Alcohol Depression Research Articles

Gender Differences in Comorbidly Depressed Alcohol‐Dependent Outpatients

Clinical profiles of alcohol-dependent male and female outpatients were evaluated at treatment entry to compare the level of clinical severity in alcoholics with a coexistent comorbid depressive disorder to alcoholics who have never been depressed. Due to a higher proportion of females than males in the depressed alcoholic population, selected patient groups were oversampled to create a study group with equivalent number of males and females with and without comorbid depression. Clinical severity was assessed by examining both the extent of alcohol problems, and depressive symptomatology at treatment entry with respect to gender differences (unrelated to depression), effects of comorbid depression (unrelated to gender), and effects from the interaction of gender and depression. There were 93 DSM-III-R alcohol-dependent outpatients (50 males, 43 females), half of whom had a current or lifetime DSM-III-R depressive disorder. The amount of drinking in the 90 days before treatment entry, the degree of alcohol severity, and the number of lifetime drinking-related consequences were collected in the first week after detoxification. Diagnoses of lifetime and current depression were determined via the Structured Clinical Interview for DSM-III-R, and depressive symptoms were evaluated with rating scales 1 week after detoxification. In most cases, a depressive disorder was diagnosed only if sometime in the patient's history depressive symptoms had either predated problem drinking or been present during a 6-month abstinent period. depressed males had a more severe clinical profile with respect to their alcoholism (i.e., more drinking, drinking-related problems, and alcohol severity than depressed females and never-depressed males). Surprisingly, females who had never been depressed (also no family history of depression) reported drinking the same quantities of alcohol in the 90 days before treatment and had comparable alcohol severity and number of consequences as males who had never been depressed. Depressed females, however, were more severely depressed (i.e., reported more intensive depressive symptoms than depressed male alcoholics). Thus, determining the type and extent of clinical severity at treatment entry in comorbidly depressed alcoholics depends on the gender of the patient The significant interaction between gender and the presence of comorbid depression that was found in this study may have important implications for predicting success in treatment.

P.5.024 Treatment of depressed alcoholics

P.5.024 Treatment of depressed alcoholics

Rapid Tranquilization of Agitated Psychotic Patients

The optimal approach to rapid tranquilization is controversial. This double-blind, multicenter study randomized 98 psychotic, agitated, and aggressive emergency department patients to intramuscular lorazepam (2 mg), haloperidol (5 mg), or both drugs. Patients with CNS depression and obvious alcohol intoxication were excluded; schizophrenia was the most common final diagnosis. Patients were given up to six intramuscular …

Aetiology of secondary depression in male alcoholics.

Secondary depression is common among primary alcoholics. However, its aetiology is poorly understood. Forty men with primary alcoholism, abstinent for two weeks or more, with a secondary major depressive episode were compared with forty matched never-depressed primary alcoholic controls for risk factors for depression and recent life events. In the six months before the onset of depression depressed alcoholics had experienced significantly more life events, more life events with negative impact, more dependent events caused by alcohol, and more independent events. Significantly more depressed alcoholics than controls had a family history of depression, a family history of suicidal behaviour and had themselves attempted suicide. Having recent life events, particularly events with negative impact, and a family history of depression are risk factors for secondary depression in alcoholics.

Comorbidity of symptoms among junior and senior high school suicide attempters.

This paper examines comorbidity among depressive symptoms, conduct problems, and alcohol and drug abuse, in a sample of 1050 junior and senior high school students. Adolescents reporting high levels of depression along with either alcohol abuse or conduct problems were more likely to have made a suicide attempt than were adolescents reporting only one of these disorders. Adolescents reporting comorbid drug abuse plus either depression or conduct problems were more likely to have made a prior suicide attempt than those reporting only depression or conduct problems without drug abuse. The findings are discussed in the context of the literature on comorbidity and suicide attempts in community and clinical samples.

