Depression and Alcoholism
By Tiffney Yeager
Although the actual statistics vary from study to study, it is generally agreed that those people who have a diagnosed
mental illness are at greater risk for meeting criteria for a substance use disorder and vice versa. Do these types
of illnesses, mental illness and addiction, somehow travel together or are other factors at work? In particular, what
is the relationship between alcohol dependence and a major depressive disorder?
It is important to understand how alcohol affects the brain. Alcohol functions as a central nervous system depressant.
As a central nervous system depressant, alcohol makes it more difficult for brain cells to “talk” to one another.
The brain is the body’s “command center”. If the cells in the brain have difficulty communicating, it affects a wide
variety of functions. Motor coordination is impaired and reflexes are slowed. Breathing can become slower and shallower.
Heart rate slows down. Thought processes are dulled and judgment is impaired. Pain is not felt as acutely.
Vision is impaired, as is speech. The severity of these impairments depends upon how much a person drinks, over what
period of time the drinking occurred, the person’s weight and gender, whether the person was eating or was drinking on
an empty stomach, and so on. However, in general, the more alcohol one consumes, the more pronounced the effects.
In severe cases, where large amounts of alcohol are consumed, the central nervous system can become so depressed that
a person can pass out, slip into a coma or even die of alcohol poisoning.
So what does this have to do with depression, you ask? Actually, quite a lot. First, alcohol directly affects mood.
If a person drinks alcohol regularly and in large amounts, this can directly lead the brain to interpret the person’s
mood as “depressed”. Additionally, alcohol can affect mood indirectly in a number of ways. When drinking, people may
do things they later regret or feel guilty about. Heavy and regular alcohol use increases the risk for legal problems,
family problems, social problems and employment problems, all of which can affect mood. Alcohol use can also lead to
physical health problems which can affect mood in a variety of ways.
Interestingly, though, there are people who use alcohol to self-medicate depressive feelings. Although alcohol will
generally not make one feel less depressed in the long run, it can numb emotional pain and therefore it can give the
illusion that it helps with depression in the short run.
So if a person presents with alcohol addiction and depressed mood, where do you start? Having worked in both the mental
health field and the chemical dependency field, I believe that both can be dealt with at the same time, but a person
must stop drinking in order to fully understand the extent of the depressive symptoms. It is fairly commonplace that
people who drink heavily report feeling depressed and that if they stop drinking, often their mood improves considerably,
even if the depressive symptoms are never addressed directly. However, it is important to realize that there are some
individuals whose depressive symptoms do not resolve at all, regardless of sobriety.
For those who suffer from both alcohol dependence and symptoms of depression, my best advice is to find a treatment
program that can help you achieve sobriety. Unless the depressive symptoms are severe, such as immediate risk of
suicide or inability to function in a treatment program setting, it is often preferable to wait before trying an
antidepressant. If depressive symptoms are primarily caused by alcohol use, the depressive symptoms will often
improve with 1-2 weeks of abstinence. If a patient is still experiencing significant depressive symptoms after being
sober for a couple of weeks, it may be time to revisit the need for antidepressant medication and/or other treatment
aimed more directly at treating depression. The risk of relapse following treatment is greater if a person has an
untreated mental health condition (such as depression), so it is important not to ignore depressive symptoms.
However, there are many cases of patients who have been taking antidepressants for years and who have no history of
depressive symptoms aside from when they were drinking heavily. This makes it impossible to know whether the
depressive symptoms were caused by heavy alcohol use or whether the person had an underlying depressive disorder.
Many treatment centers are well aware of the relationship between addiction and mental illness and a patient may be
encouraged to get through detox and start a life of recovery before pursuing medication for mental health concerns
(with exceptions for severe or debilitating mental health symptoms or mental health conditions that clearly predate
the substance abuse problem). Alcohol dependence and depressive symptoms do not develop overnight and a patient
approach to sorting out the puzzle is often the best for the alcoholic in the long run.
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