The presence of depression in alcohol-dependent persons is likely to influence treatment process and outcomes. Identification of depression is important though not every depressed alcohol-dependent person requires treatment with antidepressants. Understanding the association between depression and alcohol dependence is essential for proper management of alcohol dependence. Objectives. To determine the prevalence of depression among alcohol-dependent persons before and after alcohol detoxification and rehabilitation. Design. Clinical trial with pre-/postmeasurements. Method. The CIDI and WHO-ASSIST were administered to 188 alcohol-dependent persons at intake and after six months. A researcher-designed sociodemographic questionnaire was also administered at intake. Results. The prevalence of depression among alcohol-dependent persons is high (63.8%) with a significant association between depression and the mean AUDIT score. At posttest, depressed participants had a statistically significant craving for alcohol. Conclusion. Alcohol dependence is associated with major depression. 1. Introduction The prevalence of comorbidity of depression and alcohol use disorders (AUD) has been demonstrated in a number of researches [1–4]. Depression in an alcohol-dependent person has been reported to not only lower the resolve to resisting alcohol use, but may also lead to use of alcohol to relive the depressive symptoms [5, 6]. It is important to understand the significance of cooccurrence of depression and alcohol use disorders since this may explain why majority of cases relapse after treatment for alcohol dependence [5, 6]. In addition it may explain why antidepressants have been shown to moderately benefit patients with both depression and alcohol use disorders [7]. In Kenya a study by Ndetei et al. showed that there was positive correlation between major depressive illness, panic disorder, and alcohol abuse among patients admitted at the main referral psychiatric hospital [8]. Although the cooccurrence of depression and alcohol use disorders has been confirmed by several studies, the relationship between the two disorders has been difficult to describe [9]. This cooccurrence is at prevalence rate of 16%–68% [10]. Studies have attempted to differentiate between depressed and nondepressed alcohol-dependent persons with particular focus on the participant’s level of alcohol dependence, demographic characteristics, or illness-related variables. It has been shown that depression is more related to the current alcohol drinking episode than lifetime diagnosis of depression
References
[1]
D. Spaner, R. C. Bland, and S. C. Newman, “Major depressive disorder,” Acta Psychiatrica Scandinavica, Supplement, vol. 89, no. 376, pp. 7–15, 1994.
[2]
B. F. Grant and T. C. Harford, “Co morbidity between DSM-IV alcohol use disorders and major depression: results of a national survey,” Drug and Alcohol Dependence, vol. 39, no. 3, pp. 197–206, 1995.
[3]
H. E. Ross, “DSM-III-R alcohol abuse and dependence and psychiatric co morbidity in ontario: results from the mental health supplement to the Ontario Health Survey,” Drug and Alcohol Dependence, vol. 39, no. 2, pp. 111–128, 1995.
[4]
R. C. Kessler, R. M. Crum, L. A. Warner, C. B. Nelson, J. Schulenberg, and J. C. Anthony, “Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national co morbidity survey,” Archives of General Psychiatry, vol. 54, no. 4, pp. 313–321, 1997.
[5]
D. S. Hasin and B. F. Grant, “Major depression in 6050 former drinkers: association with past alcohol dependence,” Archives of General Psychiatry, vol. 59, no. 9, pp. 794–800, 2002.
[6]
E. J. Khantzian, “Self-regulation and self-medication factors in alcoholism and the addictions. Similarities and differences,” Recent Developments in Alcoholism, vol. 8, pp. 255–271, 1990.
[7]
E. V. Nunes and F. R. Levin, “Treatment of depression in patients with alcohol or other drug dependence: a meta-analysis,” Journal of the American Medical Association, vol. 291, no. 15, pp. 1887–1896, 2004.
[8]
D. M. Ndetei, L. Khasakhala, H. Maru et al., “Clinical epidemiology in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya,” Social Psychiatry and Psychiatric Epidemiology, vol. 43, no. 9, pp. 736–742, 2008.
[9]
K. M. Davidson, “Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status,” British Journal of Psychiatry, vol. 166, pp. 199–204, 1995.
[10]
J. A. Halikas, M. A. Herzog, M. M. Mirassou, and M. D. Lyttle, “Psychiatric diagnosis among female alcoholics,” in Currents in Alcoholism, G. Galanter, Ed., vol. 8, pp. 281–291, Grune & Stratton, New York, NY, USA, 1981.
[11]
C. A. Dackis, M. S. Gold, A. L. C. Pottash, and D. R. Sweeney, “Evaluating depression in alcoholics,” Psychiatry Research, vol. 17, no. 2, pp. 105–109, 1986.
[12]
S. A. Brown and M. A. Schuckit, “Changes in depression among abstinent alcoholics,” Journal of Studies on Alcohol, vol. 49, no. 5, pp. 412–417, 1988.
[13]
W. Coryell, M. Keller, J. Endicott, N. Andreasen, P. Clayton, and R. Hirschfeld, “Bipolar II illness: course and outcome over a five-year period,” Psychological Medicine, vol. 19, no. 1, pp. 129–141, 1989.
