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Brought to you by Mayo ClinicMay 23, 1998

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

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