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Mental health professionals who treat alcoholism and depression have long known that these two illnesses occur together more often than not. In fact, it is quite common in medical settings for people to seek treatment for either of these conditions. Not only is it true that in this setting the sensitive health care provider identifies the presence of the other illness 1, but it is also known that the earlier in one's life that either of these two disorders develops, the greater the chance the other will also arise 2.
But what is known of the relationship between alcoholism and depression in people who are not seen in medical settings? In what order do they occur? This is obviously an important point in terms of understanding the development of these conditions, since people tend to seek help only in the later stages of a problem. A study recently done at the Harvard School of Public Health and a Harvard affiliated hospital has answered these questions.
Scope and aim of the study
The authors used data from a large survey that studied 14,480 people from 5 cities 3. In order to be included in the analysis, subjects could not have had a previous diagnosis of either major depression or alcoholism.
The American Psychiatric Association (APA) has established a set of criteria and symptoms that characterize various psychological disorders. In order to receive a diagnosis of major depression, a person must meet a specific number of criteria from the APA.
This means that someone may have some of the signs and symptoms of depression, but may not qualify to receive a diagnosis of the illness. Nevertheless, in practical terms, these symptoms can still affect the individual's overall functioning and well-being. And by eliminating people with a diagnosis of depression or alcoholism, the researchers were able to more clearly evaluate the order of onset of new cases of depression and alcohol dependence.
Study participants were interviewed using the Diagnostic Interview Schedule (DIS) - an interview designed to detect the presence of psychiatric disorders, including depression and alcohol dependence. All participants were interviewed twice: at the start of the study, and again at one-year follow-up.
To qualify for the study, a person had to have experienced a sad mood, along with some of the symptoms listed below for a period of two or more weeks at any point in their lifetime. They are:
Weight or appetite changes - either wanting to eat more or less than usual
Sleep disturbance - either wanting to sleep more or less than usual
Decreased interest and pleasure in one's daily activities
Feelings of guilt or worthlessness
Low energy, fatigue
Difficulty concentrating or thinking
Feeling slowed down physically, like 'walking through quicksand'
Thoughts of ending one's life
Symptoms of alcoholism were looked at on the basis of a person's behavior and use of alcohol over the course of their life. These symptoms and behaviors included:
Inappropriate use of alcohol that was harmful to oneself.
Trouble functioning on the job or in social situations
Developing tolerance, which was defined as the need to drink steadily increasing quantities of alcohol in order to achieve a desired feeling - such as relaxation or a «high».
Experiencing withdrawal, which consisted of a range of symptoms that a person experienced when unable to drink. These symptoms typically occurred over a 24-72 hour period after a person the last drink. They included feeling 'hung over'; shakiness; increased heart rate; and sweating.
In more serious situations, withdrawal can lead to dangerously high blood pressure, seizures, visual hallucinations or the sensation that bugs are crawling on one's body.
Determining the severity of symptoms
As noted, while people with some of the early signs of both conditions were included in the study, it must be emphasized that they were not so advanced as to warrant a full-fledged diagnosis of either major depression or alcohol dependence.
Researchers categorized the number of symptoms of alcoholism and depression as low, medium and high. Analysis of the data revealed that having a greater number of symptoms of alcoholism significantly increased the risk of developing depression. Women were two to seven times more at risk than men. In other words, these results mean that women are more likely to be diagnosed with both disorders at the same time in comparison to men.
Statistical analysis revealed that both men and women were at risk of developing alcohol dependence at one year with only a few symptoms of depression. However, there was an even more interesting finding. It appears that risk for women developing alcohol dependence is far greater. And as the number of depression symptoms increase from having only a single symptom to 3-7 symptoms, so did the risk of developing alcohol dependence.
Results: Risks for major depression
The presence of some alcoholism symptoms increased the chances of developing major depression at one-year follow up. These findings were true for both men and women alike.
However, women who had a greater severity of alcoholic symptoms were far more likely to experience depression compared to women who had lesser degrees of alcoholism. More important, the severity of symptoms of depression or alcohol misuse at the start of the study «predicted» the severity of the other, one year later.
The implications of this study are important. It verifies that the relationship between depression and alcohol is quite strong, especially among women. When women experience symptoms of depression, they are at increased risk for alcohol dependence subsequently.
This finding is important because many people, including health professionals, tend to view depression and alcoholism as separate problems, when in fact, they are related to one another.
As for the association between depression and alcoholism, one explanation is that depression may, in part, stem from the continued depressive effects of alcohol while the person is drinking. Another factor contributing to the relationship between alcohol and depression can also be attributed to the environment in which the individual lives. Finally, the role of genetics must also be considered. Individuals may be vulnerable to both depression and alcoholism because of their genes.
The positive relationship between alcohol and depression argues strongly for a comprehensive approach to treatment. This means not only paying attention to the problem of alcohol, but to also take into consideration the treatment of depression - which can call for anti-depressant medications and/or psychotherapy. Such a comprehensive approach will help to ensure a better outcome for the patient.
A longitudinal study of the order of onset of alcohol dependence and major depression SE. Gilman, HD. Abraham, Drug and Alcohol Dependence, 2001, vol. 63, pp. 277--286
1. Adolescent depression, alcohol and drug abuse EY. Deykin, JC. Levy, V. Wells, American Journal of Public Health, 1987, vol. 77, pp. 178--182
2. Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults KA. Christie, JD. Burke, DA. Regier, et al., American Journal of Psychiatry, 1988, vol. 145, pp. 971--975
3. Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey BF. Grant, TC. Harford, Drug and Alcohol Dependence, 1995, vol. 39, pp. 197--206
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