How Mixing Mood Stabilizers and Alcohol Impacts Your Mental Health
Several risks are associated with mixing mood stabilizers and alcohol. However, providers can help minimize these risks by helping you manage your alcohol use. This optimizes the therapeutic benefits of the medication without adding the dangers of misuse.
In this article:
- Mood Stabilizers and Their Uses
- The Effects of Alcohol and Mood Stabilizers
- Persons Who Risk Severe Side Effects of Mood Stabilizers and Alcohol
- What to Do if You Mix Mood Stabilizers and Alcohol
- Management of Co-occurring Alcohol Use Disorder and a Psychiatric Disorder
Mood Stabilizers and Their Uses
Scientists do not have a precise model of how mood stabilizers work. But they know that the medication can balance chemicals in your brain to avoid mood fluctuations.1
What Do Mood Stabilizers Treat?
Mood stabilizers primarily are used to treat bipolar disorders, but they also treat schizophrenia and major depression.2
Bipolar disorders are characterized by periods of extremely high moods known as mania. This means that 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.3
Bipolar disorders also include depressive episodes that precede or follow manic episodes. This can lead persons with the disorder to experience extreme high and low moods.3
What Mood Stabilizers Are Typically Prescribed?
Lithium is the most prescribed mood stabilizer.2 Researchers have documented the long-term effectiveness of lithium in treating manic and depressive symptoms.4,5
Other mood stabilizers include anticonvulsant medications and antipsychotic medications.6 Anticonvulsant medications also are also to treat epileptic seizures.
The anticonvulsants that are used as mood stabilizers include:6
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
- Valproic acid (Depakote)
- Gabapentin (Neurontin)
- Topiramate (Topamax)
The antipsychotic medications used as mood stabilizers include:6
- Olanzapine (Zyprexa)
- Clozapine (Clozaril)
- Risperidone (Risperdal)
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, that can intensify the effects of alcohol and mood stabilizers. This combination can boost the negative side effects of mood stabilizers and alcohol or make the medication less effective.7
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When Anticonvulsant Medications and Alcohol are Combined
Anticonvulsants, like alcohol, cause sedation because they increase inhibitory transmitters such as glycine and gamma-aminobutyric acid (GABA) that slow down brain activity. Thus, if you take an anticonvulsant, it is imperative to limit daily alcoholic drinks to one or to refrain from drinking altogether. Otherwise, the effects of alcohol are increased significantly and could lead to an overdose.6
Drinking alcohol also reduces the strength of any prescribed anticonvulsant so that the medication does not work as effectively. Alcohol quickly causes the body to produce liver enzymes that reduce the therapeutic strength of the medication.8 This is because some anticonvulsant mood stabilizers are metabolized mostly in your liver, just like alcohol.9
Additionally, alcohol might increase the side effects of anticonvulsants.8 Common side effects of anticonvulsant medications can include:10
- Blurred vision
- Upset stomach
- Urinary retention
- Sexual dysfunction
- Problems with memory, attention, or concentration
Carbamazepine also comes with these rare but dangerous side effects:9
- Low white blood cells: impairs 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.9
Mixing Antipsychotic Medications and Alcohol
While mood stabilizers are not generally addictive, people have reported misusing antipsychotics with alcohol for reasons such as enhancing the effects of alcohol and mood stabilizers to begin “feeling mellow.”6,11 Furthermore, if you misuse alcohol, you are less likely to adhere to your medication regimen.12
It is important to use alcohol sparingly when taking antipsychotic medications because higher alcohol levels can reduce the effectiveness of the medication, which can lead to a relapse of symptoms.13 Scientists also have found evidence that those with schizophrenia who take antipsychotics and misuse alcohol are likelier to have reduced volume of certain parts of the brain.14
Side effects of antipsychotics are generally temporary, but they can be exacerbated by alcohol. These side effects include:13
- Dry mouth
- Blurred vision
- Muscle stiffness
- Mild tremors
- Increased appetite or weight gain
- Sexual difficulties
Additionally, medications used to treat the side effects of antipsychotics interact with alcohol in such a way that leads to overdose. For example, benzodiazepines such as Valium might get prescribed for restlessness. Alcohol can exacerbate such side effects of Valium as drowsiness, fatigue, and motor impairment.12