[14]
K. S. Kendler, A. C. Heath, M. C. Neale, R. C. Kessler, and L. J. Eaves, “Alcoholism and major depression in women: a twin study of the causes of co morbidity,” Archives of General Psychiatry, vol. 50, no. 9, pp. 690–698, 1993.
[15]
R. Harrington, H. Fudge, M. Rutter, A. Pickles, and J. Hill, “Adult outcomes of childhood and adolescent depression: I. Psychiatric status,” Archives of General Psychiatry, vol. 47, no. 5, pp. 465–473, 1990.
[16]
T. Flensborg-Madsen, E. L. Mortensen, J. Knop, U. Becker, L. Sher, and M. Gr？nb？k, “Co morbidity and temporal ordering of alcohol use disorders and other psychiatric disorders: results from a Danish register-based study,” Comprehensive Psychiatry, vol. 50, no. 4, pp. 307–314, 2009.
[17]
J. M. Boden and D. M. Fergusson, “Alcohol and depression,” Addiction, vol. 106, no. 5, pp. 906–914, 2011.
[18]
A. Angold, E. J. Costello, and A. Erkanli, “Co morbidity,” Journal of Child Psychology and Psychiatry, vol. 40, pp. 57–87, 1999.
[19]
J. M. Bolton, J. Robinson, and J. Sareen, “Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions,” Journal of Affective Disorders, vol. 115, no. 3, pp. 367–375, 2009.
[20]
S. Bazargan-Hejazi, M. Bazargan, T. Gaines, and M. Jemanez, “Alcohol misuse and report of recent depressive symptoms among ED patients,” The American Journal of Emergency Medicine, vol. 26, no. 5, pp. 537–544, 2008.
[21]
D. W. Brook, J. S. Brook, C. Zhang, P. Cohen, and M. Whiteman, “Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders,” Archives of General Psychiatry, vol. 59, no. 11, pp. 1039–1044, 2002.
[22]
R. M. Crum, K. M. Green, C. L. Storr et al., “Depressed mood in childhood and subsequent alcohol use through adolescence and young adulthood,” Archives of General Psychiatry, vol. 65, no. 6, pp. 702–712, 2008.
[23]
R. de Graaf, R. V. Bijl, J. Spijker, A. T. F. Beekman, and W. A. M. Vollebergh, “Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders—findings from the Netherlands Mental Health Survey and Incidence Study,” Social Psychiatry and Psychiatric Epidemiology, vol. 38, no. 1, pp. 1–11, 2003.
[24]
J. F. Epstein, M. Induni, and T. Wilson, “Patterns of clinically significant symptoms of depression among heavy users of alcohol and cigarettes,” Preventing Chronic Disease, vol. 6, no. 1, article A09, 2009.
[25]
D. S. Hasin, F. S. Stinson, E. Ogburn, and B. F. Grant, “Prevalence, correlates, disability, and co morbidity of DSM-IV alcohol abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions,” Archives of General Psychiatry, vol. 64, no. 7, pp. 830–842, 2007.
[26]
V. V. Grant, S. H. Stewart, and C. D. Mohr, “Coping-anxiety and coping-depression motives predict different daily mood-drinking relationships,” Psychology of Addictive Behaviors, vol. 23, no. 2, pp. 226–237, 2009.
[27]
J. Williams, S. B. Jones, M. R. Pemberton, R. M. Bray, J. M. Brown, and R. Vandermaas-Peeler, “Measurement invariance of alcohol use motivations in junior military personnel at risk for depression or anxiety,” Addictive Behaviors, vol. 35, no. 5, pp. 444–451, 2010.
[28]
K. C. Young-Wolff, K. S. Kendler, N. D. Sintov, and C. A. Prescott, “Mood-related drinking motives mediate the familial association between major depression and alcohol dependence,” Alcoholism: Clinical and Experimental Research, vol. 33, no. 8, pp. 1476–1486, 2009.
[29]
N. R. Marmorstein, “Longitudinal associations between alcohol problems and depressive symptoms: early adolescence through early adulthood,” Alcoholism: Clinical and Experimental Research, vol. 33, no. 1, pp. 49–59, 2009.
[30]
A. L. Baker, D. J. Kavanagh, F. J. Kay-Lambkin et al., “Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: short-term outcome,” Addiction, vol. 105, no. 1, pp. 87–99, 2010.
[31]
J. R. Cornelius, O. G. Bukstein, B. Birmaher et al., “Fluoxetine in adolescents with major depression and an alcohol use disorder: an open-label trial,” Addictive Behaviors, vol. 26, no. 5, pp. 735–739, 2001.
[32]
J. R. Cornelius, O. G. Bukstein, D. S. Wood, L. Kirisci, A. Douaihy, and D. B. Clark, “Double-blind placebo-controlled trial of fluoxetine in adolescents with comorbid major depression and an alcohol use disorder,” Addictive Behaviors, vol. 34, no. 10, pp. 905–909, 2009.
[33]
G. Wilton, P. Moberg, and M. F. Fleming, “The effect of brief alcohol intervention on postpartum depression,” MCN The American Journal of Maternal/Child Nursing, vol. 34, no. 5, pp. 297–302, 2009.
