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Doc, can I have a drink?

The research is out there – if you suffer from a mood disorder (depression or bipolar disorder) and you drink alcohol – it can affect your mood stability.

Alcohol been shown tobottles_of_beer

  • Increase episodes of mood disturbances
  • Worsen the intensity of mood disturbances
  • Cause a relapse of symptoms

What does alcohol do to the brain?

Alcohol enters the body via the stomach and is absorbed and transported in the blood to the brain (amongst other organs). In the brain, it affects various neurochemicals – particularly in a way that causes euphoria (happiness), slowed thinking, sleepiness and disinhibition. This is a good explanation of what alcohol does to your body. For a slightly more scientific view have a look at one of favorite sites – where you can see how the alcohol works in the brain.

So Doc, can I have a drink?

It’s sometimes hard to explain to patients who have mood disorders, when they ask – Can I have a drink?

There is often no simple answer.

My answer is generally – ‘It depends’ and I consider the following things

  • Is your mood is affected by having a drink or two?
    • Not everyone gets affected – but I would say that about 75 % of my patients would report some change in their mood after having a few drinks. Some report terrible hangovers, terrible anxiety and or agitation the next few days. I do think if you are Bipolar you are more sensitive to any substance that works in your brain.
  • How is general current state of mind?
    • There is a difference in my mind between patients who have been stable for long period, and who have an occasional drink at a social occasion, and patients who are in / or have recently recovered from a high or low episode.
  • Are you able to just have one or two drinks and stop after that?
    • I think you know the answer then. No. I wouldn’t advise it.
  • Have you recently been unwell?
    • If you have just recovered (at least in the last six months) from a depressive or manic/hypomanic episode. I am personally advise avoiding alcohol completely. The risk of another relapse is high during this time. Additionally it is hard for yourself and your doctor to discuss your response to medication or the course of your mood difficulties, when you have had a recent binge, or even a ‘few’ drinks most nights.
  • How is your mood at the moment?
    • If you are currently depressed or have a higher mood than normal. If you start drinking, you will be more tempted than normal to drink an excessive amount to take away/enhance your emotions and feelings.
  • Are you an addict ?
    • Have you had an issue with alcohol (drugs, gambling, shopping) before, are you never able to stop after one or two drinks? If that category fits you – my advice is to stay away completely.
  • Does alcohol use trigger you to take drugs?
    • Some people find when they drink even one or two drinks, it is a trigger for them to find and use drugs. If that fits you, I think you understand why you would need to stay away from alcohol completely. Many of patients have told me after one or two drinks if drugs are available they will use them without too much thought.
  • What medications are you on?
    • The liver metabolizes most psychiatric medications and alcohol. Alcohol may affect the functioning of medications.
    • Alcohol with sleeping or calming tablets.
      • Benzodiazepines or sleeping tablets – this can be very dangerous when combined with alcohol. Both affect the same chemical receptors in the brain. If these receptors are activated too much, they can slow down breathing rates and decrease your level of awareness. Many ‘accidental’ overdoses involve a combination of alcohol / drugs and prescribed medications. You need to discuss this with your doctor.

Does it really help your moods and emotions if you abstain from alcohol use?

From what I have seen, yes it does. Some people find it difficult in the beginning without alcohol since they have been using it to self-medicate for a long time. When the alcohol is removed- your emotions become more apparent. So in the short term, it can be hard, but in the long term patients markedly see the benefits. I have seen patients stabilize with little or no change to medication – when they stop any use of drugs or alcohol.

My own thoughts

I struggle to medicate patients who are drinking consistently, and report that they are not sleeping or that they feel terribly depressed or tired all the time. Psychiatric medications are useful, but they can lose their effectiveness when they are working against to a substance like alcohol. It doesn’t make sense to me to add another drug (specifically a sedating one or a stimulant) to the mix, when individuals are not planning to stop drinking. Treating an underlying mood disorder is needed e.g. with a mood stabilizer or antidepressant is useful, but won’t help entirely while you are still drinking.

Please speak to your treating doctor if you have questions about how alcohol specifically affects you.

Take Care,

Dr M

A useful link – Alcohol, Drugs and Bipolar Disorder