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Alcohol and Depression
How common is depression in people with alcohol problems?
Why might alcohol problems and depression occur together?
Alcohol can briefly produce a pleasant and relaxed state of the mind. However, alcohol problems and depression commonly occur together.
There are several reasons for this.
Why is an alcohol problem together with depression a particular worry?
Alcohol compromises judgement and makes people impulsive and likely to take risks. Alcohol also causes a loss of inhibition and increases aggressive behaviour and violent acts. Because increased alcohol consumption often occurs together with a depressed mood, this is a particular concern.
Depression can lead to thoughts of suicide. The lack of self-control, compromised judgement and impulsivity from the alcohol can increase the chances of a person attempting suicide.
Generally, a much higher incidence of suicide, both completed and attempted, is associated with alcohol.
The common problems of depression and alcohol are frequently complicated by social problems. Alcohol can often lead to problems at work in the form of absenteeism, sickness and under performance. The loss of a job has a profound negative impact on a person's financial status and family life.
Marital problems often arise because of an alcohol problem, although it may be difficult to say which started first.
Alcohol can also cause a large number of physical problems. Few, if any, organs in the body are spared.
Liver problems commonly arise from heavy alcohol intake and can take the form of jaundice (a yellow discolouration of the skin) resulting from hepatitis, cirrhosis of the liver or liver failure. Unchecked these will lead to death.
Other common problems include:
Both alcohol intoxication and withdrawal have a damaging effect on the brain and can cause:
Although alcohol can cause you to fall asleep, the quality of the sleep that follows tends to be poor. This is why people with depression should not use alcohol to try to improve their sleep, since it will actually have the opposite effect.
Excessive alcohol intake can also lead to legal problems. These may result from driving offences, drunk and disorderly behaviour, or violent crime due to the impulsivity and lack of self-control caused by alcohol. Involvement with the legal establishment does not tend to help a depressed mood.
Alcohol problems account for:
Depression is also associated with an increased rate of accidents and so the combination can be worrying.
Some antidepressants are sedative. If they are taken with alcohol, a person can be seriously sedated and at risk of their breathing stopping. In addition, many antidepressants are broken down in the liver. Because alcohol can damage the liver, the levels of these antidepressants in the body will be higher in people who are also drinking heavily. This can lead to an increase in side effects from the antidepressants.
There are a number of ways in which alcohol and depression may be linked.
Links with brain function:
Over the last decade new research has shed light on the way alcohol affects the brain, and in the ways in which the brain is affected in depression.
It is now known that some of the systems that are involved in producing the symptoms of low mood, anxiety, poor sleep and reduced appetite in depression are also affected by alcohol. This is one explanation of why alcohol can cause depression.
There are many potential psychological and social reasons for links between alcohol and depression.
It's possible to inherit an increased likelihood of both alcohol problems and depression.
Many of the effects of alcohol on the systems of the brain depend on the 'dose' of alcohol taken.
These effects may occur at very different blood alcohol concentrations in different people because drinking alcohol produces tolerance to its effects. This means that people who regularly drink large quantities develop the effects outlined above at higher blood alcohol concentrations.
Current recommendations are that risks of problems (both physical and psychological) are greatly increased in men consuming more that 28 units of alcohol per week, and women more than 21 units.
A unit of alcohol is:
These recommendations are not a 'safe' limit - it is simply a level above which the risks get significantly greater.
When should I be worried if I have an alcohol problem?
There are a number of pointers that should lead you to consider if you have an alcohol problem. These include:
How are alcohol problems and depression treated?
Many of the symptoms reported by people drinking heavily resemble those of depression such as:
These are simply due to heavy alcohol intake. This makes it difficult to be clear if a person is suffering from an alcohol problem plus depression or simply an alcohol problem.
The situation is further complicated because heavy alcohol intake can lead to depression.
As a result, it's normal practice to deal with the alcohol problem first and see if the depression gets better. If it does not, then specific treatment for the depression would be started.
Treatment with a selective serotonin reuptake inhibitor (SSRI) antidepressant can improve both depression and an alcohol problem. This may point towards a common cause for both disorders. There are a number of things that can be done to help people with alcohol problems.
1. Detoxification to help a person come off alcohol safely:
This involves the person stopping all alcohol intake, usually covered by the administration of medication – such as diazepam or chlordiazepoxide to prevent a withdrawal syndrome.
Withdrawal symptoms include:
DTs usually occur three days or so after stopping alcohol and can last for up to seven days.
The symptoms of DTs include those described above, plus disorientation (being unaware of where you are, what time, day or year it is, and who other people are), hallucinations (seeing or hearing things that are not there) and delusions (having false beliefs about things, especially being frightened of certain situations and people).
Support and counselling is used to help the person achieve abstinence or 'controlled drinking' within safe limits.
More formal psychological therapies can be helpful, such as cognitive behavioural therapy.
Occasionally, medication can be helpful.
This includes disulfiram (Antabuse) and acamprosate (Campral).
Disulfiram can aid abstinence because it causes a person to have an unpleasant, and potentially dangerous reaction, if they drink while taking it.
Acamprosate may help to decrease the craving for alcohol.
Both of these medicines will only be helpful if the person taking them is motivated to give up alcohol. They are certainly not magic wands.
If you think you have a problem with alcohol, you may well have managed the first and hardest step in sorting it out – acknowledging the problem to yourself.
What you need to do now is to speak to somebody about your concerns.
Support and help for alcohol problems can come from a number of sources.
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