The relationship between alcohol use disorder and depression

The relationship between alcohol and depression reminds me of John and Deborah who have been married for about 30 years. They were high school sweet hearts and started their family while Deborah was 19. John did not bother going to college and has a steady job as a foreman in a local factory while Deborah had to drop out of college because she couldn’t cope with being a mother of two as well as handle all the course work. Now they are in their late 50s and are empty nesters. With no one to parent or coach, they now turned on themselves.

Sometimes they stay late arguing about something trivial with John refusing to back down but he’s forced to when an exhausted Deborah falls asleep. The only thing they do together with dignity is Sunday mass where they enjoy the company and sermons of the local pastor. Although John always had drinks after work, it has clearly become a problem because his manager called Deborah to tell her that he drinks before he gets to work. Lately John has been very quiet at home and he hasn’t been playing his favorite songs or working in the garden as he used to.

John is an example of the paradox that confronts scientists when it comes to alcohol use disorder and depression. Depressed mood is known to lead to alcohol seeking behavior in college students but it has not been demonstrated in non-college adults (Kenney et al, 2018). In John’s case it is difficult to tell if his alcohol abuse led to his depression symptoms or if his depression symptoms led to alcohol use disorder. One thing is clear; there is a causal link between alcohol use disorder and depression. Alcohol abuse disorder has been shown to lead to major depression (Boden and Fergusson, 2011). Neurophysiological and metabolic changes induced by alcohol are thought to be behind the depressive effects of alcohol abuse. That said, about one third of patients with major depression have substance abuse as a co-morbidity making it important to consider alcohol use disorder while managing major depression patients (Davis et al, 2008).

Here are some of the effects of harmful and hazardous alcohol use;

·         Brain/Central nervous system-dependence, depression, memory loss, irrational behavior, arguments, violence, anxiety, paraesthesia, loss of sensation, numbness, position sense abnormalities

·         Accelerated aging- drinker’s nose

·         Immune system-frequent colds, Pneumonia, Cancer of the throat, mouth, breast.

·         Heart-cardio-myopathy, heart failure, anemia

·         Nutrient deficiency- bleeding, severe inflammation, vomiting, diarrhea, malnutrition

·         Gastro-intestinal tract-ulcer, pancreatitis, liver cirrhosis and cancer.

·         Genito-urinary-impaired sexual performance. In women; birth abnormalities

(Adapted from AUDIT, WHO)

Ideally, the goal would be to prevent alcohol abuse because it will cut the risk of depression.

Overall, it is important to screen for alcohol abuse as well as depression because of the causal relationship between the two.