Comorbid Alcoholism and Depression: Treatment Issues

Unless there is decisive professional intervention, people who suffer from both a depressive disorderand alcoholism are at great risk of chronic impairment, both at home and in the workplace; persistentsymptomatic misery; and premature death. Untreated alcoholism intensifies depressive states, decreasesresponsiveness to conventional therapeutics, and increases the likelihood of suicide, suicideattempts, and other self-destructive behavior. During the past decade, evidence has emerged fromplacebo-controlled studies supporting the utility of tricyclic antidepressants and selective serotoninreuptake inhibitors (SSRIs) for treatment of depressed alcoholics. The superior safety and tolerabilityof SSRIs provide strong justification for their first-line use despite higher drug acquisition costs. Evidencehas similarly emerged concerning the use of several novel pharmacotherapies and focused psychotherapiesfor people with alcoholism. These newer therapeutic options complement more traditionalintervention such as chemical dependence counseling, disulfiram, and Alcoholics Anonymousso that it is now possible for a majority of depressed alcoholics to be treated effectively. The availabilityof effective treatments provides further impetus for health care professionals to improve recognitionof comorbid alcoholism and depressive disorders. Improved recognition and treatment will savelives, and the benefits are likely to extend across generations.