Commentary on the Comorbidity of Alcohol Use Disorder and Depression among Patients Attending a Tertiary Hospital in the Niger Delta Region of Nigeria

Department of Neuropsychiatry, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

*Corresponding Author:

Chidozie Donald Chukwujekwu
Department of Neuropsychiatry
University of Port Harcourt Teaching Hospital
Port Harcourt, Rivers State, Nigeria
Tel: 08035928593
E-mail: chidozie.chukwujekwu@uniport.edu.ng

Received date: February 10, 2017; Accepted date: April 10, 2017; Published date: April 17, 2017

Citation: Chukwujekwu CD (2017) Commentary on the Comorbidity of Alcohol Use Disorder and Depression among Patients Attending a Tertiary Hospital in the Niger Delta Region of Nigeria. J Addict Res Ther 8:319. doi:10.4172/2155-6105.1000319

Copyright: © 2017 Chukwujekwu CD. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Addiction Research & Therapy

Abstract

A commentary on “The co-morbidity of Alcohol Use Disorder and depression among patients attending a tertiary hospital in the Niger Delta region of Nigeria” is the objective of this exercise. The study demonstrated a higher rate of alcohol use disorders (AUD) among those who presented with depressive symptoms. Furthermore, about half of the subjects who met the criteria for AUD in the study also met the criteria for depression while only a quarter of those who didn’t satisfy the criteria for AUD were also found to be depressed. This underscores the concept of comorbidity which is well documented as a challenging phenomenon for therapists. The coexistence of two chronic illnesses in the same individual constitutes double jeopardy because of their synergistic deleterious consequences on the body. Even though many plausible theories have been propounded to explain the concept of co-morbidity of AUD and Depression, none has sufficiently explained the common risk factor for and/or the exact cause of this challenge. Nevertheless, the need for a routine comprehensive clinical assessment of any patient with co-existing disorders in clinical settings is recommended.

Keywords

Co-morbid; Depression; Alcohol; Disorder; Studies; Psychiatric; Risk

Introduction

When a patient suffers from two or more disorders simultaneously, the person’s health situation is referred to as “a co-morbid one” or a case of “co-morbidity”. According to Kessler et al., “Majority of individuals who meet the criteria for a major psychiatric illness will also meet the diagnostic criteria for at least one additional disorder” [1]. Co-morbidity has become a topic of growing interest because of its clear impact on clinical severity. Many studies opine that “chronicity” and “treatment resistance” are the hallmarks of many co-morbid conditions and most sufferers are more vulnerable to experience disabilities of different types and varying dimensions than in a single psychiatric condition [2-4]. Studies show that depression with comorbid substance use disorders are among the most common psychiatric co-morbidities recorded globally [5-7].

Okeafor et al. demonstrated significant more occurrence of alcohol use disorders among depressed than non-depressed patients [8]. They also noted that “45.8% of those with alcohol use disorders use were diagnosed with depression in comparison to 26.0% of those without” alcohol use disorder [8].

Several theorists have attempted to explain the phenomenon of this co morbidity. While some studies show that the pathological effects of a mood disorder may increase the risk for substance use disorder, others maintain that the presence of mood symptoms and substance use disorder in the same individual are mutually exclusive events [9,10]. Other researchers proposed “kindling’’, the concept that repeated disruptions sensitize brain cells [5,9]. The kindling theory of co morbidity, posits that individuals who are predisposed to suffer these disruptions, a possible underlying neurobiological tendency to sensitization may promote both drug dependence and mood disorders [11]. The effectiveness of many mood stabilizers, most of whom are anticonvulsants in the management of mood disorders as well as alcohol use disorders validates the kindling theory.

Sullivan reported that “drinking and related symptoms may promote depression indirectly as well by contributing to stressful life circumstances that in turn are known to promote depression” [12]. This view has been supported by other researchers [13]. This stressdiathesis etiological model of psychiatric disorders is very applicable to the AUD/Depression co-morbidity. The fact that chronic stressful life events can precipitate psychological difficulties, including depression and that many individuals resort to alcohol use as an immature way of coping with their challenging life events is common knowledge. Despite the multiple erudite explanations for co-morbidity that have been enunciated, none has sufficiently addressed the issue of the joint underlying cause and/or vulnerability for Depression and AUD [14].

Many studies have been done to elucidate the unique phenomenon of AUD/Depression co-morbidity in Psychiatry [15-18]. While some suggest that the frequency of alcohol use predicts the emergence of depression in a patient [19], others maintain that binge drinking is a more reliable risk factor for the development of depression [20,21]. It is difficult to ascertain which of these two is exactly correct because methodological differences and individual genetic differences in metabolizing alcohol as well as the body’s response to the effects of alcohol are confounding factors.

Risk ratios for the development of AUD and mood disorders of 1.8 to 4.2 have been reported, which indicates an appreciable link between the two disorders [22,23]. Nevertheless, it is not clear which of these disorders constitute more of a risk factor for the development of the other [24-27]. While some researchers suggest that women are more prone to start using alcohol in response to their depressive symptoms and hence are more likely to suffer from co-morbid AUD/Depression than men [26,28], others think otherwise [29]. The less tolerant stance by societies especially in the undeveloped world towards use of alcohol by women is a confounding variable for genuine comparison of alcohol habits and effects between both genders.

Conclusion

The high prevalence and the consequences of the co morbidity between AUD and Depression demand more urgent attention. The need for a routine comprehensive clinical assessment of any patient with one of these disorders or the other in clinical settings is recommended.

