Depression, Bipolar Disorders and Alcohol

Michael is 30 years old. He works full time. He was diagnosed 6 months ago with Bipolar II. He is working with a psychiatrist and is feeling more stable in that his moods do not fluctuate as much, he is feeling less depressed and anxious, and more capable of staying focused at work.

And he goes out with friends a couple of times per month and drinks multiple shots of tequila.

Joann is 27. She has been struggling mightily with depression. Antidepressants seem to be mostly working. Her mood is much better. Her activity level has increased.

Joann likes to have several glasses of wine with dinner throughout the week.

It would be beneficial to greatly reduce or eliminate alcohol use…

This is the standard recommendation to people working with mood disorders in general and especially those who are taking medication.


*This is my social life, this is what people my age do.
*I have always had wine with dinner, it can’t possibly be effecting me.
*I have already missed or given up so much, you are not taking this away from me.
*It relaxes me and helps me to sleep.
When the topic of alcohol comes up it is often met with resistance, and sometimes outright anger. It can be hard to imagine being with friends and not having alcohol. The associations can be strong that alcohol produces pleasure or connection or relief. Drinking as self medicating may have been part of a survival strategy prior to seeking more effective recovery tools.

What is true.

Alcohol is a depressant, so fundamentally it is working against medication.

Although there is an initial relaxation that comes with drinking, it disrupts sleep.

As we know, good sleep is a major foundation for mood disorder recovery.

Cost vs. Benefit

For Michael and Joann our discussions about alcohol were ongoing over a period of months. My request to them was to pay attention not only when they drank but the days afterward and to do the same when they did not drink for periods of time.

Michael noticed that he in his words, drank more than he needed to when out with friends. That is, he drank without awareness. As he began to pay closer attention, he had no trouble slowing down and reducing his intake. He also noticed that when he did drink heavily he was foggy and irritable for days afterward. In a word, he felt more unstable.

Joann initially was angry about even considering changing her habits. Her wine was a ritual and a deeply imbedded part of her life. Grudgingly, she agreed to examine what this ritual meant to her, how it manifested each day. The first thing she acknowledged it was that the minute she came home from work she would pour herself a glass of wine. This drink represented destressing from the work day. She usually felt frazzled and edgy when she got home. As Joann looked more deeply into her alcohol consumption, she realized that most of the time she wasn’t consciously tasting or enjoying it. It was like a holiday that had lost its original meaning. And Joann did notice that most nights after she had several glasses of wine, she would toss and turn for part of the night and feel tired and unfocused at work.
Michael and Joann continued to explore and experiment with their alcohol use. Frankly, they were not willing to just let it go. Drinking with friends had been something that made Michael feel like a part of his group, normal. And for Joann, at least in the short run, the wine numbed out some of her loneliness and despair.

Joann occasionally has a glass of wine. Her new parameters are that she buys a good bottle of wine and has one glass with friends. Michael has recognized that hard liquor is hard on him and has gradually been able to socialize without drinking. He also has discovered that hiking, climbing and biking with friends is much more satisfying to him than a night of drinking.


Drinking alcohol can be a part of one’s social life and habit. It can be useful to explore the beliefs associated with drinking. It will relax me, it helps me sleep, I can’t socialize without drinking. And then to assess the cost vs. benefit. Many people with mood disorders come to the long term decision that minimal or no alcohol use is their best choice.

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