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Alcohol and Depression: The Link Between Depression and Alcohol Use

Alcohol use disorder (AUD) and depression are common co-occurring disorders. This page will help you understand how depression and AUD affect each other, what the common risk factors are, and what types of treatment are available for depression and co-occurring alcohol use disorder.

Signs and Symptoms of Depression

Depression is one of the most common mental health diagnoses as it affects approximately 280 million people globally. 4 There are several different types of depression that are distinguished by the frequency, duration, onset, and severity of symptoms.3  A mental health or medical provider can assess for these different types of depression to help clarify your treatment plan. Although there are many types of depressive disorders, common symptoms include:3  

  • Sadness or feelings of emptiness
  • Easily annoyed and irritated
  • Loss of interest or pleasure in activities you once enjoyed
  • Decreased energy and lack of motivation to participate in normal daily functions
  • Changes to appetite: not feeling hungry, not eating enough, or eating too much
  • Difficulty with sleep: trouble getting to sleep, staying asleep, or oversleeping
  • Feeling inappropriately guilty
  • Psychomotor agitation: restless movements that serve no purpose such as tapping or fidgeting.
  • Feelings of worthlessness
  • Suicidal thoughts

If you are feeling suicidal, it’s important to talk to your doctor or mental health provider. If the suicidal feelings escalate, seek help by calling 911 or going to your local emergency room.

What is Depression?

Depression is classified as a mood disorder and has many different sub-types.3 In order to make a clinical diagnosis for a depressive disorder, a trained medical or mental health clinician must assess symptoms, duration, frequency, onset, and make sure the individual meets the diagnostic criteria for the specific depressive disorder.3 Common types of depressive disorders include: 2,3,4

  • Major Depressive Disorder (MDD). With MDD, specific symptoms of depression must be present for at least 2 weeks in duration to meet the diagnostic criteria. Symptoms of depression must interfere with your daily living, meaning they affect your personal life, professional life and day-to-day living.
  • Persistent Depressive Disorder. This causes less severe symptoms than major depression, but symptoms are present for a longer duration (at least two years in duration).
  • Postpartum Depression (perinatal depression). This type of depression occurs during pregnancy or immediately after birth, during the postpartum period, and if severe enough, some women can have psychotic symptoms.
  • Seasonal Affective Disorder (SAD). People can experience depressive symptoms due to seasonal changes, such as lack of exposure to daylight. While it can occur any time of year, it typically begins in the fall or early winter and improves in the spring or summer.
  • Psychotic Depression, also known as depression with psychosis. This is a severe form of depression where people experience psychotic symptoms with depression. Psychotic symptoms include hallucinations (seeing, hearing, feeling, or smelling things that aren’t there) or delusions (believing things that aren’t true).
  • Bipolar Disorder. This is also classified under the category of mood disorders, which is the same category as depression, however bipolar disorder, also called bipolar depression or manic depression is characterized by episodes of mania that alternate with periods of depression.
  • Medication- or substance-induced depression. This is a type of depression where depressive symptoms emerge during or soon after exposure to a substance (i.e., intoxication) or medication or while experiencing withdrawal symptoms from a substance or medication.

The Link Between Depression and Alcohol: Trauma, Genetics and Social Environments

Alcohol misuse is a pattern of unhealthy alcohol consumption that can be harmful to your health and relationships. People who misuse alcohol to the extent that they cannot control their alcohol consumption, despite the negative consequences may be diagnosed with an Alcohol Use Disorder (AUD).

Alcohol use and mental health conditions are frequently seen together but can also occur independently of each other.6

Although several risk factors have been identified for depressive disorders, depression or alcohol use disorder can occur in anyone. Not everyone who experiences risk factors will develop a depressive disorder, but risk factors can play a role in its development. These risk factors may include, post-traumatic stress disorder, genetics, certain medications, your social and physical environment.1,2,3,6

Even if you are not diagnosed with PTSD, past traumatic experiences such as emotional abuse, life-threatening accidents, war, neglect, or sexual abuse might increase your risk of developing AUD and depression.3  For many people, these experiences have a negative impact and can be hard to process through alone, without therapy, and as a result, people may tend to misuse alcohol to numb these past traumatic events and associated negative feelings. These traumatic events can also lead to depression, especially if the individual does not have the correct coping mechanisms or social support. Self-medicating with alcohol or other substances, to alleviate or cope with these experiences or other pre-existing symptoms is a common link between depression and alcohol use disorder .7  Consequently, withdrawing from certain substances like alcohol might increase depressive symptoms, as withdrawal symptoms can leave one feeling sad, exhausted and irritable.


