Author: Gary Jackson

Alcohol Use Disorder and Depressive Disorders PMC

In people with bipolar disorder or AUD, it’s believed that the chemicals that regulate moods don’t work properly. Your environment as a young person can also influence whether you’re likely to develop AUD. All that’s needed for a diagnosis of bipolar I disorder is the development of a manic episode. These episodes may be so severe that they require hospitalization in order to stabilize. If someone has both conditions, it matters which condition appears first.

People may turn to alcohol as a way to cope with mood problems, but drinking alcohol can also contribute to symptoms of depression. Alcohol use can also affect how antidepressants work, which can affect depression treatment. Suicidal thoughts and behavior are common among people with bipolar disorder.

How do bipolar disorder and alcoholism interact?

However, for the best results, your doctor will likely treat them together. Alcohol may be a form of self-medication for people with depression. The “burst” of energy from alcohol can be a welcome relief against some symptoms. For example, alcohol may temporarily reduce anxiety and lower inhibitions.

Alternatively, symptoms of bipolar disorder may emerge during the course of chronic alcohol intoxication or withdrawal. Still other studies have suggested that people with bipolar disorder may use alcohol during manic episodes in an attempt at self-medication, either to prolong their pleasurable state or to sedate the agitation of mania. Finally, other researchers have suggested that alcohol use and withdrawal may affect the same brain chemicals (i.e., neurotransmitters) involved in bipolar illness, thereby allowing one disorder to change the clinical course of the other. In other words, alcohol use or withdrawal may “prompt” bipolar disorder symptoms (Tohen et al. 1998). It remains unclear which if any of these potential mechanisms is responsible for the strong association between alcoholism and bipolar disorder.

Depressive Symptoms and Alcohol

The lifetime prevalence of alcohol abuse is approximately 10 percent (Kessler et al. 1997). Alcohol abuse often occurs in early adulthood and is usually a precursor to alcohol dependence (APA 1994). The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes.

John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Or, if you think you can do so safely, take the person to the nearest hospital emergency room. CBT can teach you ways to modify your thoughts and behavior to feel better and help you avoid misusing alcohol. In addition, your doctor may prescribe medicines that are meant to lower alcohol cravings, which can reduce your desire to drink.

Diagnosing Bipolar Disorder and Alcohol Addiction

Regardless, the reason behind this high level of comorbidity is complicated and likely works in both directions (i.e. bipolar disorder can prompt alcoholism and alcoholism can prompt or worsen symptoms of bipolar disorder). Providers may treat bipolar disorder and alcohol use disorder sequentially (one before the other), independently (by themselves), or using an integrative approach (together). There is also the possibility that bipolar disorder and alcohol addiction symptoms will present concurrently, which adds a level of complexity to the diagnosis.

Finally, the etiology, course, and treatment of both AUD and depression differ substantially by gender. Women have been underrepresented in much of the research on co-occurring AUD and depressive disorders, particularly in the early research on this topic. The research needs more representation of women to increase understanding of the sex differences and to better characterize the mechanisms underlying women’s heightened vulnerability for depressive disorders. These populations experience disparities in access to care for AUD and depressive disorders but are underrepresented in studies of these disorders. If you have bipolar disorder and alcohol use disorder or another addiction, you have what’s known as a dual diagnosis.

Issues Surrounding the Treatment of Comorbid Bipolar Disorder and Alcoholism

If you’re dealing with severe alcohol withdrawal symptoms, such as anxiety, insomnia, nausea, and hallucinations, among others, then your doctor may suggest medications such as chlordiazepoxide or other benzodiazepines. Drinking persistently and excessively can increase your risk of developing a major depressive disorder. It can also aggravate symptoms of pre-existing depression and endanger your health and mental health. The combination of bipolar disorder and AUD can have severe consequences if left untreated. People with both conditions are likely to have more severe symptoms of bipolar disorder. However, manic depression (commonly known as bipolar disorder) is a much different animal.

“An experienced psychiatrist [or another mental health professional] familiar with mood disorders and the effects of alcohol abuse can be instrumental in recommending appropriate medications and monitoring medication efficacy,” says Kennedy. However, alleviating depression does not resolve the alcohol use disorder. In some cases, you may receive a dual diagnosis of a major depressive disorder (MDD) and an alcohol use disorder (AUD).