Depression and Social Phobia Secondary to Alcohol Dependence

Abstract

Background: According to the self-medication hypothesis, individuals with depression and anxiety disorders use alcohol to control their symptoms and subsequently become dependent. Conversely, alcohol dependence disorder (ADD) can cause or exacerbate psychiatric disorders. This study analyzed the characteristics of depression and social phobia secondary to ADD. (1) What is their functional impact? (2) Are they independent or associated conditions? (3) Do they completely remit in abstinent individuals? (4) Is the remission of one disorder associated with the remission of the other disorder? Methods: Sixty-four inpatients with ADD were evaluated with depression and anxiety disorder scales upon admission to hospital and after 5 weeks of detoxification. Results: Baseline comparisons differentiated patients with a Hamilton Rating Scale for Depression (HDRS) score >35 (n = 50; 78%) from those with an HDRS score ≤35 by higher levels of generalized anxiety and lower global functioning. Patients with generalized social phobia [Leibowitz Social Anxiety Scale (LSAS) score >60: n = 20; 31.2%] were not distinguishable from those with an LSAS score ≤60 by depressive and anxiety disorder symptoms. In postdetoxification assessment, patients who remitted from depression (HDRS score <7: n = 35; 54.6%) had a lower generalized anxiety and marginally higher levels of hypochondriasis compared to nonremitter subjects (HDRS score ≧7). Patients who remitted from social phobia (LSAS score <30: n = 32; 50%) did not significantly differ from nonremitter subjects in depressive and anxiety disorder symptoms. Generalized anxiety (Hamilton Rating Scale for Anxiety) and hypochondriasis (Whiteley Index) were the significant predictors of global functioning (Global Assessment Scale). Conclusions: Depression and social phobia secondary to ADD are independent conditions that do not completely remit after cessation of drinking. Specific treatments are needed to reduce residual depressive and anxiety symptoms in abstinent alcoholics.

Mechanism of coping in patients of alcohol dependence and its correlation with anxiety, depressive symptoms

“…Depression is a common comorbidity in alcohol use disorder. 1,17 In our study two third of patients reported depressive symptoms and majority were mild depression. Though mild depressive symptoms are commonly reported but the diagnosis of major depressive disorder is missed hence many cases might go untreated.…”

“…Common co-morbid psychopathologies in alcohol dependence include negative affective disorders like severe depression and anxiety disorders. 1,2 Though alcohol dependence may both contribute to and result from negative affective disorders, abstinence often alleviates depressive and anxiety symptoms. The presence of depressive and anxiety symptoms complicates the course of alcohol dependence and poses challenges for treatment and prevention of relapses.…”

“…The presence of depressive and anxiety symptoms complicates the course of alcohol dependence and poses challenges for treatment and prevention of relapses. Though anxiety is a common withdrawal symptom, 1 anxiety disorders are not rare even after prolonged abstinence from alcohol.…”

“…5 In various studies the prevalence of co-morbid psychopathologies ranges from 15-70% including depression & anxiety disorders like social phobia, generalized anxiety disorder. 1,2,6 Coping skills are crucial in relapse prevention strategies of alcohol dependence. A complex interaction of psychopathologies, coping skills, and alcohol use can influence the outcome of alcohol dependence.…”

Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors

“…However, the diagnosis of SAD in alcohol-dependent patients may be hampered by its clinical similarity with withdrawal symptoms (e.g. anxiety, tremors, sweating, increased heart rate) 8,15 and by the fact that some persons with AUD may develop social anxiety symptoms due to the shame of their behaviors while intoxicated 16 . In anxiety disorders, the comorbidity with AUD has great clinical relevance, as it implies a worse prognosis, including poor treatment response and increased suicide risk 8,17 .…”