Comorbid Alcohol Use and Depression Needs New Treatment Guidelines

silhouette of man drinking alcohol
silhouette of man drinking alcohol
Individuals with co-occurring AUD and depression often receive treatment for one or the other disease. Little evidence exists on whether this type of intervention is effective.

Alcohol use disorder (AUD) and depressive disorders often go together. When they do, patients experience worse treatment outcomes on average than those with AUD or depression alone. Individuals with co-occurring AUD and depression often receive treatment for one or the other disease. Little evidence exists on whether this type of intervention is effective.

To gain more insight, a study recently published in PLOS Medicine performed a network meta-analysis which combines both direct and indirect comparisons of intervention effects. The researchers combed 9 clinical trial and medical databases from inception to December 2020 to find randomized trials related to alcohol use and depression.

After applying inclusion and exclusion criteria, the researchers identified 98 citations reporting 36 studies which randomized a total of 2729 participants. The interventions assessed included cognitive behavioral therapy (CBT), tricyclic antidepressants (TCAs), and selective serotonin reuptake inhibitors (SSRIs).

Looking at remission from depression, the researchers reported “very low confidence in all effect estimates, meaning we are very uncertain about the existence (or not) of a non-null effect based on the available evidence. Sensitivity analyses did not substantively differ from the primary analyses for remission from depression.”

They did find a small beneficial effect of SSRIs over placebos for remission from alcohol use, but found patients receiving SSRIs were more likely to experience an adverse event than patients receiving placebos. The researchers also reported low confidence in psychological and pharmacological effects concerning withdrawal symptoms and quality of life.

While research design and a comprehensive search helped yield strong data, the study had its limitations. For example, the researchers did not contact study authors for any additional information, such as missing data or studies not identified in the search. The researchers also analyzed psychological and pharmacological interventions in separate networks. And while data came from established measures, “the development and use of core outcome measurement sets for this clinical area would help allay concerns about the sensitivity of the direction and magnitude-of-effect estimates arising from application of suboptimal instruments,” the researchers stated.

“Researchers, policymakers, funders, and practitioners may wish to use findings to establish future priorities on researching clinical interventions for this patient population,” the researchers conclude.

“In addition to seeking to replicate evidence underpinning the abovementioned potentially actionable benefits, future trials could prioritize direct comparisons of comparisons with effect estimates suggesting intervention superiority but for which we have insufficient confidence to support consideration for policy and practice recommendations on the basis of evidence on effectiveness. Examples include SSRIs on remission for alcohol use and depressive symptoms at long term follow-up, and opioid antagonists in combination with SSRIs on remission for alcohol use, depressive symptoms, and heavy drinking at postintervention.”


Grant S, Azhar G, Han E, et al. Clinical interventions for adults with comorbid alcohol use and depressive disorders: A systematic review and network meta-analysisPLoS Med. Published October 8, 2021. doi:10.1371/journal.pmed.1003822