Q: How Does Active Alcoholism Affect Diagnosis & Treatment of BP
Hi Dr. Phelps,
I am about to undergo inpatient treatment for alcoholism. The treatment center
deals with dual diagnosis.
My question is, how does active alcoholism affect diagnosis and treatment of
I've recently been diagnosed with bipolar 2 after suffering years of major
depression. I think the diagnosis was based on how I respond to
antidepressants. I experienced a very uncomfortable period of agitation,
hallucinations and insomnia while coming off of cymbalta and ambien, and then
was diagnosed with bipolar 2. I have also been on many, many different
antidepressants with no real relief.
I am now on lamictal, lexapro and seroquel; the seroquel is for sleep. Should
my medications and diagnosis be re-evaluated? I should add that I've tried most
of the antidepressants when I was sober, I've been drinking on the new
medications (lamictal, lexapro and seroquel that is) for a couple of years now.
My psychiatrist knows this and was the one who encouraged evaluation and
treatment for alcoholism.
Dear Jan --
When treatment is not working as hoped, for any reason, it's good to
re-think the diagnosis. If your current treatment was working well overall, that
might not be warranted at this point. But if it isn't, and perhaps the need for
inpatient treatment suggests that in the big picture it is not, then rethinking
is good. The first rethinking I'd be inclined to do under these circumstances,
though, would be to wonder whether the antidepressant you're currently on
might be part of the reason why you need inpatient treatment, given your
reaction to antidepressants before. If you've not had a period on the Lamictal
and Seroquel without the antidepressant, that would be the first thing I'd
consider. To my knowledge, there has been no report of these agents contributing
to a need to drink, whereas antidepressant-induced mixed states are commonly
associated with a desire to use drugs that will slow thinking or stop the
negative circles of thought or at least help get to sleep, all of which as you
know alcohol can do in the right dose and timing, for a few hours anyway (too
bad things are usually worse afterward...).
Later when things are going smoothly and clean/soberly,
you could discuss with your doctor a very cautious taper off of whatever you'd
accumulated at that point as the question will likely remain in your and her/his
mind: how much of the problem was alcohol and not bipolar disorder? However,
that must be done extremely cautiously, very slowly (like taking 6 months to a
year to get off both agents), and with a very tight safety net ready to catch
the earliest signs of mood relapsing, lest the mood relapse lead to alcohol
relapse and back into the place you're now trying to leave. Some doc's would be
very hesitant to consider this plan. Just yesterday I heard another horror story
about a guy who was told he didn't have bipolar disorder after all, when he'd
been doing well for a while, that his original problem was just a brief reactive
psychosis associated with a stressful life event. His mood stabilizer treatment
was stopped, and he had another psychotic episode with considerable personal
risk, again. So be cautious there. Good luck with all that.
Published December, 2006