"My husband and I have been together for 28 years, married for 21. Throughout our relationship he has been a binge drinker with some mild to intense mood swings...
He retired from the military in 07, we moved to a new state and he started a job he hated. He became increasingly agitated and angry, very depressed and seemed to be drinking more often, losing control and yelling...I just don't know what to do. I feel he is bipolar and his lack of feelings for me are associated with that but I can't get him to see this..."
A recent article in the Psychiatric Times discusses the problem presented by the wife in the email above. Alcohol abuse and depression are often comorbid disorders, meaning that they happen at the same time. In the past, psychiatrists would not prescribe anti-depressant medications for alcohol abusers out of concern for the health consequences from mixing medications and alcohol. As the article points out, psychiatry has a new way of looking at this problem.
Studies show that the newer SSRI anti-depressants can be used to reduce depression while treating the alcohol abuse with another medication. That other medication is Naltrexone. This medication reduces the craving for alcohol and can be used with an SSRI to reduce depression. This is an exciting development for the following reason:
Some people drink in an attempt to medicate their depression. The result is that the depression worsens as a result of the alcohol. When psychotherapy is used in an effort to get them to stop drinking the depression worsens and they relapse into drinking again. If psychotherapy is used to help them with their depression but the depression but the biggest problem is drinking, not depression, they continue to drink. In other words, the disorders reinforce one another. Now, with the use of anti depressants and Naltrexone, both conditions are treated with the hope that the chances of relapse are reduced.
It must be emphasized that psychotherapy remains a vital and necessary part of treatment for both conditions. Medication cannot do everything and people drink and get depressed for many personal reasons that are best dealt with in psychotherapy. Here, too, there was once a belief that psychotherapy cannot work while someone is drinking, even if they are depressed. Now, psychotherapy is used while people are drinking and this can be sharply reduced with Naltrexone medication.
While much research will continue to be done in the area of this comorbid condition, at least this is a good start. At this point it is unknow how many people will be helped by this but at least there is great hope. In addition, it is a positive thing that alcohol abuse and depression are seen as disorders that can be dealt with at the same time.
Your comments are encouraged.
Allan N. Schwartz, PhD