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Mental health – depression and alcohol


A great deal of research suggests that heavy drinkers are more vulnerable to mental ill-health, one serious effect alcohol abuse can have on an individual is causing depression.

What is depression?


Depression is a serious illness. Health professionals use the words depression, depressive illness or clinical depression to refer to it. It is very different from the common experience of feeling miserable or fed up for a short period of time. When depressed, a person may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with daily life, and can last for weeks or months, rather than days.

A few people still think that depression is not a real illness and that it is a form of weakness or admission of failure. This is simply not true. Depression is a real illness with real effects, and it is certainly not a sign of failure

How are depression and alcohol linked?


Alcohol works as a depressant drug on the nervous system, contrary to popular belief, alcohol is not a stimulant. As well as making some people sleepy, it can lower inhibitions and reveal or increase underlying feelings. This is one of the reasons many people become impulsive, tearful, angry or aggressive when drinking. If an individual’s underlying feelings are anxious or sad, alcohol can exaggerate them. Heavy drinking may even uncover or increase an existing tendency to psychiatric illnesses like psychosis.

What are the symptoms of depression?


When depressed you often lose interest in things that you used to enjoy. Depression commonly interferes with work, social and family life. In addition, there are many other symptoms, which can be physical, psychological and social.

Psychological symptoms:

  • continuous low mood or sadness
  • feelings of hopelessness and helplessness
  • low self-esteem
  • tearfulness
  • feelings of guilt
  • feeling irritable and intolerant of others
  • lack of motivation and little interest in things
  • difficulty making decisions
  • lack of enjoyment
  • suicidal thoughts or thoughts of harming someone else
  • feeling anxious or worried
  • reduced sex drive

Physical symptoms:

  • slowed movement or speech
  • change in appetite or weight (usually decreased, but sometimes increased)
  • constipation
  • unexplained aches and pains
  • lack of energy or lack of interest in sex
  • changes to the menstrual cycle
  • disturbed sleep patterns (for example, problems going to sleep or waking in the early hours of the morning)

Social symptoms:

  • not performing well at work
  • taking part in fewer social activities and avoiding contact with friends
  • reduced hobbies and interests
  • Difficulties in home and family life

Heavy drinking may also accelerate or uncover an existing psychiatric illness like psychosis because of its widespread effects on the brain.

Heavy drinking can also be associated with anxiety, and this can be a feature of early or worsening dependence, particularly in the mornings.

Psychosis

Psychosis is a term that is used to describe a mental condition where somebody is unable to distinguish between reality and their imagination. People with psychosis often experience:

  • hallucinations - where you hear or see things that are not there
  • delusions - where you believe things that are untrue

Psychosis is not a condition in itself. It is a symptom of other conditions. The most common cause of psychosis is a mental health condition such as depression. Psychosis can also be triggered as a result of alcohol abuse; this is referred to as Alcohol Related Psychosis (ARP).

Alcohol Related Psychosis is a condition in which hallucinations occur during alcohol intoxication or during withdrawal from alcohol. This is often an indication of chronic alcoholism that affects about 3% of people with alcohol dependence. Typically these hallucinations stop and do not continue once the crisis of intoxication or withdrawal is over.

Alcohol Related Psychosis can be symptomatic of conditions that are serious health concerns and could even be life-threatening. It often signals the acute stage of alcohol withdrawal in which seizures and other physiological crises occur.

Alcohol Related Psychosis is marked by major hallucinations, psychotic or schizoid behaviour and disorientation. These episodes can occur during any phase in the alcohol dependency cycle, such as intoxication, after sharply cutting back alcohol consumption or during the withdrawal phase.

Most often, Alcohol Related Psychosis occurs after chronic alcohol dependency that has endured for years, and sometimes causes further neurological and psychological issues. More often than not, Alcohol Related Psychosis will disappear spontaneously after alcohol recovery has successfully taken place. However, if an individual returns to alcohol use, psychosis can recur.

These could be life endangering without proper treatment. Alcohol psychosis can also indicate an excessive amount of ingested alcohol resulting in a high alcohol blood content level or alcohol poisoning. Intoxication related death by alcohol is commonly due to alcohol poisoning or overdose. Luckily alcohol-related psychosis will dissipate once the individual stops drinking.

Anxiety


Anxiety is the emotion experienced when you feel tense, fearful or worried. Anxiety can also mean:

  • Feeling worried or uneasy a lot of the time
  • Having difficulty sleeping
  • An inability to concentrate
  • Being irritable or quick to get angry
  • A feeling of no control over your actions
  • Being detached from the environment

Alcohol can temporarily relieve these negative thoughts and feelings because it alters the chemistry of your brain. That’s why some use drinking as a tool to help ‘cope’ with life or stress. But over the long term, heavy drinking can magnify problems and make life more difficult.

Where alcohol dependency and mental illness are both present it adds up to a complex picture. Some people who experience mental distress turn to alcohol as a way of ’self-medicating’ and this can result in dependency that may worsen their symptoms.

However, with alcohol being a depressant, it can be difficult to know which problem started first, and which symptoms relate to alcohol and which relate to mental health.

This kind of ‘self-medicating’ with alcohol changes the psychology of the brain and reduces its ability to deal with anxiety naturally. This can lead to more alcohol being needed to experience the same reduction in anxiety.

Similarly with depression, levels of serotonin are depleted through regular drinking. That means feeling more depressed and more anxious and probably drinking more to deal with it. Meaning in the long term, a heavy drinker will need more and more alcohol to cope with their feelings.

Long term heavy drinking changes the chemistry of the brain and there is a significant link between heavy drinking and suicide. UK studies show that 39% of men and 8% of women who’ve attempted suicide were long-term heavy drinkers. And 70% of attempted suicides by men and 40% by women followed heavy drinking.

Treatment for depression


Treatment for depression usually involves a combination of drugs, talking therapies and self help. Hardly anyone with depression is admitted to a psychiatric hospital. Most get treatment from their GP and make a successful recovery.

Treatment for depression is generally based on how severe your condition is:

Mild depression

  • If diagnosed with mild depression but the GP thinks there can be an improvement, there will be another assessment in two weeks’ time to monitor progress of the condition. This is known as ‘watchful waiting’
  • Antidepressants are not usually recommended as a first treatment
  • Exercise seems to help some people. While progress is being monitored, the GP may refer the individual to an exercise scheme with a qualified fitness trainer
  • Talking through feelings may also be helpful. Either to a friend or relative, or the GP may suggest a local self-help group
  • The GP may recommend self-help books and computerised cognitive behaviour therapy (CBT)

Chronic mild depression (present for two years or more) is called dysthymia. This is more likely in people over 55 years and can be difficult to treat. If diagnosed with dysthymia, the GP may suggest that a course of antidepressants would be best.

Moderate depression

If you have mild depression that is not improving, or you have moderate depression, your GP may recommend a ‘talking treatment’ or prescribe an antidepressant.

Severe depression

Your GP may recommend that you take an antidepressant, together with talking therapy. A combination of an antidepressant and cognitive behavioural therapy (CBT) usually works better than having just one of these treatments.

You may be referred to a mental health team. These teams are usually made up of psychologists, psychiatrists, specialist nurses and occupational therapists. They often provide intensive specialist talking treatments, such as psychotherapy.

Finding help


The Inexcess Support Directory lists more than 1600 service providers throughout the UK and is divided by region to help support and advise people how to find help in their own area. Click here to visit the Support Directory.