Bipolar, Alcohol and Young People

My 17 year old daughter was diagnosed with bipolar a year and a half ago.

This weekend is her Sr. prom, she has informed me she WILL drink even though I do not approve and will not buy it for her.  She called her Dr. to ask if she should not take her meds that day and he told her, no drinking, end of discussion.  She is on Lithium, Effexor and Hydroxyz.  She also takes Migratine as needed for migraines.  Could you please tell me the dangers of mixing alcohol with these drugs?  Also, couldn't drinking trigger a migraine?

Dear Mary -- 
It would be easier if we all just did what many pharmacists do, namely emphasize that one simply can't take alcohol with these medications period.  And I certainly can't tell you or your daughter it's safe to do so.  I can tell you I've seen many folks who have used alcohol with these medications and they didn't die, but most do agree with the warning I give my patients, which is that even small amounts of alcohol can pack quite a wallop when you have something like lithium (not to mention hydroxizine) on board and that people need to be prepared for that if they do drink (like figure you're going to be drunk after one drink and need a ride home, where before it took 3 to reach that point).  

The main reason not to drink, in my view, is that is messes up what we're trying to treat in the first place. Alcohol is a sedative, and using it is like pushing down hard on the bed springs: when it wears off in about 3-4 hours, the springs bounce back hard.  Usually this means a night of very disturbed sleep, and that's precisely what we don't want with this illness.  

However, understand that this is how I work with my patients, and that when we're having this discussion we usually have a solid understanding that the patient is driving the car, and I'm in the backseat offering some ideas and directions; and that we can travel that way because they know I'm generally giving them sound advice, not moral guidance; and that I'll help them understand the "why" as best I can, leaving them to make the decisions (the exception being when they need to be in the hospital for their own safety, as occurs once in a while).  

The point there is that I would not presume to tell you how to handle your daughter, or necessarily to say that the way I give out information is going to work better than what her doc' already did.  Unfortunately, many young people seem to need to learn the hard way.  You can help there by setting up as many safety factors as possible (who she's with, rides home, numbers to call, interventions that will happen if she doesn't check in reasonably sober by 12 midnight, etc.).  Good luck with this very tough job. 

Dr. Phelps

Published March, 2001