How Mixing Mood Stabilizers and Alcohol Impacts Your Mental Health

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Mood Stabilizers and Their Uses

Neurotransmitters are chemicals in the brain that help to regulate our mood, sleep, appetite, attention and stress responses. Mood stabilizers work by modulating the release and stability of certain neurotransmitters in the brain.

What Do Mood Stabilizers Treat?

Mood stabilizers are primarily used to treat bipolar disorder, but they also treat schizophrenia and major depression.

Bipolar disorders are characterized by extreme mood swings, from depressive lows to mania. Mania refers to a period where your mood is at such an intense level that you experience symptoms such as extreme irritability, rapid speech and flight of ideas. In this state, people often engage in high risk behavior such as extensive shopping sprees, gambling large amounts of money or unsafe sexual activity. During depressive states, individuals may experience low motivation or energy and lose interest in socializing or doing activities that they would normally enjoy.

Although they can be helpful in the treatment of schizophrenia, they are not considered a first line treatment. Schizophrenia is primarily treated with antipsychotic medications. In major depression, mood stabilizers may be used if symptoms are resistant to traditional antidepressants.

What Mood Stabilizers Are Typically Prescribed?

Lithium, a mood stabilizer, is considered the gold standard for the treatment of bipolar disorder. In addition, anticonvulsant and antipsychotic medications have mood regulating properties.

Anticonvulsants used as mood stabilizers include:

Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Valproic acid (Depakote)

Antipsychotic medications used as mood stabilizers include:

Olanzapine (Zyprexa or Lybalvi)
Quetiapine ( Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Lurasidone (Latuda)
Asenapine (Saphris)
Lumateperone (Caplyta)
Cariprazine (Vraylar)

The Effects of Alcohol and Mood Stabilizers

If you have bipolar disorder, scientists advise avoiding alcohol because it can worsen manic or depressive episodes. In addition, if you drink while taking these medications, the effects of both alcohol and these drugs are intensified.

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When Anticonvulsant Medications and Alcohol are Combined

Anticonvulsants, like alcohol, cause sedation by increasing inhibitory transmitters such as glycine and gamma-aminobutyric acid (GABA), which slow down brain activity. The combination of alcohol and anticonvulsants can lead to over sedation, overdose and have life threatening consequences. You should speak with your medical provider before consuming any amount of alcohol while taking an anticonvulsant. The safest practice would be to refrain from drinking altogether.

Drinking alcohol also reduces the strength of any prescribed anticonvulsant, making it less effective.

Additionally, alcohol may increase the side effects of anticonvulsants. Some common side effects of anticonvulsant medications may include:

Fatigue
Dizziness
Blurred vision
Upset stomach
Nausea
Urinary retention
Sexual dysfunction
Problems with memory, attention, or concentration

Carbamazepine, a commonly used anticonvulsant, also comes with these rare but dangerous side effects:

Low white blood cells: impairs the immune system
Aplastic anemia: impedes new blood cell creation
Stevens-Johnson syndrome: flu like symptoms followed by a painful rash that spreads and blisters
Toxic epidermal necrolysis: peeling and blistering of the skin

If you or a loved one experiences any of these side effects, it is critical to seek immediate medical attention as soon as possible.

Mixing Antipsychotic Medications and Alcohol

While mood stabilizers are not generally addictive, people have reported misusing antipsychotics with alcohol. When used together, the effects of both substances are enhanced. You should never use alcohol and antipsychotics together without speaking with a medical provider first.

Side effects of antipsychotics are generally temporary, but they can be exacerbated by alcohol. These side effects include:

Drowsiness
Dizziness
Dry mouth
Blurred vision
Muscle stiffness
Mild tremors
Restlessness
Increased appetite or weight gain
Sexual difficulties

The Effects of Alcohol with Lithium or Valproic Acid (VPA)

Side effects of mood stabilizers and alcohol, specifically regarding lithium or valproic acid (VPA), include:

Upset stomach
Appetite loss
Irregular bowel movement
Drowsiness
Dizziness
Tremors
Muscle pain
Joint pain
Depression
Liver damage
Higher risk for side effects such as restlessness and loss of motor control

Additionally, drinking alcohol while taking lithium can lead to toxic amounts of lithium in your blood. This is due to a decrease in the ability of the kidneys to excrete the drug when combined with alcohol. Furthermore, chronic alcohol use can lower the effectiveness of lithium, potentially causing future depressive episodes.