The Effects of Alcohol with Lithium or Valproic Acid
Side effects of mood stabilizers and alcohol, specifically regarding lithium or valproic acid (Depakote), include:15
- Upset stomach
- Appetite loss
- Irregular bowel movement
- Muscle pain
- Joint pain
- Liver damage
- Higher risk for side effects such as restlessness and loss of motor control
Additionally, scientists speculate that drinking alcohol while taking lithium can lead to toxic amounts of lithium in your blood. They also speculate that chronic alcohol use could lower the effectiveness of lithium, potentially causing future depressive episodes.16
Persons Who Risk Severe Side Effects of Mood Stabilizers and Alcohol
Some groups are at especially elevated risk for experiencing the severe side effects of mood stabilizers and alcohol when combined. For these individuals, avoiding certain mood stabilizers or alcohol is highly advisable.
Tolerance for alcohol in the body decreases with age. As a result, you can feel the effects of alcohol quicker. Therefore, combining the effects of alcohol and mood stabilizers for older adults could lead to falls and serious injuries.15 Heavy drinking also worsens liver problems and mood disorders for older adults.17
Those Assigned Female at Birth
Even after adjusting for differences in body weight, females have higher blood alcohol levels from drinking the same amount as males. Scientists believe this is because females have more body fat and thus a lower amount of water in their bodies compared to men. Thus, alcohol is metabolized slower by women, so it stays in their bodies longer.18
Those Who are Pregnant
If you are pregnant, valproic acid (VPA) can damage the embryo or fetus. The risk for this would be greater if you combine VPA with alcohol.9
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.9
Those With Loss of Liver Function
Scientists advise using VPA with caution if you have a damaged liver because your liver metabolizes it. Taking this medication could put even more stress on your liver.9
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 drank 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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Since certain mood stabilizers can enhance the effects of alcohol significantly, it is critical to get immediate medical attention if you experience symptoms of overdose.6 Call 911 if you notice:15
- Difficulty breathing
- Vomiting while unconscious
- Inability to awaken
- Very low body temperature
- Cold, clammy, pale, or blue skin
Management of Co-occurring Alcohol Use Disorder and a Psychiatric Disorder
About one in three people with bipolar disorder also have alcohol use disorder (AUD), and for those with schizophrenia, AUD is the most common co-occurring disorder.19,20
Experts recommend treatment that integrates both medication and therapy. Therapy can help you adhere to your medication regimen and reduce your alcohol use. This, in turn, can reduce your psychiatric symptoms. Furthermore, a reduction in psychiatric symptoms could lead to a reduction in alcohol use as a coping strategy.20
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.20 Additionally, abstaining from alcohol can increase your likelihood of reducing your psychiatric symptoms.21
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.7,22
In addition to mood-stabilizing medication, therapy also can benefit managing AUD and depression. Researchers have found that cognitive-behavioral therapy (CBT) coupled with motivational interviewing (MI) was effective in decreasing both depressive symptoms and alcohol consumption.23
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, research-backed therapy strategy that helps you to examine how your thought processes are linked to your emotions and behaviors. It enables you to change your thoughts to experience more positive emotions and utilize healthier coping strategies.
While there can be significant side effects of mood stabilizers and alcohol, the medications can be effective in treating psychiatric conditions. The key is to collaborate closely with your provider and follow their directions. It is best to avoid drinking alcohol altogether if you take a mood stabilizer. However, with the guidance and supervision of your provider, you may be able to have an occasional drink while on the treatment.6
If you are concerned about your ability to control alcohol use while taking mood stabilizers, please call 800-839-1686Who Answers? for 24/7 help. Our specialists can help you find treatment providers.
