<html> <head> <title></title> </head> <body> <p>NewsstandResourcesAsk MayoWhat's Hot<br> </p> <p><br> </p> <p>Brought to you by Mayo ClinicMay 23, 1998<br> </p> <p>Alcoholism and Depression<br> Antidepressants can help<br> May 1 1996<br> For decades, people who were alcoholic and depressed have confounded physicians <br> and other treatment professionals. These people raised troubling questions with <br> few answers. <br> "It can be difficult to diagnose clinical depression, to know if it's a true <br> depression or just a constellation of unhappiness," says Patricia L. Owen, PhD, <br> director of the Butler Center for Research and Learning at the Hazelden <br> Foundation, Center City, Minn. Dr. Owen is also author of I Can See Tomorrow: A <br> Guide for Living With Depression . Owen says health care professionals have <br> wrestled with the dilemma of how to treat alcoholism when it comes bundled with <br> depression. "Should you just let nature run its course, hoping that the <br> depression will lift as the alcoholism recovery process gets underway?" asks <br> Owen. "Or is it better to vigorously treat depression in these instances with <br> medication and therapy?" <br> A study reported in the March 13, 1996, issue of the Journal of the American <br> Medical Association (JAMA) provides some answers. The study indicated the drug <br> desipramine can safely and effectively relieve major depression in alcoholics. <br> Study raises larger issues<br> The JAMA report touched on profound issues for alcoholics and health care <br> providers. Thirty to 40 percent of alcoholics may relapse, that is, return to <br> problem drinking within one year after treatment. Also, alcoholics are at risk <br> for mental health problems including schizophrenia, anxiety disorders, and major <br> depression. Finally, the symptoms of depression and alcohol withdrawal mimic <br> each other, making it hard to separate the two conditions. <br> Misconceptions cloud treatment<br> Also complicating the treatment picture are three common misconceptions : <br> Alcoholics Anonymous (AA) and other self-help groups prohibit <br> antidepressants. <br> Antidepressants are mood-altering and intoxicating. <br> Antidepressants are addictive. <br> None of these statements are true. An AA pamphlet titled "The AA <br> Member--Medication and Other Drugs" addresses the need for some alcoholics to <br> take antidepressive drugs such as desipramine. In addition, desipramine is <br> neither intoxicating nor addictive. <br> Method and results of the study<br> The authors of the JAMA article studied 71 alcoholics, dividing their subjects <br> into four groups: <br> Those who were depressed and took desipramine. <br> Those who were depressed and took a placebo. <br> Those who were not depressed and took desipramine. <br> Those who were not depressed and took a placebo. <br> This was a double-blind study. Neither the patients nor the treatment providers <br> knew which alcoholics received desipramine and which the placebo. All subjects <br> were in outpatient psychiatric treatment, and all had abstained from alcohol for <br> at least one week before the study. <br> The researchers found that, after six months, the depressed alcoholics who took <br> desipramine experienced significantly greater relief from depression. ("Relief" <br> was defined as a lower score on the Hamilton Depression Rating Scale, a <br> psychological inventory.) And overall, the recovering alcoholics who took <br> desipramine stayed abstinent from alcohol longer than those who took the <br> placebo. <br> Implications for treatment<br> "This study indicates that it's possible to make a fairly accurate diagnosis of <br> depression after a week of abstinence from alcohol and take a reasonable <br> approach to treating depression," says Dr. Owen. At treatment centers such as <br> Hazelden, this approach combines medication with alcoholism treatment, therapy <br> and AA attendance. "There's little research that's been done specifically on <br> recovering alcoholics and depression, so the JAMA study is very helpful," Owen <br> adds. <br> Emotional/Mental Health & Sexuality | Medicines | May Index<br> <br> <br> <br> </p> <p>© 1996 Mayo Foundation for Medical Education and Research. All rights reserved. <br> Materials copyrighted by Mayo may be reprinted for personal use only. 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