Depression: Before, During, and After Alcohol Use

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Depression and alcohol addiction often co-occur.¹ The mental health condition of major depression can occur before, during, or after alcohol use, as depression can lead to alcohol use, which may, in turn, increase the risk for depression.

In this article:

• • What Is the Prevalence of Co-Occurring Depression and Alcohol Addiction?
  • Why Do People Drink Alcohol When They Are Depressed?
  • How Does Alcohol Affect Your Mood and Brain Chemistry?
  • How Can Depression Lead to Alcohol Use?
  • Why Does Depression Occur After Alcohol Addiction?
  • Do Depression and Alcohol Addiction Share Any Risk Factors?
  • How Are Depression and Alcohol Addiction Treated Together?

What Is the Prevalence of Co-Occurring Depression and Alcohol Addiction?

Depression is a mental health disorder that can co-occur with alcohol misuse and addiction.¹ Research shows that major depressive disorder is the most common co-occurring psychiatric disorder among people with alcohol use disorder (AUD).¹ According to a 2019 study, people with AUD are 2.3 times more likely to have major depression than those who are not addicted to alcohol.¹

Alcohol dependence—which can precede and develop into AUD—also correlates to an increased risk of a dual diagnosis of depression. The 2019 study indicated that people who are diagnosed with alcohol dependence are 3.7 times more likely to also have a diagnosis of major depression.¹ Another study shows that the prevalence of depression among people who are physically dependent on alcohol is approximately 64%.² By comparison, the prevalence of depression among people addicted to alcohol ranges between 16% and 68%.²

The preexistence of a mental health condition can also lead to alcoholism. The National Institute on Drug Abuse states that roughly 50% of people with a mental illness, such as depression, will also experience a substance use disorder, and vice versa.^2,3

AUD—which is also called alcoholism and alcohol addiction—is considered a mental health condition and is characterized by compulsive behaviors of seeking and using alcohol. Over time, these compulsive behaviors can be difficult to control despite direct negative consequences.³ Some of the symptoms and life changes that can happen due to AUD are similar to those seen with other mental health conditions, including depression.³

Why Do People Drink Alcohol When They Are Depressed?

Depression can often precede alcohol addiction.³ As a central nervous system depressant alcohol has sedative effects that create feelings of relaxation, lack of acute focus on stressors, decrease in anxiety and social inhibition. Some individuals may take advantage of these effects to manage mental health symptoms—a practice clinically known as “self-medicating” and as a “maladaptive coping strategy.”

Self-medicating with alcohol may look like using alcohol to “wind down” on a daily basis; to use alcohol frequently when you feel intense anxiety, sadness, or stress; or using alcohol in place of other coping mechanisms, such as getting better quality sleep, reaching out to loved ones, or seeking treatment for your depression symptoms. It’s important to understand that the short-term effects of alcohol won’t produce long-term relief for major depression.⁴

Drinking alcohol when you’re depressed may make you feel happier, less anxious, or even euphoric until the effects of alcohol wear off. After that, your symptoms of depression will likely remain, especially if the symptoms are situational as well as chemical. For example, if some of your symptoms are related to your relationships or finances. Some researchers suggest that drinking alcohol when you’re depressed may worsen your symptoms of depression. ⁵ The effects of alcohol on your body and brain can interfere with any depression treatment you are currently receiving.⁵

How Does Alcohol Affect Your Mood and Brain Chemistry?

Alcohol interacts with multiple neurotransmitters—or brain chemicals—that help regulate your mood.^4,6 The most notable brain chemicals affected by alcohol use are gamma-aminobutyric acid (GABA), dopamine, and serotonin—all of which are also implicated in depression.^4,6

GABA is an inhibitory—or blocking—neurotransmitter. When GABA is functioning correctly, it attaches to neural receptors, it reduces the brain activity related to acute stress, anxiety, and fear, producing a feeling of calm. Dopamine mediates the pleasure and reward center of your brain. Serotonin affects your anxiety level, as well as your overall mood stability and, specifically, your feelings of happiness.^4,6

Alcohol causes intense activation in the brain that can flood the pleasure and reward center with dopamine initially, but may cause imbalances in chemical levels and issues with neurotransmitter function during while you are recovering from heavy alcohol use, experiencing alcohol withdrawal, or dealing with the return of your mental health symptoms. Problems with serotonin levels specifically is indicated as a causal factor in several mental health disorders, including obsessive-compulsive disorder (OCD), anxiety disorders, and depression.⁶

How Can Depression Lead to Alcohol Use?

