Researchers followed 584 participants with bipolar I or II disorder

—Drinking more alcohol than usual can lead to worse mood symptoms and problems at work for people with bipolar disorder, according to a new study. 

Researchers at the University of Michigan followed 584 adults with bipolar I or II disorder over nearly two decades. Participants were surveyed every six months between 2006 and 2022. 

The researchers tracked alcohol use, symptoms of depression and mania, anxiety, and work performance. The findings were published June 7, 2024 in JAMA Network Open.

The study is noteworthy because about half of all people with bipolar disorder also struggle with alcohol use. It offers new insight into how alcohol and mood disorders interact — and challenges the common belief that people mainly drink to cope with symptoms.

The data showed that when participants drank more than usual, they were more likely to report worse depression and manic symptoms six months later. Participants also reported a decline in job performance.

Surprisingly, the study found that mood swings didn’t seem to cause people to drink more — it was the drinking that came first.

The researchers used well-established screening tools for alcohol use (AUDIT), depression (PHQ-9), and mania (Altman Self-Rating Scale). They analyzed data over time to observe how changes in drinking habits affected mental health and daily functioning.

People with bipolar II disorder were especially affected. 

Bipolar II is a mental health condition with mood swings that include depression and hypomania—a milder form of mania. Unlike Bipolar I, it does not include full-blown manic episodes. Hypomania involves elevated mood, increased energy, or irritability, but symptoms are less severe and don’t typically require hospitalization.

For the participants, even moderate increases in alcohol use were linked to more significant mood and work problems. However, alcohol use didn’t seem to affect anxiety levels.

“Patients with bipolar disorder may benefit from reduced alcohol consumption if their treatment goals included improving work functioning and/or reducing mood symptoms, complemented by other skills to prevent future problematic alcohol use,” the study says.

The findings suggest that health care providers should closely monitor alcohol use in patients with bipolar disorder — even if their drinking doesn’t qualify as an alcohol use disorder. Addressing alcohol habits early may help prevent mood episodes and workplace issues.

The researchers say that future studies should examine whether reducing or quitting alcohol improves long-term outcomes. They also say that routine bipolar treatment includes brief alcohol screenings to catch risks early.

Even small increases in drinking can have big consequences, the researchers said. Helping people manage their alcohol use may be one way to protect their mental health and daily lives.

Source: JAMA Network Open, June 7, 2024.

Submitted comment: It makes sense that reducing any mind-altering substance, including alcohol, would benefit a person suffering from bipolar disorder. Addiction is frequently a co-factor in the condition. Certainly any increases in abuse should be a red flag for hypomania or mania.

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