Knowledge of the psychiatric illnesses that run in the patient’s family also may enhance diagnostic accuracy. For example, men and women with alcohol dependence and independent major depressive episodes have been found to have an increased likelihood of having a family history of major mood disorders (Schuckit et al. 1997a). Similar findings have been obtained for alcohol-dependent bipolar patients (Preisig et al. 2001). Thus, a family history of a major psychiatric disorder other than alcoholism in an individual may increase the likelihood of that patient having a dual diagnosis. Several studies found that approximately 60 percent of alcoholics who experience a major depressive episode, especially men, meet the criteria for an alcohol-induced mood disorder with depressive features (Schuckit et al. 1997a; Davidson 1995).
- Without treatment, bipolar disorder can severely impact your personal life.
- These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
- The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.
- The importance of continued followup for several weeks also is supported by empirical data showing that most major symptoms and signs are resolved within the first 4 weeks of abstinence.
- This characteristic distinguishes them from the major independent psychiatric disorders they mimic.
Women with depression are also more likely to engage in binge drinking. The “burst” of energy from alcohol can be a welcome relief against some symptoms. For example, alcohol may temporarily reduce anxiety and lower inhibitions.
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. By Geralyn Dexter, PhD, LMHC
Geralyn Dexter, PhD, LMHC, is a mental health counselor based in Delray Beach, Florida, with a focus on suicidal ideation, self-harm, help-seeking behavior, and mood disorders. In certain cases, psychosis with delusions or hallucinations can occur in people with bipolar disorder.
How do bipolar disorder and alcoholism interact?
When evaluating the likelihood of a patient having an independent psychiatric disorder versus an alcohol-induced condition, it also may be helpful to consider other patient characteristics, such as gender or family history of psychiatric illnesses. For example, it is well established that women are more likely than men to suffer from independent depressive or anxiety disorders (Kessler et al. 1997). Although heavy, prolonged alcohol use can produce psychiatric symptoms or, in some patients, more severe and protracted alcohol-induced psychiatric syndromes, these alcohol-related conditions are likely to improve markedly with abstinence. This characteristic distinguishes them from the major independent psychiatric disorders they mimic. Bipolar I disorder is a mental health illness in which a person has major high and low swings in mood, activity, energy and ability to think clearly. To be diagnosed with bipolar I disorder, you have to have at least one episode of mania that lasts for at least seven days or have an episode that is so severe that it requires hospitalization.
While you might feel like you no longer need meds, when the episode is over, stopping meds can have unpleasant side effects. An effective treatment plan for bipolar disorder is often a combo of medication and psychotherapy. 1The DSM–IV classifies mental disorders along several levels, or alcohol addiction and abuse axes. In this classification, axis II disorders include personality disorders, such as ASPD or obsessive-compulsive disorder, as well as mental retardation; axis I disorders include all other mental disorders, such as anxiety, eating, mood, psychotic, sleep, and drug-related disorders.
You can also use the Substance Abuse and Mental Health Services Administration’s online Behavioral Health Treatment Services Locator to search for facilities that provide dual diagnosis/co-occurring disorders treatment. Craving, or the pathological desire to seek out and use substances, is a core
symptom of alcohol and drug addiction (1,
2). Cravings, which can vary in frequency,
duration and intensity, are characterized by psychological distress and
physiological reactivity and commonly manifest when experiencing new cafe opens in germantown to support those who are recovering stress/negative
affect or when exposed to conditioned drug cues (2–7). Obsessive thinking
about drug use, and the craving which accompanies it, can seriously impair
functioning and place the addicted individual at risk for continued substance use
and relapse (2, 7). By Nancy Schimelpfening
Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.
