The number of RCTs evaluating pharmacological interventions and psychological interventions should also be given. This systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist recommendations for systematic review and meta-analysis 13. This systematic review was performed by searching electronic databases to include eligible trials from 2010 till September 2020 in four databases, including Medline, PsycInfo, Embase, and Ovid. The guidance in this article is derived from a narrative synthesis of high-quality studies, published clinical guidelines and recent systematic reviews or meta-analyses where available.

• This narrative review synthesizes current best evidence, including guideline-concordant care and recent meta-analyses, to provide clinician-oriented, practical guidance.
• If any of the co-authors have not filled in the statement, we will remind them to do so when the paper is revised.
• My main concern relates to the interpretation of the data and the conclusions of the study, which in my view do not accurately reflect the results of the study.
• Two recent reviews, however, indicate that research does not unanimously support the prior existence of severe depressive or anxiety disorders as a usual cause of alcoholism (Allan 1995; Schuckit and Hesselbrock 1994).

Remission from alcohol use

• Also, the role of psychotherapy in these patients was examined by Brown et al., who evaluated the use of CBT-D in patients with severe depression co-existing with alcohol dependence.
• Prospective associations across developmental periods are the strongest evidence in favor of a causal relation between MDD and AUD.
• Among people with AUD, depressive disorders are one of the most common co-occurring psychiatric conditions.
• Despite successfully reducing her alcohol consumption with acamprosate, she struggled with low mood, anhedonia and social withdrawal.
• This raises the possibility that a mechanism other than self-medication mediates long-term associations.
• In your rebuttal letter you should indicate your response to the reviewers’ and editors’ comments and the changes you have made in the manuscript.

Although there are multiple medications used for managing depression, treatment success is usually low, especially in patients with alcohol dependence or SUDs 9. Hence, some studies have investigated different treatment modalities and examined depression treatment outcomes in these patients. The present review investigated the outcomes of depression treatment in patients with alcohol dependence or substance use. The present review demonstrated that pharmacological treatment alone might not lead to sufficient outcomes of depression treatment in patients with alcohol dependence or SUDs.

It is also important to remember that some studies indicate a potential relationship between alcoholism and anxiety/ depressive disorders. In addition, alcoholism and these psychiatric disorders may operate together within some families, or individual instances may occur whereby a person develops alcoholism as a direct reflection of a preexisting psychiatric syndrome. In addition to more studies on interventions included in this review, studies are needed on other interventions used to treat AUDs and depressive disorders. Examples of interventions missing from this body of evidence that are recommended in clinical practices guidelines for AUDs include 12-Step Facilitation, behavioral couples therapy, the community reinforcement approach, disulfiram, gabapentin, motivational enhancement therapy, and topiramate 7. Consistent with the generally negative results of these family type studies are the conclusions drawn from a recent study of 1,030 female-female twin pairs (Kendler et al. 1995).

What do these findings mean?

Information was available on the subjects’ psychiatric symptoms and AOD-use patterns and problems, both at the time of enrollment into the study and at several points during the long-term follow-up. Despite finding that rates of alcohol abuse or dependence were relatively high in both samples, the researchers saw no evidence that preexisting depressive or anxiety disorders occurred at higher rates among those subjects who later developed alcoholism. Although these studies raise important questions, researchers cannot draw definitive conclusions about the association between alcoholism and psychiatric disorders for a number of reasons. The major problem encountered in these studies involved the use of research methods that failed to address several important issues that might have explained the observed relationships (Allan 1995; Schuckit and Hesselbrock 1994).

4) 40% of studies involved outpatient care, 26% involved inpatient care and 11% involved both. Similarly, 49% were conducted in treatment settings related to AUD, 3% in depression treatment settings and 26% in dual care; again, adding up to 78%. Also, what about the 22% (or is it 29%) of the original studies that failed to state were their cases were ascertained? This would seem to be such a glaring omission in reporting, it could be argued that these studies should not be included. CBT, cognitive behavioral therapy; DSM, Diagnostic and Statistical Manual of Mental Disorders; IPT, interpersonal therapy; PHQ, Patient Health Questionnaire; SP, supportive psychotherapy; SUD, substance use disorder. A crucial aspect of NMAs involves visualizing the interventions that have been evaluated for a population of interest as forming a network in which the interventions are represented by dots (or “nodes”) and comparisons between interventions are represented by lines (or “edges”) in a diagram.

Study selection and characteristics

In the DSM-5, AUD requires at least two symptoms, whereas DSM-IV alcohol abuse required only one symptom. Also, from DSM-IV to DSM-5, modifications were made to the symptoms that were included as diagnostic criteria. For example, the criterion of legal problems related to alcohol was removed, and the criterion of alcohol craving was added.

