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What is alcohol depression?
Alcoholic depression is a term that combines a group of pathological conditions associated with harmful alcohol use. Such mental disorders may be temporary, but with the progression of addiction acquire a chronic course.
Frequency of development of depressive disorders in people who abuse alcoholic drinks is about 40%. According to other studies, the rate may range from 3% to 98% due to different statistical estimation criteria.
Alcohol-conditioned disorders of the emotional sphere are considered secondary, since they develop due to a specific damaging factor. At the same time, the isolated existence of mental illness cannot be ruled out. Depression itself can be a risk factor which leads to alcohol addiction, considerably aggravating its course (R. Wilsnack).
Harmful use of alcohol is among the key risk factors for NCDs, including mental disorders, a well-documented fact. Comorbidity between harmful use or dependence on alcohol and mental health disorders is recognized worldwide as a major public health problem, influencing the structure, course, manifestations, severity and outcomes of these disorders. However, the link between harmful use or dependence on alcohol and mental health disorders is still poorly understood.
When it comes to true alcoholic depression, the most common clinical variants are these:
- Progressive alcohol dependence. Psycho-emotional disorders in this case correspond to the length of abuse, which determines the degree of damage to the CNS structures. At the first stage of the disease the symptoms are not strongly pronounced, the person can keep an apparent “control” over his behavior. As the personal and social degradation worsens, the clinic becomes more pronounced.
- Withdrawal from alcoholic products – withdrawal syndrome, hangovers, treatment attempts. In this variant, depressive symptomatology arises acutely, with bright manifestations. The main part of negative experiences is based on the experience or possible guilt.
The first variant of depressive disorders is hard to be therapeutically corrected because of the long-growing changes. Some damage to the central nervous system (CNS) becomes irreversible. Not only the mood changes, but the personality and character of the person changes. The prognosis depends on the timeliness of treatment of the main disease, the addiction syndrome.
The second variant of alcoholic depression often goes away on its own, which is associated with natural elimination of alcohol metabolites from tissues (or relapse of abuse). However, the symptoms are more acute and differ in their severity. Accompanying withdrawal phenomena significantly aggravate the person’s condition, which can cause impulsive suicidal behavior.
Causes of occurrence
The toxic effect of alcohol and its derivatives underlies the development of neuropsychiatric disorders. Depressive phenomena arise due to the combined influence of the following processes:
- disturbance of metabolic and neurovegetative processes;
- Decrease of antitoxic and metabolic functions of the liver;
- Hypovitaminosis, especially of thiamine (group B);
- Disorder of the metabolism of amino acids, in particular glutamic acid – leads to improper regulation of excitation processes in the central nervous system;
- electrolyte imbalance;
- gastrointestinal disorders;
- diuretic disorders;
- local circulatory disorders;
- increased vascular permeability, including for toxic compounds;
- imbalance in the work of neurotransmitter systems;
- the influence of concomitant somatic diseases;
- hereditary factor;
- genetic (individual) predisposition to depression, which was realized under the influence of chronic alcohol intoxication;
- presence of concomitant mental disorders – possible primary existence of a subdepressive background.
Postintoxication syndrome (hangover) is a reflection of acute psychophysical disorders occurring in the body due to ingestion of large doses of alcohol. Deterioration of the mental state is caused by a combination of many pathogenetic factors. The natural normalization of functions occurs within 1-6 days, which depends on the individual characteristics of the metabolism.
It is necessary to take into account that the situation worsens under the influence of social factors. Financial and economic instability, problems in the family or professional team are stress triggers potentiating dysphoria (emotional disorders). Alcoholic beverages often only exacerbate the negative mood, contrary to popular myths about the exhilarating effects.
The most frightening consequence is irreversible mental degradation
It is necessary to recognize the addiction as early as possible and begin treating it.
Symptoms and signs of the disorder
In the mild course of the disorder, symptoms may be nonspecific. The severity of clinical manifestations depends on the history of abuse and personal characteristics of withdrawal. Alcoholic depression can be suspected by such signs:
- increased fatigue;
- Atypical behaviour which may mask psycho-emotional instability;
- an unwillingness to do anything;
- anhedonia – inability to enjoy familiar hobbies;
- sleep disorders;
- decreased appetite;
- concealment or disguise of addiction;
- Voluntary social self-isolation;
- episodes of abuse succeeded by feelings of guilt and diminished mood;
- presence of constant irresistible craving for alcohol, which patients tend to hide or justify by unfavorable life situations;
- psychomotor retardation;
- impaired social functioning;
- Inability to perform professional duties;
- Associated withdrawal symptoms, if the disorder develops against the background of “withdrawal” – blood pressure fluctuations, pain of any localization, edema, heaviness in the subcostals, fever with chills, sweating.
