Alcoholism and Depression

There is a significant, though complex, relationship between alcoholism and depression. Major depression is the most common co-occurring psychiatric disorder among those with alcoholism, or alcohol use disorder (AUD). In one survey, approximately one-third of people with alcohol dependence had a mood disorder.1

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Relationship Between Alcoholism and Depression

Almost 30% of Americans will experience issues with alcohol at some point in their lives.2 According to the 2019 National Survey on Drugs and Health (NSDUH), approximately 14.5 million people age 12 and older have alcohol use disorder (AUD).3

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, depression affects how you feel, think, and behave. Major depressive disorder is the most common psychiatric disorder and affects approximately 10 to 15% of people in their lifetimes.4

While issues with alcohol and depression co-occur frequently, not everyone is prone to developing both simultaneously. Some factors that may contribute to increased vulnerability to developing AUD and depression:5

  • Genetics—Those with a family history of either condition tend to have a higher risk. A genetic predisposition can lead you to experience depression and alcohol use disorder.
  • Personality—People who experience low self-esteem and difficulties in social situations may be more likely to develop issues with depression and alcohol.
  • Personal history—Those who have experienced abuse, trauma, and interpersonal problems may be more likely to be depressed and to misuse alcohol.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) states that depression can arise and increase during the presence of alcoholism.6 This depression can lead to more drinking as the cycle perpetuates itself.

The cyclical nature of comorbid alcoholism and depression can happen due to several circumstances, including:

  • Self-medication—When someone uses alcohol to manage their mental health symptoms, this is a practice known as “self-medication.” The sedative effects of alcohol may be used as a distraction or sleep aid. However, in people with depression, alcohol misuse can cause worsening depressive symptoms. 1
  • Unhealthy coping mechanism—Both severe depressive symptoms and long-term alcohol misuse can result in negative effects in multiple areas of a person’s life. However, if a person has not developed other coping skills, they may use alcohol to cope with the consequences of their mental health symptoms and their alcohol misuse.
  • Medication interaction—Antidepressants taken to manage depression can interact with alcohol, making the antidepressants less effective. This issue may also lead to a pattern of self-medication.

It is difficult to know whether AUD or depression occurs first, but research shows that both issues are among the most prevalent psychiatric disorders and co-occur often regardless of the order of occurrence. Studies have also indicated that this dual diagnosis is associated with greater severity and a worse prognosis for both issues.7

Research indicates that it is more likely for alcoholism to lead to depression than for depression to result in alcohol issues.8

Side Effects of Alcoholism and Depression

Both misusing alcohol and depression can have a significant impact on your life. Alcoholism produces some symptoms that are similar to the experience of clinical depression, which can make it difficult to distinguish the two without professional help.

Typical physical side effects from alcoholism include:9

  • Chronic hangovers
  • Frequent blackouts
  • Unexplained stomach pain
  • High tolerance for alcohol
  • Withdrawal symptoms when attempting to stop drinking

The most common psychological effects of alcoholism include:8

  • Insomnia
  • Paranoia
  • Hallucinations
  • Depression
  • Anxiety
  • Compulsive behavior
  • Personality changes

Depression can have physical and mental effects. These are some of the most common effects of depression on your health:10

  • Chronic pain
  • Headaches or migraines
  • Chronic fatigue
  • Change in sleep patterns
  • Weight changes
  • Appetite changes
  • Decreased sex drive
  • Increased chance of autoimmune disorders

Psychosocial effects of depression include:10

  • Loss of interest in previously enjoyable activities
  • Difficulty concentrating on tasks
  • Feeling frustrated, restless, or irritable
  • Persistent anxiety or sadness
  • Feeling helpless, vulnerable, guilty, or worthless
  • Having a pessimistic or hopeless outlook
  • Difficulty with decision-making

If you are experiencing issues with both alcohol and depression, you may have a combination of symptoms of both disorders, which may, in turn, intensify each other.

