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The Course of Depressive Symptoms in Alcoholism and Affective Disorders

As many as 50% of patients with alcoholism have comorbid depressive symptoms, but it is difficult to distinguish primary depressive disorders from transient affective symptoms that are secondary to alcoholism. This study assessed whether the distinction can be made based on the course of depressive symptoms.

Researchers used carefully defined criteria for primary and secondary affective disorder and alcoholism, based on symptom chronology, to divide 54 unmedicated men into four groups: 15 patients from an inpatient alcohol and drug treatment program who met criteria for primary alcohol dependence, 12 patients from the same program with alcohol dependence who also met criteria for lifetime secondary affective disorder (one or more episodes of depression during episodes of drinking, but none prior to the onset of alcoholism), 15 patients from an inpatient clinical research center who met criteria for primary affective disorders, and 12 patients from the same center with both affective disorders and lifetime secondary alcohol dependence (with onset after the affective disorder).

Patients were selected from a larger pool to assure careful matching for age and demographic variables. Only 17% of patients with primary alcoholism and secondary depression had an initial Hamilton depression scale (HAM-D) score of 20 or more versus 87% of patients with primary depression and secondary alcoholism. The course of depressive symptoms in each group was compared for four weeks using the HAM-D scale.

Depressive symptoms of patients with secondary affective disorder had a faster remission rate than those of patients with primary mood disorders. However, three weeks of abstinence from alcohol was necessary before these distinctions could be made with confidence. Furthermore, alcoholism neither increased the severity nor delayed resolution of depressive symptoms in patients with primary affective disorder.

Comment: Although this was not a treatment study, the findings imply that depressed alcoholic patients should not necessarily be treated with antidepressants initially unless they clearly meet criteria for primary affective disorder, or unless depressive symptoms persist after three weeks of abstinence. Higher initial HAM-D scores may suggest a greater likelihood of primary affective disorder and the need for earlier treatment of the mood disorder. Future studies are needed to examine the efficacy of antidepressants for treating patients with both alcoholism and depression.

— J Yager

Published in Journal Watch Psychiatry March 1, 1995

Citation(s):

Brown SA et al. Alcoholism and affective disorder: clinical course of depressive symptoms. Am J Psychiatry 1995 Jan 152 45-52.

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