What's the Connection Between Alcohol and Depression?

Alcohol and depression are connected in several ways, and the two often feed off of one another. People may turn to alcohol as a way to cope with mood problems, but drinking alcohol can also contribute to symptoms of depression. Alcohol use can also affect how antidepressants work, which can affect depression treatment.

For some people, treating alcoholism will relieve depression. However, alleviating depression does not resolve the alcohol use disorder. In some cases, you may receive a dual diagnosis of a major depressive disorder (MDD) and an alcohol use disorder (AUD). This co-occurring disorder isn’t uncommon, but it can be difficult to treat.

Effects of Alcohol Use

Alcohol can produce feelings of euphoria and excitement, making you feel instantly happier and more confident, but those feelings are fleeting. Alcohol is a depressant. Much like barbiturates (sedatives), alcohol is a drug that affects the central nervous system (CNS) and the brain’s functionality. Yet, many Americans drink alcohol, even if they’re depressed.

"In our society alcohol is readily available and socially acceptable," says Jill Bolte Taylor, PhD, author of Whole Brain Living, explains. "Depression and alcohol misuse are often tied because we take a depressant to counter a chemical depression which only makes it worse."

The more alcohol you drink, the more severe the symptoms. Depending on your intoxication level, you may experience decreased inhibition, loss of judgment, confusion, and mood swings, among others.

No matter your drink of choice, alcohol can easily be abused and often is, especially when it’s used to self-medicate. Pouring yourself a glass of wine or cracking a beer at the end of a long day may temporarily relieve feelings of depression, because alcohol acts as a sedative, but it will exacerbate those feelings and actually intensify them.

Drinking persistently and excessively can increase your risk of developing a major depressive disorder. It can also aggravate symptoms of pre-existing depression and endanger your health and mental health. 

Factors Contributing to Alcohol Use and Depression

The co-occurrence of a major depressive disorder and an alcohol use disorder is surprisingly common. Yet, there are certain factors that can put you at a higher risk of experiencing these comorbid disorders. Those factors include:

• Genetics, including a family history of depression or substance misuse
• History of trauma or abuse, or PTSD, which may result from child abuse, sexual assault, combat, etc.
• Underlying mental health conditions
• Environmental factors, including exposures to violence, trauma, assault, abuse, etc.

Alcohol Use Disorder and Depression

Many studies have found that alcohol dependence is closely linked to depression. When it comes to diagnosing an alcohol use disorder and a major depressive disorder, it’s important to address them simultaneously, as they can significantly impact your recovery.

Alcohol Use Disorder (AUD)

Alcohol may be a socially acceptable drug, but it’s still a drug. Alcohol abuse and dependence are both considered an alcohol use disorder, with studies finding that alcohol dependence is more closely tied to the persistence of depressive disorders.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5-TR), these are some signs and symptoms that could reveal an alcohol use disorder:

• Your drinking is interfering with home, school, or work.
• You’ve stopped engaging in activities that are important to you.
• You’ve found yourself in dangerous situations while drinking, such as driving, swimming, or having unsafe sex while under the influence.
• You’ve drank to experience a certain effect.
• You’ve experienced withdrawal symptoms from alcohol, such as nausea, sweating, racing heart, or trouble sleeping.
• You’ve tried to cut back, but can’t.
• You’ve drank more or longer than you intended on more than one occasion. 
• You’ve continued drinking even though you’ve felt depressed, anxious, or blacked out.
• You’ve wanted to drink so badly you couldn’t think of anything else.

The Centers for Disease Control and Prevention has found that 9 out of 10 adult binge drinkers don’t have a severe alcohol use disorder, but that doesn’t mean alcohol isn’t a problem for them. Drinking to cope with depression, no matter if you have an alcohol use disorder, is concerning.

Alcohol use disorders may be mild, moderate, or severe, depending on the combination of symptoms you’re experiencing, but drinking problems can exist regardless of a clinical diagnosis.

Whether you’re experiencing depression or not, it’s essential to evaluate your drinking habits and consider why you drink, when you drink, and how you feel when you drink.