Severe depression is accompanied by more pronounced psychotic manifestations, often not corresponding to the character of the person. Motor lethargy, stupor, delusions of guilt are added to the symptomatology. A continuous relapsing course of depression is observed in more than 20% of patients with a long history of addiction syndrome.
The presence of psycho-emotional disorders is accompanied by suppression of instinctive urges – sexual, food, social. Alcohol consumption does not bring relief, provoking aggravation of the disease. Combined pathology is a factor of more rapid progression of both disorders.
The following consequences of alcoholic depression are distinguished
- rapid transition to the next (more severe) stage of alcoholism;
- Personality degradation due to encephalopathy – toxic damage to the brain;
- alcoholic psychosis;
- suicidal behavior;
- Aggression towards others, close people;
- family breakdown;
- job loss;
- increased traumatism;
- a more severe course of existing chronic diseases of another spectrum;
- development of related neuropsychiatric disorders – schizophrenia, epilepsy, neuroses, personality disorders.
Chronic alcoholism is accompanied by recurrent depressive episodes. Incomplete remissions can cause a decrease in professional suitability. Eventually, disability develops.
The most tragic outcome of alcohol-associated depression is suicide. It is not uncommon for suicide attempts to occur spontaneously after a massive alcohol intake. Another common cause of self-harm is the painful course of withdrawal, accompanied by an overwhelming craving for the coveted psychoactive substance.
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Most psycho-emotional disorders associated with binge drinking or withdrawal are subject to gradual reversal. If dependence syndrome persists for a long time, complex therapy is chosen. However, medical help is necessary for any clinical variant in view of presence of high risk of suicidal behavior.
The fight against the negative consequences associated with the intake of alcoholic beverages should be carried out under the supervision of a doctor. Full-fledged treatment of dependence syndrome is provided, the scheme of which includes measures aimed at correction of combined disorders. Successful outcome depends to a large extent on a conscious desire to lead a sober life.
At complex delusional depressions, especially in patients with a long period of dependence, only in-patient treatment is indicated. The therapeutic tactics are aimed at stopping the acute symptomatology as quickly as possible. Visually apathetic patient may pose a threat to himself and others.
The recovery process is accelerated with the help of individually selected medications. The regimen may include the following groups of pharmaceuticals:
- Antidepressants (thymoanaleptics): amitriptyline, fluoxetine, sertraline, citalopram.
- Antipsychotics (for severe delirium): chlorpromazine, haloperidol, risperidone.
- Tranquilizers (anxiolytics): lorazepam, zolpidem.
- Detoxification from ethanol and its derivatives – infusion therapy (IVs), copious drinking, forced diuresis.
- Supportive therapy: B-group vitamins, nootropics (poorly proven effectiveness), electrolytes.
- Symptomatic therapy of withdrawal syndrome.
- Correction of existing chronic pathology.
- Antiretroviral therapy.
- Physical therapy – in the absence of contraindications.
Antidepressant therapy starts with low doses, gradually titrating (adjusting) to the appropriate therapeutic dose. If in the first 3-4 weeks there is no significant effect, the drug is replaced by another. In severe cases, combinations of different pharmaceutical agents are used.
Often clinics use several methods in order to fully cover the entire emotional and mental sphere. Possible psychotherapeutic directions are as follows:
- Behavioral or cognitive-behavioral;
- Gestalt therapy;
- Hypnotic intervention;
- art therapy;
- motivational interviewing;
- “effective self-motivation” stimulation;
- neurolinguistic programming;
- occupational therapy;
- Self-help groups with the presence of a psychotherapist supervisor.
Medication treatment for both addiction syndrome and depression is conducted only against the background of psychotherapy. These two approaches complement each other, providing the maximum efficiency of treatment. With a mild course of complications, a course of visits to a psychotherapist on an outpatient basis is sufficient.