A Double-blind, Placebo-Controlled Trial of Desipramine for Primary Alcohol Dependence Stratified on the Presence or Absence of Major Depression

To assess the use of desipramine for secondary depression in primary alcohol dependence and its effect on abstinence. Randomized, double-blind, placebo-controlled trial, with stratification on the presence of secondary depression. Seventy-one volunteer and referred patients with primary alcohol dependence, abstinent a median of 8 days before randomization. A subset of 28 patients had major depression secondary to alcoholism. The outpatient psychiatry departments of two urban medical centers. Six months of a clinically determined dose of desipramine. Hamilton Depression Rating Scale, and Time Line Follow Back Interview, with breath alcohol concentrations and collateral verification. Hamilton Depression scores of desipramine-treated depressed alcoholics decreased significantly, controlling for baseline Hamilton Depression scores (P=.04). Overall, patients were abstinent significantly longer when receiving desipramine (P=.03). Rates of relapse of depressed vs nondepressed patients, analyzed separately, were not significant, although the survival function approached significance for the depressed subgroup (P=.09). Desipramine-treated depressed patients were more satisfied and were rated as more improved. Major depression secondary to alcohol dependence that is diagnosed after at least 1 week of abstinence can remain stable in some placebo-treated alcoholics and can respond to desipramine. Treating depression secondary to alcoholism may reduce risk for drinking relapse in some patients. Use of desipramine to reduce relapse in nondepressed alcoholics is not supported.

Detoxified alcoholics, major depressives and tyramine sulphate excretion

The excretion of tyramine sulphate after challenge with an oral load of tyramine was assessed in recently detoxified, clinically depressed alcoholics and a matched group of major depressives. Tyramine excretion in the alcohol group (mean 5.95 ± 3.28 mg/3 h SD) was in the range previously observed in controls and was significantly higher than in the matched depressives (mean 3.43 ± 2.37 mg/3 h SD). Tyramine sulphate excretion has been suggested as a genetic vulnerability marker for major depression. This study suggests that depression associated with alcohol withdrawal is not characterised by decreased tyramine sulphate excretion after oral tyramine challenge, such decreased conjugation only being present, perhaps, in those patients with pre- existing endogenous depressive vulnerability. Although a genetic link between alcoholism and depression exists, these results support the absence of such a link to major depression.

Desipramine in the treatment of depressed alcoholics

Desipramine in the treatment of depressed alcoholics

Alcoholism

Several medications may help improve treatment of alcoholic patients. Medications that effectively and specifically reverse symptoms of alcohol intoxication or coma currently are lacking. Benzodiazepines remain the most effective medications for the treatment of alcohol withdrawal and for the prevention of withdrawal seizures and delirium, even though the adrenergic agents clonidine or atenolol may hasten resolution of withdrawal symptoms and facilitate outpatient detoxification. Psychosocial rehabilitation of alcoholics may be improved by judicious addition of the alcohol-sensitizing agents disulfiram and carbimide, the serotonergic drugs fluoxetine and buspirone, the opiate antagonist naltrexone, and, for primarily depressed alcoholics, tricyclic antidepressants. As in psychosocial alcohol rehabilitation, patient-treatment matching may improve results of pharmacotherapeutic intervention.

Imipramine treatment of alcoholism with comorbid depression

Of 60 depressed alcoholics who completed an open trial of imipramine, 27 (45%) responded with improvement in both mood and drinking behavior, and eight (13%) responded after further dosage increases or treatment with disulfiram. In a subsequent 6-month, randomized discontinuation trial, four of 13 subjects (31%) relapsed during imipramine treatment and seven of 10 (70%) relapsed while taking placebo. This suggests a potential treatment approach for a high-risk subgroup of alcoholics.

INVITED REVIEW<subtitle>EVALUATION OF LITHIUM TREATMENT IN ALCOHOLISM</subtitle>

In psychiatric practice, lithium prevents manic depressives recidivism. Lithium could also be useful in non-manic-depressive conditions with a reduction of aggression and impulsivity. From the observation that alcoholics often present mood swings and impulsivity, several authors studied the effects of maintenance doses of lithium on alcohol intake and the depressive symptoms of alcoholics. This article reviews all the published controlled and uncontrolled studies on the effects of lithium in chronic alcoholics. Wren, Kline and colleagues firs demonstrated that lithium treatment could significantly decrease the number of disabling alcoholic episodes and that its effect was independent of an effect on the depressive symptoms. These initial optimistic conclusions were not confirmed by later controlled studies involving a larger number of patients. Most of the recent studies failed to demonstrate a significant effect of lithium on the depressive symptoms of alcoholics. Thus, it is now established that lithium is not an effective treatment of affective disorders in alcoholics. The latest published studies also suggest that lithium treatment does not decrease alcohol intake or craving for alcohol in either depressed or non-depressed alcoholics.