Persons Who Risk Severe Side Effects of Mood Stabilizers and Alcohol

Some groups are at an elevated risk of experiencing severe side effects from combining mood stabilizers and alcohol. For these individuals, avoiding certain mood stabilizers or alcohol is highly advisable. If in doubt, always consult your medical provider before using these substances together.

Older Adults

Tolerance for alcohol in the body decreases with age. As a result, you can feel the effects of alcohol more quickly. Therefore, combining alcohol and mood stabilizers could increase the risk of accidents and falls, leading to serious injuries.

Those Assigned Female at Birth

Even after adjusting for differences in body weight, females have higher blood alcohol levels when drinking the same amount as males. This is because females have more body fat and a lower amount of water in their bodies when compared to men. Additionally, alcohol is metabolized more slowly by women, so it stays in their bodies longer, leading to a potential for serious side effects.

Those Who are Pregnant

If you are pregnant, valproic acid (VPA) can damage the fetus, causing congenital malformations and cognitive and behavioral impairments. This risk is greater if you combine VPA with alcohol.

Those With Urea Cycle Disorder

If you have urea cycle disorder, a genetic disorder that causes ammonia buildup in your bloodstream, you should avoid taking VPA and other anticonvulsants altogether. This is because a side effect of VPA is a further increase of ammonia in the blood that could lead to brain damage, coma, or death.

Those With Loss of Liver Function

Scientists advise using VPA with caution if you have liver damage. Taking this medication could put even more stress on your liver.

What to Do if You Mix Mood Stabilizers and Alcohol

Accidentally drinking alcohol when taking a mood stabilizer can happen, especially if you have started taking the medication recently. If this occurs:

Inform your provider that you have inadvertently drunk alcohol
Ask your doctor about potential side effects that you should watch out for
Ask your provider about what you should do if those side effects occur
Inform your provider of any side effects you experience in general from either your mood stabilizer or from mixing it with alcohol

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Management of Co occurring Alcohol Use Disorder and a Psychiatric Disorder

Studies indicate that people with bipolar disorder have between a 30%-50% of developing a substance use disorder at some point in their lives. This risk is higher for men than for women. Individuals with schizophrenia have a 50% lifetime risk of developing a co occuring substance use disorder, with alcohol and cannabis being the most commonly abused substances.

Experts recommend treatment that integrates both medication and therapy. Therapy can help you adhere to your medication regimen and reduce your alcohol use. Both help to reduce your psychiatric symptoms.

Medication Treatment

If you have AUD along with another psychiatric disorder, such as bipolar disorder, major depression or schizophrenia, taking a mood stabilizer could help reduce your alcohol use as well as balance your mood. Additionally, abstaining from alcohol can increase your likelihood of reducing your psychiatric symptoms.

Given the consequences of mixing alcohol and mood stabilizers, there are some things that your provider might do to lower the associated risks and side effects. These can include adjusting your dose, changing your medication and adding other medications to your regimen.

Therapeutic Treatments

In addition to mood stabilizing medication, therapy is an important component in the treatment of AUD and co occuring disorders. Researchers have found that cognitive-behavioral therapy (CBT) coupled with motivational interviewing (MI) was effective in decreasing both depressive symptoms and alcohol consumption.

MI works to help you sort through your conflicting feelings about alcohol use. By doing this, you slowly gain a greater desire to reduce your use. CBT is a commonly used, evidenced based strategy that helps you to examine how your thought processes are linked to your emotions and behaviors. CBT enables you to change your thoughts to experience more positive emotions and utilize healthier coping strategies.

If you are concerned about your ability to control alcohol use while taking mood stabilizers, please call 800-948-8417 Sponsored for 24/7 help. Our specialists can help you find treatment providers.