Electroconvulsive therapy (ECT) is the treatment of choice for protracted depressive states that show signs of drug resistance. Electroconvulsive therapy is also used in cases of intolerance to psychotropic drugs. At the same time, it is intended not only to relieve periodically occurring exacerbations, but also in some cases – to achieve long-term stabilization of the condition by means of periodic repeated sessions of electroconvulsive therapy (maintenance electroconvulsive therapy).
Federal clinical guidelines for the diagnosis and treatment of recurrent depressive disorder. 2013
Can I cure myself at home?
Alcoholic depression with a mild course, resulting from withdrawal from alcohol, can go away on its own. All it takes is to stop abusing, eat a balanced diet, and normalize sleep and rest patterns. Unfortunately, this cannot guarantee a long-term remission.
The addiction syndrome remains even after the negative symptoms subside. Therefore patients at any outcome require long-term complex therapy with subsequent rehabilitation. Timely elimination of depressive symptoms prevents relapses and provides long periods of sobriety.
Drug use causes irreversible harm to health and is life threatening!
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Alcoholic depression, how to detect and treat a dangerous condition
Excessive consumption of alcohol is very dangerous, because when a person is exposed to ethyl alcohol for a long time, he develops alcoholic depression. This is a rather serious condition that, from a medical point of view, belongs to the category of mental disorders. This kind of depression can lead to a pronounced psychosis during withdrawal (hangover).
What is alcoholic depression, peculiarities and dangers of the pathological condition
Before figuring out how to get rid of alcoholic depression, it is necessary to understand what the pathological process is. This condition most often occurs after a binge, with an abrupt cessation of alcohol consumption. The development of the pathological phenomenon, accompanied by psychological disorders, is directly influenced by a pronounced intoxication of the body, provoked by an excessive amount of alcohol. According to its condition, post alcoholic depressive syndrome is subdivided into 2 types:
- Short-term disorder. This form is characterized by a milder course. The pathological condition is caused by alcoholic beverages consumed by the person in large quantities and the hangover syndrome provoked by them. The patient feels apathetic, suffers from guilt over the large amount of alcohol consumed and at the same time suffers from the unpleasant physiological effects of the hangover.
- Prolonged severe depression. This condition is similar to the previous one, but occurs after the person has given up alcohol, and in most cases is very severe. The longer the binge lasted, the worse the patient is and more time is needed for normalization. Usually the help of a narcologist is needed to relieve post alcoholic depressive syndrome.
The state of such depression is extremely dangerous, because the long-term use of alcoholic beverages leads to mental trauma. As a rule, depression caused by alcoholism provokes serious family problems, disturbance of social adaptation, suicidal intentions. Depression after a long binge, when a person suffering from a hangover is severely weakened mentally and physically, can provoke the occurrence of a repeat binge, which will provoke the occurrence of more severe consequences.
Causes of alcoholic depression
Relatives of drinkers often wonder why an alcohol-dependent person often falls into an apathetic state. As experts explain, depression in this case is a so-called way of “self-injury” – a person who has decided to stop drinking, suffers because of the problems that arose during a binge. The main reason that provokes the development of depression against the background of alcohol abuse is the disruption of the nervous system and the brain, which arose due to intoxication of the body with products of ethanol. Even a small amount of ethanol activates inhibitors of GABA (gamma-aminobutyric acid, an important inhibitory neurotransmitter of the CNS), which provokes apathetic states of different duration in a drinker.
Risk factors that can cause the development of post-alcohol mental disorder:
- social and domestic problems;
- Uncontrolled craving for alcohol;
- Metabolic (metabolic) disorders;
- Disorder of CNS and brain functioning;
- development of withdrawal, acute hangover, when giving up alcohol,
As the clinical practice of narcologists shows, constant drinking of large quantities of alcohol undermines a person’s nervous system, but does not relieve him of the burden of existing problems, but only increases them. Long-term alcohol consumption at the psychological and physical level creates an addiction to ethanol. A person who has decided to stop drinking faces the problem of losing the colors of life: he seems to stop drinking, goes to work, behaves as usual before drinking, but everything around seems dull and gray to him. Such emotional depression, an apathetic state, is the post-alcoholic depression. If the person is not helped at this time, he may start another binge.
