Given that alcohol is commonly referred to as a “depressant,” one might think people dealing with depression would steer clear of a stiff drink when they’re feeling low.
Yet—as life and pop culture so frequently show us—many people trying to cope with the pain, numbness, anxiety, or other symptoms of depression all too often turn to booze. According to George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, it is an especially common form of self-medication for depression, perhaps more so than even pop wisdom suggests.
Why do people drink when they're depressed?
This isn’t some bizarre, paradoxical behavior: As Koob and other experts point out, alcohol is a complex and multifaceted substance; calling it a simple depressant may even be a misnomer. It has many short-term effects that often feel like they’re helping with a bout of depression. However, alcohol also has a number of immediate and long-term adverse effects that can exacerbate one’s depression as well, which far outweigh any short-lived, subjective benefits.
It's difficult to pin down how alcohol interacts with depression because there are probably many forms of depression, says Harvard Medical School psychiatrist and alcohol use expert Rocco Iannucci. Where the borders lie, and how exactly these depressions differ from each other, remains murky and controversial. But “even within major depression,” Iannucci notes, “there are some people who have a form of depression where it pushes them entirely in a down direction, so they have no energy, they are in bed all the time, they aren’t eating anything…Then you have other people who have more agitated depression.” Each one might be searching for a unique type of relief in, or have some unique reactions to, any given self-medication.
However, alcohol has wide-ranging effects on the brain and body. It won’t appeal to every depressed person. But it does enough that folks seeking relief from a variety of depressive pains can theoretically find something that appeals to them at the end of a shot or two.
Why does drinking alcohol make me feel better when I'm depressed?
Chief amongst these appeals for many, Koob notes, is that “alcohol releases neurotransmitters that make you feel good and blunts, at least temporarily, the transmitters that make you feel bad.” It also suppresses activity in the part of the brain that does the heavy thinking and planning. That might help some people zone out the negative thoughts that usually gnaw at the edges of their minds, says Susan Ramsey, an associate professor of psychiatry and human behavior expert at Brown’s Warren Alpert Medical School. Even negative memories and emotions can get dulled down, Koob adds. The end result is, at least briefly and for many people, a release from fixations and pains, a carefree euphoria.
A little booze can reduce inhibitions, too, allowing those with social anxieties to break through barriers that trouble them, notes Joseph Boden, an alcohol use expert at New Zealand’s University of Otago. For more anxious forms of depression, the experts I spoke to all pointed out, alcohol often mellows out the body and leads to earlier sleep. The quality of that sleep is poor, but that’s not often what a person fighting depression-liked insomnia cares about.
These are all common effects of the initial stages of alcohol consumption. But people will feel them to different degrees. We're not sure why one person might get a bigger jolt of euphoria from the same amount of liquor than another with a similar body type or metabolism, Koob acknowledges. (Although some studies worryingly suggest that people who get a larger rush are also prone to alcohol use disorders.) All we know is that the “anti-depressant” value of alcohol will be more appealing to and “effective” for some individuals with depression than others.
None of this fully explains why so many folks dealing with depression reach for alcohol, though. Someone with anxious depression may just want a relaxant, not the euphoria of a drink, while someone experiencing lethargy and a lack of sensation may want the opposite. Yet each person may feel a little of both. A sedative pill like Xanax might better serve the former, and an upper like cocaine the latter, with their more targeted and “clean” physiological effects.
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Many people do use other substances to cope with depression, the experts I’ve spoken to all note. “But the thing with alcohol is, it is legal in much of the world. You don’t need a prescription. You don’t need a drug dealer,” Iannucci says. Plus, Boden adds, most people in booze-consuming countries are familiar from their youth with its effects, more intimately than they might be with those of a more controlled substance, and see it as safe and acceptable.
Koob, though, suspects that many people coping with depression may like the fact that alcohol is such a wide-ranging drug. It kicks on multiple cylinders if you need it to. And, he adds, it often works quicker on the body than other substances. This may explain, in part, why alcohol use is common even in cultures where it is illicit; humans are just especially drawn to this drug.
