Consuming alcohol isn’t just common, it’s also widely accepted and promoted as a way to relax, let go, and have a good time.
While plenty of people use alcohol moderately, there are many others for whom this is not so easy. Some of these people may develop an addiction to alcohol, becoming entangled in a cycle that is difficult to break.
The toll that alcohol abuse takes on one’s physical and mental health is undeniable. Research shows numerous health risks associated with alcohol use and alcoholism. Among the most common is a strong link between alcohol and depression.
What exactly is the relationship between alcohol and depression? Does alcohol cause depression? Or is it depression that leads to alcohol abuse?
It’s a classic “chicken vs egg” dilemma, and it may work both ways. Research suggests that the occurrence of one doubles the chance of developing the other.
Depression is more common than you might think. According to the American Psychiatric Association (APA), depression affects approximately one in 15 people. Depression, which can affect every aspect of a person’s life, is characterized by the following symptoms (which can range from mild to severe):
- Feeling sad
- Experiencing a depressed mood
- Loss of interest in activities one typically enjoys
- Difficulty sleeping (not sleeping enough or sleeping too much)
- Loss of energy/fatigue
- Feelings of guilt or worthlessness
- Trouble concentrating
- Suicidal thoughts
Alcohol abuse is also more common than many people realize. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), over 15 million adults in the U.S. (6.2 percent of the population) suffer from alcohol use disorder.
Have you ever noticed that a couple of drinks can help lift your mood when you’re feeling out of sorts?
You’re not alone.
Alcohol is commonly used as a way to escape reality, and suppress the dull, empty emotions associated with depression. In fact, there are countless people worldwide who turn to alcohol as a way to manage their depression. This is commonly referred to as “self-medication.”
Over time, many people come to believe that alcohol is helping them cope, helping them sleep, and taking the edge off feelings of sadness, restlessness, and irritability. However, while alcohol might provide momentary feelings of well-being when someone is struggling, in the big picture it can actually make things worse.
To better understand how alcohol can cause depression, let’s have a look at how alcohol works in the brain.
In a 2012 study published in Science Translational Medicine, researchers found some reasons why alcohol might temporarily make a person feel “better.” It appears that alcohol consumption releases endorphins in certain areas of the brain, specifically the nucleus accumbens and the orbitofrontal cortex.
The nucleus accumbens plays a key role in the brain’s reward circuit. Its action is mainly based on two primary “feel good” chemicals in the brain, serotonin and dopamine.
The orbitofrontal cortex is associated with expectation, sensory integration, and decision making. Research shows that feelings of depression (specifically low self-esteem and loss) are linked to orbitofrontal cortex function.
Considering the way alcohol affects these two brain regions, it makes sense that it could help one temporarily feel better. Anyone who has drank alcohol to escape feelings of depression, however, knows that this feeling doesn’t last.
In fact, alcohol often makes depression more severe.
Alcohol has several adverse health effects that contribute to depression:
Alcohol Decreases Serotonin Levels
Drinking alcohol temporarily boosts serotonin levels, which is why so many people feel “better” after having a few drinks. In the long term, however, excess alcohol consumption does the exact opposite.
Low serotonin levels are linked to feelings of depression and low energy. They can also lead to symptoms of anxiety, decreased self-esteem, difficulty sleeping, aggression, and more.
The more you drink, the lower your serotonin levels become overall. So if you already suffer from depression, drinking can intensify these feelings.
Excessive Drinking Can Increase Stress Hormone Levels
Research indicates that heavy and long term drinking can put significant strain on the body, and lead to an increase in the stress hormone cortisol.
Because of its role in our “fight-or-flight” response, increased levels of cortisol can result in feelings of chronic stress. This continual state of “high alert” can cause neurotransmitters such as serotonin to stop functioning correctly, which can in turn lead to depression.
People with depression tend to have higher levels of cortisol in their bloodstream to begin with. Excessive alcohol consumption can exacerbate these chronically high cortisol levels, causing feelings of depression to become worse.
