Daily Archives: 28/02/2015

Depression-related drinking: going against the grain

I’ve reblogged this from Libby over at the Depression Lab who has let me re-blogged her work before here.

In Britain, people who experience anxiety or depression are said to be twice as likely to be heavy or problem drinkers.  It surprises me the risk is not much higher.  I mean, why wouldn’t anyone with depression want to get ‘off their head’ with alcohol and into a different head, one with colour, laughter, song, relief and sleep? Perhaps it doesn’t feel like that for everyone; perhaps the light-headedness and loss of control that comes with intoxication is not pleasant to some drinkers. Or the hangover is worse than the anguish of depression.

Sadly, even for people like me who love(d) drinking – from the initial, fleeting pulse of joy at the start of a session, to the numbing slide into sleep – too much of a good thing is a Bad Thing.  Too much alcohol brings headache, fatigue and nausea the morning after. Too much too often and the mental and physical effects become hard to ignore: weight gain (in that peculiar waist-thickening pattern female drinkers have), puffy complexion, jowls appearing from nowhere, sleep deprivation, and loss of self esteem as the drinking starts to take priority over things and people that used to be important.  These are profoundly unhelpful for depression sufferers.

If you persist with the getting off your head trick, as I did for many years, (long after passing the point of too much too often), you may well find yourself with an alcohol dependency problem to add to the depression.  Trying to moderate your drinking becomes extremely difficult, and the inevitable failure to do so further reduces self esteem, with a new twist of despair on top. Very bad news for depression sufferers.

How to tackle a depression-related drinking problem

The NHS has struggled to cope well with ‘dual diagnosis’ – where patients have co-existing mental ill-health and alcohol dependency.  Indeed this was my own experience when I was referred to a CBT course for depression via my GP, only to be told I was drinking too much, and thus unsuitable. (In the end I reduced my consumption levels as much as I could, lied a bit, and was accepted. The CBT course was useful for managing depression, but did not address my drinking. At all.)

I wrote here about how I stopped drinking, and how it only became possible when my depression had improved to a certain level. It had got to that level – and no further – after a few months of trying to do all the right things, eg getting plenty of sleep, healthy eating, exercise, absorbing activity, social contact.  I realised I had to stop drinking if I wanted to feel any better.

Stopping drinking was not easy, but the improvement in my depression and overall health is undeniable, and the benefits came mercifully quickly. If you find yourself in the situation I was in – depressed and drinking out of compulsion (not desire) every day, unable to stop – take heart, there is hope. Here’s what I recommend:

1. Cut back the drinking to a level you can comfortably stand whilst you concentrate on tackling your depression (I am not suggesting you drink  ‘moderately’ – just try to keep the level stable, and not increasing)

2. Use your most lucid/sober spells to do some work on your depression eg CBT, mindfulness, diet, sleep, exercise, social activity. In theory, unless you are drinking 24+ units of alcohol a day, there will be times when the alcohol has cleared your system and you are not ‘under the influence’ – this is the time to tackle the depression.

3. When you start to feel a bit better, plan how and when you will stop drinking – there’s lots of useful guidance and support online eg here, here, here and here as well as AA etc.

4. If you are physically dependant on alcohol (eg experiencing shakes, sweats, hallucinations or fits), take the risks associated with alcohol withdrawal very seriously, as they can be fatal – read this.

5. Stop drinking as per your plan, and give it top priority for as long as it takes. Here’s what I found successful:

  • pick a symbolic date to stop
  • tell nearest and dearest what you are doing
  • find some like-minded new friends in the sobersphere (see links above), or AA
  • use the Soberistas chatroom or other forums to talk through cravings
  • eat lots of chocolate to cope with cravings
  • read lots of sober books
  • buy lots of alcohol free beer and wine here (but note not everyone finds this helpful)
  • start running
  • buy regular treats as a reward

6. Go back to working on the depression when you feel ready. It took me about 6 months to feel stable enough in my not-drinking to go back to prioritising depression.

Note this approach is the exact opposite of official guidance, which is to stop drinking before tackling the depression.  That just was not possible for me; I tried many, many times. Drinking was a habitual coping mechanism, and the depression seemed unbearable without it.  One could easily use this as an excuse to carry on drinking: don’t.

Sources/Further reading

Drinkaware: Mental health and alcohol

NICE Guidance CG115

Alcohol Policy UK

Thanks once again Libby for an excellent guide on depression-related drinking and going against the grain.  Don’t forget to go check out her blog here 🙂

Edited to add: 06/10/2015 A new review and meta-analysis

Depression in patients with alcohol use disorders

Alcohol use disorders are highly comorbid with depression in both the general population and in treatment (Schuckit, 2006). It is estimated that 30-40% of individuals with an alcohol use disorder, experience an episode of comorbid depression (Anthenelli and Schuckit 1993; Schuckit et al. 1997a). In particular patients entering treatment for alcohol use disorders often have high levels of depressive symptoms (Davidson, 1995; Brown et al, 1995)