Can drinking make depression worse?
Unfortunately for those trying to use alcohol for depression management, its wide-ranging effects make it a double-edged sword. Even during the high, Boden points out, booze slows our mental processes, metabolism, breathing, and other functions. For some, those are already the symptoms of their depression, so they may feel as if their condition is worsening. These downer effects, some studies suggest, may grow more powerful after an early euphoric peak.
On top of that, as one’s blood alcohol content starts to decline, which Koob notes can happen fairly quickly after one stops drinking, the body starts to go into a mini-withdrawal. That doesn’t necessarily mean “a wicked hangover,” Boden stresses. “Even after a little alcohol, you’re still having hangover-like” mental and physiological symptoms to at least some degree.
As part of this initial mini-withdrawal, you start to cope with the over-taxation of your pleasure systems, Koob says. Perhaps more importantly, your body starts to produce neurotransmitters associated with stress. It also produces another transmitter, dynorphin, that, as Koob describes it, “just makes you feel lousy.” This sudden crash in pleasure and rise in stress, like any effect of alcohol, will vary in intensity from person to person. But, Iannucci notes, they will likely be magnified in someone who’s going through an active bout of depression. It is almost impossible to say how long this general lowness will last in someone after drinking, Ramsey notes.
By the time one gets beyond initial withdrawals to a proper hangover, they will be dealing with physical symptoms like dehydration and gastric distress, Iannucci says. This, for most people, just compounds any neurochemical issues because, he notes, “if you’re not feeling well” physically, “it is hard for your mood to be better.” This physical duress can make it harder for someone to keep up with behaviors that help to generally control their depression the day after drinking, Iannucci adds, like eating well, avoiding cigarettes, or getting regular exercise.
The morning after, a depressed person will have to deal with anything they regret doing while uninhibited. “When someone is depressed, they are pretty vulnerable,” Iannucci says, “so what might be a minor social mishap the night before can be magnified in their mind." It can be something they might really ruminate on, he adds, now that their higher neural functions are active again.
How does alcohol interact with antidepressants?
If one is on antidepressants, there is also fair evidence that a night of drinking will temporarily reduce their effectiveness, the experts I’ve spoken to agree. Alcohol can also interact with some antidepressants, like monoamine oxidase inhibitors, to cause negative side effects like elevated blood pressure, which could add to one’s overall sense of hangover day stress and anxiety.
All told, alcohol is pretty attractive when one is in the depths of depression and looking for a quick release. It will make many people feel better for the first drink or two—for a few hours. But the longer-term effects will just exacerbate the symptoms of many forms of depression, crash your pleasure centers, increase stress levels, and leave you feeling physically low the next day. It is “just not helpful for depression,” Iannucci says, “and probably makes it worse.”
Unfortunately, for some people with depression, this crash and exacerbation creates a vicious cycle. The alcohol makes them feel worse—even more desperate for release. So they seek out alcohol again for its short-term antidepressant effects. Then they crash again. “Not everybody with depression gyrates in this direction,” Koob says, but for some this will eventually spiral into an alcohol use disorder, a dependency on booze to feel a sense of relief from more and more severe withdrawals, and in the process often more and more severe depressive episodes.
Is it okay to drink when I'm feeling depressed?
Dependency, Ramsey points out, can further draw one away from their support networks and coping mechanisms, worsening depression. It is also linked to a higher suicide risk, fueled by the impulsivity and narrowed thought patterns that alcohol consumption triggers.
Given all of this, Boden recommends that anyone dealing with depression just stay away from alcohol. “I don’t think it is safe at any level,” he says. However, he acknowledges how hard it can be for many people—especially in places where alcohol is a key social binding agent—to give up booze wholesale, even if they don’t have a dependency issue with it. For those who do not want to stop drinking entirely, Iannucci recommends taking a break from it for a time to see whether it improves their depression or not. At the very least, he says—especially for people on antidepressants—it's a good idea to cut back to a fairly minimal amount of alcohol.
This article originally appeared on Tonic.