Major depression causes various severe symptoms that affect the way you think and feel. The symptoms can interfere with your ability to perform daily activities, including care tasks such as eating and sleeping.⁷

Symptoms of major depression include:⁷

• Persistent feelings of sadness, anxiety, and emptiness
• Feelings of guilt, hopelessness, and worthlessness
• Irritability
• Restlessness
• Fatigue and decreased energy
• Loss of interest and pleasure in favorite hobbies and activities
• Difficulty sleeping, including clinical insomnia
• Sleeping too much
• Eating too much or too little
• Weight gain or weight loss
• Problems with memory, concentration, and decision making
• Unexplained physical aches and pains
• Thoughts of suicide or suicide attempts

Some of these symptoms may compel you to use alcohol if you think that the effects of alcohol could alleviate your symptoms disappear.³ For example, you may use alcohol to try to fall asleep if you suffer from insomnia. Or you may also drink alcohol to reduce the intensity of physical pain you experience or to distract from feelings of sadness and guilt.³ Regardless of your reason for drinking, you face a higher risk for alcohol addiction if you use alcohol as a coping mechanism.³

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This increased risk comes from the link that forms between stressors and alcohol use over time. As you use alcohol to reduce your symptoms, you increase the risk of alcohol use being the first method you try when those same symptoms arise in the future. Chronic alcohol misuse is the primary risk factor for addiction.⁸

Why Does Depression Occur After Alcohol Addiction?

Depression is a long-term health risk associated with excessive alcohol use.⁹ Researchers have found that alcohol addiction may play a stronger role in developing depression than depression in developing alcohol use disorder.² The more you misuse alcohol, the more likely you are to develop major depression.² This occurs mainly due to the way chronic alcohol use can interact with your brain chemicals to cause changes and fluctuations in your mood.^2,9

Depression is also a common symptom of alcohol withdrawal syndrome.¹⁰ Alcohol withdrawal syndrome refers to the combination of symptoms you may experience when you stop using alcohol after consuming high amounts of alcohol regularly.¹⁰ Anxiety, fatigue, irritability, mood swings, and loss of appetite are alcohol withdrawal symptoms—all of which are also symptoms of depression.¹⁰ Therefore, not only does heavy alcohol use directly cause depression, but depression can also occur as part of alcohol withdrawal.¹⁰

Do Depression and Alcohol Addiction Share Any Risk Factors?

Depression and alcohol addiction share several risk factors, which is another reason these conditions commonly co-occur and why one condition may lead to the other.

Risk factors shared between depression and alcohol addiction include:^11,12,13

• Stressful life events, such as divorce or the death of a loved one
• Social isolation
• Relationship problems
• Financial hardship
• Unemployment
• Child neglect
• Child abuse
• Physical illnesses, such as cancer or chronic pain
• Family history of either condition, which may include a genetic predisposition
• Trauma

The presence of risk factors does not predict or guarantee the development of any mental health condition, including depression or a substance use disorder. However, these risk factors can make you more vulnerable to mental health symptoms or chronic alcohol misuse that can become alcohol addiction.¹¹

How Are Depression and Alcohol Addiction Treated Together?

