Alcohol Use Disorder and Depressive Disorders
Sensitivity analyses did not substantively differ from the primary analyses for health-related quality of life. Some of those studies did not identify the substance included in their studies, making the outcomes to all types of abused substances unsupportive in that area. Additionally, only SSRI was examined in combination with medications for alcohol dependence. Consequently, this drives the requirement for future studies that examine other anti-depressants with a different mechanism of action in this clinical setting. On the other hand, Pettinati et al. illustrated that a combination of sertraline, an SSRI, with naltrexone as a treatment for alcohol dependence would result in higher alcohol discontinuation rates and a significant reduction in depression symptoms, with acceptable incidence of side effects 22.
- They summarize key findings from animal models and suggest that brain stress systems may be useful targets for medications development.
- The greater the amounts of alcohol consumed and the more regular the intake, the more likely a person will be to develop temporary anxiety and depressive symptoms.
- It would be helpful if the effect sizes (ORs and SMDs) were also contextualized in the same easily grasped language; e.g., small, medium and large.
- Pharmacologically, selective serotonin reuptake inhibitors and tricyclic antidepressants are commonly used to treat depression in individuals with AUD, while naltrexone and acamprosate are first-line medications for AUD.
Psychotherapeutic interventions such as Cognitive-Behavioural Therapy (CBT) and Motivational Interviewing are essential components of treatment, focusing on addressing both alcohol use and depressive symptoms. Behavioural activation has also proven effective in treating depression while reducing alcohol cravings. Integrated care models, where both disorders are addressed simultaneously, yield the best outcomes and involve coordinated pharmacotherapy, psychotherapy and ongoing follow-up care. A case example of a 33-year-old woman with AUD and MDD highlights the success of an integrated treatment approach, where a combination of sertraline, naltrexone and CBT led to significant improvements in both mood and alcohol use. Clinicians are advised to differentiate between alcohol-induced depression and primary MDD, consider potential medication interactions, and incorporate ongoing psychotherapy and monitoring for optimal patient outcomes. This approach emphasizes the importance of addressing both conditions concurrently to achieve better long-term recovery outcomes for patients with co-occurring AUD and MDD.
The COGA investigation will gather more data regarding potential alcoholic subtypes and will continue to explore possible genetic linkages between alcohol dependence and major depressive and major anxiety disorders. Certain ongoing treatment studies also are further evaluating the potential usefulness of buspirone, some specific anti-depressants, and other medications that affect brain chemicals as potential components for treating alcoholism. Each of these studies is taking steps to evaluate the importance of these psychiatric medications while considering whether subjects’ depressive or anxiety syndromes are likely to be alcohol induced or may indicate longer term independent psychiatric disorders. People with DSM-IV alcohol dependence are 3.7 times more likely to also have major depressive disorder, and 2.8 times more likely to have dysthymia, in the previous year. Among people in treatment for DSM-IV AUD, almost 33% met criteria for major depressive disorder in the past year, and 11% met criteria for dysthymia. However, major depressive disorder is the most common co-occurring disorder among people who have AUD, partly because it is among the most common disorders in the general population.
Future Research Directions
It is also important to remember that some studies indicate a potential relationship between alcoholism and anxiety/ depressive disorders. In addition, alcoholism and these psychiatric disorders may operate together within some families, or individual instances may occur whereby a person develops alcoholism as a direct reflection of a preexisting psychiatric syndrome. In addition to more studies on interventions included in this review, studies are needed on other interventions used to treat AUDs and depressive disorders. Examples of interventions missing from this body of evidence that are recommended in clinical practices guidelines for AUDs include 12-Step Facilitation, behavioral couples therapy, the community reinforcement approach, disulfiram, gabapentin, motivational enhancement therapy, and topiramate 7. Consistent with the generally negative results of these family type studies are the conclusions drawn from a recent study of 1,030 female-female twin pairs (Kendler et al. 1995).
Thirty percent of concurrent episodes were preceded by MDD only, 11% were preceded by AUD only, and 21% were preceded by non-concurrent episodes of both MDD and AUD. The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional.
- Second, the researchers conducted followup on 453 sons of alcoholics and control subjects who were tested in the laboratory at approximately age 20, thereby gathering data regarding the development of depressive, anxiety, and alcohol-use disorders during the subsequent decade (Schuckit and Smith 1996).
