The challenge of interpreting depressive symptoms in the context of an alcohol use disorder

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Aubin HJ1,2
1. Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM,  Villejuif, 94800, France
2. APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, 94800, France
Alcohol dependence is often associated with psychiatric conditions, including major depression. Psychiatric comorbidity, in turn, is associated with more severe alcohol-related symptoms. Studies have shown that psychiatric conditions increase the risk of alcohol dependence and vice versa, reflecting what appears to be a bidirectional influence, with both psychiatric disorder giving rise to heavy drinking and occurring as a consequence of it.
The symptoms associated with alcohol dependence and co-occurring depression often overlap. In fact, a long-lasting severe alcohol misuse can mimic about all depressive symptoms. In addition, alcohol detoxification or significant reduction can lead to a dramatic improvement of depressive symptoms. Because these disorders can obscure one another, it can be challenging to the clinician to differentiate the underlying conditions. This is aggravated by the fact that alcohol dependence remains one of the most stigmatised diseases and patients may present with a variety of symptoms without acknowledging that they are drinking heavily.
Patients with co-occurring disorders may not respond as well to treatment as patients with only one diagnosis, may have higher relapse rates, and may manifest symptoms that are more severe and chronic in nature. Recent practice guideline recommends that alcohol misuse be treated first in patients with comorbid depression, as this may lead to significant improvements in the associated depressive condition.