Alcohol and depression: What is the link between them? What are the risks?

What is the link between alcohol and depression?

Patients affected by depression sometimes resort to excessive alcohol consumption in order to numb the emotions that overwhelm them and that they are unable to manage or express. They drink to forget their discomfort, to cope with their suffering or to get some sleep.

Indeed, mental suffering can encourage alcohol consumption. In the short term, drinking gives people a feeling of relief, of distancing themselves from their problems, and provides a soothing effect. Alcohol is often seen as an attempt to self-medicate.

However, the immediate effects of alcohol are misleading and can aggravate the depressive symptoms.

Thus, the feeling of improved mood is short-lived and dissipates quite quickly. In addition, alcohol has depressive effects (reduced brain function, fatigue, difficulty concentrating, sadness, etc.) which are closely linked to its interference with the functioning of several neurotransmitters.

The first signs of depression (insomnia, fatigue, irritability, general disinterest) are the same as those of alcoholism.

In addition, a large majority of alcohol-dependent people experience symptoms of depression during their lifetime. Depression is often linked to low self-esteem or to social and emotional relationships made difficult by chronic alcohol use.

The combination of depression and alcohol dependence is not uncommon. Signs of alcohol dependence are found in almost one in ten people suffering with depression. Similarly, about 40% of alcohol-dependent patients have depressive disorders.

However, it is still difficult to determine whether it is depressive disorders that precede alcohol-related problems, or vice versa.

One of the theories most frequently put forward by medical research is that as soon as the first symptoms of depression appear, grief and sadness set in, alcohol can help bury these feelings and give an impression of well-being. This is only temporary, as once the effects of the alcohol have worn off, the feeling of unhappiness returns. The patient is then tempted to repeat the experience until he or she enters the vicious circle of alcohol dependence.

These two conditions do not mix well. In fact, one can lead to the other, or aggravate it, making it even more difficult to treat.

What are the risks related to depression and alcohol consumption?

Once alcohol becomes a major part of a person's daily life, its effects become increasingly perverse. Indeed, alcohol no longer has the desired euphoric effects but, on the contrary, quickly becomes anxiety-provoking, thus pushing the patient into a more severe depression.

Moreover, the use of prescribed antidepressants should be strictly monitored by the patient's care team. The use of alcohol is strongly discouraged as it may increase the possible side effects of medication.

The side effects of antidepressants depend on their class. They are transient and are due to the initial serotonin impregnation.

At the beginning of treatment some antidepressants may cause hot flushes, anxiety, insomnia, dizziness or digestive disorders, such as diarrhoea or constipation.

Thus, consuming alcohol can amplify the side effects of antidepressants but above all, diminish their therapeutic effects. Alcohol accentuates violent and impulsive behaviours caused by a nervous breakdown.

Other risks should also be highlighted: alcohol, combined with antidepressants, can lead to drowsiness and can also increase the risk of liver damage.

It is therefore important to avoid alcohol during treatment and to strictly respect the dosage prescribed by the psychiatrist and follow his or her recommendations.

Moreover, alcohol makes depression even more violent and much more difficult to overcome even with effective treatments.

Alcohol and depression, what are the care options? 

In order to heal successfully, it is necessary to tackle both depression and alcohol dependence, but this does not always happen simultaneously.

In the vast majority of cases, priority is given to alcohol withdrawal. Indeed, the cessation of alcohol use and all the medical care that comes along allows some patients to get out of depression. However, other patients need antidepressants before stopping alcohol in order to facilitate the process of withdrawal.

Comorbidity of the two disorders is very common. The psychiatrist should always look for depression in an alcohol-dependent patient, and vice versa.

Communication between a doctor and their patient is therefore fundamental, since it is crucial to find an effective treatment for depression but also for alcohol dependence. The patient's initial state of health helps determine the treatment.

A patient with suicidal thoughts has their depression treated first. A patient with alcoholic hepatitis, on the other hand, will first be treated for his or her addiction to alcohol.

Apart from these extreme cases, the psychiatrist should always take into account the patient's psyche, physical and mental condition and availability in order to choose the best treatment option.

In all cases, long-term medical care and psychological support must be considered.

Finally, short-term hospitalisation may be recommended for alcohol-dependent and depressed patients. However, treatment plan is specific to each situation and is defined together by the patient and their care team.

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