Long-Term Risks of Alcoholism and Depression

Due to the seriousness of each of these disorders, you could experience several long-term risks from the debilitating effects of alcoholism and depression. For both disorders, these risks include physical, psychological, and cognitive symptoms.

Chronic alcoholism can cause physical issues and can create or contribute to liver damage, cardiovascular disease, and multiple types of cancer.

Other long-term physical effects of alcohol misuse may include:9

  • Reduced gray and white matter in the brain
  • Memory loss
  • High blood pressure
  • Alcoholic cardiomyopathy (ACM)
  • Stroke
  • Irregular heartbeat

Long-term physical effects of depression include chronic fatigue due to loss of energy and irregular sleep patterns. In addition to a weakened immune system, this can lead to increased instances of physical illness. If you have chronic depression, you might also experience persistent aches and pains.11

Chronic depression can also cause lasting effects on relationships, such as feelings of isolation and difficulty expressing emotions and affection. Other potential effects include having difficulty with memory and an inability to concentrate.11

The long-term risks of experiencing these two disorders together include relapsing into alcohol misuse.

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Treatment for Alcoholism and Depression

If you experience problems with alcohol and depression, you may have previously tried to stop using alcohol with the hope that you could deal with both issues at the same time. Alcoholism can lead to relapse if you have a depressive disorder because depressive symptoms are greatest when you first stop using alcohol. Support is essential to help stop a relapse due to these depressive feelings.

Co-occurring depression and alcohol misuse can be especially difficult to manage, but there are treatment facilities designed to treat both disorders. The most common interventions at a treatment facility for alcohol and depression include:11

Detoxification

If you have AUD, you can develop a physical dependency on alcohol. Quitting suddenly can cause withdrawal symptoms that can be severe and may even be life-threatening. A rehab facility for safe detox and withdrawal from alcohol is essential.

Medication

Alcohol can significantly impact the levels of neurotransmitters in the brain, which may make depression worse. Antidepressants can balance these chemicals, relieve depressive symptoms, and adjust your brain chemistry to stabilize your mood. Medication may also be prescribed to lower alcohol cravings and reduce the urge to drink.

Therapy

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that helps people understand the events and thought processes that lead to depression and alcohol misuse. CBT can teach modification of thoughts and behavior patterns. This therapy is often used to prevent relapse in people undergoing alcohol addiction treatment.

Group therapy

Group therapy gives you the opportunity to connect with others in treatment by sharing experiences and receiving feedback from fellow participants. Counseling groups can help you share your experiences, listen to others’ experiences, and try new coping skills in a safe environment.

12-Step Program

Support groups like Alcoholics Anonymous (AA) provide a community and help to facilitate a 12-step program that outlines a plan for recovery following rehab treatment.

If you or a loved one is struggling with alcohol and depression, call 800-839-1686Who Answers? to speak with an addiction treatment specialist.

Resources

  1. Petrakis, I.L, Gonzalez, G., Rosenheck, R., & Krystal, J.H. (2002). Comorbidity of alcoholism and psychiatric disorders. Alcohol Research & Health, 26(2), 81-89.
  2. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol facts and statistics.
  3. Substance Abuse and Mental Health Services Administration. (2019, December 8). 2019 National Survey on Drug Use and Health.
  4. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. Centers for Disease Control and Prevention. (2018). Prevalence of depression among adults aged 20 and over: United States, 2-13-2016.
  6. National Institute on Alcohol Abuse and Alcoholism. (2000). Alcoholism and co-occurring disorders.
  7. National Institute on Alcohol Abuse and Alcoholism. (2019, October 21). Alcohol use disorder and depression.
  8. Centers for Disease Control and Prevention. (2021, February 23). Alcohol use and your health.
  9. Mayo Clinic. (2018, February 3). Depression (major depressive disorder).
  10. DeVido, J. J., & Weiss, R. D. (2012). Treatment of the depressed alcoholic patient. Current Psychiatry Reports, 14(6), 610-618.
  11. Harvard Medical School. (2009). Managing chronic depression.

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