Long Term Exposure to Alcohol Leads To Decreased GABA Levels
GABA is a neurotransmitter responsible for blocking impulses between nerve cells in the brain. When GABA is at its optimal level, it’s believed that this neurotransmitter can improve mood and help relax the central nervous system.
Long term heavy drinking seems to reduce GABA levels in the brain, which research suggests can ultimately make depression worse. Decreased GABA levels may also lead to increased anxiety, which can increase feelings of depression as well.
If you’ve been suffering from depression, and have been attempting to drink your blues away, you’re certainly not alone.
Research shows that most people who abuse alcohol and enter treatment have high scores on depression rating scales. For many, these ratings tend to decline after a few weeks of abstinence from alcohol.
For others, depression will continue to be an issue, especially if their alcohol abuse developed from an attempt to self-medicate. No matter which came first, however, an ever-increasing number of health professionals and addiction experts believe that treating alcohol use and depression at the same time is the best path.
An integrated model of treatment—including both pharmacological and psychological therapy—is often seen as the most effective way to do this.
There are several FDA-approved drugs for the treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are among the most popular. When receiving treatment for both depression and alcohol abuse, however, there’s something important to be aware of: antidepressants and alcohol don’t mix well.
While combining the two isn’t life threatening, using alcohol while taking antidepressants has some serious side effects.
For one thing, SSRIs can increase some people’s desire to drink. Alcohol can also worsen the side effects of antidepressants, which include dizziness, drowsiness, insomnia, blurred vision, headaches, and more. If you are struggling with depression, and also trying to cut back on your drinking, you may want to discuss alternatives with your doctor.
There are also prescription drugs that can help a person drink less alcohol. FDA-approved medications for the treatment of alcohol use disorder include:
Several other drugs are considered effective “off-label” medications for alcohol abuse. This means they are FDA approved for another purpose, but deemed safe for alcohol addiction treatment. These include:
Some of these medications also help with anxiety and depression. But once again, because everyone is different, consult with your doctor before trying any of these. In rare cases, some of these drugs can make depression much worse.
Aside from medication, an integrated model of treatment for alcohol and depression should involve at least one type of therapy or behavioral health support. Many options exist, and different approaches will suit some people more than others. Methods can include:
- Cognitive behavioral therapy
- Motivational enhancement therapy
- Relapse prevention therapy
- 12-step programs (such as Alcoholics Anonymous)
What matters most is that a person can access some form of psychological care and support. Anyone struggling with depression who is giving up alcohol will need new coping mechanisms. Therapy can help people establish new patterns, and work on underlying issues. Support groups offer a like-minded community to connect with. Both can be essential.
Finally, therapy or coaching is a big part of matching treatment to each person’s unique needs. Knowing the whole story helps doctors and addiction counselors identify the best path for each individual.
- In the 2010 National Survey on Drug Use and Health, nearly one sixth of U.S. adults who met the criteria for substance abuse disorder reported at least one major depressive episode in the same period of time.
- People who experienced a major depressive episode in the past year were also more likely to report problems with substance abuse or dependence.
- The majority of people struggling with both depression and substance abuse reported that alcohol was their most used substance.
- Struggling with either depression or alcohol abuse can double a person’s risk of developing the other issue.
- Individuals experiencing both major depression and alcohol use disorder have an increased risk of suicide. One study found that blood alcohol concentration was above or at the legal limit in 30 percent of suicide deaths. 50 percent were experiencing major depression at the time of suicide.
The connection between alcohol and depression is well documented. Experts agree that where there is one, the other often appears.
Fortunately, there seems to be an answer. Treating both problems at once with a combination of medication and therapy has shown very positive results. This is especially true when treatment is customized to the unique needs of the individual.
Ria Health is one program that strives to do exactly this. We offer both medication and coaching for alcohol addiction via telemedicine. Treatment plans are customized to each person’s needs. Our program is 100 percent accessible through your smartphone or personal device, and is even covered by many insurance providers.
Our approach has a high success rate: On average our members reduce their drinking by 70% within the first 6 months. If you’re ready to learn more, schedule a call with us today, or read more about how it works.
Help is available for those struggling with alcohol abuse and depression. Ria Health is here whenever you need us!