Are all alcoholics depressed? Yes, in my opinion and in my experience as a psychiatrist. But many former alcoholics and other physicians believe not. Personally, I almost systematically note elements of depression in the context of alcoholic illnesses.
Patients often ask me this question: “Doctor, am I drinking because I am depressed or am I depressed because I am drinking?” “ For me, this is a pivotal question. In reality, the two situations coexist. You should know that 65% of women in difficulty with alcohol and 44% of men have experienced at least once in their life a depressive or anxious episode.
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The dialogue between the doctor and his patient around depression is fundamental because it will make it possible to treat both problems at the same time: that of alcohol and that of depression. The mistake that should not be made is to neglect alcohol consumption and only treat depression. This is because the effectiveness of antidepressant drugs halves when taken with alcohol and their sedative effect increases. At the same time, alcohol appears to be an antidepressant in the short term, but it is depressogenic in the medium and long term. So, it worsens the depressive state, disrupts sleep and exacerbates anxiety.
Unfortunately, patients are not always warned about the risks of the combined consumption of antidepressants and alcohol. Thus, the lack of improvement may cause them to drink even more, since they feel frustrated.
It is therefore important that the doctor diagnose and treat depression, while warning the patient of possible interactions with alcohol.
Ideally, they should stop drinking or, at a minimum, reduce their consumption. To help it, we can play on the levers of motivation and, possibly, prescribe anxiolytics and specific drugs to stop alcohol.
This will allow him to feel the effect of the antidepressants and start to give him a positive mood. He will therefore be less sad and will have less tendency to seek euphoria with alcohol.