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Bipolar Disorder StatPearls NCBI Bookshelf

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. Acknowledging the risks and consequences of alcohol use, as well as seeking professional help and support, is a crucial step in managing alcohol consumption. With education, a strong support system, and access to appropriate treatment resources, individuals with bipolar disorder and alcohol concerns can navigate the complexities of this dual diagnosis and work towards improved mental health and well-being. In this article, we will dive deep into the intricate relationship between bipolar disorder and alcohol, exploring the effects and risks involved.

  1. A 2018 review looked at epidemiological data to evaluate the likelihood of people diagnosed with mood and anxiety disorders to self-medicate with alcohol or drugs to cope with challenging symptoms.
  2. When someone develops bipolar disorder, it usually starts when they’re in late adolescence or young adulthood.
  3. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.
  4. Although researchers have proposed explanations for the strong association between alcoholism and bipolar disorder, the exact relationship between these disorders is not well understood.

For intermediate and long-term treatment, the dogma persisted for a long time that AUD needs to be treated first and sufficiently before attention should be paid to the mental health disorder. Today, strategies that promote concomitant therapy of dual disorders are the established adult children of alcoholics treatment of choice (80) and recommended in major guidelines (81). However, treatment adherence and compliance remain a challenge in this special group, since medications are often not taken as prescribed (61) and psychotherapy appointments are often missed.

Bipolar Disorder

Research into the effects of certain substances on mood episodes in people with bipolar disorder is ongoing. Some medical experts disagree about findings that cannabis can worsen the progression of bipolar disorder. If you are interested in helping researchers learn about the best ways to treat bipolar disorder, check out Before joining a clinical trial, be sure to get the go-ahead from your doctor. If you’re concerned about a loved one and believe they may need residential care, we can help.


The evidence base for suitable psychotherapies in comorbid BD and AUD remains poor. The German S3 Guidelines for AUD (49) recommends cognitive behavioral therapy (CBT) as the best evidenced modality whereas there is no recommendation for other psychotherapies due to insufficient data. In neuroimaging studies, there are a number of areas of interest in BD and indeed in AUD that have emerged in different studies in different populations. Have identified areas including the pre-frontal cortex, the corpus striatum and the amygdala as being abnormal in early BD, potentially predating illness (Chang et al., 2004, Strakowski et al., 2005b).

What is bipolar disorder?

There are many reasons to avoid drinking if you have bipolar disorder, including the potential interactions with medications. Therapy and other treatment strategies are important in managing bipolar disorder, but so is medication. Antidepressants, mood stabilizers, antipsychotics, and other drugs help manage symptoms and reduce the frequency and severity of mood cycles.

It comes with feelings of sadness, guilt, hopelessness, anger or possibly no feeling at all. It can also come with sleeping too much or not enough, changes in weight, unexplained aches and pains, and in some worst cases, thoughts of suicide. If you or a loved one are struggling, you should know that treatment is available to help you take back control and begin a healthier and more productive life. If you suspect that you or your loved one have bipolar disorder, you may consider reaching out to your doctor.

According to SAMHSA, people with bipolar disorder may misuse substances for a number of reasons, including because both disorders change brain areas important in regulating impulsivity and feelings of reward and pleasure. 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. The FIRESIDE Principles for an integrated treatment of bipolar disorder and alcohol use disorder. Despite the considerable public health significance of co-occurring BD and alcohol dependence, there are few effective pharmacotherapeutic interventions.

People who have four or more mood episodes in a year, or who also have drug or alcohol problems, can have forms of the illness that are much harder to treat. Are you or a loved one struggling with addiction to alcohol and bipolar disorder? Many inpatient and outpatient how to sober up fast from molly, cocaine, meth or alcohol programs help deal with both disorders, ideally eliminating the cravings for alcohol and stabilizing bipolar disorder. Contact a treatment provider today for more information on treatment plans and options for dealing with this co-occurring disorder.

Why and How Drinking Alcohol Affects Bipolar Depression Medication

Subsequently, the same group conducted a double-blind, placebo-controlled study (119) in patients with BD + AUD. Quetiapine add-on to treatment as usual (TAU) had no effect on any alcohol-related outcomes, but produced a faster and significantly greater decrease of depressive symptoms. This finding is of note as many antidepressant treatment modalities are less effective in BD patients with comorbid AUD.

The Relationship between Bipolar Disorder and Alcohol: Exploring the Effects and Risks

The lack of efficacy of quetiapine against AUD was also confirmed in another placebo- controlled study (120). No controlled data for other aAP or antidepressants have, so far, been generated (see Table 1). About 45 percent of people with bipolar disorder also have alcohol use disorder (AUD), according to a 2013 review.

The detrimental impact of substance use and BD has been well-established, both for the individual and for society (54, 55). Numerous investigations demonstrated that comorbid AUD influences the clinical course of BDs unfavorably [for a review, see (50)]. Especially in younger people BD as well as SUD results in severe and lasting impairment and a loss of healthy years lived (56, 57). BD and SUD are afflicted with high rates of suicide attempts and suicide that are even topped in case of coexistence of both disorders (24). A Brazilian study reports of at least one suicide attempt in 68% of BD patients with AUD compared to 35% in BD without AUD, with virtually no difference between BD patients with DSM-IV alcohol abuse and dependence (23).

Treatment involves pharmacotherapy and psychosocial interventions, but mood relapse and incomplete response occur, particularly with depression. Continual reevaluation and treatment modification are commonly required during the long-term care of patients with bipolar disorder. Management of comorbid psychiatric and chronic medical conditions may also be necessary. This activity reviews the etiology, classification, evaluation, management, and prognosis of bipolar affective disorder, and it also highlights the role of the interprofessional team in managing and improving care for patients with this condition. Medication compliance is an important issue to consider when assessing the effectiveness of medications. Side effects, including lethargy, weight gain, and tremors, were listed as the main reason for non-compliance with lithium (Weiss et al. 1998).

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 demi lovato shows off new tattoo to celebrate sobriety 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). Although researchers have proposed explanations for the strong association between alcoholism and bipolar disorder, the exact relationship between these disorders is not well understood.

Therapies, including cognitive behavioral therapy, group therapy, and others, will also help. A good therapist can give you an outlet for expressing your feelings but also practical strategies for managing bipolar symptoms and alcohol cravings. Those with both bipolar and a substance use disorder are more likely to commit suicide. 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.

Alcohol and symptoms of bipolar disorder

Alcohol use has been shown to increase the severity of bipolar disorder, its symptoms and its complications. People who struggle with any substance use disorder and have bipolar are less likely to stick with their treatment. The NESARC survey revealed strong associations between depression, substance use, and other psychopathologies. 5 Compared with MDD alone, SUD combined with MDD conferred high vulnerability to additional psychopathology, depressive episodes that were more severe and greater in number, and more suicide attempts. This review details methods for meeting the challenges of diagnosing and treating mood disorders that coexist with substance use disorders.

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