Mental Health in Mariel Cubans and Haitian Boat People

This article presents prevalence data on four specific mental disorders in samples of 452 Cuban immigrants who arrived during the Mariel crisis and 500 Haitians who arrived at about the same time. The disorders are: Major Depressive Disorder, Anxiety Disorder, Alcohol Disorder, and Psychosis. Cubans had higher rates of disorder than Haitians at all levels of education and income, but only in the Cuban sample was the standard inverse relationship between socioeconomic status and rate of mental disorder observed. These and other results presented suggest no single theory can explain the relationship of immigration to the range of specific mental disorders.

Lymphadenitis as dominant presenting manifestation of Kawasaki disease

To determine the prevalence of eating disorders among university students and its relationship to behavioral characteristics and substance use.Cross-sectional study collected socioeconomic characteristics and behavioral risk.University of Upper Normandy, France.University student volunteers.The Sick, Control, One stone, Fat, Food (SCOFF) screening test was used to identify subjects with eating disorders by a confidential questionnaire self-administered either online or on paper.Multivariate logistic regression models with P < .05 considered significant.A total of 3,457 students were included with a male-to-female ratio of 0.57. The prevalence of positive SCOFF screening was 20.5% among students. A positive relation between the positive SCOFF was observed with female gender (adjusted odds ratio [AOR], 2.98; 95% confidence interval [CI], 2.28–3.89; P < .001), stress (AOR, 1.10; 95% CI, 1.09–1.12; P < .001), depression (AOR, 8.62; 95% CI, 3.37–22.10; P < .001) alcohol abuse problems (AOR, 1.52; 95% CI, 1.20–1.95; P = .006), and risk of cyber-addiction (AOR, 5.09; 95% CI, 2.69–9.62; P < .001).Eating disorders are highly prevalent among university students in France and associated with other behavior risks, stress, and depression. It might prove necessary in the future to screen students with the SCOFF questionnaire upon entry to the university to inform student about the risk of eating disorders and advise them to consult with their general practitioner.

An intriguing association between ancestral mortality and male affective disorder.

We examine the relationship between ancestral age at death and affective disorder. A cohort of 204 socioeconomically favored men was selected for mental and physical health 50 years ago and followed up until age 69 +/- 1 (+/- SD) years in an interdisciplinary study. During follow-up, 49 of these men were identified at some point as being psychosocially impaired. Of these 49 men, 25 were identified as having probable affective disorder based on family history of affective illness, clinical signs, subjective symptoms, clinical diagnosis, and choice of pharmacological treatment. Objective signs and symptoms distinguished these 25 men from the remaining 24 men, whose adjustment over the 50 years was equally psychosocially impaired, but who were never noted to be significantly depressed. The mean age at death of the maternal grandfathers for the 25 depressed men was 60.4 years, significantly younger than the mean age at death of maternal grandfathers for either the total sample (70.1 years) or the 25 psychosocially impaired but not depressed men (68.8 years). The mean age at death of the depressed men's other five first-degree ancestors was not significantly different from the age at death of the ancestors of the rest of the sample. If depressed alcohol abusers were excluded, the mean age at death of maternal grandfathers of alcohol abusers did not differ from that of the controls' maternal grandfathers. The evidence for possible X-chromosome linkage in male psychobiological vulnerability to affective spectrum disorder is discussed.

The depressed alcoholic: Clinical features and medical management

A relationship between depression and alcoholism has long been postulated. A review of prior research studies reveals that though patients with depression do not appear to develop alcoholism to any great extent, recently detoxified alcoholics have a depressive syndrome about 20% of the time. This cannot be accounted for readily from data on family studies or genetic studies, which generally suggest that alcoholism and depression are two independent illnesses, albeit both quite common. Clinically, depressed alcoholics resemble alcoholics more than they resemble depressives. The clinical course of depression when it coexists with alcoholism is generally benign and selflimited, with most patients becoming euthymic over the course of 2–4 weeks without specific antidepressant treatment. In some depressed alcoholics, however, a more chronic depression persists, and may predict a worse outcome for the alcoholism. Treatment of depression in alcoholics should be initially conservative. Tricyclic and other antidepressants should be used with extreme care as they may potentiate toxic effects of alcohol.

