Comparison of induced and independent major depressive disorders in 2,945 alcoholics.

OBJECTIVE Depressive episodes among alcohol-dependent men and women are heterogeneous in causation and clinical course. This study tested three hypotheses regarding the rates and clinical characteristics of two potential subtypes of these affective states: those that appear to be substance-induced mood disorders and those that are independent major depressive episodes. METHOD Semistructured, detailed interviews were administered to 2,945 alcohol-dependent subjects as part of the Collaborative Study on the Genetics of Alcoholism. With the use of a time line method for determining the type of mood disorder among probands, relatives, and comparison subjects, individuals with histories of the two types of mood disorders were compared. RESULTS Major depressive episodes with an onset before the development of alcohol dependence or during a subsequent long abstinence period (i.e., independent depressions) were observed in 15.2% of the alcoholics, while 26.4% reported at least one substance-induced depressive episode. According to a logistic regression analysis, the subjects with independent (as compared to substance-induced) major depressive episodes were more likely to be married, Caucasian, and female, to have had experience with fewer drugs and less treatment for alcoholism, to have attempted suicide, and, on the basis of personal interviews with family members, to have a close relative with a major mood disorder. CONCLUSIONS These results support the contention that it is possible to differentiate between what appear to be substance-induced and independent depressive episodes in alcoholics. Such differentiation might be important for establishing prognosis and optimal treatment.

[1]  G. Saenger,et al.  The abstinent alcoholic. , 1962, Archives of general psychiatry.

[2]  M. Gold,et al.  Evaluating depression in alcoholics , 1986, Psychiatry Research.

[3]  K. Merikangas,et al.  Familial transmission of depression and alcoholism. , 1985, Archives of general psychiatry.

[4]  R. Dahl,et al.  Unipolar depression in adolescents: clinical outcome in adulthood. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[5]  M. Schuckit.  Alcoholic patients with secondary depression. , 1983, The American journal of psychiatry.

[6]  J. Nurnberger,et al.  A new, semi-structured psychiatric interview for use in genetic linkage studies: a report on the reliability of the SSAGA. , 1994, Journal of studies on alcohol.

[7]  R. Fowler,et al.  Alcoholism in manic depressive (bipolar) patients. , 1993, Journal of studies on alcohol.

[8]  M. Weissman,et al.  Prognostic significance of psychopathology in treated opiate addicts. A 2.5-year follow-up study. , 1986, Archives of general psychiatry.

[9]  R. E. Belleville,et al.  An experimental study of the etiology of rum fits and delirium tremens. , 1955, Quarterly journal of studies on alcohol.

[10]  H. Pettinati,et al.  Four year MMPI changes in abstinent and drinking alcoholics. , 1982, Alcoholism, clinical and experimental research.

[11]  J. Becker,et al.  Changes in alcoholics' self-reported depression. , 1973, Quarterly journal of studies on alcohol.

[12]  G. Winokur.  The Development and Validity of Familial Subtypes in Primary Unipolar Depression , 1982, Pharmacopsychiatria.

[13]  H. Akiskal,et al.  Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction. , 1995, The American journal of psychiatry.

[14]  M. Irwin,et al.  Alcoholism and affective disorder: clinical course of depressive symptoms. , 1995, The American journal of psychiatry.

[15]  J. Nurnberger,et al.  The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls. , 1997, Addiction.

[16]  M. Hesselbrock,et al.  Effect of major depression and antisocial personality on alcoholism: course and motivational patterns. , 1986, Journal of studies on alcohol.

[17]  D. W. Goodwin,et al.  Pharmacological treatment of alcohol intoxication, withdrawal and dependence: a critical review. , 1987, Journal of studies on alcohol.

[18]  M. Schuckit,et al.  Changes in depression among abstinent alcoholics. , 1988, Journal of studies on alcohol.

[19]  M. Schuckit,et al.  Drug and alcohol abuse : a clinical guide to diagnosis and treatment , 1979 .

[20]  E. S. Parker,et al.  Alcohol and sober mood state in female social drinkers. , 1983, Alcoholism, clinical and experimental research.

[21]  Harrington Rc.  Adult outcomes of childhood and adolescent depression. , 1991 .

[22]  E. Nickel,et al.  The stability of coexisting psychiatric syndromes in alcoholic men after one year. , 1988, Journal of studies on alcohol.

[23]  T. Smith,et al.  An 8-year follow-up of 450 sons of alcoholic and control subjects. , 1996, Archives of general psychiatry.

[24]  M. Willenbring.  Measurement of depression in alcoholics. , 1986, Journal of studies on alcohol.

[25]  J. Nurnberger,et al.  Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives. , 1996, The American journal of psychiatry.

[26]  J. Kocsis,et al.  A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression. , 1996, JAMA.

[27]  J. Feighner,et al.  Diagnostic criteria for use in psychiatric research. , 1972, Archives of general psychiatry.

[28]  S. Guze,et al.  Alcoholism and depression. , 1973, Archives of general psychiatry.