Psychotherapeutic interventions such as Cognitive-Behavioural Therapy (CBT) and Motivational Interviewing are essential components of treatment, focusing on addressing both alcohol use and depressive symptoms. Behavioural activation has also proven effective in treating depression while reducing alcohol cravings. Integrated care models, where both disorders are addressed simultaneously, yield the best outcomes and involve coordinated pharmacotherapy, psychotherapy and ongoing follow-up care. A case example of a 33-year-old woman with AUD and MDD highlights the success of an integrated treatment approach, where a combination of sertraline, naltrexone and CBT led to significant improvements in both mood and alcohol use. Clinicians are advised to differentiate between alcohol-induced depression and primary MDD, consider potential medication interactions, and incorporate ongoing psychotherapy and monitoring for optimal patient outcomes. This approach emphasizes the importance of addressing both conditions concurrently to achieve better long-term recovery outcomes for patients with co-occurring AUD and MDD.

Integrated Management of Co-Occurring Alcohol Use Disorder and Depression: Clinical Approaches for Concurrent Disorders

Sensitivity analyses did not substantively differ from the primary analyses for health-related quality of life. Some of those studies did not identify the substance included in their studies, making the outcomes to all types of abused substances unsupportive in that area. Additionally, only SSRI was examined in combination with medications for alcohol dependence. Consequently, this drives the requirement for future studies that examine other anti-depressants with a different mechanism of action in this clinical setting. On the other hand, Pettinati et al. illustrated that a combination of sertraline, an SSRI, with naltrexone as a treatment for alcohol dependence would result in higher alcohol discontinuation rates and a significant reduction in depression symptoms, with acceptable incidence of side effects 22.

Future studies are needed to provide more conclusive evidence about the (comparative) effectiveness of clinical interventions for treating adults with depressive disorders and AUDs. Co-occurring alcohol use disorder (AUD) and major depressive disorder (MDD) are common and complex conditions that significantly impact patient outcomes. The bidirectional relationship between alcohol use and depression complicates diagnosis and treatment, as alcohol exacerbates depressive symptoms and vice versa.

This approach did not allow us to investigate the specific importance of dependence symptoms (1, 3, 15) and use of a broad definition may increase the possibility of conflicting findings across studies (36). On the other hand, our approach is consistent with DSM-5 (24) and is supported by the facts that alcohol abuse is hard to diagnose reliably and that diagnoses of abuse and dependence tend to form a single latent dimension (37). Another justification for examining a single diagnostic category is that more than a quarter (28%) of individuals in the AUD group had a history of both diagnoses by age 30. Using prospective assessments paired with recall allowed us to have full diagnostic coverage from adolescence to adulthood, but this strategy still involved a degree of recall bias. Third, the OADP dataset is not fully representative and particularly over-represents White participants. Fourth, we used OADP weights to adjust for missing data by design, but did not correct for potential attrition bias using approaches such multiple imputation or maximum likelihood estimation.

Case Example: Integrated Treatment Success

Patients with alcohol dependence or SUD usually suffer from treatment-resistant depression, particularly patients abusing opioids. Combined psychotherapy with anti-depressants and dependence medications can result in best patient outcomes, where SSRI use was commonly studied. Interestingly, telecommunication and computer-based sessions had a higher effect than face-to-face sessions. As a result, such methods should be utilized further with future programs along with the combined therapy approach. Future studies are needed to assess the role of other anti-depressants combined with psychotherapy for patients with alcohol dependence and SUDs as well as study it within the computerized setting. This body of evidence predominantly consists of psychometrically validated questionnaires measuring constructs immediately at postintervention.

If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, alcohol use disorder and depressive disorders pmc or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. We ask every co-author listed on the manuscript to fill in a contributing author statement. If any of the co-authors have not filled in the statement, we will remind them to do so when the paper is revised.

Specifically, some studies focused on drinking patterns rather than on alcohol dependence or described mood/anxiety symptoms rather than true psychiatric disorders. The distinction is important, because symptoms might be only temporary, whereas true psychiatric disorders are likely to require long-term and more intensive treatments, including psychotherapy and medication. Thus, few of the investigations offered assurance that an alcoholic or alcoholic’s relative actually had a long-term psychiatric syndrome rather than a temporary alcohol-induced condition. Most clinicians and researchers would agree that alcoholics experience high rates of anxiety and depressive symptoms and that these problems must be addressed early in treatment (Brady and Lydiard 1993).

Rates of period comorbidity were highest in early adulthood and the majority of individuals with AUD already had a history of MDD by that time. Fourth, we found roughly equal lifetime rates of concurrent and successive comorbidity by age 30. In most cases, concurrent episodes developed after remission from non-concurrent episode(s) of MDD, AUD, or both.

Thirty percent of concurrent episodes were preceded by MDD only, 11% were preceded by AUD only, and 21% were preceded by non-concurrent episodes of both MDD and AUD. The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional.