Comorbid Depression & Alcohol Dependence
Recent Research Regarding Depression & Alcohol Use Treatment
Recently, there have been significant changes in how individuals with comorbid depression and alcohol dependence are offered treatment. While once inpatient treatment was the standard, as it was thought that the patient must abstain from alcohol in order to isolate their depressive disorder, outpatient treatment is becoming even more popular. It is understood that alcohol use may bring about depression, and depression may also bring about alcohol use.1 Also, clinicians used to be extremely concerned with the interactions medicines might have with excessive alcohol use; however, those concerns have also been reevaluated in recent studies.1 Research Professor in the Department of Psychiatry at University of Pennsylvania School of Medicine, Helen M. Pettinati, Ph.D. and Director of Operations and Clinical Services in the Center for Studies of Addiction at University of Pennsylvania, William D. Dundon, Ph.D. discuss the prevalence, assessment, and treatment of comorbid depression and alcohol dependence in their article “Comorbid Depression and Alcohol Dependence: New Approaches to Dual Therapy Challenges and Progress.”1
According to Pettinati and Dundon, there is an estimate of the co-occurrence of these disorders that is derived from the National Epidemiologic Survey on Alcohol and Related Conditions, where 43,093 individuals were interviewed in order to determine lifetime and current DSM-IV diagnoses. It was found that of those diagnosed with current alcohol dependence, 20.5 percent had a diagnosis of independent major depressive disorder (MDD).2 Also, they were 3.7 times more likely to have MDD than those in the general population.2
Diagnosing Comorbid Depression and Alcohol Dependence
Diagnosing comorbid depression and alcohol dependence is difficult, as it is hard to distinguish between an independent mood disorder and a substance-induced one.1 While prolonged abstinence from alcohol is extremely helpful in diagnosing a mood disorder, Brown and Schuckit found that depressive symptoms significantly plummeted in those who primarily had alcohol dependence and abstained for a period of four weeks. However, most have difficulty abstaining. Greenfield and colleagues stated that untreated depression led to worsened drinking. However, the DSM-IV-TR does distinguish between an independent depressive disorder and a substance-induced one.1 Pettinati and Dundon state that “for a depressive episode to be considered substance-induced, the depressed mood and diminished interest and pleasure must occur during or within one month of periods of intoxication or withdrawal and symptoms cannot be better explained by an independent mood disorder.”1 They also state that an independent mood disorder is one that precedes alcohol use and persists after an abstinence of one month.1
Effective Treatments for Depression and Alcohol Dependence
Pettinati and Dundon state that there are three different psychosocial intervention approaches that can be taken to treat comorbid depression and alcohol dependence: sequential, which is treating the primary disorder initially and then treating the secondary disorder; parallel, which is treating both disorders at the same time but in different settings; and integrated, which is treating both disorders simultaneously.1 Research has shown that the integrated approach is the intervention that is most successful.1
Research regarding pharmacotherapy for treating comorbid depression and alcohol dependence is sparse.1 As major depression is generally treated with antidepressants, studies have yet to approve them for use in patients with a comorbid alcohol use disorder.1 However, SSRIs have shown to alleviate many safety concerns about depressed alcohol-dependent patients taking antidepressants, as they are well-tolerated and safer than many other antidepressants.1 Also, adverse effects are mild.
Recently, Pettinati and Dundon published a study of a 14-week trial of 170 alcohol-dependent patients with major depressive disorder.1 They studied two medicines: one for depression (sertraline) and one for alcohol dependence (naltrexone).1 The aim of the study was to compare mood and drinking outcomes with the combined medications with those of placebo and with single-medication treatment.1 Those who received the sertraline-naltrexone combination had a higher abstinence rate of alcohol and a longer delay before relapsing than the placebo or single medicines alone.1 However, Pettinati and Dundon state that patients treated with an SSRI and an opiate agonist achieved a greater rate of abstinence from alcohol and relief of depressive symptoms than those who received the sertraline-naltrexone combination.1
Treating patients with comorbid depression and alcohol dependence is difficult. Positive treatment outcomes depend on the medicine and intervention used. While recently published data states that the combination of sertraline and naltrexone may be successful in treating this comorbidity, the study needs to be replicated before it can be integrated into the system of care. However, this may be a strong foundation for future research.
 Pettinati, H.M. and Dundon, W.D. (2011, June 9). Comorbid Depression and Alcohol Dependence: New Approaches to Dual Therapy Challenges and Progress. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/mdd/content/article/10168/1875691
 Grant BF, Stinson FS, Hasin DS, et al. Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61:1226-1233.
 Brown SA, Schuckit MA. Changes in depression among abstinent alcoholics. J Stud Alcohol. 1988;49:412-417.
 Greenfield SF, Weiss RD, Muenz LR, et al. The effect of depression on return to drinking: a prospective study. Arch Gen Psychiatry. 1998;55:259-265. Alcohol.