References

1. Kessler R, McGonagle K, Zhao S, Nelson C, Hughes M, et al. (1994) Lifetime and 12 month prevalence of DSM-IIIR psychiatric disorders in the United States: Results from the national co morbidity survey. Arch Gen Psychiatry 51: 8-19.
2. Hirschfield R, Hasin, D, Keller M, Endicort J, Wunder J. Depression and alcoholism: Comorbidity in a longitudinal study in Maser J and Cloninger C. (Eds). Washington, DC.
3. Kendall PC, Clarkin JF (1992) Introduction to special section: comorbidity and treatment implications. J Consult Clin Psychol 60: 833-834.
4. Hagnell, O, Grasbeck A (1990) Co-morbidity of anxiety and depression in the lundby 25 year prospective study: The patter of subsequent episodes. In Maser J and Cloninger C. (Eds). Co-morbidity of mood and anxiety disorders. Washington DC: American Psychiatric Press Inc., pp: 139-152.
5. Quello SB, Brady KT, Sonne SC (2005) Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect 3: 13-21.
6. Meyer R, Krazler H (1991) Alocohol abuse, dependence and co-morbid anxiety and depression. In Maser J. Cloninger C (Eds). Co-morbidity with other mental disorders in adolescents and adults. J Abuse Psychol 100: 214-222.
7. Hasin DS, Endicott J, Keller MB (1991) Alcohol problems in psychiatric patients: 5 year course. Compr Psychiatry 32: 303-316.
8. Okeafor CU, Chukwujekwu CD, Stanley PC (2016) Comorbidity of alcohol use disorder and depression among patients attending a tertiary hospital in the Niger Delta region of Nigeria. Am J Psychiatr Neurosci 4: 38-42.
9. Nunes E, Quitkin F, Brady R, Koenig T (1994) Antidepressant treatment in methadone maintenance patients. J Addict Dis 13: 13-24.
10. Brown SA, Inaba RK, Gillin JC, Shuckit MA, Stewart MA, et al. (1995) Alcoholism and affective disorder. Clinical course and depressive symptom. Am J Psychiatry 152: 45-52.
11. Markou A, Kosten TR, Koob GF (1998) Neurobiological similarities in depression and drug dependence. A self-medication hypothesis. Neuropsychopharmacology 19: 135-174.
12. Sullivan IE, Fiellin DA, OâÂ?Â?Connor PG (2005) The prevalence of and impact of alcohol problems in major depression. A systematic review. Am J Prev Med 118: 330-341.
13. Shuckit MA, Smith TL, Daeppen JB, Eng M, Li TK, et al. (1998) Clinical relevance of the distinction between alcohol dependence with or without a physiological coupment. Am J Psychiatry 155: 733-740.
14. Swendsen JD, Merikangas KR (2000) The comorbidity of depression and substance use disorders. Clin Psychol Rev 20: 173-189.
15. Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, et al. (1996) The epidemiological of co-occuring addictive and mental disorders: Implications for prevention and service utilization. Am J Orthopsychiatry 66: 17-31.
16. Degenhardt L, Chiu WT, Sampson N, Kessler RC, Anthony JC, et al. (2008) Toward a Global view of alcohol, tobacco, cannabis, and cocaine use. Findings from the WHO world mental health surveys. PLOS Med 5: e141.
17. Okpataku CI, Kwanashie HO, Ejiofor JI, Olisah VO (2014) Prevalence and socio-demographic risk factors associated with psychoactive substance use in psychiatric out-patients of a tertiary hospital in Nigeria. Niger Med J 55: 460-464.
18. Gureje O, Uwakwe R, Udofia O. The epidemiological and service research unit, Ibadan, Nigeria. 2002 mental disorders among adult Nigerians. A report from the national survey of mental health and wellbeing 12.
19. Swendsen JD, Merikangas KR, Canino GJ, Kessler RC, Rubio-Stipec M, et al. (1998) The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities. Compr Psychiatry 39: 176-184.
20. Graham K, Massak A, Demers A, Rehm J (2007) Does the association between alcohol consumption and depression depend on who they are measured? Alcohol Clin Exp Res 31:78-88.
21. Wang J, Patten SB (2001) Alcohol consumption and major depression: Findings from a follow-up study. Can J Psychiatry 46: 632-638.
22. Lynskey MT (1998) The comorbidity of alcohol dependence and affective disorders: Treatment implications. Drug Alcohol Depend 52: 201-209.
23. Hasin DS, Grant BF (2002) Major depression in 6050 former drinkers association with past alcohol dependence. Arch Gen Psychiatry 59: 794-800.
24. Boschloo L, Vanden Brink W, Pennix BW (2011) Alcohol use disorder severity predicts first incidence of depressive disorders. Psychol Med 26: 1-9.
25. McCarthy CA, Kusterman R, Mason WA (2009) Longitudinal associations among depression, obesity and alcohol use disorders in young adulthood. Gen Hosp Psychiatry 10.
26. Kuo PH, Gardener CO, Kendler KS, Prescott CA (2006) The temporal relationship of the onsets of alcohol dependence and major depression using a genetically informative study design. Psychol Med 36: 1153-1162.
27. Kessler RC, Bergland P, Demler O (2003) The epidemiology of major depressive disorders; results from the national comorbidity survey replication (NCS-R). J Am Med Assoc 289: 3095- 3105.
28. Hartka E, Johnstone B, Leino EV, Motoyoshi M, Temple MT, et al. (1991) A meta-analysis of depressive symptomatology and alcohol consumption over time. Br J Addict 86: 1283-1298.
29. Moscato BS, Ransell M, Zieleny M (1997) Gender differences in the relationship between depressive symptoms and alcohol problem. A longitudinal perspective. Am J Epidemiol 146: 966-974.