Doctors will commonly advise you to avoid alcohol while taking certain medications, particularly those used to treat mental health disorders. While it would be fair to assume that drowsiness is the main concern, there may be other, more serious consequences of mixing alcohol with bipolar drugs.
Whether you are a heavy or occasional drinker, alcohol can undermine your therapy and increase your risk of drug toxicity, side effects, and even suicide.
Bipolar Disorder and Alcohol Use
Bipolar disorder and substance use disorders often go hand in hand. According to a 2014 survey from the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorders occur more frequently in people with mental health disorders than the general population.
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
This is largely due to the fact that co-occurring conditions like substance abuse and bipolar disorder (BP) are often treated as a single problem rather than as separate entities. As such, symptoms suggestive of bipolar depression or mania may actually be related to a drinking problem and go untreated. The opposite also holds true.
According to an analysis of extensive research, no less than 30% of bipolar people met the clinical definition of substance abuse disorder (SUD). Of these, 42% were classified as having an alcohol abuse disorder (AUD). Cannabis abuse was seen in 20% of people with BP, followed by cocaine and methamphetamine at 11%. Men with BP were two to three times more likely to have AUD than women with BP.
Research published in the Journal of Affective Disorders concluded that alcohol abuse was the single most prevalent substance use disorder in people with bipolar I and bipolar II disorders.
Complications of BP and AUD
Alcohol abuse can complicate the management of bipolar disorder. Drinking impairs your judgment and makes you more impulsive and increases the risk of suicide, injury, hospitalization, and sexually transmitted infections like HIV. According to research, the risk for attempted suicide is nearly twice as high in people with BP and AUD as it is in those with BP alone.
Due to these inherent risks, it is best to abstain from alcohol completely if you have bipolar disorder. Not only can drinking make your BP symptoms worse, achieving sobriety may be far more difficult when faced with the dual diagnosis.
Moreover, the effect alcohol has on a person’s moods and judgment can make adherence to drug therapies all the more difficult, undermining the very goals of treatment.
Adverse Interactions
These following groups of psychotropic drugs used may have serious interactions with alcohol, ranging in severity from mild to life-threatening:
Group A: Anti-Anxiety and Sedating Drugs
This group of drugs includes benzodiazepines and certain prescription sleep aids such as:
- Ambien (zolpidem)
- Ativan (lorazepam)
- Klonopin (clonazepam)
- Lunesta (eszopiclone)
- Prosom (estazolam)
- Restoril (temazepam)
- Sominex (diphenhydramine)
- Valium (diazepam)
- Xanax (alprazolam)
Group B: Tricyclic Antidepressants
Tricyclic antidepressants are an older class of drug used to treat severe mood disorders and include:
- Anafranil (clomipramine)Elavil (amitriptyline)Norpramin (desipramine)
Group C: SSRI and SNRI Antidepressants
Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants include:
- Celexa (citalopram)
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Paxil (paroxetine)
- Prozac (fluoxetine)
- Zoloft (sertraline)
Group D: Atypical Antidepressants
Atypical antidepressants are a newer class of antidepressant which include:
- Desyrel, Oleptrol (trazodone)
- Remeron (mirtazapine)
- Serzone (nefazodone)
- Wellbutrin (bupropion)
St. John’s Wort, an herbal supplement believed to have antidepressive effects, is also included in this drug group and has many other potentially dangerous interactions.
Group E: Anticonvulsants
Anticonvulsants used as mood stabilizers in people with BP include:
- Lamictal (lamotrigine)Tegretol (carbamazepine)
Group F: Mood Stabilizers
Other commonly prescribed mood stabilizers include:
- Depakene, Depakote (valproic acid)Lithobid, Eskalith (lithium)
Group G: Antipsychotics
Examples of antipsychotics used in bipolar therapy include:
- Abilify (aripiprazole)Geodon (ziprasidone)Risperdal (risperidone)Seroquel (quetiapine)Zyprexa (olanzapine)
Possible Complications
A Word From Verywell
Some over-the-counter products, especially cough syrup and laxatives, may contain enough alcohol to interact with your medications. Ask your doctor or pharmacist if they are safe to use.
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
Hunt GE, Malhi GS, Cleary M, Lai HMX, Sitharthan T. Journal of Affective Disorders. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis. 2016 Dec(206):331-349. doi:10.1016/j.jad.2016.07.011
Tolliver BK, Anton RF. Assessment and treatment of mood disorders in the context of substance abuse. Dialogues Clin Neurosci. 2015;17(2):181-90.
National Institute on Alcohol Abuse and Alcoholism. Harmful Interactions: Mixing Alcohol with Medications. Washington, D.C.: National Institutes of Health. U.S. Department of Health and Human Services.
Substance Abuse and Mental Health Services Administration (SAMHSA). An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders. Rockville, Maryland: SAMHSA Advisory. Summer 2016;15(2); HHS Publication No. (SMA) 16-4960.
By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.
