Mindpath Health’s Dean Drosnes, MD discusses treatments for co-occurring alcohol use and depression. See highlights below or read the full article with sources here. 

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Symptoms of Alcohol Use Disorder (Alcoholism)

Alcohol use disorder (AUD), commonly known as alcoholism, occurs when alcohol consumption becomes so uncontrollable that it negatively affects important aspects of your life. Alcoholism can cause damage to relationships, job prospects, finances, and physical and mental health. 

The CDC reports that physical effects of long-term excessive alcohol use include: 

  • Organ damage 
  • High blood pressure 
  • Weakening of the immune system 
  • Learning and memory problems 

Alcohol’s depressant nature hampers the pleasure centers of your brain, which can eventually lead to chronic mood issues. 

Symptoms of Depression

Depression is a persistent feeling of sadness, worthlessness, or guilt that lasts for an inordinate amount of time and interferes with daily life. Other symptoms of depression include: 

  • Exhaustion 
  • Trouble focusing or making decisions 
  • Lack of enjoyment in normally pleasurable activities 
  • Thoughts of suicide 

Depression may also manifest with the misuse of substances such as alcohol.  

Which mental disorder is most commonly comorbid with alcoholism? 

Experts such as the National Institute on Alcohol Abuse and Alcoholism (NIAA) and National Institutes of Health (NIH) have reported that major depression, bipolar disorder, and anxiety disorders occur commonly alongside alcohol misuse.  

Additionally, a 2020 paper published by Lancet Psychiatry notes that AUD can cause other psychiatric conditions to develop, and vice versa. However, the presence of AUD that is comorbid with another psychiatric disorder can also manifest as a result of shared genetic, psychopathological, and environmental factors.  

What are the treatment options for comorbid alcohol abuse and depressive disorders?

Treatment options for comorbid alcohol abuse and depressive disorders can vary from person to person, depending both upon individual patient characteristics/preferences, as well as the severity of both the alcohol abuse and the given mood disorder. 

“There are many different treatment approaches for comorbid alcohol and depressive disorders, including medications, psychotherapy, and behavioral interventions,” Ryan Warner, PhD and clinical psychologist at Prosperity Haven, tells WebMD Connect to Care. “These include, but are not limited to selective serotonin reuptake inhibitors, cognitive behavioral therapy, support groups, and detoxification.” 

It is important that the particular type(s) of therapy employed fully take into account the intersection between alcohol abuse and depression. “Many alcohol treatment programs have been designed to provide some of the basic psychotherapy components that are effective for depression,” Dean Drosnes, MD and addiction specialist and psychiatrist with Mindpath Health, tells WebMD Connect to Care. 

“For more severe depression, co-occurring disease programs are available to simultaneously address the mood issues and the drinking problem more intensively. Antidepressant medications, although not shown to reduce drinking per se, are beneficial to many people with comorbid depression and alcohol use disorder,” Drosnes says. 

Different experts offer varying opinions of which antidepressants are best for alcoholics, and research is ongoing. “SSRI and SNRI antidepressants have become the norm for treating depression in those with AUD,” Drosnes says. “Others, such as tricyclic antidepressants, may be helpful in some patients.” 

Drosnes also lists other interventions that he says can be helpful for those dealing with alcohol use disorder and depression. “Ketamine therapy is controversial for people with alcohol use disorder due to the potential for abuse or addiction. Newer treatments, such as transcranial magnetic stimulation, hold promise for treating both alcohol use and depression. The landscape changes constantly,” Drosnes says. 

Alcohol-Induced Depression

As noted, depression and alcohol abuse are frequently comorbid, meaning they occur at the same time. However, distinctly, depression can also be specifically triggered by alcohol use, producing what is known as alcohol-induced depressive disorder. 

“Alcohol-induced depressive disorder is a type of depression that occurs when a person uses alcohol or during withdrawal from alcohol,” McGrath says. “Alcohol-induced depression can cause significant distress. It may affect a person’s work, school, and relationships. The good news is that it typically goes away after three to four weeks of abstinence.” 

Some data suggest that alcohol-induced depression is not an especially common diagnosis. A 2019 Alcohol Research: Current Reviews article cites research suggesting that under 1% of people with substance abuse disorders have depressive disorders that are considered substance-induced. The article also notes some cases diagnosed as substance-induced depression were later re-diagnosed as independent depression, due to the psychological disorder’s persistence with abstinence. 

How long does it take to recover from alcohol-induced depression?

Most experts characterize recovery as a process that takes several weeks. “Time to complete recovery depends on the amount and duration of alcohol consumption, but in purely alcohol-induced depression, remission of depressive symptoms is often apparent within 90 days,” Drosnes says. 

Often, treatment begins with stopping alcohol consumption. “Following cessation of alcohol intake, duration of depressive symptoms is typically less than for a primary depressive disorder. It is not unusual for depressive symptoms to begin to clear within the first four weeks of abstinence from alcohol,” Drosnes says.  

Get Help Now

The good news is that dual diagnoses, also called co-occurring disorders, are common and treatable. If you’re feeling depressed or turning to alcohol during times of stress, it might be time to get help. Also, if you consume alcohol in large amounts, you might want to consider underlying mental health issues behind the drinking 

“It is rare to see anyone with a major drinking problem who is not currently struggling with mood-related issues,” Dr. Ryan Drzewiecki, licensed psychologist and director at All Points North Lodge in Colorado, says. “Luckily, in my experience, most alcoholics find that when they get sober, they are better able to deal with their depression than they had been telling themselves all along.” 

Dean Drosnes, M.D.

Raleigh, NC

Dr. Dean Drosnes chose this field because of his strong personal family history of addiction. He is passionate about helping those with addiction to minimize their pain and suffering, and instead maximize their enjoyment of life. Dr. Drosnes understands that addiction is a complex disease that can be treated successfully for most patients. He states that lifelong recovery is achievable and sustainable. What differentiates Dr. Drosnes from other clinicians is ... Read Full Bio »

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