Mood Disorders

When corrected for clinical significance (Narrow et al., 2002) 1-year major depression prevalence rates are approximately 5%. Women are twice as likely as men to experience major depression. Major depression will be found nearly four times more commonly in individuals with alcohol dependence compared to the non-alcohol-dependent population. Those with a diagnosis of alcohol abuse (rather than alcohol dependence) have only a slight increased risk of major depression compared to the general population. There is a strong sex difference in order of onset. For example, in males, alcoholism precedes depression in 78% of cases, whereas for women, the reverse is true (i.e., depression precedes alcohol dependence in about 66% of cases) (Helzer & Pryzbeck, 1988).

Bipolar disorder and alcohol use disorders have a strong association. Bipolar I patients have alcohol dependence in approximately 31% of cases, and another 15% meet criteria for alcohol abuse. Patients with bipolar II ill ness have a rate of alcohol dependence at approximately 21% and an alcohol abuse pattern of 18%. Non-substance-abusing patients with bipolar illness have a more favorable course of treatment than do those who are using alcohol or other drugs. For example, the patients with comorbid substance use and bipolar disorders have more frequent hospitalizations for mood symptoms, earlier onset of bipolar disorder, more rapid cycling, and a greater prevalence of mixed mania. It is more common for bipolar disorder to precede alcoholism, although the reverse situation is certainly found. In either case, it is critical that the alcohol use disorder and the mood disorder be treated in a synchronous fashion, because failure to address one is likely to aggravate the occurrence of the other.

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