Bipolar Disorder and Alcohol: Why Drinking May Make Symptoms Much Worse
Mental Health ConditionsBipolar Disorder

Can You Drink Alcohol With Bipolar Disorder?

Can You Drink Alcohol With Bipolar Disorder?
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Published on November 26, 2025
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Note: While research on alcohol is evolving, the World Health Organization says drinking less or not at all is better for your health.

When you have bipolar disorder, you may wonder if it’s safe to drink. Alcohol can help you relax at first, but it often leaves you feeling worse once the effects wear off. In fact, when you drink a lot, alcohol actually increases your risk of anxiety, depression, and unstable mood.

Bipolar disorder causes mood instability, with periods of mania and depression. In a manic phase, you may feel extremely happy or irritable; depressive episodes often bring feelings of sadness, hopelessness, and apathy.

Experts agree: Bipolar disorder and alcohol don’t mix. According to research, drinking even moderate amounts of alcohol is not safe when you have bipolar disorder — it has been linked to increased mood episodes.

How Alcohol Affects Bipolar Disorder

Bipolar disorder and alcohol have a complex relationship. When you have a bipolar disorder, your brain fluctuates between excitatory and inhibited states, says Ashvin Sood, MD, a psychiatrist in private practice in Washington, DC.

In an excitatory state, your brain prompts racing thoughts and impulsive decision-making, but inhibited states look more like severe melancholy and avoidance, says Dr. Sood.

 “From a neurobiological standpoint, alcohol is a central nervous system depressant that primarily acts on [gamma-aminobutyric acid, or] GABA receptors, which act like the ‘brakes’ in the brain, slowing down our motor and impulse control.”

But as blood alcohol levels decline, the central nervous system rebounds and swings back into “gas” mode, increasing heart rate, anxiety, and stress levels, says Sood. This means alcohol can worsen bipolar symptoms by destabilizing mood, triggering manic episodes, and impairing judgment, he says.

 “Over time, this leads to more frequent and severe mood swings, faster cycling, and higher relapse rates.”

Research also shows a correlation between bipolar disorder and alcohol use disorder (AUD), says Marsal Sanches, MD, PhD, a psychiatrist and a professor at McGovern Medical School at UTHealth Houston. Researchers estimate that up to 45 percent of people with bipolar also have AUD.

“The reasons for that association are not totally clear,” says Dr. Sanches, but some research suggests that alcohol use disorder and bipolar disorder have some shared genetic predispositions. “That means that the same genetic factors that are involved in bipolar disorder might also predispose patients to develop alcohol use disorder.”

Is It Safe to Drink During or After Mood Episodes?

It is not safe to drink alcohol during manic or depressive episodes of bipolar disorder, says LaMont Moss, MD, a psychiatrist at Kaiser Permanente in Denver. “Not only can alcohol make medications less effective, but it can also impair decision-making beyond the challenges that come with a manic episode.”

Drinking during a depressive episode can worsen symptoms like low mood, hopelessness, suicidal thoughts, and other aspects of depression, says Dr. Moss. In one study of 584 people with bipolar disorder who drank regularly, an increase in alcohol use was linked with worse depressive and manic or hypomanic symptoms.

More specifically, one study of about 1,400 people found that drinking alcohol with bipolar disorder — even if it didn’t rise to the level of AUD — increased the risk of suicidal thoughts.

 Another study that included 40 people with bipolar disorder found that, even during times of stability, alcohol upset that delicate balance and triggered a relapse.

Apart from worsened symptoms, drinking during either a depressive or manic episode can make it difficult for your healthcare provider to know if your medications are working, says Sanches. “This is not only due to difficulties in assessing the patient’s response to treatment but also because of potential interactions between alcohol and psychiatric medications.”

Does Alcohol Interact With Bipolar Medications?

Alcohol interacts with almost all medications taken for bipolar disorder, says Sanches. “For example, medications with sedative potential, such as mood stabilizers and some atypical antipsychotics, might have their sedating properties increased while in combination with alcohol, leading to different risks, including falls, motor vehicle accidents, and medical complications.”

Benzodiazepines like alprazolam (Xanax) and clonazepam (Klonopin) are sometimes used for short periods during manic states, and these medications are particularly dangerous when combined with alcohol because they can slow breathing drastically, says Sood.

Bipolar disorder treatment varies, but often includes mood stabilizers, antipsychotics, and antidepressants.

 Here are some of the most common bipolar medications and their side effects, if taken with alcohol:

  • lithium (Lithobid): drowsiness, toxicity if you’re dehydrated

  • aripiprazole (Abilify): decreased benefits, increased side effects, including sedation and dizziness

  • olanzapine (Zyprexa): decreased benefits, increased side effects, including sedation, dizziness, dry mouth

  • quetiapine (Seroquel): decreased benefits, increased side effects, including drowsiness, dizziness, headache, dry mouth

  • lamotrigine (Lamictal): decreased benefits, increased side effects, including headache, dizziness, drowsiness

  • risperidone (Risperdal): decreased benefits, increased side effects, including sedation, headache, anxiety, restlessness

  • valproate (Depakote): decreased benefits, increased side effects, including headache, dizziness, drowsiness

Are Some Alcoholic Drinks Safer for Bipolar Disorder Than Others?

Avoiding alcohol altogether is best when you have bipolar disorder, but if someone with bipolar disorder chooses to drink, they should try to stick with beverages that have a lower alcohol content to lower the risk of exacerbating mania or hypomania symptoms, and to prevent potential interactions that may reduce the effectiveness of prescribed medications, says Moss.

Spirits like whiskey, vodka, or grain alcohol can have between 40 and 95 percent alcohol concentration in each 1.5-ounce (oz) serving, but these options contain less in each standard drink, on average:

  • Beer: about 5 to more than 10 percent per 12 oz serving
  • Malt beverages, including hard seltzer and wine coolers: about 7 percent in an 8- to 10 oz serving
  • Wine: about 12 percent per 5 oz serving

You can also try an increasing number of nonalcoholic options, with more and more beverage companies offering alcohol-free beer and wine.

Tips for Limiting Alcohol With Bipolar Disorder

No amount of alcohol is recommended if you have bipolar disorder, though it can feel overwhelming to give up your favorite beverages. In general, experts recommend limiting drinking to promote health and prevent chronic disease, even if you don’t have bipolar disorder.

 Sanches recommends a personalized approach, working closely with your healthcare provider to manage your risk.
According to the National Institute on Alcohol Abuse and Alcoholism, drinking in moderation is defined as no more than two drinks per day for men, or one drink per day for women. Heavy drinking is consuming 8 or more drinks per week, or 4 or more in a day for women; for men, it’s 15 drinks in a week, or 5 or more in a day. A drinking binge results in a blood alcohol level of 0.08 percent — this typically translates to about 4 standard drinks in about two hours for women, or 5 drinks for men.

Sood sometimes recommends a medication called naltrexone, which can help cut cravings.

He offers these tips if you choose to drink:

  • Avoid binge drinking. Space drinks out and pair them with food to slow alcohol absorption.
  • Prioritize sleep hygiene. Sleep deprivation is an early bipolar destabilization trigger.

  • Communicate openly with your psychiatrist. Treatment plans can be adjusted to minimize risk rather than punish substance use.

“But I emphasize: ‘Less harmful’ is not the same as ‘safe,’” says Sood. “Even moderate alcohol intake can subtly destabilize mood in someone with bipolar disorder.” If you want to stop drinking and need support, speak with your healthcare provider, who can provide options and encourage you on your journey.

The Takeaway

  • Alcohol can worsen bipolar disorder symptoms like anxiety, hopelessness, impulsiveness, and avoidance in both manic and depressive episodes.
  • Drinking alcohol can make bipolar medications less effective, and can increase side effects like drowsiness, dizziness, and dry mouth.
  • If you have bipolar disorder and want to stop drinking, reach out to your healthcare provider, who can offer strategies, medications, and other resources to help.

Resources We Trust

EDITORIAL SOURCES
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Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

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