Alcohol and Bipolar Disorder: What's the Connection?

Life can often feel like a rollercoaster ride, with its ups and downs, its twists and turns. Now imagine those highs and lows amplified — this is the case in bipolar disorder, a mental illness characterized by extreme, often unpredictable, shifts in mood and energy.

Managing bipolar disorder (formerly known as manic depression) can be challenging. It’s no wonder that it can drive us to alcohol as a way of coping. This article explores the connection between bipolar disorder and alcohol, shedding light on the potential risks, underlying factors, and the importance of getting help.

Understanding Bipolar Disorder 

What is manic depression (or bipolar disorder)? Bipolar disorder affects roughly 40 million people worldwide. It involves alternating episodes of mania and depression that can each last weeks or months. Understandably, it can disrupt daily functioning and strain relationships.

A closer look at the brain helps us understand bipolar disorder a bit better. As we know, our brain runs on neurotransmitters — chemical messengers that communicate between brain cells.  Two key players in bipolar disorder are the neurotransmitters dopamine and serotonin. Dopamine — associated with reward and motivation — surges during manic episodes, leading to heightened energy and euphoria. Serotonin, on the other hand, regulates mood. It becomes depleted during depressive episodes, leading to feelings of sadness and low energy.

Bipolar disorder is shaped by our genes and environment. Disrupting the balance between dopamine and serotonin can trigger episodes in those of us with bipolar disorder. While specific genes play a large role, environmental triggers — like stressful events or sleep disruptions — also play a factor. 

It’s also important to note: bipolar disorder (BD) should not be confused with borderline personality disorder (BPD). This is a common mistake, and the two are very different! Be aware of this when doing research or talking with others about these conditions.

Bipolar Disorder: What Are the Symptoms?

Understanding bipolar disorder extends beyond neurotransmitters or genes. When we shift from a manic episode to a depressive episode — called a “swing” — dramatic changes happen in the way our brain communicates. Brain signals literally move differently during these phases, and they can be complicated by outside factors like environment, weather, social circumstances, health, and substance use.

While swings are a defining characteristic of bipolar disorder, they’re not the whole picture. Some of us can go years without a swing, while others can experience several swings in a single year (called “rapid cycling”). If we have experienced one single manic episode and one single depressive episode in our life, we meet the criteria for a bipolar disorder diagnosis. This underscores the idea that bipolar disorder isn’t necessarily always active — it can go into remission for decades, and those with bipolar disorder may not exhibit obvious symptoms.

It's crucial to recognize the symptoms that manifest during manic and depressive episodes — and some lesser-known phases of bipolar disorder. Let's break down these symptoms one by one.

Phase 1: The Manic Episode

What is a manic episode? Well, it’s different for everyone. Manic symptoms and manic behaviors show up differently in different people, but there are some commonalities. Manic episodes usually involve some combination of the following:

• Euphoria: A sense of invincibility and overwhelming happiness
• Boundless energy: Feeling extremely energetic, often with little need for sleep
• Grandiose ideas: Thinking expansively, such as planning big projects or making life-altering decisions
• Risky behavior: Engaging in activities like excessive spending, reckless driving, or substance abuse
• Decreased need for sleep: Feeling rested after only a few hours or no sleep at all

Dopamine floods the brain during mania, magnifying the symptoms and making everything seem intensely appealing. And yet, consequences can be severe, affecting personal relationships, careers, and physical health.

Manic episodes can last anywhere from a week to several months.


Phase 2: The Depressive Episode

We’ve all heard of depression, but is it the same as a “depressive episode” in bipolar disorder? Generally, the symptoms are the same, but a bipolar depressive episode may be accompanied by confusion about the extremity of the swing. When in a depressive state, we may experience the following symptoms:

• Emptiness: Overwhelming feelings of sadness or despair
• Lack of energy: Little to no energy to accomplish daily tasks
• Loss of interest: Hobbies and activities become meaningless
• Isolation: Tendency to withdraw from friends and family
• Thoughts of self-harm or suicide: Severe depressive episodes may include dangerous thoughts

In this phase, serotonin, the mood-regulating neurotransmitter, becomes depleted, wrapping us in a fog of ongoing melancholy and lethargy. These symptoms can last anywhere from a few weeks to several months or years.


