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Alcohol and depression have a strong relationship, although we don't quite understand it. Research is confusing and defining depression and alcoholism are both challenging tasks. Does alcoholism cause depression? Does depression cause alcoholism? What about alcohol use to manage stress and depression, can it be a good thing?
There have been many attempts to explain away the correlation between depression and alcoholism by suggesting that depression in individuals with alcoholism directly results from alcohol intoxication, and/or alcohol withdrawal. For some people this is true. It is also true that some experience depression along with their alcohol use in this context, but not as a separate diagnosis. To eliminate some confusion the DSM suggests that you can have major depressive disorder if you were diagnosed prior to your alcohol addiction, or four weeks after you have stopped having withdrawal symptoms.(Hassin 2002).
Still even with clearer criteria all social science research is challenging. If you are an alcoholic, and have real major depression, not major depression due to your withdrawal, use or detoxification, what do we know about you and how to help you? Unfortunately, we still understand little about how to help.
Some have suggested that heavy alcohol use can actually cause major depression. We don't know if this is or isn't the case. It does seem that alcoholism might cause risk factors for depression to be higher. For example if you are an alcoholic you will likely have family and marital strain or job loss . Then, clearly you are at risk for depression.
Once again, Studies are mixed and confusing in determining causality. It's most likely that each individual with alcohol and depression issues presents with a separate situation, which makes treatment protocols less precise and individual assessment for clinicians more important.
We do know that the relationship between alcohol and depression is different for women than it is for men. Firstly the relationship between alcohol and depression is stronger in women than it is in men( more likely to occur together). Some research suggests that for women it is more likely that the depression comes first and is later followed by alcoholism. For men, this is the opposite.(Dixit 2000).
I have certainly observed in my female clients that depression often seems to come first. In seeking to self medicate and avoid the pain they are experiencing, they will drink, and often this will start a negative cycle. So often, women who are depressed also have body image issues, are taking antidepressants and battling weight gain. Alcohol often causes them to over eat or consume more calories than they would like, leading to regret, depression, and reinforcing the cycle. Alcohol also wreaks havoc on blood sugar levels, appetite, and sleep, all causing a sense of disequilibrium that may make depression more likely.
To further complicate things, some population based studies suggest that moderate alcohol( 1 to 2 drinks a day) use may lower depression and anxiety and improve overall positive feelings and emotional health. However these studies compare moderate drinking with heavy drinking concluding moderate drinkers have less anxiety and depression than heavy drinkers. When compared with those who abstain some show moderate drinkers have lower levels of depression and anxiety and some do not. How can this be??
It seems possible that if you are a light or moderate drinking, you are drinking socially and not to self medicate. I think this is a different situation entirely. A pattern of avoiding problems and feelings by drinking alcohol will reinforce depression. A pattern of light social drinking may not. However, I don’t know many people, or clients who fit this profile.
If you are wondering about your own relationship with alcohol and depression you may need to pay careful attention to when and why you are drinking and how you feel before after and during drinking. If you feel depressed the day after you drink, and find that meeting your goals and /or responsibilities is difficult you may consider cutting down.
If you notice you are drinking specifically to deal with depression, again you may need to reexamine whether this is the best way for you to cope with your negative thoughts and feelings.
The relationship between alcohol and depression is a complex one. It varies among men and women, different levels of drinking ( moderate, heavy and light) and different diagnoses.
Please refer to this journal chart to help you determine if you may have an issue with alcohol and depression. If you find that there are many concerning areas identified, you may need to work on your drinking patterns
Click here to get the PDF file for free Alcohol and Depression Worksheet.
A great page on goal setting and how it's related to depression can be found here
Dixit, Anita R., Crum, Rosa M.Prospective Study of Depression and the Risk of Heavy Alcohol Use in WomenAm J Psychiatry 2000 157: 751-758
Hasin, D. Grant, B.F.Major Depression in 6050 Former Drinkers: Association With Past Alcohol DependenceArch Gen Psychiatry. 2002;59(9):794-800.
Paschall, Mallie J., Freisthler, Bridget, Lipton, Robert I.Moderate Alcohol Use and Depression in Young Adults: Findings From a National Longitudinal StudyAm J Public Health 2005 95: 453-457