Depression and its treatment in alcoholics: a review.

The relationship between Affective Disorder and Alcoholism is complex and has been studied extensively. Increased rates of depression are reported in alcoholics and in families of alcoholics. Some studies report that drinking behaviour may be influenced by the coexistence of depressive disorder while others indicate that depressed mood has little impact on the course and treatment of alcoholism. Some people who are depressed turn to alcohol as a form of self-medication and many of these have positive results from it, both due to the pharmacological effects of the drug and the self-limiting nature of most depressive episodes. Those with more severe depression, however, are less likely to benefit in this way. Excessive alcohol taken under such circumstances results in diminishing returns; alcohol becomes more of a contributor to the problem than a solution to it. There is no convincing evidence that drugs including anti-depressants and lithium are effective in the treatment of depressed alcoholics, except for those minority of patients where the diagnosis of primary affective disorder can be established. In such cases the indications for lithium and anti-depressant usage are similar as for non alcoholics with affective disorder. Decisions about the choice of treatment to be offered the alcoholic must be made as quickly and as accurately as possible and can only be done after a careful assessment, which may include hospitalization. It is worth noting that the pharmacologically induced depression of heavy drinking and the depression associated with the withdrawal phase may be clinically similar to the depression of primary affective disorder.