What We Know, and Don’t Know, About Depression and Alcoholism | The Fix
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What We Know, and Don’t Know, About Depression and Alcoholism

The recent death of actor Robin Williams cast a spotlight on the complicated relationship between addiction and depression.

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By Paul Gaita

08/28/14

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At the time of his death, Robin Williams had been reportedly struggling with both severe depression and had completed several weeks of rehabilitation at Hazelden Addiction Treatment Center in Minnesota.

But Williams’ situation was not unusual. Nearly 28% of Americans with alcohol dependence also have a major depressive disorder, according to the National Institute on Alcohol Abuse and Alcoholism. Individuals with alcohol dependency are 3.9 times more likely to have a major depressive disorder than someone without the latter condition, and some studies have claimed that there is a genetic link between susceptibility to alcoholism and depression.

Despite this, treatment for individuals with both alcohol dependency and depression has not progressed much beyond the speculative phase. A Huffington Post feature on the subject outlined the central quandary of comorbidity with the two conditions: alcohol is a depressant, but also produces initial euphoric qualities. Scientists are unsure whether people drink to alleviate preexisting depressive feelings, or whether the depression causes them to drink. Unfortunately, the current approach for both the medical and scientific communities is to treat the conditions as separate entities and not part of an entropic cycle.

However, strides are being made to treat the combined conditions through a combination of different therapies and/or medications. Stephanie Gamble, Ph.D, an assistant psychiatry professor at the University of Rochester Medical Center, has launched pilot studies to determine if individuals with both alcohol dependency and depression will respond to both traditional substance abuse therapy and interpersonal psychotherapy. An uncontrolled study she conducted in 2013 found that the 14 test subjects—all women—showed significant improvement in their alcohol intake, depression, and interpersonal behavior over the course of a 32-week course.

Addiction psychiatrist Charles O’Brien, M.D of the University of Pennsylvania School of Medicine, approached the situation through pharmacology. In a double blind controlled study conducted in 2010, he treated 170 participants in one of the following manners: by administering them with naltrexone (which reduces alcohol cravings), sertraline (which treats anxiety or depression), a combination of both drugs, and neither medication at all.

Of the four groups, the individuals who received both drugs had longer alcohol abstinence rates. O’Brien hopes that other research groups will follow his lead and conduct similar tests over longer periods of time. “The brain is the cause of all of this,” he noted. “Addiction is a brain disease. Depression is a brain disease. [And] not many doctors know about the brain.”

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