Natural History of Mood Disorders

The literature on the natural history of mood disorders and suicidal behavior in children and adolescents is reviewed. There is considerable specificity in the continuity of depressive disorders between childhood and adulthood. The limited evidence indicates that the unipolar depressive disorders are differentiated by their age at onset and rate of recovery. Clinical factors predict a bipolar course in adolescents with major depression. Suicidal ideations and attempts, but not suicide completion, are relatively common in depressed children. Suicidal thoughts in adolescents are often associated with depressive symptoms, conduct problems, alcohol or drug abuse, life stresses, and suicidal behavior.

Depression Among Alcoholics

Although depression is common among alcoholics, its determinants are poorly understood. Among 339 alcoholics, 111 (33%) had a history of major depression. Depressed, compared with never-depressed alcoholics, had a higher daily alcohol intake, more lifetime diagnoses of other anxiety and affective disorders and drug abuse, more had attempted suicide, and more reported alcoholism in both parents. Depressed alcoholics also had significantly lower cerebrospinal fluid levels of the dopamine metabolite homovanillic acid and of gamma-aminobutyric acid. Among subgroups of depressed alcoholics, secondary compared with primary depressives were more often divorced, of lower social status, with an earlier onset of alcoholism, and higher Michigan Alcohol Screening Test scores. Secondary depressives also had significantly lower cerebrospinal fluid concentrations of homovanillic acid than never depressed alcoholics. These results suggest that certain psychosocial variables, alcohol consumption, and neurochemical variables may be specifically associated with depression in alcoholics.

Alcoholism Treatment Research: New Directions for an Old Problem

Unlike areas in medicine where the rigorous scientific evaluation of treatments before patient exposure has become standard, validating the effectiveness of various treatments for alcoholism is a fairly new enterprise. The study of the efficacy of lithium carbonate as a treatment for alcoholism by Dorus et al, 1 in this issue ofThe Journal, is highly encouraging since it demonstrates again that modern standards of treatment evaluation can be applied to alcoholism treatment. 2 Although earlier research in animals and in smaller-scale studies on human subjects had led to the hypothesis that lithium carbonate might be useful in treating alcoholics, 3-5 Dorus and colleagues, in their large-scale, multisite evaluation, found that lithium carbonate did not affect the course of alcoholism in either depressed or nondepressed alcoholics. In conducting their study, the authors avoided weaknesses common to many alcoholism treatment studies. Principal among these weaknesses are having too few subjects to

Lithium Carbonate Prophylaxis of Alcoholism: Its Time Has Come

<h3>To the Editor.—</h3> I was delighted to see the publication by Fawcett et al¹in the March 1987 issue of thearchivesas a significant addition to the already noticeabie,^2,3although still controversial, literature demonstrating beneficial effects of lithium carbonate therapy for alcoholism. In their report, therapeutic serum levels were associated with better outcome over and above the behavioral compliance effect, ie, low levels. Furthermore, Fawcett et al found no evidence that depressed alcoholics showed a better treatment response than nondepressed alcoholics or that lithium carbonate had any significant impact on the mood or social adjustment of alcoholics. Thus, the authors concluded that "lithium carbonate seems to have a beneficial effect on drinking behavior, not necessarily related to the treatment of affective symptoms." The above conclusion is congruent with the data but is not exclusive and not without at least one point of contention, ie, Fawcett and colleagues

Depression and alcoholism: clinical considerations in management.

When alcohol abuse occurs with depression, both the substance abuse and the mood disorder necessitate treatment. These conditions may have some similar manifestations, making differential diagnosis difficult. Depressed alcoholics report more previous treatment for substance abuse, withdrawal symptoms, and marital problems than those without depression. They also incur greater loneliness, unemployment, and social ineptness. Depressive symptoms found commonly in this group include work inhibition, guilt, self-disgust, dissatisfaction, and social disinterest. A history of depression among relatives favors a dual diagnosis of alcoholism and depression. Distinguishing those alcoholics with specific depressive illness enhances the therapeutic efficacy. Alcohol abusers need treatment, but those with concomitant depression persisting well beyond detoxification often require antidepressant medications. In long-term care, lithium may reduce alcohol-related rehospitalizations. A strong doctor-patient relationship with or without pharmacotherapy promotes continuation in a therapeutic regimen. Involvement in Alcoholics Anonymous and disulfiram maintenance therapy are other deterrents to drinking relapse.