Alcohol and Depression: The Link Between Alcoholism and Depression

Can drinking alcohol cause depression and, conversely, can depression lead to misusing alcohol?

If you or someone you care about is struggling with depression and alcohol misuse, you may be interested in learning more about how alcohol can play a role in depression and vice versa, as well as the different factors that can affect alcohol, depression, and addiction.

Simultaneous treatment for alcohol misuse and a depressive disorder can help you or your loved one take back control of your mental health, physical wellbeing, and overall happiness.

What is Depression?

Everyone feels blue or down from time to time, and people often say that they feel “depressed” during these temporary bouts of sadness. But clinical depression isn’t just a matter of feeling the occasional ups and downs or periodic sadness caused by issues of daily life.

Major depressive disorder, persistent depressive disorder, and other depressive disorders are treatable mental health disorders that are characterized by symptoms of sadness, emptiness, and/or irritable mood that affects a person’s body and mind, specifically the ability to function. Although researchers have identified several risk factors for depressive disorders, these episodes can occur in anyone. However, not everyone who experiences risk factors will develop a depressive disorder. These risk factors include:^1,2,3,4,5

• Genetics and heritability. Genes are not destiny, but a family history of depression is considered a risk factor. First-degree family members of individuals with major depressive disorder have a risk 2- to 4-times higher than the general population.
• Biological factors and illness. This includes your physical health, such as having a serious illness such as cancer, diabetes, or heart disease, as well as your levels of neurotransmitters (brain chemicals), which can become imbalanced and influence depression.
• Stress, major life changes, and exposure to trauma. Any of these can be a risk factor but they’re particularly imporatnt if you experienced them in childhood.
• Taking certain medications. Some of the side effects of medications can cause or contribute to depressive symptoms.
• Low socioeconomic status. While socioeconomic status can play a role at any point in your lifespan, it can be a particular risk factor early in life.
• Using illicit substances or alcohol. Different substances can increase your risk of developing depression.

Signs and Symptoms of Depression

To be diagnosed with major depressive disorder or another depressive disorder, people typically need to display symptoms almost every day for at least 2 weeks. The symptoms are severe enough that they cause significant stress and impairment in social, occupational, and/or other important areas of functioning.⁵ While the specific types of depressive disorders can look a bit different, they tend to share common symptoms that include:^1,5,6

• A persistent low mood, feelings of sadness, and/or feeling anxious or empty.
• Feeling hopeless or pessimistic.
• Irritability, frustration, or restlessness.
• Feeling excessively or inappropriately guilty, worthless, or helpless.
• Losing interest or pleasure in activities or hobbies you once enjoyed.
• A lack of energy or fatigue.
• Moving or talking more slowly than usual.
• Difficulty thinking, remembering, and/or making decisions.
• Changes in sleep, such as trouble falling or staying asleep (i.e., insomnia) or sleeping more than usual (i.e., hypersomnia).
• Changes in appetite with significant weight loss or weight gain (e.g., a change of more than 5% of body weight).
• Having thoughts of self-harm, death, or suicide, or making suicidal attempts.
• Aches, pains, headaches, cramps, or digestive problems that aren’t easily explainable and do not improve with treatment.

How Alcohol Abuse Can Factor into Depression

Can alcohol cause depression or vice versa? Research has shown that there seems to be a bidirectional relationship between alcohol use disorder (AUD) and depressive disorders. Both disorders can exist together, each disorder increases the risk for the other disorder, and each disorder can worsen the other.⁷ Regardless of the order of which came first, AUD or a depressive disorder, both issues are among the most prevalent psychiatric disorders and co-occur often.^7,8,9,10

The pathways leading to the development of co-occurring AUD and a depressive disorder are complex and intertwined. Some individuals may be genetically susceptible to both. For others, symptoms of a depressive disorder can influence the development of an AUD. One possible contributor to co-occurrence is that people may alleviate symptoms of a depressive disorder with substances such as alcohol. People who experience major depressive symptoms may start to rely on alcohol to ease their symptoms and feel better, but over time, this can develop into a full-blown alcohol use disorder.¹⁰

Even in instances where a person doesn’t develop an AUD, self-medication may not be helpful long-term, as it is associated with increased psychiatric comorbidity, higher stress levels, and lower health-related quality of life.^3,10 Research also has associated AUD with a risk not only for the onset of depressive symptoms but also for depressive disorders.

It’s important to note that the co-occurrence of AUD and depressive disorders, specifically major depressive disorder and persistent depressive disorder, is associated with greater severity and worse prognosis than either disorder alone. This includes a heightened risk for suicidal behavior.⁷

It’s a vicious pairing that can be difficult to overcome; however, treatment can be effective.

How is Depression Diagnosed?

