), and carbamazepine (Tegretol), among others. It’s not completely known how mood stabilizers work, but the most recent research indicates they work by increasing GABA to help calm the nervous system, helping to clear out excess glutamate, and inhibiting dopamine to combat mania. Lithium also helps increase the volume of parts of the brain that tend to be smaller in patients with bipolar disorder.
When combined, alcohol and mood stabilizers cause a buildup of available neurotransmitters so that the effects and risks of both substances increase. As the effects of alcohol wear off, the GABA system is thrown off balance again, which can cause increased anxiety and sleeplessness. There is also a greater risk of depression once the effects of the alcohol have worn off.
With alcohol, levels of lithium in the bloodstream are increased. Having too much lithium in the blood is toxic. The advantage of increased brain volume with lithium is also negated by the shrinking effect alcohol has on the brain over time.
Combining alcohol with mood stabilizers can result in dizziness, drowsiness, problems concentrating, impaired motor control, upset stomach, joint or muscle pain, and depression. Lithium toxicity symptoms include nausea, vomiting, diarrhea, tremor and blurred vision.
Antipsychotics act as sedatives, and they primarily target the excess dopamine thought to trigger psychosis. So, antipsychotics reduce and limit the amount of dopamine in the system. They also affect GABA function in much the same way as mood stabilizers.
So combine the effects of mood stabilizers and alcohol with the additional complication of alcohol increasing dopamine while the antipsychotic attempts to lessen it. There is an increased risk of alcohol withdrawal-related seizures with antipsychotics. Alcohol also increases the sedative effect of antipsychotics, which can lead to coma and respiratory depression.
Combining alcohol with antipsychotics can result in increased risk of overdose, drowsiness, dizziness, difficulty breathing, impaired motor control, memory problems, and depression.
When combining any types of substances, it’s best to play it safe. Talk to your doctor or another qualified mental health professional if you have questions. If you think you or a loved one may be abusing alcohol, you can find more information at www.dualdiagnosis.org.
Image credit: Alex Ranaldi