Influence of Alcohol Use Disorders on Clinical Patterns of Major Depressive Disorder

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Individuals with a dual diagnosis of depression and alcohol use disorder suffer a more severe disease profile with more frequent comorbidities compared with individuals with MDD only.
Individuals with a dual diagnosis of depression and alcohol use disorder suffer a more severe disease profile with more frequent comorbidities compared with individuals with MDD only.

Individuals with a dual diagnosis of major depressive disorder (MDD) and alcohol use disorder (AUD) suffer a more severe disease profile with specific symptoms and more frequent comorbidities compared with individuals with MDD only, according to a study published in Drug and Alcohol Dependence.

The study used a general population survey to explore the distribution of MDD clinical criteria among depressed subjects with and without alcohol use disorders. The Mental Health in the General Population (MHGP) survey included 38,694 French subjects assessed between 1999 and 2003.

Of the total survey participants, 11.2% (n=4339) individuals were diagnosed with MDD. Of those diagnosed with MDD, 9.5% were diagnosed with AUD (n=413), 6.3% (n=275) for alcohol dependence and 3.2% (n=138) for alcohol abuse.

Data analysis found that with the non-AUD group as reference, anhedonia (odds ratio [OR],1.66; 95% confidence interval [CI], 1.06–2.73) and sadness (OR, 0.46; 95% CI, 0.29–0.74) were associated only with alcohol abuse, and thoughts of death (OR, 1.95; 95% CI 1.49–2.55), feelings of guilt (OR, 1.41; 95% CI, 1.05–1.90), sleep disorders (OR, 2.07; 95% CI, 1.51–2.88), and diminished concentration and indecisiveness (OR ,1.52; 95% CI, 1.12–2.07) were associated only with alcohol dependence.

Post-traumatic stress disorder and bipolar disorder were also associated only with alcohol dependence. Appetite and weight variations were associated with both alcohol dependence (OR, 1.41; 95% CI, 1.06–1.88) and alcohol abuse (OR, 1.7; 95% CI, 1.15–2.53). Panic disorder, psychotic features, and previous suicide attempts were more prevalent within the MDD-AUD group than the MDD-only group.

Study investigators conclude that the distinct clinical profile, more frequent comorbidities, and wider array of symptoms found in subjects with both MDD and AUD, particularly if the subjects were alcohol dependent, suggest they be considered an explicit subpopulation featuring increased severity markers.

 “Moreover, our findings were the first to differentiate between alcohol abuse and dependence, thereby showing that alcohol abuse also exhibited some distinctive features and an overall clinical profile closer to that of ‘noAUD' MDD subjects compared to those with alcohol dependence.”

Reference

Carton L, Pignon B, Baguet A, et al. Influence of comorbid alcohol use disorders on the clinical patterns of major depressive disorder: a general population-based study [published online March 23, 2018]. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2018.02.009

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