Alcoholism and Depression

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Researchers have known for quite some time that alcoholism and depression tend to occur together and that both disorders may run in families. 

In fact, previous studies of adopted siblings and twins have suggested that there are genes in common underlying alcoholism and depression and that these disorders seem to take place in families.  Indeed, a family history of either alcoholism or depression puts an individual at increased risk for developing either illness.

Some Key Facts About Alcoholism and Depression

The following list represents some important information that researchers have discovered about alcoholism and depression:

• When individuals abuse alcohol and/or drugs, depression can develop.
• Alcoholism and depression are frequently associated, leading to a high potential for alcohol-antidepressant interactions.
• Even though research has not shown that depression actually causes alcoholism, the two disorders are commonly seen in the same patients at the same time.
• The use of alcohol and drugs can complicate the diagnosis and treatment of depression.
• Depressed people often turn to alcohol in the belief that it has the ability to ease their symptoms.  Not all heavy or long time drinkers, however, will become depressed. 
• Most people with depression do not seek treatment, although the great majority of individuals, even those whose depression is extremely severe, can be helped with professional treatment.
• Without treatment, a major depressive episode can last up to 6 to 12 months or longer.
• Frequently, the reasons for depression are not clear.  That is, there may not be just one "cause," but a variety of contributing factors that accumulate over time and make people feel defeated, helpless, demoralized, hopeless, and depressed.

What is Depression?

Depression is a mental state characterized by a despondent lack of activity and a pessimistic feeling of inadequacy.  When an individual is depressed, he or she usually feels exhausted, worthless, hopeless, and helpless.

It is important to emphasize the fact that while "normal" depression is related to any downturn in mood that might be relatively transitory and even triggered by something trivial, "clinical depression," on the other hand, is associated with symptoms that last two weeks or more and are so serious that they interfere with daily functioning and living.

Symptoms of Alcoholism and Depression

Mental heath researchers have discovered the fact that some of the dynamics that are involved in producing the symptoms of reduced appetite, poor sleep, low mood, and anxiety that are characteristic of depression are also affected by alcohol.  The following represents some of the major facts about the symptoms of alcoholism and depression:

• Up to 40 per cent of individuals who drink excessively have symptoms that resemble depression.
• Among alcoholics entering treatment, approximately two-thirds of them have symptoms that resemble anxiety disorders.
• Roughly 5 to 10 per cent of individuals with depression also have symptoms of alcohol abuse or alcoholism.
• The strongest association between alcoholism and severe anxiety takes place in the context of alcohol withdrawal.
• If a drinker has never experienced alcohol problems, he or she will tend to not have symptoms of depression.
• When depressive symptoms are secondary to alcoholism, they are likely to disappear within a few days or weeks of abstinence, as the alcohol withdrawal symptoms lessen.
• Due to the fact that symptoms of depression associated with alcohol are greatest when an individual first stops drinking, recovering alcoholics with a history of depression should be carefully monitored during the early stages of withdrawal.
• The symptoms of depression in alcoholics are greatly reduced after three to four weeks of sobriety.
• Since symptoms of depression are likely to develop during the course of alcoholism, some patients with mood disorders may increase their drinking when undergoing a mood change, fulfilling criteria for secondary alcoholism.  

Depression and the Elderly

Some individuals have the erroneous belief that it is normal for the elderly to feel depressed.  Research, however, demonstrates that individuals who experience alcohol problems both before and after age 60 have the highest rates of depression.  In fact, seniors who suffer from depression and alcoholism are at an increased risk of suicide.

Due to the fact that depression and alcohol abuse are associated with suicide, and given the high rate of suicide in older individuals, substance abuse treatment professionals need to be sensitive to the presence of suicidal ideation in older patients.  In a word, clinicians must raise their awareness about depression and alcoholism in older adults and these professionals should not confuse these disorders with “normal aging.” 

Alcoholism, Depression, and Suicide

Alcohol impairs judgment, which to a great extent explains its association with suicide.  Furthermore, since alcohol abuse and alcoholism can intensify depression and increase impulsiveness, an individual suffering from major depression and who abuses alcohol has a much higher risk of attempting and succeeding at taking his or her own life.

Because of the risk of suicide, it is critical that people suffering from major depression and alcohol abuse receive immediate medical attention.

Treatment for Alcoholism and Depression

Unfortunately, many individuals, including health professionals, tend to view alcoholism and depression as separate problems when in fact, they are related to one another.  As a result, the positive correlation between alcohol abuse or alcoholism and depression argues strongly for a comprehensive approach to treatment.  This means not only paying attention to the problem of alcohol, but also taking into account the treatment of depression - which can require psychotherapy and/or anti-depressant medications.  It is asserted that this type of extensive treatment approach will help ensure a more effective and productive outcome for the patient. 

There is general agreement in the psychiatric community that alcoholic individuals are at increased risk for depression and bipolar illness and depressed individuals are at increased risk for alcoholism and alcohol abuse.  According to some clinicians and researchers, therefore, the clinical assessment of current and past alcohol use and alcohol-related disorders should be considered a routine part of all psychiatric or medical evaluations.

In addition, all depressed patients should be frequently asked about their alcohol and drug use throughout the course of their treatment and advised to refrain from alcohol and drug abuse.  Since relapse prevention is one of the most critical tasks in the management of depressed patients with a past history of alcoholism, it is important to maximize the chance of long-term sobriety in patients with depression.

In short, when alcohol abuse or alcoholism occurs with depression, both the substance abuse and the mood disorder demand treatment. 

Famous People Who Had Depression

Abraham Lincoln is perhaps the most noted person to successfully cope with depression. Another famous person, Winston Churchill, the British Prime Minister, successfully managed his depression he referred to as his "black dog."  Leaders in other fields like film (Jim Carrey and Woody Allen), television (Dick Cavett and Mike Wallace), sports (Terry Bradshaw) and any number of educators, scientists, doctors, nurses, and lawyers have dealt with depression and moved forward to live productive and successful lives.  These "success stories" should remind others who suffer from depression that this illness need not be a crippling blow to the ways in which they live their lives.

Alcoholism and Depression: Conclusion

Alcoholism and depression have a high comorbidity.  Stated more precisely, alcoholism and depression occur in the same people at a rate higher than they would occur if both disorders were not related.  The "link" can psychological, genetic, social, biological, or most likely a combination of these and other factors. 

Patients who are alcoholic and who also suffer from depression deserve the same kind of comprehensive care as a cancer patient with pneumonia, or a diabetic patient with glaucoma.  The bottom line is this:  when alcoholism or alcohol abuse occurs with depression, both the "drinking problem" and the mood disorder require quality treatment.

If people can be made aware of the strong association between alcoholism and depression AND made aware of some great people in history who battled through depression and lived productive lives, some of them may be more able to deal with depression without resorting to alcohol abuse or alcoholism.

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