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)

13 thoughts on “Depression-related drinking: going against the grain

  1. Dear Lucy,
    I love Libby’s site!
    My alcohol induced depression was awful.
    I still suffer with depression, but at least now, I can work on it without the extra horrible feelings drinking brought on!
    Thank you!

    1. That’s great Wendy! I’m meeting Libby for lunch tomorrow so I’ll tell her that and I’m sure it will make her day 🙂

  2. I’m also pleased you have flagged up Libby’s site- it’s my next visit. I hadn’t realised you had depression too Lucy, yet another thing we have in common and illustrates how reluctant people are to drop it into conversation. I found a cycle of self medicating depression with alcohol which made me more depressed. When I first got help I was told alcohol with antidepressants was like driving with the brakes on and would have little or no chance of being effective.

    1. Hey Rachel. Libby’s site is excellent and yep depression has been a constant companion on and off since my twenties. It’s one of those chicken and egg things: which came first, the booze or the depression? And like you I drank whilst on anti-depressants even though I knew it was contra-indicated!! No wonder it didn’t improve!! 🙂

  3. That first paragraph hits home for me so much:
    ” 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?” 4 months and 1 day sober but am really thinking is it worth it?

    Like you Lucy I stupidly drank all the while whilst taking antidepressants but is the only way I seem to be able to get any mind relief, at the moment I am not even bothered about the hangover I just want some rest for my mind. It might not be what people want to hear but Alcohol did give me relief, is it only me that feels this way. Feel like I am stuck between a rock and a hard place!

    I am sorry for being so negative I don’t want to throw away four months but I don’t want to feel this bad also. I see my GP every week by the way am on different meds.

    Please, please if anyone has any advice would they email me.
    Thank you for listening

    1. Minnymoo69 I’m no expert on depression so I’m hoping Libby who wrote this post will chime in for me. It’s okay to be negative but please don’t drink just yet! You’ve done so well getting to 4 months and I would hate to see you throw that away. Hang on in there xx

    2. Hello Minny, I am sorry to hear you still feel bad, even with four months alcohol free-ness under your belt (congratulations on that though, brilliant).

      If you have always used alcohol, as I did, to ease the mental pain of depression then it’s not surprising the depression is still a problem now you have taken the alcohol away.

      Like I said in this article, I had to get my depression under control before I could successfully stop drinking. And I tried it the other way round many, many times before I got the message!

      I’m not saying go back to drinking – please don’t do that if you can help it. But if you can find the strength, really see if you can tackle the depression as if your life depended on it. Which it may well do.

      Sort the basics: get the meds working as well as possible – type and dose; get plenty of healthy sleep; eat properly and think carefully about what your optimum diet could be; do sweaty exercise most days; get some sunshine in your eyes and on your skin; don’t let yourself ruminate – distract yourself when it happens; give yourself easily achievable things to do (and do them!); try and do things you enjoy; interact with people socially. Some of these will work better than others for you but they seem to have a cumulative effect.

      With over half my life gone now, I wish I had realised earlier that it is possible to recover from depression, or at least be misery-free, and that there is a lot you can do to help yourself. Email me if you like

      Look after yourself x

  4. Hope I am not reposting this, It has deleted it once (I think)
    Thank you Lucy and Libby for replying it has made me feel better saying how I feel out loud.
    Libby you have hit the nail on the head I drink/drank to ease the mental pain and at the moment I am not finding an outlet for that. I will keep trying.

    I AM NOT going to drink. Thank god for sites and people like yourselves.

    For me it was definitely depression that came first, and alcohol in the beginning was like a magic cure, obviously it doesn’t stay that way. I wish I could just find a cure for my depression I have tried just about every medication out there. I do think also it has a lot to do with hormones but Doctors don’t seem to take that on board.

    Thank you both once again

    1. Hey Minny I’m happy that you vocalising it has helped 🙂 Please drop by Libby’s blog Depression Lab as she has lots of hints and tips for managing depression and please let us know how you go. Once again HUGE congrats on 4 months – having struggled with depression please know that this is a huge achievement and you should be proud xx

      1. Dear Lucy and Libby

        I just wanted to give you an update.

        It’s hard to believe it was two days ago when I was posting to you in absolute desperation. I am so, so glad I didn’t give in and drink, I was so tempted but managed to get through.

        I hope this isn’t going to be too much information but it just might help someone else. As you can read from my previous post I was in a pickle on Saturday, I hadn’t been too good with depression all last week but the craving for alcohol on Friday and Saturday was horrendous I just don’t know where it came from, it took all my willpower and just going to bed not to drink. Well last night I started my period and it is like I have had a personality transplant 🙂 Good job because today is my birthday and it is the best birthday present I could have wished for. The cravings have totally gone – completely. I have had friends over today whom I have served wine to and it just didn’t bother me at all.

        So if anyone else gets intense cravings from out of nowhere (if your female) maybe check if it could be the time of the month.

        I am not very regular but have a rough idea of dates. So if this happens again I will be better prepared and just knowing that it will pass make me feel more in control.

        Thank you once again to you both and Libby I love your site there is some great ideas and advice on there.

      2. That’s so great to hear Minny and not TMI at all! 🙂 All this knowledge helps and Happy Birthday!! Enjoy the rest of your day xx

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