Having a stressful day, socializing, holidays, because it feels good- these are all reasons people drink. Drinking alcohol is not inherently bad. Humans have been drinking alcohol for about 10 million years. When consumed in moderation, it can have health benefits like reducing the risk for stroke, heart disease and diabetes. However, heavy use of alcohol carries risks like increased risk for some cancers, stroke, high blood pressure and liver disease. For people with bipolar disorder, there are even more reasons why alcohol should be avoided.
1 Alcohol can worsen symptoms.
Alcohol is a mind-altering substance and can therefore manipulate already fragile mental states. Mania comes with lowered inhibitions and bad judgement. In this case, it may become easier for a person to drink in excess.
Increased blood alcohol levels can also mimic highs felt in bipolar disorder or seem to help treat depression and anxiety. However, as BAC decreases, it can increase depressive symptoms.
2 Alcohol interacts with most bipolar disorder medications.
Lithium is a common drug used to treat bipolar disorder, but must be closely monitored in order to avoid lithium toxicity. Alcohol increases blood levels of lithium, making symptoms like memory loss, dizziness, seizures and kidney disease more likely.
Mood stabilizers like lamotrigine, quetiapine and carbamazepine partly work by increasing the neurotransmitter GABA, which calms the nervous system. Alcohol also increases GABA, which when combined with the medication throws the system off balance, especially when GABA decreases as BAC decreases. Symptoms of combining alcohol with mood stabilizers include increased risk of overdose, dizziness, problems concentrating, motor control issues and depression.
Combining antipsychotics with alcohol carries the same risk as combining alcohol and mood stabilizers, but there is an additional risk. Alcohol increases dopamine levels while antipsychotics work to decrease dopamine in order to treat manic symptoms. The combination can increase the risk of respiratory depression, coma and overdose.
3 More than half of people with bipolar disorder also have substance abuse disorder.
Among severe mental illnesses, bipolar disorder carries the highest risk of combined substance use disorder. Approximately 60% of people with bipolar disorder will experience SUD at some point in their lives. Compare this to 7-8% in the general population.
Alcohol is the most commonly abused substance. Thirty-two percent of people with bipolar I are alcohol dependent compared to 21% of people with bipolar II. However, people with bipolar II are more likely to abuse alcohol.
Because of the risks of increasing symptoms, negative drug interactions and the high risk of substance use disorder, it may be best for people with bipolar disorder to avoid alcohol altogether. At the very least, patients should speak with their doctors before using.
Image credit: Dominick