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Alcohol use disorders and depression
This month in our Resource Centre we are focusing on alcohol use disorders and depression, which are among the most common psychiatric disorders in Western societies. An accurate understanding of their comorbidity is crucial to both prevention and treatment. While there is ample evidence of important relationships between the disorders, as yet nosingle nor specific etiological risk factor has been identified.
As Professor Henri-Jean Aubin of the Paris-Sud University demonstrates in his presentations, the diagnosis of current mood or anxiety disorders among active alcohol abusers is complicated by the fact that many symptoms of alcohol intoxication and withdrawal resemble those of mood and anxiety disorders. Alcohol itself can produce negative mood swings (not necessarily independent major depressive episodes), especially when consumed in high doses. Conversely depressed individuals might use alcohol as a self-medication to reduce tension and stress, which can result in secondary alcohol dependence − a finding significantly more frequent in women than in men. Sustained alcohol reduction or abstinence can lead to a significant improvement in depressive symptoms, as well as to a better response to antidepressants. In patients with an alcohol use disorder and comorbid depressive or anxiety disorder, NICE treatment guidelines recommend treating alcohol misuse first.
Find out more on the relationship between alcohol misuse and mood disorders in the articles and video presentations on our Resource Centre.
Alcohol use disorders and depression
Relationships among independent major depressions, alcohol use, and other substance use and related problems over 30 years in 397 families
Marc A. Schuckit, Tom L. Smith, Jelger KalmijnSchuckit MA et al. J Stud Alcohol Drugs 2013
There is ample evidence of important relationships between heavy drinking and mood changes as well as between alcohol use disorders and major depressive episodes. However, the mechanisms that underlie these relationships and the clinical implications of these syndromes are complex. The authors present data from a 30-year longitudinal study of almost 400 families where careful efforts were made to identify independent depressions separately from substance-induced depressions. The study showed a relatively high prevalence of alcohol-induced versus independent major depressive episodes in individuals with alcohol abuse or dependence (data collected from male probands). This finding is important to clinicians because the clinical course, overall prognoses, and optimal treatments for these induced conditions are different from independent depressive episodes.
Depression outcome in alcohol dependent patients: An evaluation of the role of independent and substance-induced depression and other predictors
Foulds JA et al. J Affect Disord 2015
The authors conducted a trial in which 138 outpatients with alcohol dependence and major depression participated. Patients were prescribed naltrexone and randomized to citalopram or placebo for 12 weeks, followed by a 12-week naturalistic outcome phase. Alcohol dependent patients whose depression was categorized as substance-induced showed greater improvement in depression during treatment compared to those with independent depression. However this appears to be mainly because they reduced their drinking more. The authors conclude that regardless of whether depression is believed to be independent or substance-induced, alcohol reduction should be prioritized as the first step in treating depression in all actively drinking, alcohol dependent patients
Randomized controlled trial of MICBT for co-existing alcohol misuse and depression: Outcomes to 36-months
Baker AL et al. J Subst Abuse Treat 2014
This trial evaluates changes over 36 months following randomization of 284 outpatients to one of four motivational interviewing and cognitive–behavior therapy (MICBT) based interventions: (1) brief integrated intervention (BI); or BI plus 9 further sessions with (2) an integrated-, (3) alcohol-, or (4) depression-focus. Given the pattern of study results, the authors see currently no reason to rule out an integrated intervention strategy addressing both conditions. The best approach seems to be an initial focus on both conditions followed by additional integrated- or alcohol-focused sessions. Alcohol-focused treatment was found to be as effective as depression-focused treatment at reducing depression and more effective in reducing alcohol misuse. Psychological interventions such as MICBT clearly contribute to sustained improvement by individuals with co-existing alcohol misuse and depression. An integrated brief intervention should be considered as a useful, but often not sufficient, first step to help contextualize possible associations between alcohol misuse and depressive symptomatology.
Investigating biases of attention and memory for alcohol-related and negative words in alcohol-dependents with and without major depression after day-clinic treatment
Fridrici C et al. Psychiatry Res 2014
Impaired cognitive control in alcohol use disorders contributes to the development and maintenance of addictive behaviour, and addictive behaviour may – vice versa – deteriorate impairments of cognitive control. To gain a better understanding of the nature of these impairments, this study focused on attentional and memory biases, two aspects of cognitive control. The authors compared alcohol-dependents without depressive symptoms with alcohol-dependents suffering from co-morbid depression and healthy controls by means of the alcohol Stroop task and the directed forgetting paradigm. While the authors did not find cognitive biases for alcohol-related words in alcohol-dependents without co-morbidity, nor for negative words in alcohol-dependents with co-morbid depression, alcohol-dependents with depression showed a memory bias for alcohol-related material, suggesting that this group may be more pre-occupied with alcohol than alcohol-dependents without such co-morbidity.
