Alcohol problems and depression

Many of the symptoms reported by people drinking heavily resemble those of depression such as: 

• fatigue  

• disturbed sleep  

• early morning waking   

• poor energy levels  

• poor appetite.  

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 is 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: 

• tremor   

• anxiety  

• restlessness   

• sweating  

• nausea   

• seizures   

• delirium tremens (DTs).  

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). 

2. Counselling

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. 

3. Medication

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.