The Mixed Episode

Some of us face mixed episodes that combine symptoms from both manic and depressive episodes:

• Emotional turmoil: Feeling energetic yet simultaneously despairing
• Confusion: Rapid shifts between feelings of euphoria and sadness
• Impulsiveness: Engaging in risky behavior while feeling emotionally low

Mixed episodes are emotionally exhausting, making it challenging for us and those around us to comprehend what's happening.

Hypomania

Bipolar disorder is generally categorized into two subtypes. Bipolar disorder type 1 is characterized by episodes of mania and depression, whereas Bipolar disorder type 2 involves depressive episodes with episodes of hypomania. Those of us with bipolar type 1 can also experience hypomania, but a single manic episode disqualifies us for a diagnosis of bipolar type 2. 

Hypomania is a milder version of mania. While mania often leads to dangerous behaviors, hypomania is stealthier and harder to identify. We may just feel extra happy or energized, maybe even like we are “back to our old self.”

Because hypomania is not always as noticeable or alarming as mania, bipolar disorder type 2 is theorized to be significantly underdiagnosed. Depressive episodes tend to be more frequent and more severe in bipolar 2, and many people with bipolar type 2 are misdiagnosed with major depressive disorder (MDD). While the treatments are largely the same, there are approaches that better serve bipolar type 2 and help us avoid some of the most detrimental consequences of our condition.

Bipolar and Addiction: The Vicious Cycle 

When faced with the challenges of bipolar disorder, some of us may turn to alcohol as a form of self-medication or escape. 

Alcohol may initially provide a sense of relief, but its effects are short-lived. This is especially the case with a pre-existing mental illness, like bipolar disorder. Drinking excessively can create a vicious cycle that may exacerbate symptoms. Here are a few common issues that can arise:

Central Nervous System Depression

Alcohol functions as a depressant on the central nervous system. While the initial effects might include relaxation or even a temporary uplift in mood, these are brief. Alcohol enhances the effectiveness of a neurotransmitter known as GABA (Gamma-Aminobutyric Acid), which calms the nervous system. At the same time, it reduces the activity of another neurotransmitter, glutamate, which keeps us alert and focused.

Dopamine Release

Alcohol triggers the release of dopamine, the neurotransmitter associated with feelings of pleasure and reward. This can be particularly perilous for those of us with bipolar disorder. When the brain links the act of drinking with emotional relief or pleasure, it can foster a more frequent and potentially harmful drinking habit.

Disruption of Sleep Patterns

The damaging effects of alcohol can create a cascade of problems, including the disturbance of normal sleep rhythms. Proper sleep is crucial for everyone, but it’s of paramount importance for those of us dealing with bipolar disorder, in which a simple sleep disruption can trigger mood episodes.

Impaired Judgment and Decision Making

Alcohol is notorious for impairing our ability to make rational judgments. In the context of bipolar disorder, impaired judgment can lead to risky behaviors that we might not otherwise engage in. This can further destabilize our emotional state, adding fuel to bipolar disorder’s already volatile nature.

Exacerbation of Mood Instability

Frequent alcohol consumption has the potential to heighten mood swings and emotional instability, core symptoms of bipolar disorder. Alcohol-induced mood changes can, in fact, mimic or even exacerbate the symptoms of a manic or depressive episode, making it difficult to manage the disorder effectively.

The Aftermath: The Hangover Phase

Following alcohol consumption, the aftermath sets in, often intensifying feelings of guilt, shame, and regret. These amplified emotional states can serve as triggers for depressive episodes. Once this occurs, it is not uncommon for many to turn back to alcohol in an attempt to self-medicate, continuing the harmful cycle.

The Perpetuating Cycle

The consequence of all these factors is the creation of a self-perpetuating loop of worsening symptoms and increased alcohol consumption. Each time we go through this cycle, it becomes increasingly challenging to break free, complicating the management of bipolar disorder.

The Domino Effect

The combined effects of alcohol and bipolar disorder create a domino effect, with the negative consequences spilling over into many aspects of life, including relationships, work, and overall well-being. This escalating series of problems can further isolate us, making it even harder to seek and adhere to professional treatment.

The Need for Professional Help

Given the complexities of how alcohol interacts with bipolar disorder, it’s essential to approach the issue with extreme caution. Self-medication with alcohol is not only ineffective but dangerous. The best course of action is to seek professional medical advice for a comprehensive treatment plan that includes medication, therapy, and lifestyle changes.

