Alcohol depression is an affective disorder that occurs in people suffering from alcoholism. Usually lasts from 2 weeks to 1 month. The maximum severity of symptoms is usually observed during the development of withdrawal syndrome. This condition often occurs after coming out of alcoholic psychosis, it can also develop during periods of binge drinking and remissions. Accompanied by a decrease in mood, melancholy, a sense of guilt, uselessness and uselessness. Suicidal thoughts and actions are possible. The diagnosis is made on the basis of anamnesis and clinical manifestations. Treatment is drug therapy in combination with psychotherapy.
ICD 10
F10 Mental and behavioral disorders caused by alcohol use
General information
Depression in alcoholism was described by Bleiler in 1920 under the name “alcoholic melancholy”. Subsequent studies have confirmed both the presence of special depressive and subdepressive states in alcoholics, as well as complex, diverse links between alcoholism and depressive disorders. The frequency of the disease and the severity of symptoms directly correlates with the duration and severity of alcoholism. Middle-aged and elderly patients suffer from depressive disorder more often than young ones. Most of the patients are people over 40 years old.
The average duration of depression in alcoholism ranges from 2 weeks to 1 month. In severe cases, symptoms may persist for a year or more. The duration of the disease depends on the psychoemotional characteristics, character traits, features of the constitution and the state of the patient’s body. Women suffer more often than men, but depression is more severe in men and is more often complicated by suicide attempts. The aggravation of male depression is facilitated by the fact that representatives of the stronger sex rarely seek medical help with the development of the disease. Specialists in the field of narcology, psychotherapy and psychiatry are engaged in the treatment of depression in alcoholism.
Causes of alcohol depression
Depression in alcoholism is a multifactorial disease. A whole complex of circumstances leads to its development, including changes in general metabolism, disruption of brain receptors, personality changes, characteristic mental and somatic disorders, uncontrolled craving for alcohol, withdrawal symptoms when stopping alcohol intake, social and domestic problems. Narcologists constantly have to deal with alcohol depression, which develops in different clinical situations.
Alcoholic depression is part of the symptom complex of deprivation syndrome, acute alcohol intoxication, binge drinking and uncontrolled craving for alcohol. The most common cause of depressive disorder is withdrawal syndrome. Mental suffering of patients is provoked by pronounced physical and psychological discomfort and social problems in combination with a pathological need for alcohol.
Several bouts of depression occur in patients undergoing treatment for alcoholism in specialized clinics. At the initial stages of therapy, such patients develop a “sobriety phobia” – a pronounced fear of the possibility of a life without alcohol. This stage is accompanied by a kind of grief caused by the loss of alcohol. The second wave of depression is usually observed before the discharge of patients from the hospital, at the stage when a person no longer suffers from the effects of intoxication. Longing for alcohol and psychological problems come to the fore.
Sometimes depressive disorders develop against the background of remission, when a person feels lost, unable to fit in, “dropped out” of the normal rhythm of life and social environment, suffering from changes in habitual patterns of behavior, forced to solve numerous problems that arose during alcoholism, not having enough external support and internal reserves for this. Such depressions can cause a breakdown and further alcoholization of the patient.
Risk factors
It should be borne in mind that the premorbid background has a certain importance in the development of alcoholism. Even before the start of alcohol consumption, many patients have an increased tendency to mood swings, the development of asthenic states, depressive neurosis, subdepression and all kinds of borderline disorders. As alcoholism develops, this tendency worsens and becomes heavier due to secondary psycho-emotional and personal changes.
Symptoms of alcohol depression
Symptoms of depression in alcoholism are usually mild. Severe affective disorders are relatively rare. The mood is constantly lowered, the patient suffers from a feeling of emptiness and meaninglessness of existence. There is a feeling of loss of colors characteristic of depressive disorders, emotional colorlessness of the world. This perception causes depression and anxiety. Anhedonia develops – a person loses the ability to rejoice, cannot have fun.
Psychological changes are combined with motor and intellectual inhibition. Gait and movements slow down, the voice becomes quiet, monotonous. Mimic diversity disappears, a sad expression is almost constantly preserved on the patient’s face. The patient spends a significant part of the time in a state of inactivity, answers questions with a delay, has difficulty trying to understand someone else’s thought or instruction. It is difficult for him to think and formulate statements.
Hallucinations and delusions are usually absent. Often there are super-valuable ideas of their own guilt, uselessness, uselessness, fatal maladjustment and inconsistency. There is a tendency to self-deprecation and self-blame. The future seems bleak, hopeless, hopeless. Some patients consider some of their own previous actions as a serious crime. Many patients have thoughts of suicide, suicide attempts are possible. Sometimes (mainly in elderly patients) alcoholic depression is combined with increased anxiety.
Differential diagnosis
Alcoholic depression is differentiated from other depressive disorders and conditions that include individual symptoms of depression. Unlike depressive disorder, “drunken grief” is not accompanied by a feeling of colorlessness of the world and the loss of the ability to feel a variety of emotions. This condition occurs on an “emotional wave” and passes within a few hours, occasionally for several days.
Individual elements of depression are often observed with withdrawal syndrome, but, unlike real alcoholic depression, disappear after abstinence from alcohol for 1-3 days. Reactive depression in alcoholics develops against the background of severe traumatic events (death of a relative, divorce, etc.), with alcoholic depression, there are no similar events in the recent past of patients. Alcohol intake can provoke an exacerbation of other mental illnesses (psychogenic depression, depressive phase of bipolar affective disorder), therefore, when affective symptoms appear in patients with alcoholism, a thorough history collection is necessary.
Treatment of alcohol depression
Treatment of depression in alcoholism is carried out in a narcological hospital. In the course of treatment, medications, psychotherapy and non-drug methods are used. Patients are prescribed antidepressants (usually tricyclic antidepressants or MAO inhibitors). With increased anxiety and sleep disorders, short-term courses of drug therapy are carried out using sleeping pills and tranquilizers (diazepam, phenazepam, tazepam, etc.). In parallel, detoxification therapy is carried out and psychological assistance is provided.
Forecast
With early detection and timely hospitalization, the prognosis for alcohol depression is relatively favorable in most cases. Isolated depressive episodes, as a rule, are quickly stopped, suicidal intentions disappear, the ability to work is restored (if it has not been disrupted due to other diseases). However, if the patient continues to drink alcohol, such conditions may recur and worsen as alcoholism develops.