- As many as 80 percent of alcoholics report periods of sadness in their medical histories, with approximately one out of three alcohol-dependent men and women having experienced a severe depression that lasted for at least several weeks and interfered with his or her functioning (Brown and Schuckit 1988; Winokur 1983).
- Mixed results from previous studies could be partly due to a failure to account for developmental timing.
- As cited in our recent review, however, an evaluation by Hill and colleagues1 of 95 COA’s and control subjects at ages 8 to 18 showed no evidence of increased rates for depressive or anxiety disorders in the offspring of alcoholics (Schuckit and Hesselbrock 1994).
- Second, the possibility that a longer term anxiety or depressive disorder exists in an alcoholic must always be considered.
Fig 2. Network structure.
Other data also suggest a greater-than-chance association between panic disorder (and perhaps social phobia) and alcoholism (Cowley 1992; Cox et al. 1990; Kushner 1996). These studies, however, do not clearly establish the intensity of the relationship between these psychiatric disorders and alcoholism (e.g., what percentage of alcoholics have independent anxiety disorders?), and the association of alcoholism to other mood or anxiety disorders is even less clear. The available evidence does suggest that CBTs likely reduced, and TCAs may have resulted in a slight reduction of depressive symptoms.
It has been estimated that up to 40% of patients with depression have a history of SUD or alcohol dependence during their lifetime 4. However, only 19% of these patients seek medical help for themselves, where most of them were alcohol dependence 4. Despite the availability of information on the correlation between depression and SUD and/or alcohol dependence, their causality is still controversial 5. The association between substance use and depression has been specified more significantly for some substances, including alcohol, cannabis, and opioids.
Do not disregard or avoid professional medical advice due to content published within Cureus. Out of the eight included studies 15-22, only one study had a retrospective design 16, whereas the remaining seven studies were prospective, where one study was a case-control study 15, five studies were randomized controlled studies 17,19-22, and one study was a prospective cohort study 18. 1) We are told how confident we can be in each result in multiple prominent locations in the article.
Data Availability Statement
Nor did a review of several recent studies alcohol use disorder and depressive disorders pmc by Fyer and colleagues1 and Noyes and colleagues1 reveal high rates of alcoholism in relatives of people with social phobia or other anxiety disorders (Schuckit and Hesselbrock 1994). Prospective associations across developmental periods are the strongest evidence in favor of a causal relation between MDD and AUD. Our findings suggest modest, bidirectional, and developmentally-specific associations between the two disorders. This finding is broadly consistent with studies showing AUD to predict MDD (12, 13), MDD to predict AUD (8, 11) or both (9, 14, 15). Mixed results from previous studies could be partly due to a failure to account for developmental timing. Adolescent AUD may contribute to MDD risk in early adulthood by bringing about negative psychosocial consequences that are developmentally salient as adolescents move into adulthood (e.g. academic difficulties).
Rates of period comorbidity were highest in early adulthood and the majority of individuals with AUD already had a history of MDD by that time. Fourth, we found roughly equal lifetime rates of concurrent and successive comorbidity by age 30. In most cases, concurrent episodes developed after remission from non-concurrent episode(s) of MDD, AUD, or both.
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The greater the amounts of alcohol consumed and the more regular the intake, the more likely a person will be to develop temporary anxiety and depressive symptoms. People with AUD have a heightened risk for depressive disorders, which are the most common co-occurring psychiatric disorders for this population. AUD and depressive disorders appear to share some behavioral, genetic, and environmental risk factors, yet these shared risks remain poorly understood. Limited information exists regarding the long-term development of comorbidity between Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD; abuse/dependence).
Maybe I missed it (but I did search the document for the term “NetworK” and I did look at S1) but I couldn’t figure out how studies were assigned to networks or what they were for. This section collects any data citations, data availability statements, or supplementary materials included in this article. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximise its impact. If the press office is planning to promote your findings, we would be grateful if they could coordinate with If you have not yet opted out of the early version process, we ask that you notify us immediately of any press plans so that we may do so on your behalf. Please let me know if you have any questions, and we look forward to receiving the revised manuscript.
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Table 6. Summary of findings table for the psychological intervention network.
Although there are multiple medications used for managing depression, treatment success is usually low, especially in patients with alcohol dependence or SUDs 9. Hence, some studies have investigated different treatment modalities and examined depression treatment outcomes in these patients. The present review investigated the outcomes of depression treatment in patients with alcohol dependence or substance use. The present review demonstrated that pharmacological treatment alone might not lead to sufficient outcomes of depression treatment in patients with alcohol dependence or SUDs.