- Rapoport, S.I., Basselin, M., Kim, H., & Rao, J.S. (2009). Bipolar disorder and mechanisms of action of mood stabilizers. Brain Research Reviews, 61(2), 185-209.
- Chiu, C., Wang, Z., Hunsberger, J.G., & Chuang, D. (2013). Therapeutic potential of mood stabilizers lithium and valproic acid: Beyond bipolar disorder. Pharmacological Reviews, 65(1), 105-142.
- American Psychiatric Association. (2013). Bipolar and related disorders. In Diagnostic and Statistical Manual of Mental Disorders 5, 490-491. American Psychiatric Publishing.
- Geddes, J.R., & Miklowitz, D.J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682.
- Licht, R.W. (2011). Lithium: Still a major option in the management of bipolar disorder. CNS Neuroscience and Therapeutics, 18(3), 219-226.
- United States Department of Veterans Affairs. (n.d.) Facts about mood stabilizers.
- Centre for Addiction and Mental Health. (2012). Mood stabilizing medication.
- Leach, J.P., Mohanraj, R., & Borland, W. (2012). Alcohol and drugs in epilepsy: Pathophysiology, presentation, possibilities, and prevention. Epilepsia, 53(s4), 48-57.
- Subbarao, B.S., Silverman, A., & Eapen, B.C. (2021, July 13). Seizure Medications.
- Mutanana, N., Tsvere, M., & Chiweshe, M.K. (2020). General side effects and challenges associated with anti-epilepsy medication: A review of related literature. African Journal of Primary Health Care and Family Medicine, 12(1), 1-5.
- Malekshahi, T., Tioleco, N., Ahmed, N., Campbell, A.N.C., & Haller, D. (2015). Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse. Journal of Substance Abuse Treatment, 48(1), 8-12.
- Garcia, S., Martinez-Cengotitabengoa, M., Lopez-Zurbano, S., Zorrilla, I., Lopez, P., Vieta, E., & Gonzalez-Pinto, A. (2016). Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients. Journal of Clinical Psychopharmacology, 36(4), 355-371.
- United States Department of Veterans Affairs. (n.d.). Facts about antipsychotic medications.
- Nesvag, R., Frigessi, A., Jonsson, E.G., & Agartz, I. (2007). Effects of alcohol consumption and antipsychotic medication on brain morphology in schizophrenia. Schizophrenia Research, 90(1-3), 52-61.
- National Institutes of Health. (2014). Harmful interactions.
- Finley, P.R. (2016). Drug interactions with lithium: An update. Clinical Pharmacokinetics, 55, 925-941.
- National Institutes of Health. (n.d.). Older adults.
- Mumenthaler, M. S., Taylor, J. L., O’Hara, R., & Yesavage, J. A. (1999). Gender differences in moderate drinking effects. Alcohol Research & Health, 23(1), 55–64.
- Balanza-Martinez, V., Crespo-Facorro, B., Gonzalez-Pinto, A., & Vieta, E. (2015). Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates. Frontiers in Physiology, 6, 1-9.
- Drake, R.E., & Mueser, K.T. (2002). Co-occurring alcohol use disorder and schizophrenia. Alcohol Research and Health, 26(2), 99-102.
- Zhornitsky, S., Rizkallah, E., Pampoulova, T., Chiasson, J. Stip, E., Rompre, P., & Potvin, Stephane (2010). Antipsychotic agents for the treatment of substance use disorders in patients with and without comorbid psychosis. Journal of Clinical Psychopharmacology, 30(4), 417-424.
- Frye, M.A. (2006). Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disorders, 8(6), 677-685.
- Riper, H., Andersson, G., Hunter, S.B., De Wit, J., Berking, M., & Cuijpers, P. (2013). Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis. Addiction, 109(3), 394-406.