Do you sometimes drink to cope with feeling low or empty? Alcohol and depression are closely linked. Alcohol pushes difficult feelings into the background for a while. But it can also make depressive symptoms worse. So it's worth taking a closer look at the role drinking plays in your mood.
The link is especially close when drinking has become an illness. A large review analysed studies on alcohol use disorder and depression. It found that people with an alcohol use disorder are more likely to have depression as well. Conversely, alcohol use disorders are more common among people with depression.
That can sound discouraging at first. But there's good news in it too. Where alcohol is behind part of your low mood, your mood can lift once you drink less or stop. Often that happens sooner than people expect.
Why alcohol is so tempting when you feel low
After a draining day, a pint can sometimes seem like the easiest way to switch off. Alcohol pushes brooding and difficult feelings into the background for a while. That feels like relief and makes it tempting to drink more often when life gets heavy.
This brief relief easily turns into a cycle:
You feel low. You feel empty or worn out.
Alcohol brings brief relief. The evening seems easier to bear and difficult thoughts grow quieter.
Afterwards you may feel even worse. Alcohol can disrupt your sleep and weigh further on your mood the next day.
You reach for another drink. You drink again to ease that strain. The cycle starts over.
Recognising yourself in this is already a first step towards change. Your GP or an addiction counselling service can help you with it.
Which came first, the depression or the drinking?
For some people, depression was there long before drinking became a problem. For many, alcohol is a way of coping with a feeling that is hard to bear. For others, low mood only develops through regular drinking. Clinicians therefore distinguish between independent depression and depression brought on by alcohol.
Researchers consider the path from alcohol to depression the more likely one. The more heavily people drink, the more their risk of depression rises. There is little evidence that depression itself causes an alcohol use disorder to develop.
You don't need to work out straight away whether the depression came before the problem drinking or developed because of it. This question matters when it comes to finding the right treatment. The answer often only becomes clear after a few weeks of drinking less.
What changes when you cut down or stop
Mood can improve during alcohol treatment as well. One study followed 191 men with alcohol dependence during inpatient treatment. At the start, 42 per cent had marked depressive symptoms. After four weeks without alcohol, 6 per cent did. Symptoms fell most sharply in the second week. These results apply to this group and can't predict how quickly you yourself will feel better.
Drinking less is also linked to better mental health. Researchers in the US followed around 22,000 people over three years. Some drank very heavily at the start and then cut down considerably. Three years later, they were less likely to have depression or an anxiety disorder. The study can't show whether drinking less alone made the difference.
Intoxication and withdrawal make depressive symptoms hard to read. The German treatment guideline therefore recommends waiting until this phase has passed. Only then should clinicians assess whether someone with alcohol dependence also has depression and what treatment they need. You don't have to wait to talk to a doctor, though. You can get support now.
For alcohol dependence, the first goal of treatment is to stop drinking completely. If that isn't achievable right now, the guideline recommends cutting down to limit the harm to your health.
When your body is used to alcohol, stopping suddenly or even drinking much less can trigger dangerous withdrawal symptoms. If you regularly drink larger amounts or have had withdrawal symptoms before, talk to your doctor first. Together you can work out how to change your drinking safely.
How to tell when it's more than a low patch
A bad day after a late night doesn't mean you have depression. Take a closer look if you notice the following on most days for at least two weeks:
Your mood stays low. You feel down or empty for much of the day.
You've lost your enjoyment. Things that usually matter to you interest you less. A hobby or meeting friends hardly appeals any more.
You lack energy. Even shopping or showering feels hard. You tire more quickly than usual.
A doctor or psychotherapist can help you find out whether depression is behind this. Get support if the symptoms persist or make daily life harder. When you feel very unwell, there's no need to wait two weeks. Go to your GP or straight to a psychotherapy practice. In Germany you don't need a referral for an initial psychotherapy consultation.
Seek support straight away if you're thinking about harming yourself or ending your life. In Germany, the TelefonSeelsorge is free, anonymous and available day and night on 0800 111 0 111. In immediate danger, call the emergency number 112.
Help for both at once
When you're dealing with depression and alcohol dependence, treatment should keep both in view. The German treatment guideline recommends cognitive behavioural therapy and motivational interviewing for this. In cognitive behavioural therapy, you learn to recognise distressing thoughts and habits and change them. Motivational interviewing is about what you want to change about your drinking, and why. Both can help ease depressive symptoms and change how you use alcohol.
For moderate or severe depression, the guideline recommends also offering medication for depression, known as antidepressants. Whether such a medication suits you, and which one, is something to discuss with your doctor.
You can find support at your GP practice, an addiction counselling service or a psychotherapy practice. Anyone already treating you should hear how you're doing with both your mood and your drinking. The German Depression Foundation (Stiftung Deutsche Depressionshilfe und Suizidprävention) also answers questions about depression and support on its Info-Telefon Depression, 0800 3344533.
A first step can be small. Call your GP practice this week and say you'd like to talk about your mood and your drinking. If you like, jot down a few observations beforehand, such as how you sleep and when you reach for a drink more often. Whether depression is present and what role alcohol plays is something you'll work out together in treatment.