Navigating bipolar disorder symptoms is difficult enough without adding the complications alcohol brings. Far from offering a solution, alcohol magnifies the problems and leads to a vicious cycle that can severely hinder the management and treatment of bipolar disorder. The best recourse is professional intervention, which can offer a multi-faceted approach to effectively manage the condition.

Seeking Support and Breaking Free 

Several factors contribute to the connection between bipolar disorder and alcohol use. Here’s how we can break the cycle and reclaim our health. 

Recognizing Underlying Factors

The intricate relationship between bipolar disorder and alcohol use is far from straightforward. Many layers contribute to this complex interplay, ranging from the desire to self-medicate to bipolar disorder’s predisposition for impulsivity. Further complications may arise from additional issues like anxiety and other substance use disorders. Recognizing these multidimensional factors is the first step toward treating the issue in a comprehensive, holistic manner.

The Importance of Professional Support

The challenges of living with bipolar disorder can be daunting, but help is available. Professional guidance is a crucial starting point for anyone grappling with bipolar disorder and alcohol use. Doctors and mental health professionals can conduct an in-depth diagnosis and create an individualized treatment plan that addresses both issues concurrently.

Comprehensive Treatment Plans

A well-rounded treatment plan typically includes a blend of medication, psychotherapy, and lifestyle adjustments. Medication like mood stabilizers or antipsychotics can be effective in controlling the symptoms of bipolar disorder. At the same time, medications such as disulfiram or naltrexone can deter alcohol use. However, it's vital to consult healthcare providers for a tailored medication plan, as combining medications can sometimes lead to adverse effects.

The Role of Therapy

Psychotherapy, including cognitive behavioral therapy (CBT) and other evidence-based methods, can offer valuable techniques for managing emotional states and behavioral tendencies. Therapy provides an opportunity to dig deep into the underlying triggers and coping mechanisms that might contribute to alcohol use, allowing for more focused and effective intervention.

Support Groups and Online Communities

Participation in support groups and online communities can be an indispensable part of the healing journey. Platforms like Reframe offer virtual spaces where we can discuss our experiences, obtain practical advice, and feel less isolated in our struggles. 

Building a Strong Support Network

The role of a strong personal support network cannot be underestimated. Friends and family who understand the complexities of bipolar disorder and alcohol use can offer emotional sustenance, which is essential for long-term recovery. It's often helpful to include loved ones in therapy sessions or educational programs so they can gain a better understanding of the challenges faced and how best to offer support.

Lifestyle Changes

Lifestyle adjustments, such as a balanced diet, regular exercise, and adequate sleep, contribute significantly to treatment efficacy. Nutritional choices can affect both mood and alcohol cravings. Exercise releases endorphins, which naturally uplift mood and can act as a buffer against depressive episodes. Quality sleep is crucial for mood stability and cognitive function; its absence can trigger manic or depressive episodes in those of us with bipolar disorder.

Coping Mechanisms and Mindfulness Techniques

Learning new coping strategies is another key component in breaking the cycle of bipolar disorder and alcohol use. Mindfulness and stress-reduction techniques can help us become aware of our triggers and thought patterns, giving us the tools to cope without resorting to alcohol. Activities such as journaling, meditation, or even artistic pursuits can serve as healthy outlets for emotional expression and tension release.

Encouraging Consistency and Routine

Sticking to a routine is often advised for managing bipolar disorder symptoms. Regular meal times, sleep schedules, and medication intake can instill a sense of normality and control, which can be empowering for those of us juggling both bipolar disorder and alcohol use.

Living with bipolar disorder can be challenging, but there is hope and help available. If you or someone you know is struggling with bipolar disorder and drinking, seeking professional support is crucial. 

A comprehensive treatment plan may include a combination of medication, therapy, and lifestyle changes. Therapists, support groups, and online communities — like the ones at Reframe — can provide a safe space to share experiences, gain valuable insights, and develop coping strategies. A strong support network of understanding friends and loved ones is equally important.

Key Takeaways

Bipolar disorder can be a turbulent journey, and drinking can complicate matters. While alcohol may temporarily mask the hardship, it ultimately makes symptoms worse and hinders the path to wellness. 

Recognizing the connection between bipolar disorder and drinking is the first step toward breaking free from this cycle. By seeking professional help, understanding the underlying factors, and building a supportive network, those of us with bipolar disorder can navigate our emotions with resilience and hope. 

Remember: you are not alone on this journey — Reframe is here! Together, we can overcome the challenges and create a brighter future.