Major Depressive Disorder (MDD)

Depression is a common and serious mood disorder, which can impact your thoughts, feelings, and behaviors. In the United States alone, an estimated 17.3 million adults have had at least one major depressive episode.

Some common signs and symptoms of depression, according to the DSM-5-TR include:

• Feeling sad, empty, or hopeless
• Losing interest in activities you once enjoyed
• Experiencing a significant change in weight or decrease in appetite
• Having trouble sleeping, experiencing fatigue, or sleeping too much
• Experiencing thoughts of death or suicidal thoughts
• Having difficulty concentrating

Major depressive disorder involves persistent and prolonged symptoms, but depression, in general, takes on many different forms. Depressive symptoms can result from life stressors, mental health conditions, medical conditions, and other factors.

Though depression is experienced by many, it can often go undiagnosed and untreated. You don’t have to battle the depression alone and relying on alcohol to make you feel better will only cause further pain. Reach out to a mental health professional to talk about treatment and strategies for dealing with depression. 

How Inflammation Connects Alcohol and Depression

Some experts also suggest that both depression and alcohol use disorders share underlying pathophysiology in that they are both neuroinflammatory conditions.

Because of this shared connection, treatment for both should include a diet to improve gut function and reduce endotoxin load that contributes to neuroinflammation. Following a Mediterranean diet rich in omega-3s, for example, might be one recommendation.

Treating Alcohol Use and Depression

It's very important to address both alcohol misuse and depression simultaneously when looking into treatment options, as these conditions are closely intertwined and can exacerbate each other, Kennedy explains. 

"Cells are living beings, and if you want to fix the issue of depression at the level of the cells, they cannot be inebriated," says Taylor. "Alcohol makes us feel drunk and confused because alcohol makes the cells drunk and nonfunctional."

Kennedy suggests that treatment options can vary depending on the severity of your condition. You might see a therapist in an outpatient setting once a week. Or you might attend an intensive inpatient group a few times each week. Residential treatment is also an option.

In residential treatment, "an individual stays in a treatment setting, receives intensive therapy, and is physically separated from alcohol in order to recover,” says Kennedy.

Therapy

"Therapeutic interventions designed to address both issues often include a focus on addressing emotional pain or trauma, as well as developing and practicing healthy coping behaviors," says Kennedy. 

Treatment depends on the individual, but there are many different therapeutic interventions that are used to address both alcohol use disorder and major depressive disorder. Among them, Kennedy recommends:

• Trauma-specific therapy
• Dialectical behavioral therapy (DBT)
• Individual therapy 
• Group therapy
• Family therapy

Cognitive behavioral therapy can also be used to treat co-occurring AUD and MDD, by improving your emotional regulation, changing your cognitive behaviors, and helping you develop personal coping strategies.

Depending on the severity of the disorders, you may need more intense treatment, such as outpatient care, integrated assertive community (ACT) treatment or a residential stay, which may be required to begin or continue your recovery journey.

Medication

The use of medication to treat an alcohol use disorder and a major depressive disorder depends entirely on the individual and their circumstances. 

According to Kennedy, possible medications include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Monoamine oxidase inhibitors (MAOIs) 
• Tricyclic antidepressants
• Mood stabilizers

It is important to note that medications for alcohol use disorder are a first-line treatment. They can be helpful for many, so talk to your doctor about this option. If you’re dealing with severe alcohol withdrawal symptoms, such as anxiety, insomnia, nausea, and hallucinations, among others, then your doctor may suggest medications such as chlordiazepoxide or other benzodiazepines.

"An experienced psychiatrist [or another mental health professional] familiar with mood disorders and the effects of alcohol abuse can be instrumental in recommending appropriate medications and monitoring medication efficacy," says Kennedy.

Takeaway

It can be tempting to drink if you’re feeling unhappy, but there’s a better solution out there. When treating depression and substance abuse, consult with a mental health professional and/or an addiction specialist who can provide resources and recommendations for possible treatment options. 

For more information and resources, visit the NIAAA's Alcohol Treatment Navigator or the National Institutes of Health's "Rethinking Drinking" website.