[29]  M. Weissman,et al.  Symptom patterns in primary and secondary depression. A comparison of primary depressives with depressed opiate addicts, alcoholics, and schizophrenics. , 1977, Archives of general psychiatry.

[30]  M. Hesselbrock,et al.  Methodological considerations in the assessment of depression in alcoholics. , 1983, Journal of consulting and clinical psychology.

[31]  K. O'sullivan,et al.  A Comparison of Alcoholics with and without Coexisting Affective Disorder , 1983, British Journal of Psychiatry.

[32]  J. Nurnberger,et al.  The prevalence of major anxiety disorders in relatives of alcohol dependent men and women. , 1995, Journal of studies on alcohol.

[33]  S. Bingham,et al.  Primary and secondary depression in alcoholic men: an important distinction? , 1987, The Journal of clinical psychiatry.

[34]  M. Weissman,et al.  THE FREQUENCY AND PERSISTENCE OF DEPRESSIVE SYMPTOMS IN THE ALCOHOL ABUSER , 1978, The Journal of nervous and mental disease.

[35]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[36]  A. Coppen,et al.  PROPHYLACTIC TREATMENT OF ALCOHOLISM BY LITHIUM CARBONATE A Controlled Study , 1976, The Lancet.

[37]  V. Pollock,et al.  A 30‐year follow‐up study of the sons of alcoholic men , 1993, Acta psychiatrica Scandinavica. Supplementum.

[38]  J. Morrison.  The family histories of manic-depressive patients with and without alcoholism. , 1975, The Journal of nervous and mental disease.

[39]  R. Cadoret,et al.  Depression spectrum disease, I: The role of gene-environment interaction. , 1996, The American journal of psychiatry.

[40]  J. Allen,et al.  Pharmacotherapies for alcoholism: promising agents and clinical issues. , 1991, Alcoholism, clinical and experimental research.

[41]  M. Schuckit.  The clinical implications of primary diagnostic groups among alcoholics. , 1985, Archives of general psychiatry.

[42]  H. Akiskal,et al.  Prognostic effect of the variable course of alcoholism on the 10-year course of depression. , 1994, The American journal of psychiatry.

[43]  K. M. Davidson.  Diagnosis of Depression in Alcohol Dependence: Changes in Prevalence with Drinking Status , 1995, British Journal of Psychiatry.

[44]  A. Bellack.  Drug and alcohol abuse: A clinical guide to diagnosis and treatment (4th ed.) , 1996 .

[45]  M. Linnoila,et al.  Depression among alcoholics. Relationship to clinical and cerebrospinal fluid variables. , 1991, Archives of general psychiatry.

[46]  M. Thase,et al.  Disproportionate suicidality in patients with comorbid major depression and alcoholism. , 1995, The American journal of psychiatry.

[47]  K. Bucholz,et al.  Periods of abstinence following the onset of alcohol dependence in 1,853 men and women. , 1997, Journal of studies on alcohol.

[48]  K. Merikangas,et al.  Parental concordance for affective disorders: psychopathology in offspring. , 1988, Journal of affective disorders.

[49]  M. Hesselbrock,et al.  Affective disorder in alcoholism. , 1983, The International journal of the addictions.

[50]  T. Reich,et al.  MANIC DEPRESSIVE ILLNESS , 1984, The Lancet.

[51]  Y. Nakazawa,et al.  Primary and secondary depression in alcoholism--clinical features and family history. , 1991, Drug and alcohol dependence.

[52]  D. Ciraulo,et al.  Imipramine Disposition in Alcoholics , 1982, Journal of clinical psychopharmacology.

[53]  F. Goodwin.  Manic-Depressive Illness , 1990 .

[54]  S. Hill,et al.  Childhood psychopathology in families with multigenerational alcoholism. , 1992, Journal of the American Academy of Child and Adolescent Psychiatry.

[55]  E. Nickel,et al.  Co-morbidity of lifetime psychiatric disorder among male alcoholic patients. , 1994, Alcoholism, clinical and experimental research.

[56]  F. Earls,et al.  Psychopathology in children of alcoholics. , 1993, Journal of the American Academy of Child and Adolescent Psychiatry.

[57]  D. Mayfield.  PSYCHOPHARMACOLOGY OF ALCOHOL: I. AFFECTIVE CHANGE WITH INTOXICATION, DRINKING BEHAVIOR AND AFFECTIVE STATE , 1968, The Journal of nervous and mental disease.

[58]  J. Mendelson,et al.  Alcoholics' expectancies and recall of experiences during intoxication. , 1970, The American journal of psychiatry.

[59]  E. Nickel,et al.  Outcomes of co-morbid alcoholic men: a 1-year follow-up. , 1992, Alcoholism, clinical and experimental research.

[60]  G. Huba,et al.  Depression, alcohol use, and smoking over one year: a four-wave longitudinal causal model. , 1983, Journal of abnormal psychology.

[61]  R. Fieve,et al.  Bipolar illness: factors in drinking behavior. , 1979, The American journal of psychiatry.