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Your social and physical environment can influence your susceptibility towards AUD and depression.3  Environments such as college, high-stress professions, stress within your personal or family life can all trigger feelings of wanting to misuse alcohol to alleviate the stress or numb the pain of depression.

For instance, being in a college setting and drinking in excess is normalized within American society and symptoms of depression often go unnoticed and untreated, especially among college students who are struggling.8  College is when the heaviest drinking is reported and the typical age of students is when they are at the highest risk of developing AUD.8  For many people in this age range, moving away from their parents, the stress of higher academic achievement and peer pressure combined can increase the risk of developing either depression or AUD or both.

Stress at work or stress within your personal life can also contribute to feelings of depression and the need to misuse alcohol to numb the stress.

For others, there may be a family history of AUD or depression that can increase your likelihood of developing a disorder.3  

The etiology, or cause of diagnosis, is similar among both AUD and depression.7  There is no definitive cause for either AUD or depression instead, risk factors can increase your likelihood of developing either of these disorders.3  Alcohol may initially alleviate the symptoms of depression but can lead to a pattern of misusing alcohol, while an alcohol use disorder (AUD) can increase the risk of depression, as prolonged alcohol misuse can disrupt the brain chemistry causing depressive symptoms.

It’s important to note that the co-occurrence of AUD and depressive disorders, specifically major depressive disorder, and persistent depressive disorder with AUD, is associated with greater severity and worse prognosis than either disorder alone. This includes a heightened risk for suicidal behavior.6

Co-occurring Alcoholism and Depression Treatment

Treatment often includes an integrated approach to address both alcohol use disorder and depression.  Because each person is unique, treatment will be tailored to your specific needs.  Some of the treatments for co-occurring depression and AUD can include1,8,9

  • Medical Detox. Medical Detox is usually the first step in the recovery process followed by entry into a formal rehabilitation program. Detox helps you safely and comfortably withdraw from alcohol.
  • Antidepressants/Medications. You may receive antidepressants, which can help treat both the depression and some symptoms of AUD. In addition, you may receive naltrexone, a medication that helps people stop drinking and reduces depressive symptoms. Disulfiram and acamprosate can also be used to help curb alcohol cravings and abstain from alcohol.
  • Cognitive-Behavioral Therapy (CBT). This helps you learn positive coping mechanisms to replace the thought and behavioral patterns that can contribute to or worsen AUD and depression.
  • Dialectical Behavior Therapy (DBT). This type of therapy is mainly used to help reduce self-harm and suicidal behavior.
  • Behavioral Activation. Behavioral Activation is a therapy that is effective for both AUD and depression. It involves developing an understanding of how negative life experiences and behaviors influence your mood and emotions and encourages you to take an active approach to increase your positive life experiences.
  • Mutual support groups. Support groups include 12-step groups like Alcoholics Anonymous (AA) and non-12-step groups like SMART Recovery. These groups are effective both as treatment and as aftercare for both AUD and depression. You’ll benefit from the support of others who know what it’s like to be in your shoes, which can lessen feelings of isolation and help you feel connected.

If you or a loved one is affected by AUD and depression, there is treatment available. Be sure to talk with your medical or mental health provider about your experiences and symptoms. They can work with you to determine your best course of treatment and inform you about dual diagnosis or co-occurring disorder rehab facilities.

Sources:

  1. National Alliance on Mental Illness. (2020, May). Substance Use Disorders.
  2. National Institute on Alcohol Abuse and Alcoholism. (2020). Understanding Alcohol Use Disorder.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  4. World Health Organization. (2021, September 13). Depression.
  5. National Alliance on Mental Illness. (2020, May). Substance Use Disorders.
  6. McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research : current reviews, 40(1), arcr.v40.1.01.
  7. Fergusson DM, Boden JM, Horwood LJ. Tests of Causal Links Between Alcohol Abuse or Dependence and Major Depression. Arch Gen Psychiatry. 2009;66(3):260–266. (This was a recommended source)
  8. National Institute on Drug Abuse. (2020). Common Comorbidities with Substance Use Disorders Research Report: What are the treatments for comorbid substance use disorder and mental health conditions?
  9. National Alliance on Mental Illness. (2020). Substance Use Disorders.
  10. National Institute on Mental Health. (2020). Post-Traumatic Stress Disorder.
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