Alcohol, Anxiety, and Depressive Disorders

T relationship between alcohol­ to require treatment. When depressed or consequence of the person’s consump­ use disorders and psychiatric anxious alcohol­dependent people are tion of high doses of alcohol (i.e., the symptoms is both clinically im­ asked their opinions about cause and complaints are alcohol induced), then portant and very complex (Brady and effect, they often reply that they believe the symptoms are likely to improve Lydiard 1993). As a typical depressant, they drink in order to cope with their fairly quickly with abstinence. In this alcohol affects the brain in many ways, symptoms of sadness or nervousness. case, it is uncertain whether the longer and it is likely that high doses will cause Two recent reviews, however, indi­ term treatment of alcoholism requires feelings of sadness (i.e., depression) cate that research does not unanimously additional aggressive therapies aimed during intoxication that evolve into support the prior existence of severe at treating underlying depressive or feelings of nervousness (i.e., anxiety) depressive or anxiety disorders as a anxiety disorders. during the subsequent hangover and usual cause of alcoholism (Allan 1995; This article briefly reviews some of withdrawal. The greater the amounts of Schuckit and Hesselbrock 1994). In this the recent literature on the complex in­ alcohol consumed and the more regular article, the term “depressive disorders” teraction between alcohol dependence the intake, the more likely a person will refers to an episode of major depressive and the longer lasting anxiety or depres­ be to develop temporary anxiety and disorder that significantly interferes sive disorders. The interactions between depressive symptoms. As consumption with a person’s functioning over many alcoholism and these disorders are eval­ increases even more, these symptoms weeks or months, and “anxiety disor­ uated by posing a series of questions, also are likely to intensify. ders” refers to any of a number of It is, therefore, not surprising that serious and typically lifelong anxiety MARC A. SCHUCKIT, M.D., is a profes­ more than one out of every three alco­ conditions (for further detail, see glos­ sor of psychiatry at the University of holics has experienced episodes of in­ sary, p. 86). Of course, when an alcohol­ California–San Diego, School of tense depression and/or severe anxiety dependent person complains of severe Medicine, and director of the Alcohol (Cox et al. 1990; Wilson 1988). These depressive or anxiety symptoms (which Research Center, Veterans Affairs psychological conditions are often in­ might or might not indicate a long­term Medical Center, San Diego, California. tense enough to interfere with life func­ disorder), those conditions must be tioning, and the symptoms are often acknowledged and steps must be taken This research was supported by NIAAA recognized by physicians and other to help decrease them. If the psychi­ grants 05526, 08401, and 08403 and by health care providers as serious enough atric symptoms occur, however, as a the Veterans Affairs Research Service.