Individuals with clinically significant mood disorders such as depressive disorder and bipolar disorder are at risk of alcohol abuse and dependence. Periodic and problematic alcohol use such as binge drinking and alcoholism can sometimes be an indication of an underlying mood disorder.
Some people with mood disorders report using alcohol or other substances as a way to “self-medicate” the negative symptoms of their condition — either to diminish their high moods (mania or hypomania) or improve their low moods (depression). Unfortunately, the effects of substance use are unpredictable and can result in worsened symptoms.
Understanding Bipolar Disorder
Bipolar disorder is a chronic psychiatric disorder characterized by episodes of mania or hypomania that typically alternate with episodes of depression.
Three different types of bipolar disorder are clinically recognized, and each has individualized symptoms and experiences. The three types are Bipolar Type I, Bipolar Type II and Cyclothymic Disorder — and all require appropriate treatment to help the individual safely manage the cycles of mania or hypomania and depression.
Bipolar Type I is generally the diagnosis if in a 12-month period the individual has one or more manic episodes (or episodes that include mixed symptoms of mania and depression) that last at least seven days, and depressive periods that last about two weeks. For people with Bipolar Type II, the manic episodes are typically less pronounced and are termed “hypomania.” People with Type II typically have one or more major depressive episodes per year and at least one hypomanic episode.
Psychosis is a concern during manic cycles in people with Bipolar Type I, and hospitalization is sometimes necessary to treat and stabilize the patient. Hypomanic episodes in people with Bipolar Type II can be less pronounced, and are sometimes so subtle that they are overlooked or unreported. In people with Cyclothymic Disorder, which is characterized by numerous alternating periods of less pronounced of hypomania and depression, the episodes can last longer — sometimes 1-2 years, with severity sometimes increasing over time.
Bipolar Disorder and Hypomania
People who are experiencing a hypomanic episode are often unusually cheerful, have excessive energy and need little sleep. For people with bipolar disorder, hypomania can sometimes manifest as a pleasurable state that leads to a heightened sense of creativity and power, and other times it can manifest in behaviors such as increased energy and activity or agitation and heightened irritability.
While hypomania is not typically severe enough to lead to the functional impairments associated with more pronounced manic episodes, it is important to keep in mind that too much confidence may impair decision-making and blind one to associated consequences. Although hypomania is not considered to be as severe as mania, it can lead to serious repercussions, especially if the person suffers from a co-occurring substance use disorder. It is also important to keep in mind that episodes of hypomania or mania are followed by depressive episodes, which can put an individual at greater risk for suicide.
Facts and Stats
- The lifetime risk of suicide among individuals with bipolar disorder is estimated at 10% to 15%.
- More than 50% of people diagnosed with bipolar disorder have comorbid alcohol use disorders, which further increases the risk of suicide.
- Individuals with hypomania are 2.9 times more likely to meet the criteria for alcohol abuse/dependence than other people after adjusting for other factors. The relationship between hypomania and substance use outcomes does not vary by race/ethnicity.
- A 2004 study found that more than 25% of individuals who met the criteria for hypomania also had a substance use disorder.
A hypomanic episode is associated with a change in functioning uncharacteristic of the person’s normal behavior. An individual may be more productive or outgoing than they usually are, though this is not always obvious to the person, family members, friends and colleagues. Hypomanic symptoms are similar to manic episodes, but a person experiencing hypomania may not have symptoms extreme enough to cause problems at work or in social situations.
Hypomanic episodes typically last at least four consecutive days. During the period of mood elevation and increased energy and activity, three or more of the following hypomanic symptoms typically persist, representing a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., feels rested after only three hours of sleep)
- More talkative than usual
- Racing thoughts or flight of ideas
- Distractibility (e.g., attention easily drawn to unimportant or irrelevant external stimuli)
- Increased goal-directed activity (socially, at work/school or sexually)
- Excessive involvement in pleasurable activities with a high potential for painful consequences (e.g. uncontrollable shopping sprees, sexual indiscretions or foolish business investments)
Hypomania and Drinking
Drinking and substance use in people with bipolar disorder is not well understood, though experts think alcohol and other substances may be a coping mechanism people use in an attempt to manage early symptoms of manic, hypomanic and depressive episodes. According to research studies on bipolar disorder and substance abuse and dependence, hypomania is positively associated with the presence of alcohol abuse or dependence. Some study findings indicate that people with bipolar disorder consume their first alcoholic drink an average of 2.2 years earlier than those without the disorder.
Researchers believe that people with underlying bipolar disorder who have episodes of hypomania may alter their drinking behaviors as they experience a fluctuation in their moods. In other words, people who are cycling in and out of hypomanic episodes may not drink consistently. Over an extended period of time, for example, they may have a number of abstinent days that alternate with a pattern of binge drinking as their moods fluctuate. The alcohol use might be considered emotional drinking that coincides with mood instability.
More research is needed on the role of illicit substances as coping strategies for episodes of mania or hypomania in people with bipolar disorder. Limited studies have implied that substance use can precipitate hypomanic episodes, but more in-depth research is needed to prove or refute this theory.
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