Last Updated on February 17, 2021
This article is the second in a two part-series, outlining an approach to diagnosing and treating anxiety and depression in heavy alcohol users. Previously, we focused on the relationship of alcohol addiction to anxiety, and possible solutions. Here, we’ll continue with part 2: Depression and Alcohol Use Disorder (AUD). What are the connections between the two conditions, and what can you do about it?
Part 2: Treating Depression and Alcohol Addiction
About half of all people who drink alcohol excessively also suffer from diagnosable depression.
It’s no surprise that people with both depression and alcohol problems experience a greater severity of each illness—and an overall worse prognosis—than those with one condition or the other. Denial of depression can be deadly.
Depression vs Sadness
How does major depressive disorder (the formal name for depression) differ from ordinary sadness? After all, being human means experiencing losses from time to time. Becoming sad and tearful is a normal human response to this.
Losses that trigger intense sadness can range from getting in trouble at work, to the death of a loved one, and everything in between. Arguments with your partner, job loss, breakups, financial stress, sickness, injury, and even permanent disability can all lead to perfectly normal feelings of sadness and grief. So, where is the line? How do you know when grief has turned into depression?
A major depressive episode1 (or a bout of clinical depression) is when sadness persists for two weeks or longer, with worsening severity. Other symptoms include an inability to enjoy usually pleasurable things, low energy, appetite and sleep changes, lowered self-esteem, hopelessness, helplessness, crying spells, impaired concentration, and sometimes a wish to die.
Clinical depression causes ongoing distress, and impacts your usual performance at home and at work. It can also worsen or lead to the development of anxiety, which, as discussed previously, can be the other side of the same coin.
The two conditions have some distinct differences, however. Unlike anxiety, which is on a spectrum with normal human reactions, major depression is by definition a pathological beast with well-researched genetic and biological underpinnings.
As a psychiatrist, I think of depression as “coming as a package deal” and also “taking on a life of its own.” While it may begin psychologically in response to a loss, it can also become a self-perpetuating imbalance, with its own unique characteristics.
When Is Depression Life-Threatening?
Suicidal thoughts are not uncommon in depression—or in many other conditions and situations for that matter. These can sometimes extend to making a decision to commit suicide, making plans for how you would bring about the end of your life, and going so far as to actually attempt suicide.
Intense suicidal thoughts with intention and plans require an urgent psychiatric evaluation—or, at least, a call to a suicide crisis hotline.
Depression and Alcohol Use
So, what’s the relationship between alcohol and depression? Here, as with anxiety, there are two distinct variables:
First, people drink alcohol to self-medicate depressive thoughts. This may be due to an existing, underlying depression. Moderate to severe loss may also cause an acute episode of depression, or worsen chronic depression.
Second, excessive alcohol use can affect your brain chemistry, making you more likely to feel depressed. This can become a self-reinforcing pattern. You may drink more to manage worsening feelings of depression, entering into a vicious cycle. This may in turn cause other parts of your life to unravel, further feeding the cycle and making your mood even worse.
Studies show that the combination of depression and heavy alcohol intake has an especially severe impact on women2. The reason is unclear, but this may have to do with the fact that women suffer from a higher overall baseline rate of depression than men do.
Treatments for Depression and Alcohol Abuse
If you struggle with any of the above issues, don’t despair: there are solutions.
As mentioned previously, treating both depression and alcohol addiction at the same time gets lasting results for many people. Beginning to decrease the amount you drink may already start to improve your mood. Starting coaching and/or psychotherapy can also provide some measure of relief. Specific approaches, such as cognitive-behavioral therapy (CBT) are proven by research to treat depression effectively.
Medications are also often used to address the two-headed monster of heavy alcohol use and depression. In fact, studies show that the combination of therapy and medication work better than either one alone.
The medication naltrexone, for example, can help reduce a person’s cravings for alcohol while also having a modest antidepressant effect of its own. Acamprosate (Campral), another FDA-approved medication that helps people maintain abstinence, can have a similar antidepressant effect.
For many patients, however, the above medications will not be enough to adequately treat depression, even with psychotherapy. The standard medications of choice in this situation are selective serotonin reuptake inhibitors (SSRIs). These include Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), and Lexapro (escitalopram).
SSRIs do come with vexatious side effects at times. These include gastrointestinal issues, sexual dysfunctions (most commonly delayed or stopped orgasms), headaches, fatigue/drowsiness, or motor restlessness. However, many people have few or no side effects. SSRIs can take up to 12 weeks to fully kick in, but are often effective sooner and work at a rate approaching 70 percent.
Interestingly, two formal studies were done on the combination of naltrexone and Zoloft3 (sertraline), and acamprosate with Lexapro4 (escitalopram), in treating the twin problems of alcohol abuse and depression. In both cases, the combination was found to be more effective than either medication alone.
Summary of Alcohol Use and Depression
Of those who drink alcohol excessively, about 50 percent suffer from depression. While sadness is a normal part of life, clinical, major depression is most definitely not. It causes distress, dysfunction, and, in the most severe cases, a potential for death.
Medications used to treat alcohol dependence have modest antidepressant effects themselves. When combined with SSRIs, they work effectively against the twin afflictions of alcohol abuse and depression.
Whether depression is an independent disorder, or the consequence of alcohol misuse, it is an eminently treatable condition. This is especially true when psychotherapy and medication are combined.
The stakes for each condition are highest when you are struggling with both. But there is hope. Recognizing that you drink too much and have depression, accepting this reality, and deciding to take care of yourself gets you on the path to recovery. By finding help from caring and competent professionals, and working at it, you can begin to lead yourself out of your suffering.
Professional support for alcohol use disorder, including prescription medications that treat both anxiety and alcohol addiction, is now available online. Get expert medical advice, weekly coaching support, and tools to measure your progress—all from an app on your smartphone. Get in touch today, or learn more about how it works.