You may be wondering “does alcohol make depression worse?” Unfortunately, alcohol and depression go hand-in-hand. In short, yes, alcohol does make depression worse. However, the real question for people with alcohol use disorder is which came first: alcohol abuse from depression or depression from alcohol abuse. Many people seeking treatment for alcohol use disorder are often treated not just for alcohol misuse, but also for depression. When drawing up a treatment plan it is important to determine which symptoms are from alcohol use and which are from depression. It’s important to know that alcohol is a depressant that affects mental health. The risks of alcohol and depression can be deadly to those who have co-occurring conditions. That’s why treatment is so critical.
If you or someone you love is caught in this confluence of depression and alcohol misuse, call our treatment experts at (385) 327-7418 today. It’s the first step to saving your life.
Alcohol is a Depressant
Alcohol is a stealthy depressant. In fact, during the early stages of consumption, it acts as a stimulant.
“When you first drink it, alcohol can make you feel happier or calmer,” says Dr. Cory Walker, assistant professor at the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. “But alcohol is a central nervous system depressant. It depresses the activity of the brain.”
When alcohol’s impact on mental health is the most obvious is the morning after drinking, especially if you have drunk too much the previous day.
Alcohol is a depressant that affects the brain’s natural level of “happiness” chemicals such as serotonin and dopamine. It means that although you’ll feel an initial “boost” the night before, the next day you will be deficient in these same chemicals. This may lead to feeling anxious, down, or depressed.
In small doses, alcohol can increase your heart rate, aggression, and impulsiveness. However, in larger doses, alcohol typically causes sluggishness, disorientation, and slower reaction times. It decreases your mental sharpness, blood pressure, and heart rate.
Once alcohol reaches your brain, it triggers a number of chemical changes, including:
- release of the body’s “feel-good” chemicals, such as dopamine and serotonin.
- release of gamma-Aminobutyric acid, or GABA, the body’s slow-down chemical.
- reduction in the release of glutamate, the body’s speed-up chemical.
The chemical changes lead to physical side effects.
“Alcohol slows reflexes and speech, which is why people slur words and the ability to process information when they drink,” Walker explains. “If you drink too much, it can slow body temperature and breathing. It’s poisonous. In all of these ways, alcohol is a depressant.”
Also, higher doses of alcohol can suppress dopamine production. In this way, alcohol makes depression worse, as a person feels sad or listless.
Why People With Depression Drink
People who are sad may feel a need to reach for a daily drink as a way to self-medicate. However, doctors say that can be dangerous.
“The risk is that they will develop physical and (psychological) dependence, and over time, the pleasurable effects diminish,” says Dr. Eric C. Strain, director of the Center for Substance Abuse Treatment and Research at Johns Hopkins University.
Over time, this can lead to depression from alcohol use. People who drink to cope with psychological distress may drink more over time, especially when they wake up feeling anxious or depressed. Chronic drinking significantly increases the risk of alcohol use disorder.
Depression Often Comes First
Nearly one-third of people with major depression also have an alcohol problem. Often, depression comes first. Research shows that depressed kids are more likely to have problems with alcohol a few years down the road. Also, teens who’ve had a bout of major depression are twice as likely to start drinking as those who haven’t.
Women are more than twice as likely to start drinking heavily if they have a history of depression. Experts say that women are more likely than men to overdo it when they’re down.
The morning after, a depressed person will have to deal with anything they regret doing while uninhibited.
“When someone is depressed, they are pretty vulnerable,” says Harvard Medical School psychiatrist and alcohol use expert Rocco Iannucci. “So, what might be a minor social mishap the night before can be magnified in their mind.”
“It can be something they might really ruminate on,” he adds, “now that their higher neural functions are active again.”
Given all of this, Joseph Boden, an alcohol use expert at New Zealand’s University of Otago, recommends that anyone dealing with depression just stay away from alcohol.
For those who do not want to stop drinking entirely, Iannucci recommends taking a break from it for a time to see whether it improves their depression. At the very least, he says — especially for people on antidepressants — it’s a good idea to cut back to a fairly minimal amount of alcohol.
Alcohol Makes Depression Worse
Similar to its impact on anxiety, not only can alcohol worsen depression, it can actually cause it too. When the effects of alcohol wear off, it changes our brain chemistry for the worse. In fact, people who drink heavily are more likely to suffer from depression. Also, alcohol dependence is roughly three times more likely among people with depression.
People with depression try to use alcohol to manage the condition. Unfortunately, alcohol’s wide-ranging effects make it a double-edged sword. Even during the initial alcohol high, Boden points out that alcohol slows our mental processes, metabolism, breathing, and other functions.
For some, those are already the symptoms of their depression. As a result, they may feel as if their condition is worsening. These downer effects, some studies suggest, may grow more powerful after an early euphoric peak.
Going Through Mini Withdrawal
George Koob is the director of the National Institute on Alcohol Abuse and Alcoholism. As one’s blood alcohol content starts to decline, which Koob notes can happen fairly quickly after a person stops drinking, the body starts to go into a mini withdrawal.
