Treatment of the Depressed Alcoholic Patient

Abstract

Alcohol use disorders (AUDs) and depressive illnesses are highly prevalent, frequently co-occur, and are associated with worse outcomes when paired. The assessment and treatment of patients with co-occurring alcohol use disorders and depressive illnesses is wrought with many significant challenges. When it comes to advocating treatment guidelines for this dually diagnosed population, the data are limited, but nonetheless do suggest that an integrated approach to patients presenting with co-occurring AUD and depressive symptoms can be efficacious. In this approach, ongoing evaluation and treatment are provided under one roof according to the evolving needs of each patient. Utilizing antidepressant medications in conjunction with psychosocial therapies may augment overall treatment efficacy; data also suggest that combining and tailoring psychosocial therapies such as motivational enhancement therapies, cognitive therapies, and twelve-step facilitation may further improve treatment outcomes for patients with co-occurring depressive and alcohol use disorders.

Medications for substance use disorders (SUD): emerging approaches

“…A number of studies have investigated whether approved psychiatric medications are effective in persons with dual mood and substance use disorders [34]. Treatment of these comorbid psychiatric disorders is important for quality of life and treatment engagement, but may not necessarily have a major impact on SUD per se [36]. Further pharmacogenomic or phenotypic refinements may determine if a subset of these dually diagnosed persons would have a more global benefit from anti-depressant or anxiolytic medication.…”

Efficacy of an Online Self-Help Treatment for Comorbid Alcohol Misuse and Emotional Problems in Young Adults: Protocol for a Randomized Controlled Trial (Preprint)

“…involves treating alcohol misuse and emotional problems separately by two distinct professionals and/or clinical teams [13,14]. A notable example of this approach would be a person seeing a family doctor for management of antidepressant medications, while working with a psychologist to reduce drinking.…”

“…A sequential approach may be necessary in crisis situations, such as when a person needs hospitalization for alcohol-related seizures or for acute suicidality. However, in the absence of an emergency warranting the immediate stabilization of one disorder over the other, sequential treatment may impede the treatment of both disorders [13]. Specifically, sequential treatment does not consider the interconnectedness of alcohol misuse and emotional problems.…”

The Complexities of Depression

“…As described by DeVido and Weiss (5), alcohol use disorders are nearly three times more common in depressed individuals than the general population and the converse is also true, i.e., that depression is over-represented in people with alcoholism. These patients are more likely to exhibit poor treatment outcomes and all aspects of treatment, from initial assessment to treatment decisions to treatment adherence, are more difficult than in subjects with each condition separately.…”