Bipolar Disorder

Addiction often coincides with other mental health conditions; this overlap is referred to as dual diagnosis.  People who suffer from schizophrenia, depression, post-traumatic stress disorder, and bipolar disorder may develop an addiction as a form of self-medicating problems that they often do not realize can be easily treated by a psychiatrist or other mental health practitioner.  This article discuss the specific considerations related to addiction and bipolar disorder.

What is Bipolar Disorder?

As the name suggests, patients with bipolar disorder fluctuate between two mood states: depression and either irritability or general well-being.  There are three types of bipolar disorder.  Patients with type I have experienced at least one past episode of mania as well as major depression.  Mania is characterized by an extremely positive mood (almost euphoria) and decreased sleep.  During a manic episode (which should last a week as part of official diagnostic criteria), a patient may be disinhibited, aggressive, hypersexual, and even psychotic (i.e., out of touch with reality). They may make comments about racing thoughts, be easily distractible, and be more inclined to use substances or engage in behaviors that they would not otherwise consider.  If a person experiences less intense manic episodes (i.e., hypomania), a diagnosis of bipolar disorder type II may be made.  A third form is cyclothymia; people with this condition may be misdiagnosed with depression.  Individuals with this type of bipolar disorder alternate between periods of mild depression and hypomania.

The causes of bipolar disorder are not completely understood.  Manic episodes can be triggered by major life events like giving birth as well as by substance abuse, going without sleep for extended periods of time, and certain prescription drugs such as steroids or antidepressants. 

The Relationship Between Bipolar Disorder and Addiction

The connection between these two conditions depends on whether the patient is in a manic or depressive phase.  During a manic phase, the person may feel invincible, exhibit little self-control, and willingly engage in dangerous, reckless behaviors that, at other times, they never would have considered.  This may include excessive drinking, drug use, and/or binge eating.  Originating from the mania and often exacerbated by substance use, they may not consider the potential consequences of taking risks in sexual encounters, and they may max out their credit cards.  During the depressed phase (as for someone who suffers from depression), the person may use drugs or behaviors as a type of coping mechanism.  The combination of depression and substance use put people with bipolar disorder at an elevated risk for suicide attempts compared to the general population.

Treating Bipolar Disorder and Addiction

Bipolar disorder is commonly treated with mood-stabilizing medicines such as Lamotrigine, Carbamazepine, Lithium, or Valproate.  If these are not effective, anticonvulsants (i.e., medicines to prevent seizures) are attempted next. Benzodiazepines and antidepressant prescription medicines  as well as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) may also be used depending on the severity of symptoms and effectiveness of other options.  When addiction co-occurs, doctors will avoid prescribing addictive medications and will encourage the patient to participate in psychotherapy to learn healthy coping strategies for dealing with stress and periods of depression.