Symptoms indicating the development of the disease
As a rule, this type of pathological phenomenon has certain clinical signs that resemble a manic-depressive state. Mental problems in an alcohol-dependent person who has stopped drinking without medical help can last up to six months. It is difficult to independently determine that a person has a post-alcoholic depressive state, because only alcoholic depression that has just begun to develop has moderately pronounced symptoms. The emergence of severe affective disorders occurs very rarely. The main complaints of patients faced with this pathological phenomenon include:
- Suicidal thoughts – their appearance has a direct connection with the fact that a long-term drinker loses contact with society, becomes unclaimed both professionally and socially.
- Reduced instinct of self-preservation – alcohol addicts during a depressive syndrome perceive danger poorly and may provoke an accident because they become inattentive to their surroundings.
- Slowing down of the rhythm of life – a person in this condition prefers to spend time alone, sitting in front of a computer or television, because they feel a pronounced feeling of depression, guilt to others and themselves.
- Loss of meaning in life – against the backdrop of alcohol addiction all around begins to seem monotonous, boring and uninteresting, the sense of joy is completely missing, and the patient only gets satisfaction after consuming a new portion of alcoholic beverage.
The above clinical signs occur simultaneously with physiological disorders: a person shows signs of dyspepsia (nausea and vomiting), alimentary disorders, decreased libido, cardiovascular system activity changes.
If a person develops alcoholic depression, the symptoms and treatment will be completely similar to those for neurotic depression. In order for the patient to cope with the dangerous state for the psyche as quickly as possible, the family must persuade him to see a specialist and undergo a special course of therapy. However, in most cases it is difficult because the alcoholic does not admit that he is sick.
Diagnosis and treatment of alcoholic depression
Only a specialist can make a diagnosis of post alcoholic psychological disorders, based on the differentiation made with other types of depressive syndromes that have similar clinical signs. To confirm the diagnosis, the doctor analyzes the patient’s complaints and conducts a physical examination. Only after clarifying the nature of the pathological process can the specialist decide how to cope with alcoholic depression in a particular clinical case, and choose an appropriate treatment plan.
The main difficulty in choosing a therapeutic regimen is the inadequate attitude of most patients toward their condition. They do not want to realize that it was not depression that caused the binge drinking, but on the contrary, the excessive use of alcoholic beverages provoked the development of depressive syndrome. Relatives of drinkers should know that if a person who drinks a lot and often has alcoholic depression, its treatment should be complex and carried out in a narcological clinic. Most often, the following therapies are used to eliminate the post-alcoholic depressive state:
- Medication. Patients are prescribed pharmacological drugs belonging to the medicinal groups of antidepressants, tranquilizers and sleeping pills. At the same time, detoxification therapy is conducted to relieve the symptoms of withdrawal syndrome.
- Sessions of psychotherapy. They are necessary to consolidate the effect achieved by the use of medications. Owing to group or individual psychotherapeutic sessions, it is possible to finally solve the problem of alcoholism and teach a person to enjoy life again.
- Physical therapy. Physiotherapeutic procedures show high efficiency in treating post-alcoholic depressive syndrome. The most effective, according to the mutual opinion of narcologists, are artificial sleep, electrostimulation, acupuncture. These procedures harmoniously complement the treatment with pharmaceuticals and speed up the patient’s recovery from a depressive state provoked by prolonged alcohol consumption.
The optimal variant of getting rid of a person’s pathological condition is inpatient treatment under the constant supervision of doctors and medical personnel. But the patient himself should decide to begin treatment and be sure of its success. Only then will he be able to get rid of alcohol addiction.
Is it possible to cope with alcoholic depression on your own?
It happens that a person suffering from alcoholism and understanding his condition, begins to wonder how to get out of alcoholic depression on their own, without seeking qualified medical help. Usually people on a binge, whose condition at the time of such a decision is not quite adequate, self-prescribe themselves various psychotropic drugs, sedatives and tranquilizers. Such self-treatment is extremely dangerous because it leads not to recovery but to the aggravation of the pathological process. Self-medication of narcotic drugs can provoke such dangerous consequences as:
- The appearance of pronounced problems with brain activity, memory and the ability to work mentally.
- Development of schizophrenia or a manic-depressive state.
- Attempts to commit suicide.
In order to prevent the occurrence of irreversible consequences, people whose relatives include alcoholics should be more attentive to their condition and make an urgent call to a psychotherapist with a drug addiction practice when the first signs indicating the beginning of post-alcoholic depression appear. If allowed to progress pathological condition, the negative psychoemotional mood of the drinking person can provoke a suicide attempt.