Brief Report: Excessive alcohol use negatively affects the course of adolescent depression: One year naturalistic follow-up study
Esa Meririnne, Olli Kiviruusu, Linnea Karlsson, Mirjami Pelkonen, Titta Ruuttu, Virpi Tuisku, Mauri MarttunenJournal of Adolescence 2010, Volume 33, pages 221–226
In this brief report, the authors present findings from a study conducted in Finland on the impact of the core alcohol use phenomenon of drunkenness-oriented drinking, in terms of weekly drunkenness, on the course of unipolar depression and psychosocial functioning in a group of adolescent outpatients. Baseline alcohol consumption of 197 adolescents with unipolar depression was categorized in three groups: excessive use (defined as weekly drunkenness), regular use (monthly use, not weekly drunkenness), and no/occasional use (abstinence/less than monthly use). From the findings of the study the authors conclude that excessive alcohol use (defined as weekly drunkenness) seems to negatively affect the course of depressive symptoms and psychosocial functioning. Even after one year, more than two thirds of the participants in the excessive alcohol use group still showed marked impairment of psychosocial functioning. These findings, in line with those from other studies, call for novel approaches for attending to depressed adolescents with excessive alcohol use. Weekly drunkenness seems to be of predictive value and this can be easily examined with a few simple questions.
Cross-cultural patterns of the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety: Secondary analysis of the WHO Collaborative Study on Psychological Problems in General Health Care
Stefanos Bellos, Petros Skapinakis, Dheeraj Rai, Pedro Zitko, Ricardo Araya, Glyn Lewis, Christos Lionis, Venetsanos Mavreas
Drug and Alcohol Dependence 2013, Volume 133, pages 825–831
This international study, involving a sample of 5348 primary care attenders who participated in the WHO Collaborative Study of Psychological Problems in General Health Care, aimed to investigate whether there are any differences in the association of the two most common mental disorders, depression and generalized anxiety disorder, with varying levels of alcohol consumption. In the study, light/moderate drinking was associated with a lower prevalence of depression, while excessive drinking was associated with an increased prevalence of depression. This was observed in all types of primary care centres. Only a marginally significant association was found between light/moderate alcohol consumption and a lower prevalence of generalized anxiety disorder, while in contrast to the finding for depression, heavy or excessive drinking was not associated with an increased prevalence of generalized anxiety disorder compared to abstinence with either measure of alcohol use. Due to its cross-sectional nature, the study cannot distinguish between issues of “causality” or reverse causality. Large longitudinal studies with more explicit recording of possible confounding or moderating variables are needed to explore whether light or moderate alcohol consumption may be beneficial for mental health.
Part 1 of lecture series Alcohol dependence and depression: cause or consequence?Many major depressive symptoms can be related to an underlying alcohol use disorder – to acute intoxication, chronic high risk drinking and alcohol withdrawal.
Part 2 of lecture series Alcohol dependence and depression: cause or consequence?Major depression can induce alcohol use disorder, and conversely alcohol use disorder can induce major depression. But in a given patient, what came first?
Part 3 of lecture series Alcohol dependence and depression: cause or consequence?A significant number of depressed alcohol dependent patients will undergo a rapid improvement of depressive symptoms and subsequent normalisation of mood following medically assisted withdrawal, the effect of this can be striking to both patient and clinician.
Highlight from presentation Future horizons in patient care using social media and new technologyComputer-driven text messages like “If you are having a good day, share it with others; if you are having a bad day share, it with others and accept their help” can help support depressive symptoms
Breakout session highlightFor patients with an alcohol use disorder and a comorbid depressive disorder, we should treat alcohol misuse first. This may lead to a significant improvement in depression.
Presentation at EPA 2014 by Prof. Dr. Henri-Jean Aubin, University Paris Sud, FranceAlcohol dependence is highly prevalent and wide-spread among people of all ages and socioeconomic groups, and has enormous health consequences...