MeSH terms
Consistent with the generally negative results of these family type studies are the conclusions drawn from a recent study of 1,030 female-female twin pairs (Kendler et al. 1995). The researchers concluded that the genetic influences important in alcoholism appear to be relatively specific for that disorder and did not significantly alter the risk for additional psychiatric disorders, including major depression and major stages of alcoholism anxiety disorders. Another twin study by Mullin and colleagues1 showed no increased risk for anxiety disorders in identical twins of alcoholics with the exception of conditions (e.g., anxiety) that might have resulted from the alcoholism in the person’s twin. Moreover, an appropriate medical evaluation may also be prudent to ensure that mood symptoms are not the result of reversible medical issues such as hypothyroidism.
Bipolar Disorder vs. Manic Depression
This method not only ensures the most accurate chronological reconstruction of a patient’s problems, but also, on a therapeutic basis, helps the patient recognize the relationship between his or her AOD abuse and psychological problems. Thus, this approach begins to confront some of the mechanisms that help the patient deny these associations (Anthenelli and Schuckit 1993; Anthenelli 1997). Early signs (called “prodromal symptoms”) that you’re getting ready to have a manic episode can last weeks to months.
Alcoholism with Comorbid, Independent Psychiatric Disorders
Therefore, unless there is ample evidence to suspect the patient has an independent psychiatric disorder, a 2- to 4-week observation period is usually advised before considering the use of most psychotropic medications. Problems can develop in your social life, work/school functioning and home life when you have symptoms of mania, which include mood swings and an abnormal level of energy and activity. You may require hospitalization if you have severe hallucinations or delusions, or to prevent you from harming yourself or others.
These aren’t usual “ups and downs.” When you feel “up,” you may have extreme joy or crankiness and so much energy that you don’t want to sleep. During your “down” times, you may feel sad, hopeless, or have thoughts of suicide. A recent report from the Collaborative Study on the Genetics of Alcoholism (COGA) focused on 591 personally interviewed relatives of alcohol-dependent men and women (Schuckit et al. 1995).
In a 5-year followup study, Winokur and colleagues (1995) evaluated a group of bipolar patients with and without alcoholism. In the alcoholic patients, bipolar illness and alcoholism were categorized as being either primary or secondary. The patients with primary alcoholism had significantly fewer episodes of mood disorder at followup, which may suggest that these patients had a less severe form of bipolar illness. 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. With a combination of things — good medical care, medication, talk therapy, lifestyle changes, and the support of friends and family — you can feel better.
Electrical currents can be safely used to change your brain chemistry and improve your symptoms. ECT is often an option when you haven’t gotten better with other types of treatment. CBT can teach you ways to modify your thoughts and behavior to feel better and help you avoid misusing alcohol.
Unfortunately, it’s common for people living with bipolar disorder to face a lack of understanding, negative beliefs, and discrimination. That can start to affect your quality of life and how you interact with other people at work, school, and in your personal life. While mania is the main symptom of bipolar I disorder, bipolar II has less intense periods known as hypomania. These “high” periods might not disrupt your work or personal life and don’t include delusions or hallucinations.
The condition is manageable with medications, talk therapy, lifestyle changes and other treatments. Many of the symptoms you may have during manic or depressive episodes can look like signs of other mental health conditions including anxiety, ADHD (attention deficit hyperactivity disorder), autism, and depression. Fortunately, several important ongoing studies will help answer some remaining questions regarding the treatment of coexisting depressive or anxiety disorders in the context of alcoholism. The COGA investigation will gather more data regarding potential alcoholic subtypes and will continue to explore possible genetic linkages between alcohol dependence and major depressive and major anxiety disorders.
Thus, valproate appears to be a safe and effective medication for alcoholic bipolar patients. The researchers found that patients in the complicated group had a significantly earlier age of onset of bipolar disorder than the other groups. They also found that the complicated and secondary groups had higher rates of suicide attempts than did the primary group. Preisig and colleagues (2001) also reported that the onset of bipolar disorder tended to precede that of alcoholism. They concluded that this finding is in accordance with results of clinical studies that suggest alcoholism is often a complication of bipolar disorder rather than a risk factor for it. There is also the possibility that bipolar disorder and alcohol use disorder symptoms will present concurrently, which adds a level of complexity with diagnosis.
