Alcohol and Depression: New Research Challenges Common Mental Health Beliefs

A groundbreaking study from the University of Chicago Medicine has unveiled a startling truth: individuals grappling with both alcohol use disorder and depression experience an electrifying surge of stimulation and pleasure when intoxicated—mirroring the highs felt by those untouched by depression. This revelation shatters the long-held myth that alcohol’s allure fades as addiction deepens and that excessive drinking is merely a desperate bid to escape inner torment through self-medication.

“We have this folklore that people drink excessively when they’re feeling depressed and that it’s really about self-medicating,” said Andrea King, PhD, Professor of Psychiatry and Behavioral Neuroscience at UChicago and lead author of the study. “In this study of natural environment drinking and smart phone-based reports of the effects of alcohol in real-time, participants with AUD and a depressive disorder reported feeling acute, sustained positive and rewarding alcohol effects — just like their non-depressed counterparts.”

Published February 1 in the American Journal of Psychiatry, the research challenges conventional notions about alcohol’s effects in depressed people who drink excessively and could improve treatment approaches by focusing medication and behavioral approaches more on alcohol’s pleasure reward pathways and less on stress-responsive systems.

“Currently, the focus of treatment is often on resolving stress and symptoms of depression, but that is only addressing one side of the coin if we don’t also address the heightened stimulation, liking and wanting more alcohol that occur in both depressed and non-depressed people with AUD,” said King, who has been conducting human research for decades to test responses to alcohol that lead to addiction.

The effects of alcohol on the brain are complex, and improved understanding of the factors that affect an individual’s vulnerability to AUD and depression is critical to identify and initiate early, effective treatment. However, few studies have examined how people with AUD respond to alcohol either in controlled laboratory settings or the natural environment; including individuals with AUD and another co-morbid diagnosis adds to the complexity.

It is important to note that the effects of alcohol on the brain can be reversible, especially if you reduce your drinking or quit altogether. However, some of the effects of alcohol may be permanent, such as damage to the hippocampus.

The research followed 232 individuals across the U.S. between the ages of 21 to 35, corresponding to the period when most heavy drinking occurs in a person’s lifetime. Half of the study group met the criteria for AUD in the past year and were evenly divided in terms of those who had or had not experienced a major depressive disorder in the past year. Individuals who had suicidal ideation were excluded for safety reasons, as were people who had severe alcohol withdrawal symptoms.

Through their smartphones, participants answered questions every half hour for three hours during one typical alcohol drinking episode and a non-alcohol episode. The researchers found that alcohol consumption reduced negative feelings, although the reduction was small and nonspecific to their depression or AUD status. The positive effects of alcohol were much higher in individuals with AUD than those without AUD and contrary to lore, similar in those with AUD and depression and those without depression.

“For nearly a decade, our group has been improving methods to use mobile technologies to measure real time clinically meaningful outcomes in people with AUD and those at risk for alcohol-related problems,” said study co-author Daniel Fridberg, PhD, Associate Professor of Psychiatry and Behavioral Neuroscience at UChicago. “These approaches allow us to bridge the gap between the lab and real life and have led to new insights that could one day result in better treatments.”