As part of this initial mini withdrawal, you start to cope with the over-taxation of your pleasure systems, Koob says. Perhaps more importantly, your body starts to produce neurotransmitters associated with stress.
It also produces another transmitter, dynorphin, that, as Koob describes it, “just makes you feel lousy.” This sudden crash in pleasure and rise in stress, like any effect of alcohol, will vary in intensity from person to person. But, Harvard’s Iannucci notes, the symptoms likely will be magnified in someone who’s going through an active bout of depression.
It is almost impossible to say how long this general lowness will last in someone after drinking. By the time one gets beyond initial withdrawals to a hangover, they will be dealing with physical symptoms like dehydration and gastric distress, Iannucci says.
This, for most people, just compounds any neurochemical issues because, he notes, “if you’re not feeling well” physically, “it is hard for your mood to be better.”
Risks of Alcohol and Depression
A major risk is alcohol and suicide. People who are depressed and drink too much have more frequent and severe episodes of depression. And they are more likely to think about suicide. Heavy alcohol use also can make antidepressants less effective.
Scientists have had observational evidence for decades that suggests an association between alcohol use and mood disorder. For example, a small study in 1991 concluded that depressive episodes after drinking alcohol may be related to reduced levels of serotonin.
Baylor’s Walker says it’s a combination of many chemical imbalances caused by alcohol consumption that may lead to mood disorder, but it happens over time.
Alcohol use in a person with depression may intensify the symptoms of depression and increase the risk of adverse and life-threatening outcomes.
A 2011 analysis found a correlation between using alcohol before the age of 13 and later engaging in self-harm.
Research from 2013 also supports the link between alcohol and suicide. The study found that teenagers with depression who drank alcohol were significantly more likely to act on suicidal feelings.
We know that self-harm and suicide are much more common in people with alcohol problems. It seems that it can work in two ways when you:
- regularly drink too much (including binge drinking). which makes you feel depressed OR
- drink to relieve anxiety or depression.
- Alcohol affects the chemistry of the brain, increasing the risk of depression.
- Hangovers can create a cycle of waking up feeling ill, anxious, jittery, and guilty.
Life gets more difficult as there are arguments with family or friends, trouble at work, memory, and sexual problems.
Drinking and Using Other Depressants
Many doctors recommend avoiding alcohol while taking antidepressants.
Both substances may make a person feel less alert, so they may be dangerous if a person takes them together. This is especially true for those who use other medications or have a chronic medical condition.
Some doctors advise drinking in moderation if a person must drink, which means no more than one drink per day for females or two drinks per day for males. According to the Centers for Disease Control and Prevention (CDC), a single drink means:
- 12 ounces of beer
- 5 ounces of wine
- 8 ounces of malt liquor
- 1.5 ounces of hard liquor
The specific effects of alcohol on antidepressants depend on the antidepressant a person takes. Some people who take selective serotonin reuptake inhibitors may become severely intoxicated when they use antidepressants.
People using other drugs or who use nontraditional antidepressants should be especially mindful of drinking. Benzodiazepines, a class of anti-anxiety drugs that some people with depression may use, may help with alcohol withdrawal. However, when combined with alcohol they can cause life-threatening intoxication.
“If you combine [benzodiazepines and alcohol] you can have a serious drug-drug interaction, including a lethal overdose,” says Dr. Anna Lembke is director of addiction medicine at the Stanford University School of Medicine.
The reason is that benzos and alcohol are both sedatives. Used individually, they can relax muscles, make you sleepy, and reduce feelings of panic, fear, and agitation. Use benzodiazepines and alcohol together and all those effects intensify.
However, this potentially dangerous benzos and alcohol cocktail also can simultaneously amplify the potential for serious side effects, such as respiratory depression. When your breathing slows to a dangerous level, that’s respiratory depression. The worst-case scenario?
“[You] fall asleep and stop breathing,” Lembke says.
Rehab for Co-Occurring Conditions
Having a mental illness makes treating substance dependence much more difficult. A 2013 study pointed out that when a patient has issues with alcohol and depression, treatment outcomes are worse than when each occurs individually.
The reason is that alcohol can impair the effectiveness of some antidepressant medications and cause other problems. In addition, a person who uses alcohol and who has depression may not be able to tell which symptoms are due to which issue until they seek treatment.
While quitting alcohol is crucial for people with alcohol use disorder and depression, avoiding alcohol alone will not cure depression. People may wish to seek quality psychological care from a doctor, therapist or both.
Drug and alcohol dependence also often co-occur. Research shows that people who are dependent on alcohol are much more likely than the general population to use drugs. Additionally, people with drug dependence are much more likely to drink alcohol.
People with co-occurring alcohol and other drug use disorders are more likely to have psychiatric disorders such as personality, mood, depression, and anxiety disorders. Also, they are more likely to attempt suicide and to suffer health problems.
Written by: Janet Perez
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