Psychiatrists and other healthcare professionals may utilize a variety of screening tools coupled with patient examinations and even lab tests to assess for mental health conditions such as depression and their potential contributing factors. Though official mental health diagnoses may only come from these healthcare professionals, to keep you better informed about the steps that help determine the care that you’ll ultimately be given, it’s helpful to understand some of the diagnostic criteria that lead to a depression diagnosis.

The aforementioned depressive disorders each have slightly different diagnostics criteria. However, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), major depressive disorder is the most common and well-known example of this group of disorders.⁵ Thus, the following info focuses on this particular disorder.

In order to receive a diagnosis of major depressive disorder in adults, five or more of the following symptoms must be present during the same two-week period and must represent a change from previous functioning. Plus, at least one of these five symptoms must include depressed mood (No. 1) or loss of interest or pleasure (No. 2).⁵

1. Depressed mood most of the day, nearly every day, as indicated by either personal subjective reports (e.g., feeling sad, empty, hopeless) or by observation made by others (e.g., appears tearful).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either personal account or observation).
3. Significant weight loss though not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or a decrease or increase in appetite nearly every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective personal account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

If five of these criteria are met as described above, the following must also apply in order to receive a diagnosis of major depressive disorder:⁵

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The episode is not attributable to the physiological effects of a substance or to another medical condition.
• The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
• There has never been a manic episode or a hypomanic episode.

Does Alcohol Cause Depression?

A study in JAMA Psychiatry points out that there may be a direct cause and effect association between alcohol misuse and dependence and major depressive disorder in certain instances.⁹ Alcohol can not only lead to depressive symptoms but also worsen depressive symptoms in people who already experience them or in those who may be genetically vulnerable to depressive disorders. If depressive symptoms are caused by drinking alcohol, they may stop after significantly reducing or stopping alcohol use.¹¹  However, research also suggests that substance-induced depression may turn into independent depression should symptoms persist following cessation of alcohol or other substances of abuse.¹²

Can Alcohol Make Depression Worse?

Yes, alcohol can exacerbate depression and depressive symptoms. In addition, a clinical review in the journal Professional Psychology: Research and Practice explains that drinking can interfere with recovery from depression. Depressed study participants who were heavy drinkers displayed worse outcomes from depression treatment; furthermore, even mild to moderate amounts of alcohol appeared to worsen depression, with depressed patients who drank low levels of alcohol (less than 1 oz per day) experiencing worse outcomes from pharmacological treatments.¹³

Alcohol use disorders may be more prevalent in people who also have depression than they are in the general population. The occurrence of alcohol use disorder and a depressive disorder are associated with greater severity and a worse prognosis for both disorders.

How Long Does Alcohol-Induced Depression Last?

The duration of alcohol-induced depression can vary widely. Generally speaking, depressive symptoms associated with alcohol-induced depression have been shown to improve significantly after you’ve abstained from alcohol for a certain amount of time, typically 3-4 weeks in many cases.¹¹ However, research also suggests that substance-induced depression can turn into independent depression should symptoms of depression persist following cessation of alcohol or other substances of abuse.

Take Our “Am I an Alcoholic?” Self-Assessment

Take our free, 5-minute “Am I an Alcoholic?” self-assessment below if you think you or someone you love might be struggling with an alcohol use disorder (AUD). The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an AUD. The test is free and confidential, and no personal information is needed to receive the result.

Treatment for Co-Occurring Depression and Alcohol Use Disorder

Treatment often includes an integrated approach to simultaneously address both alcohol use disorder and depression.

Many treatments can help co-occurring depression and AUD. Some of these can include:^14,15,16

• Detox. This is usually the first step in the recovery process followed by entry into a formal drug rehabilitation program. Detox helps you safely and comfortably withdraw from alcohol.
• Antidepressants/Medications. You may receive antidepressants, which can help treat both the depression and some symptoms of AUD. In addition, you may receive naltrexone, a medication that detox helps people stop drinking and reduces depressive symptoms; disulfiram, which is used as an alcohol deterrent (it causes unpleasant symptoms if you drink alcohol); or acamprosate, which is used to help maintain abstinence from alcohol.
• Behavioral therapies. These can include:
  • Cognitive-Behavioral Therapy (CBT). This helps you learn positive coping mechanisms to replace the thought and behavioral patterns that can contribute to or worsen AUD and depression.
  • Dialectical Behavior Therapy (CBT). This is mainly used to help reduce self-harm and suicidal behavior.
  • Behavioral Activation. This is a type of behavioral therapy that is effective for both AUD and depression. It involves developing an understanding of how negative life experiences and behaviors influence your mood and emotions and encourages you to take an active approach to increase your positive life experiences.
  • Mutual support groups (e.g., Alcoholics Anonymous (AA) and  SMART Recovery). These groups are effective both as treatment and as aftercare for both AUD and depression. You’ll benefit from the support of others who know what it’s like to be in your shoes, which can lessen feelings of isolation and help you feel connected.

Other Frequently Asked Questions Regarding Alcohol & Depression