The Impact of Alcohol on Depression
A glass of wine or beer after a stressful day can help you shift out of work mode, relax and recharge. Alcohol’s sedating, muscle-relaxing effects calm frazzled nerves, and its pleasant, mood-elevating benefits provide a welcome temporary respite from negative or critical thoughts. There is also a good amount of scientific evidence supporting the protective effects of light-to-moderate alcohol consumption on your brain, decreasing your risk of stroke, Alzheimer’s disease and dementia (9).
However, alcohol consumption can sometimes come to replace healthy coping techniques such as a brisk walk, or a heart-to-heart with a close friend. For some, a 5:00pm happy hour might be followed by wine with dinner, then an after dinner drink, and finally a nightcap or two. For others, the scenario might look more like a spiral of weekend binge-drinking so out of control that it requires the next five days to fully recover. Habitual, excessive alcohol consumption takes a toll on your brain. Where mood and emotions are concerned, alcohol dependency shows strong associations as both causative and perpetuating factors in depression.
Your Brain on Alcohol
The classic motor signs of inebriation—slowed movement, impaired coordination, and slurred speech—arise from alcohol’s effects on your brain’s motor centers. Alcohol also inhibits your frontal lobes where your brain anticipates, calculates and controls your emotions. Mildly inhibiting the frontal lobes can produce a pleasant sense of euphoria. However, excessive alcohol use suppresses levels of neurotransmitters such as serotonin, one of your brain’s feel-good neurotransmitters, leading to depression, or worsening it. If your brain cannot produce as much serotonin, you will have less ability to feel contentment and happiness, and will be more likely to develop symptoms of depression. Alcohol also impairs deeper structures of the brain, known as the limbic system, where memory and emotions are produced.
Dependence or Depression: Which Comes First?
So which is it—does alcohol cause depression, or do depressed people use alcohol to temporarily ease their emotional pain, and thereby gradually become addicted to alcohol?
One thing we know with certainty is that the two conditions are not mutually exclusive. An ongoing large-scale study begun in 2001, known as the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), determined that people with history of alcohol use disorder (AUD), including those in recovery, are 3.7 times more likely to experience a major depressive disorder than those without AUD(1). Not only do they often occur together, but depression and AUD seem to bring out the worst in each other, each condition becoming heightened in the other’s presence(1). And, unsurprisingly, genetic risk factors exist for both conditions.
The Gender Effect
As more research emerges, statistics show that women are more likely than men to use alcohol as a way to self-medicate symptoms of depression, while men are more likely to develop depression as a result of alcohol dependency(1). This might correlate with the fact that women are statistically twice as likely as men to experience major depression at some point in their lives(10). The National Comorbidity Survey reported that the lifetime prevalence of major depression is almost 50% among alcohol-dependent women, while only about 25% of their male counterparts experience it(2). And, for those who use alcohol to self-medicate depression, once dependency occurs it is three times more likely to persist than in those whose alcohol-dependence preceded depression(3).
Barriers to Recovery
Social stigmas surrounding depression and AUD deter many people from seeking help. Even more so when both are present simultaneously, which compounds the associated feelings of shame. Regardless of which condition precedes the other, the same spiraling pattern sets in: alcohol abuse impairs judgment and poor judgment leads to poor life decisions. As a result, relationships break down, job performance plummets, and jobs and material possessions are lost. All of these circumstances and responses circle back around on each other to cause, perpetuate, and worsen symptoms of both depression and AUD.
Historically, treatment for these conditions has been implemented through separate channels—alcohol treatment through self-help type programs, while depression is treated with psychological counseling and mood-altering drugs. This approach has further stigmatized alcohol dependence as a choice-based behavioral disorder rather than a medical condition.
A Turn For the Better
Current opinion among health professionals and experts in the field of addiction seems to favor a concurrent and coordinated treatment approach, though many questions remain regarding the most effective way to treat patients with concurrent alcoholism and depression. We know, for instance, that if depression persists after someone stops drinking they are more likely to relapse; however, some studies show that when antidepressant medications are used, they help with symptoms of depression but seem to have little to no effect on alcohol consumption(5). In a clinical trial that took a different approach, participants who received a particular type of counseling therapy along with alcohol treatment required smaller doses of medication, and were significantly less depressed than those who received a conventional treatment approach(11). Researchers are finding that when psychosocial therapies such as motivational enhancement, cognitive therapy, and twelve-step programs are combined, their benefits are enhanced(12). The result: more effective solutions for helping people recover from alcohol dependency and depression, encouraging them to stay sober, and preventing relapses over the long-term.
Reference:https://www.buffalo.edu/content/dam/www/ria/PDFs/ES18-Alcohol%20and%20Depression.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864601/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151472/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154590/ http://www.psychiatrictimes.com/major-depressive-disorder/comorbid-depression-and-alcohol-dependence http://www.med.unc.edu/www/newsarchive/2008/july/unc-study-ties-ending-moderate-drinking-to-depression https://www.ncbi.nlm.nih.gov/pubmed/28950395 https://medicine.yale.edu/intmed/geriatrics/education/medicine/BPSD_Part_1_Clinical%20Geriatrics_101893_284_38753.pdf http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.911.5095&rep=rep1&type=pdf https://www.health.harvard.edu/womens-health/women-and-depression https://soar.wichita.edu/handle/10057/1091 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712746/