Comorbid alcoholism and depression: Treatment issues

Unless there is decisive professional intervention, people who suffer from both a depressive disorder and alcoholism are at great risk of chronic impa irment, both at home and in the workplace; persistent symptomatic misery; a nd premature death. Untreated alcoholism intensifies depressive states, dec reases responsiveness to conventional therapeutics, and increases the likel ihood of suicide, suicide attempts, and other self-destructive behavior. Du ring the past decade, evidence has emerged from placebo-controlled studies supporting the utility of tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) for treatment of depressed alcoholics. The sup erior safety and tolerability of SSRIs provide strong justification for the ir first-line use despite higher drug acquisition costs. Evidence has simil arly emerged concerning the use of several novel pharmacotherapies and focu sed psychotherapies for people with alcoholism. These newer therapeutic opt ions complement more traditional intervention such as chemical dependence c ounseling, disulfiram, and Alcoholics Anonymous so that it is now possible for a majority of depressed alcoholics to be treated effectively. The avail ability of effective treatments provides further impetus for health care pr ofessionals to improve recognition of comorbid alcoholism and depressive di sorders. Improved recognition and treatment wilt save lives, and the benefi ts are, likely to extend across generations.