Clinical depression in heavy drinkers of alcohol
On many occasions, patients admitted into hospitals have been found to be taking antidepressants, even though their main problem is alcohol dependence. In both primary care and general psychiatry, patients with drinking problems are commonly prescribed antidepressants. This may be because the only complaints from such patients are of depression or inability to cope. The effect of drinking is minimised, evaded, or genuinely not seen by patients as relevant. It has been shown that drinking problems remain undetected despite many consultations.1,2
Alcohol and depression
An association between depression and alcohol dependence is seen in many cultures.3–6 A study by Kessler et al found that a quarter of patients who have had depression at some point in their lives also reported problems with alcohol. The study also reported that 15.4 per cent of patients who were then suffering from depression also met the criteria for alcohol dependence.7 Alcohol dependence multiplies the suicide rate four to fivefold.8 There are a number of explanations for the relationship between depression and alcohol dependence. These are discussed below.
A form of self-medication
Alcohol-dependent people often tell their family or therapist that they drink to relieve depression. However, retrospective explanations for excessive drinking and reasons given by alcoholic patients to explain relapse, may not be reliable. It is known that when people behave in a way that causes distress, they tend to look for explanations that excuse, or give meaning to, what seems to be pointless behaviour.
When the temporal relationship between alcohol dependence and emotional difficulties was studied in people with alcohol dependence and in controls, it was found that depression was not a frequent cause of alcohol dependence, at least not in men.9 When interviews were conducted with 2,713 alcohol-dependent patients and 919 non-alcohol-dependent controls,9 lifetime depressive disorder or dysthymia independent of alcohol misuse was reported less often in the alcohol-dependent patients (14 per cent) than in controls (17.1 per cent).
A long-term follow-up or prospective study of the general population has been used to investigate the proportion of cases of alcohol use disorders that are preceded by mood disorders. Such a study can eliminate recall bias, as well as bias that comes from only studying people referred to clinics. In the American state of New York, a random sample of adults studied in 1986, 1989 and 1993 showed that in women, depressive symptoms over a one-month period were predictive of subsequent alcohol problems up to four years later.10 There was no such finding in males. Researchers also studied the link between drinking and depression by asking women to make daily telephone calls and record their mood as well as any drinking. There was no indication that depressed mood (or premenstrual symptoms) triggered drinking.11
Prospective studies are also important in understanding whether depression precedes or follows drinking in recovering alcohol-dependent patients. When 101 patients were followed for one year after hospital admissions for alcohol dependence, monthly scores of patients’ self-reported depression did not predict relapse to drinking.12
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Citation: Hospital Pharmacist URI: 10976423
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