As a psychiatrist that specializes in addiction, most people I treat for an alcohol problem have underlying depression and anxiety. The key question is which came first the chicken or the egg? In other words, is your alcoholic husband or alcoholic wife self-medicating their depression and anxiety with alcohol or is alcohol causing these symptoms? In most cases your alcoholic spouse started out “self-medicating”, but now is actually causing more depressive symptoms using alcohol.
Here are 2 typical cases that illustrate the combination of alcoholism and depression:
M.J. is 42 years old and has been drinking on and off for the last 25 years. Recently, he has had trouble sleeping, has lost his motivation for work, and does not feel a sense of joy for much of anything. For the last year, he has been drinking about 4-5 beers every day to “wind down”. He says the only sense of “fun” he has is when he drinks with the guys after work. He dreads hanging around his wife and kids in the evening. He wants me to prescribe an antidepressant.
T.R. is a housewife with 3 young kids. She used to be a paralegal, but decided to stay home to raise her children. She feels a void now that she spends the day doing laundry, picking up the house, and juggling her children’s activities. She misses interacting with adults. She started drinking to temporarily lift her spirits. Now she feels depressed and has been drinking more over time.
Both cases show that alcohol is being used to “cope” with life stresses. In other words, both M.J. and T.R are “self-medicating, but now feel even more depressed. Why? Alcohol is a central nervous system depressant and causesdepression.
Take home point: If your alcoholic spouse quits drinking, they may no longer feel depressed and may not require antidepressants.
What is the scoop on alcohol and antidepressants?
Alcohol diminishes the effect of the antidepressants. The only way for your alcoholic spouse to fully benefit from an antidepressant is not to mix it with alcohol. Even mild drinking (a few drinks a week) may interfere with the antidepressant response.
For example, your alcoholic husband has probably become more depressed because his alcohol problem has interfered with his job performance and his marriage. Now he has 3 things to be depressed about- alcohol dependence, job insecurity, marital stress. He probably needs antidepressants to feel less depressed and have the strength to participate in his alcoholic recovery.
Here is the take home message: Whatever the reason your alcoholic spouse is depressed, depression cannot be effectively treated on antidepressants if he/she continues to drink alcohol. Alcoholism and depression is a bad combination. Both are serious illnesses and should be addressed. From a psychiatrists’ standpoint, alcohol is the number one problem and depression second.
If someone with depression and an alcohol problem responds to an antidepressant, it is a “home run” because they can be more active participants in all areas of their life and will have a better chance of maintaining their sobriety.