A co-occurring major depression and alcohol addiction diagnosis is known as a dual diagnosis or comorbid disorders.¹³ If you have a dual diagnosis, your most effective treatment plan will involve treatment for both conditions. If only one condition is treated, you face the risk of a return of depression symptoms or relapse back to alcohol misuse.¹³

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A dual diagnosis of depression and alcohol addiction is usually treated using a combination of medications, psychotherapy, behavioral therapies, and support group therapy.¹³

While selective serotonin reuptake inhibitors (SSRIs) are currently the most common antidepressant category prescribed for depression, researchers have found that older antidepressant medications such as tricyclic antidepressants may be more effective at reducing depression in patients with AUD.¹ Any antidepressant may also be combined with naltrexone (Vivitrol or Revia) to reduce drinking.¹

When SSRIs are prescribed, they may be combined with specific medications for treating AUD that have been shown to be particularly effective at treating patients with a dual diagnosis of depression and alcohol addiction. These combinations include sertraline (Zoloft) with naltrexone and escitalopram (Lexapro) and acamprosate (Campral).^1,13

Behavioral therapies that may be used to treat an alcohol and depression dual diagnosis include:^1,14

• Motivational interviewing, which focuses on motivating and empowering you to change harmful behaviors related to alcohol use
• Cognitive-behavioral therapy (CBT), which teaches you how to identify and change thought patterns that lead to behaviors related to alcohol use
• Therapeutic communities, which focus on reprogramming and re-socializing you in community settings
• Dialectical-behavioral therapy (DBT), which helps you reduce self-harm behaviors related to depression and alcohol use
• Exposure therapy, such as EMDR, which repeatedly exposes you to the trauma contributing to your depression or alcohol addiction in a controlled, safe setting overseen by a qualified licensed health professional to learn new reactions to the trauma
• Contingency management interventions, which reward you for positive, recovery-focused behaviors
• Community reinforcement, which teaches you how to make a sober lifestyle more rewarding than a lifestyle that includes alcohol use
• 12-step support groups such as Alcoholics Anonymous (AA), which connect you with peers who support you and motivate you to stay sober. Researchers have found that AA support groups are also highly effective at reducing symptoms of depression¹

Many alcohol rehab centers offer dual-diagnosis therapy because of the prevalence of co-occurring alcohol addiction and depression. If you have a dual diagnosis, your treatment program may be customized to address the root causes of both your substance use disorder and mental health disorder.¹⁵ For example, if you became depressed and started using alcohol to cope with nightmares, feelings of worthlessness, and other symptoms related to the traumatic experience, your treatment program may include exposure therapy to help you face and overcome the trauma, which will also help you stop misusing alcohol.¹⁴

Call 800-948-8417 Who Answers? to speak to a treatment specialist about your options for nearby alcohol rehab centers if you or a loved one suffers from alcohol addiction and depression symptoms or a dual diagnosis.

Resources

1. McHugh, R.K., & Weiss, R.D. (2019, October 21). Alcohol use disorder and depressive disorders. Alcohol Research: Current Reviews, 40(1),v40.1.01.
2. Kuria, M.W., Ndetei, D.M., Obot, I.S., Khasakhala, L.I., Bagaka, B.M., Mbugua, M.N., & Kamau, J. (2012, January 26). The association between alcohol dependence and depression before and after treatment for alcohol dependence. ISRN Psychiatry, 2012.
3. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts.
4. Valenzuela, C.F. (1997). Alcohol and neurotransmitter interactions. Alcohol Health & Research World, 21,144-148.
5. Ramsey, S.E., Engler, P.A., & Stein, M.D. (2005, January 1). Alcohol use among depressed patients: the need for assessment and intervention. Professional Psychology: Research and Practice, 36(2), 203–207.
6. Banerjee, M. (2014, March). Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian Journal of Human Genetics, 20(1), 20–31.
7. National Institute of Mental Health. (2018). Depression.
8. Abbey, A., Smith, M.J., & Scott, R.O. (1993). The relationship between reasons for drinking alcohol and alcohol consumption: an interactional approach. Addictive Behaviors, 18(6), 659–670.
9. Centers for Disease Control and Prevention. (2021, May 11). Alcohol Use and Your Health.
10. U.S. National Library of Medicine. (2021, May 4). Alcohol withdrawal. MedlinePlus.
11. U.S. National Library of Medicine. (2018, April 1). Depression. MedlinePlus.
12. Substance Abuse and Mental Health Services Administration. Risk and Protective Factors.
13. Medline Plus. (2016, March 25). Dual Diagnosis.
14. National Institute on Drug Abuse. (2010). Comorbidity: Addiction and Other Illnesses.
15. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.