[34]
W. B. Jaffee, M. L. Griffin, R. Gallop et al., “Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders,” Journal of Clinical Psychiatry, vol. 70, no. 2, pp. 171–176, 2009.
[35]
J. F. Kelly, R. L. Stout, M. Magill, J. S. Tonigan, and M. E. Pagano, “Mechanisms of behavior change in alcoholics anonymous: does alcoholics anonymous lead to better alcohol use outcomes by reducing depression symptoms?” Addiction, vol. 105, no. 4, pp. 626–636, 2010.
[36]
Q. Fu, A. C. Heath, K. K. Bucholz et al., “Shared genetic risk of major depression, alcohol dependence, and marijuana dependence: contribution of antisocial personality disorder in men,” Archives of General Psychiatry, vol. 59, no. 12, pp. 1125–1132, 2002.
[37]
P. H. Kuo, M. C. Neale, D. Walsh et al., “Genome-wide linkage scans for major depression in individuals with alcohol dependence,” Journal of Psychiatric Research, vol. 44, no. 9, pp. 616–619, 2010.
[38]
D. R. Langbehn, R. Philibert, K. M. Caspers, R. Yucuis, and R. J. Cadoret, “Association of a D2S2944 allele with depression specifically among those with substance abuse or antisocial personality,” Drug and Alcohol Dependence, vol. 83, no. 1, pp. 33–41, 2006.
[39]
X. Luo, H. R. Kranzler, L. Zuo, S. Wang, H. P. Blumberg, and J. Gelernter, “CHRM2 gene predisposes to alcohol dependence, drug dependence and affective disorders: results from an extended case-control structured association study,” Human Molecular Genetics, vol. 14, no. 16, pp. 2421–2434, 2005.
[40]
J. I. Nurnberger, T. Foroud, L. Flury et al., “Evidence for a locus on chromosome 1 that influences vulnerability to alcoholism and affective disorder,” The American Journal of Psychiatry, vol. 158, no. 5, pp. 718–724, 2001.
[41]
E. F. H. Saunders, P. Zhang, J. N. Copeland, M. G. McInnis, and S. Z？llner, “Suggestive linkage at 9p22 in bipolar disorder weighted by alcohol abuse,” American Journal of Medical Genetics Part B, vol. 150, no. 8, pp. 1133–1138, 2009.
[42]
J. C. Wang, A. L. Hinrichs, H. Stock et al., “Evidence of common and specific genetic effects: association of the muscarinic acetylcholine receptor M2 (CHRM2) gene with alcohol dependence and major depressive syndrome,” Human Molecular Genetics, vol. 13, no. 17, pp. 1903–1911, 2004.
[43]
R. C. McEachin, B. J. Keller, E. F. Saunders, and M. G. McInnis, “Modeling gene-by-environment interaction in co morbid depression with alcohol use disorders via an integrated bioinformatics approach,” BioData Mining, vol. 1, article 2, 2008.
[44]
L. K. Sj？holm, L. Kovanen, S. T. Saarikoski, M. Schalling, C. Lavebratt, and T. Partonen, “CLOCK is suggested to associate with comorbid alcohol use and depressive disorders,” Journal of Circadian Rhythms, vol. 8, article 1, 2010.
[45]
A. Strandheim, T. L. Holmen, L. Coombes, and N. Bentzen, “Alcohol intoxication and mental health among adolescents—a population review of 8983 young people, 13–19 years in North-Tr？ndelag, Norway: the Young-HUNT Study,” Child and Adolescent Psychiatry and Mental Health, vol. 3, article 18, 2009.
[46]
C. B. Fleming, W. A. Mason, J. J. Mazza, R. D. Abbott, and R. F. Catalano, “Latent growth modeling of the relationship between depressive symptoms and substance use during adolescence,” Psychology of Addictive Behaviors, vol. 22, no. 2, pp. 186–197, 2008.
[47]
D. M. Fergusson, J. M. Boden, and L. J. Horwood, “Tests of causal links between alcohol abuse or dependence and major depression,” Archives of General Psychiatry, vol. 66, no. 3, pp. 260–266, 2009.
[48]
T. Babor, J. Higgins Biddle, J. Saunders, and M. Monteiro, “AUDIT the alcohol use disorders identification test,” in Guidelines for Use in Primary Care, WHO/MSD/MSB/01.6, World Health Organization, Geneva, Switzerland, 2 edition, 2001.
[49]
S. H. Edwards, R. Humeniuk, R Ali, V. Poznyak, and M. Monteiro, The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Guidelines for Use in Primary Care (Draft Version 1.1 for Field Testing), World Health Organization, Geneva, Switzerland, 2003.
[50]
R. C. Kessler and B. B. üstün, “The world mental health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI),” International Journal of Methods in Psychiatric Research, vol. 13, no. 2, pp. 93–117, 2004.
[51]
National Institute on Drug abuse (NIDA), “Thirteen principles of drug addiction treatment,” in NIDA’S Principles of Drug Addiction Treatment: A Research-Based Guide, 1999, http://www.drugabuse.gov/PDF/PODAT/PODAT.
