Bipolar Depression and Alcohol Abuse: Do They Make Each Other Worse?

Living with bipolar disorder is like existing on extreme ends of an emotional spectrum with few moments balanced in the middle.  Unfortunately,  bipolar depression and alcohol abuse often co-occur as people attempt to self-medicate for their mental health issues. 

More than 5.7 million people (about 2.6% of the entire population) struggle with the condition, well acquainted with its extreme, often unpredictable highs and lows that can disrupt everything from one’s relationships to one’s success at school or work, diminishing your overall well-being and quality of life.  

What ultimately is the connection between bipolar depression and alcohol abuse? Is one an exacerbating influence on the other? The truth is that while bipolar depression and alcohol abuse can go hand in hand, addressing — and treating — both simultaneously can open the doors to healing and recovery. 

Understanding Bipolar Depression 

To connect the dots linking bipolar depression and alcohol, what is bipolar disorder, its signs and symptoms, and what role does depression play in it? In essence, bipolar disorder involves much more than just feeling up or down — in fact, as a chronic mental health condition, it can affect different people in different ways. 

What is Bipolar Disorder? 

Bipolar disorder is classified as a mood disorder and personality disorder because of the intense mood swings that define it: mania, or emotional highs, and hypomania, or depression.  

Bipolar disorder sufferers experience major fluctuations in their mood, ranging from euphoria to severe depression, tempered by periods of normal mood. These up-and-down states can run the gamut from over-excitement and hyperactivity to low periods of profound unhappiness or despondency, plus changes to their energy levels, thinking, and behavior.

Bipolar episodes can last as short as a few hours and as long as days, weeks, or even months, according to the Cleveland Clinic, making work, daily tasks, and experiences much more difficult — a sense of detachment from oneself that can create distress for someone’s family or loved ones. 

Bipolar disorder was formerly known as manic depression, but medical and psychiatric professionals have intentionally stopped using this label; one, to minimize the stigma of the word “mania” wrongly associated with “maniac,” and two, to better differentiate the manic and depressive elements of bipolar disorder, a very complex condition. 

Signs and Symptoms of Bipolar Depression 

The symptoms of bipolar disorder can vary widely from person to person, but they generally fall into two categories: manic episodes and depressive episodes. These two extremes define the condition where someone can experience wildly divergent states of mood drastically different from their usual behavior. 

Mania is characterized by several signs: 

• A persistently elevated or overly irritable mood 

• Increased energy and hyperactive behavior 

• Racing thoughts or frequently jumping from one idea to another 

• Speaking unusually fast or excessively 

• Impulsive decision-making, often without considering the negative consequences 

• Difficulty staying focused; becoming easily distracted 

• A reduced need for sleep without feeling tired 

• Inflated self-esteem or a sense of grandiosity 

The manic side of bipolar disorder can also lead someone to engage in risky behaviors that can endanger others, like excessive spending or gambling, unsafe sexual activity, reckless driving, or other impulsive actions. Mania may also trigger psychosis or a detachment from reality that can include hallucinations or delusions not unlike symptoms seen in schizophrenia. 

On the other end of the spectrum are major depressive episodes, which represent the low points of bipolar disorder and can severely impact one’s day-to-day functioning: 

• Persistent sadness or feelings of hopelessness 

• Loss of interest or pleasure in once-enjoyed activities 

• Significant changes in sleep patterns or appetite — either too much or too little 

• Chronic fatigue or low energy levels 

• Restlessness or slowed physical and mental movements 

• Difficulty concentrating or making decisions 

• Overwhelming feelings of guilt or worthlessness 

• Thoughts of death or suicide 

The Link Between Alcohol and Bipolar Depression 

For many people, alcohol may seem like a natural response to the vacillating beats of bipolar disorder — a way to cope, take the edge off,f and seek some emotional normalcy. But no matter how well-intentioned, making this attempt to “fix” depression by drinking can create a toxic, spiraling cycle that’s hard to break. 

Still, there are reasons deeper than that. The Brain & Behavior Research Foundation notes a clear link between bipolar depression and alcohol abuse. “Both conditions,” notes the foundation, “are harmful on their own, but when they happen together, the problems can be even worse.”    

Even still, the interactivity between alcohol and bipolar disorder still isn’t clearly defined, even though there are clear-cut theories as to why both share a common, if complex, connection. 

Why Do People with Bipolar Depression Turn to Alcohol? 

It’s important to look at some of the precursors to bipolar depression and alcohol to understand the reasons one with clear-cut depressive symptoms may drink. 

The Mayo Clinic notes that genetics can play a role in whether someone is predisposed in their brain chemistry to develop bipolar disorder — not to mention that neurologically, some people are more genetically prone to respond differently to alcohol and drugs, which can raise the risk of using and becoming addicted to substances. 

The manic effects in people with bipolar disorder can lead to the pursuit of alcohol. “They can be too self-confident, talk a lot more, have racing thoughts, and become distracted,” says the Mayo Clinic. “This can lead to bad judgment. People with mania are more likely to do things they usually wouldn’t do. This also can lead to more alcohol use or drug misuse.” 

And because alcohol is legal and readily available, it becomes an easy, accessible substance that someone with bipolar depression may be more likely to misuse and abuse as a way to self-medicate and ease their symptoms — posing negative effects of alcohol on bipolar symptoms. 

Statistics on Co-Occurring Alcohol Use and Bipolar Disorder 

The prevalence of co-occurring bipolar depression and alcohol abuse is high and more common than it might appear. According to the Brain & Behavior Research Foundation, approximately half of people with bipolar disorder also struggle with alcohol abuse problems. 

According to a study from the National Institutes of Mental Health, among people with bipolar I disorder (defined primarily by the presence of manic episodes), 61% had a lifetime history of drug or alcohol abuse, with 46% of them having an alcohol use disorder.  

Then, there are risk factors for those with bipolar depression developing a co-occurring substance abuse problem. “Research suggests that from 30 percent to more than 50 percent of people with bipolar disorder will develop a substance use disorder sometime during their lives,” notes the Substance Abuse and Mental Health Services Administration.