Manic Depression and Alcoholism: Prevalence, Risks, and Treatment

Manic depression–also known as bipolar disorder–and alcoholism often co-occur. Learn more about how the co-occurring disorder can affect treatment plans.

Depression and alcoholism are often co-occurring disorders. Those who enter treatment facilities for alcoholism often score high on tests for depression, while those who enter treatment for depression often use alcohol to self-medicate. This co-occurring disorder is regularly treated with Naltrexone or Acamprosate, which help with substance cravings during withdrawal, and selective serotonin reuptake inhibitors (SSRIs), which treat depression.

However, manic depression (commonly known as bipolar disorder) is a much different animal. When it co-occurs with alcoholism, the medicinal treatment for depression is not enough. Even so, treatment and management are possible.

First, though, the two illnesses must be fully understood.

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder characterized by changes among:

1. Mania: A period of high energy, euphoria, impulsivity, and/or irritability,
2. Depression: A period of lethargy, trouble sleeping and/or sleeping too much, weight gain or loss, feelings of worthlessness, avoiding activities that are normally enjoyable, and/or thoughts of self-harm or suicide,
3. Anxiety: Periods of tension, worry, intrusive thoughts, high blood pressure, avoiding certain situations, and/or physical symptoms such as shaking, sweating, rapid breathing, etc., and
4. Normal moods

Bipolar I is the most severe. In this case, manic episodes last for a week or more and/or are so intense that they require a hospital visit. Depressive episodes last for about two weeks at a time, and mixed episodes of mania and depression are also possible.

With bipolar II, depressive episodes still occur, but mania is replaced with hypomania, a condition nearly identical to mania, except for the fact that hypomania does not last as long or require hospitalization.

Cyclothymic disorder is characterized by multiple hypomanic episodes and depressive symptoms over a period of years, but the symptoms aren’t severe enough for a diagnosis of either bipolar I or II.

Related Topics:
Treatment for mania
Hypomanic treatment

What is alcoholism?

Alcohol dependence (commonly called alcoholism) can be diagnosed by noting the following symptoms:

• Craving alcohol, possibly to the point of physical dependence
• Being unable to control alcohol intake
• An increased tolerance to alcohol

Alcohol abuse, on the other hand, impairs one’s ability to function at work or school. It involves dangerous alcohol-related situations and/or legal problems and is marked by deteriorating social relationships as a result of drinking.

How do bipolar disorder and alcoholism interact?

Bipolar disorder and alcoholism co-occur more often than alcoholism and depression. In fact, 27.6% of people with any kind of bipolar disorder also experienced alcohol dependence and 16.1% experience alcohol abuse.

While the reason for this level of co-occurrence is unknown, there are several theories.

• People with bipolar disorder may be genetically at risk for alcohol dependence and/or abuse.
• Alcohol dependence and/or abuse could cause symptoms of bipolar disorder.
• Withdrawal from alcohol could cause symptoms of bipolar disorder.
• During manic episodes, alcohol use could either increase the “high” of mania.
• During episodes of anxiety, alcohol could be used to dull the symptoms.

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).

What are the negative effects?

When bipolar disorder and alcoholism co-occur, people go to the hospital more often, bipolar disorder comes forward earlier in life, cycling between depression and mania happens more quickly, and mixed episodes are more common.

Compared to patients with “pure” depression or mania, 13% of patients with bipolar disorder had co-occurring alcoholism. That substance disorder impaired their recovery from mental illness.

What can be done?

Several medicinal treatments are available for co-occurring bipolar disorder and alcoholism, including:

• Depakote, an anticonvulsant used for mood stabilization, which has proven effective in the treatment of bipolar disorder and has shown promise in trials with co-occurring patients (all patients remained sober during the trial). However, since Depakote can damage the liver, this course of treatment should be monitored with liver function tests.
• Naltrexone can be safely used with bipolar patients as with depressed patients to reduce cravings for alcohol during withdrawal.

Different studies have also shown that treating alcoholism first and then moving onto treating bipolar worked more effectively than treating bipolar first, then treating alcoholism, so pursuing sobriety with the help of Naltrexone could be a good first step, followed by treatment with Depakote.

Other therapeutic interventions, such as integrated group therapy, Alcoholics Anonymous, and cognitive behavioral therapy have also proven effective at treating both sides of the co-occurring disorder, although only if attendance was regular.

Recovery is possible

It should be noted that patients with co-occurring bipolar disorder and alcoholism fared better in substance abuse treatment than patients with co-occurring depression and alcoholism or those who suffered from alcoholism alone, and there are many resources, including inpatient detoxification, inpatient or outpatient therapy, group help, and medications to help treat and manage co-occurring bipolar disorder and alcoholism.

Regardless of the prevalence of these two issues occurring at once, or the difficulties they may present, help is out there. Now go ahead and get the life that’s rightfully yours: free from substance use and the difficulty of mental illness symptoms.

By – Liz Lazzara

Liz Lazzara is a freelance writer and editor living and working in Boston, MA. Read more