Alcohol And Depression: The Mental Health Connection

How does alcohol affect depression and major depressive disorder?

Alcohol can have complex and bidirectional effects on depression. While some individuals may turn to alcohol as a way to cope with depressive symptoms, clinical and experimental research from the National Institutes of Health shows that excessive alcohol consumption can exacerbate or contribute to the development of depression, particularly in individuals with depressive disorders like major depressive disorder. 

How drinking alcohol can affect depression

Here are some ways in which alcohol can affect depression:

• Depressant effect: Alcohol is a central nervous system depressant, meaning it slows down brain activity. While some people may initially experience a temporary mood lift or relaxation, excessive alcohol intake may worsen depressive symptoms. It can lead to a depressed mood, impaired cognitive function, and increased feelings of sadness.
• Impact on medication: For individuals who have had depression diagnosed, using alcohol may impact the effectiveness of any antidepressant medications. Research shows that the combination of alcohol intake and certain medications for depression can be a risk factor for rhabdomyolysis.
• Impact on neurotransmitters: Alcohol affects neurotransmitters in the brain, including gamma-aminobutyric acid (GABA) and glutamate. Disruptions in these neurotransmitter systems can influence mood management, and chronic alcohol use (formerly called alcohol abuse) may contribute to imbalances associated with depressive disorders’ symptoms.
• Sleep disruption: While alcohol may initially induce drowsiness and help some individuals fall asleep, it can disrupt the sleep cycle, leading to fragmented and poor-quality sleep. Sleep disturbances are commonly associated with depressive disorders, such as major depression and persistent depressive disorder.
• Negative impact on coping mechanisms: Some individuals may turn to alcohol as a way to cope with stress, anxiety, depression, or other mental health conditions. However, using alcohol as a coping mechanism can become a maladaptive pattern and lead to increased reliance on substances or self-harm instead of healthier coping strategies.
• Social isolation: Excessive alcohol use can contribute to social isolation and withdrawal from supportive relationships. Social support is crucial for managing depression, and the negative impact on relationships can exacerbate depressive symptoms.
• Increased vulnerability to depressive episodes: Chronic and heavy alcohol consumption is associated with an increased vulnerability to developing or worsening depressive episodes, psychiatric disorders, or Major Depressive Disorder. Individuals with a history of major depression (major depressive disorder), persistent depressive disorder, seasonal affective disorder, psychotic depression, or other mental disorders may find that alcohol exacerbates their symptoms over time.

Does drinking alcohol increase anxiety?

Yes, when you drink alcohol, it can increase anxiety for several reasons. Alcohol problems and anxiety are closely linked. Compared to the general population, people who regularly drink alcohol are at risk of having psychiatric disorders such as anxiety. While some individuals may initially experience a temporary sense of relaxation or euphoria when consuming alcohol, it is a central nervous system depressant that can have paradoxical effects and severe symptoms. Here are ways in which alcohol consumption may contribute to increased anxiety:

• Disruption of neurotransmitters: Alcohol affects neurotransmitters in the brain, including gamma-aminobutyric acid (GABA) and glutamate. GABA is an inhibitory neurotransmitter that promotes relaxation, while glutamate is an excitatory neurotransmitter. Alcohol enhances the effects of GABA and inhibits glutamate, leading to a depressant effect. However, as the effects wear off, there can be a rebound increase in excitatory activity, contributing to anxiety.
• Changes in hormone levels: Alcohol can affect hormone levels, including cortisol, a stress hormone. While initial alcohol consumption may temporarily reduce cortisol levels, the subsequent rebound effect can lead to increased cortisol production, contributing to heightened stress and anxiety.
• Sleep disruption: While alcohol may induce drowsiness and help some individuals fall asleep initially, it can disrupt the sleep cycle, leading to fragmented and poor-quality sleep. Sleep disturbances are closely linked to anxiety, and inadequate sleep can exacerbate feelings of tension and worry.
• Negative impact on coping mechanisms: Some individuals use or regularly drink alcohol as a coping mechanism to deal with stress or anxiety. However, relying on alcohol as a way to cope with mental health problems can become a maladaptive pattern, and the temporary relief may be followed by increased anxiety.
• Interference with medication or medical treatment: For individuals who have medications to manage anxiety, alcohol can interfere with the effectiveness of these medications. It may counteract the benefits of the medication or amplify its side effects.
• Social consequences: Alcohol misuse can have social consequences, including impaired judgment and increased vulnerability in social situations. This may contribute to feelings of social anxiety or unease.

Why is alcohol bad for anxiety and mental health?

​​Alcohol can be detrimental to individuals with anxiety for several reasons. While some people may initially turn to alcohol to alleviate stress or anxiety symptoms, it often has counterproductive and negative effects on mental health. Here are reasons why alcohol is considered bad for anxiety:

• Disruption of neurotransmitters: Alcohol affects neurotransmitters in the brain, including gamma-aminobutyric acid (GABA) and glutamate. Initially, alcohol enhances the effects of GABA, promoting relaxation. However, it may make anxiety worse. As the effects wear off, there can be a rebound increase in excitatory activity (glutamate), contributing to heightened anxiety.
• CNS depressant effect: Alcohol is a central nervous system (CNS) depressant, meaning it slows down brain activity. While some individuals may experience a temporary mood lift, excessive alcohol consumption can lead to a depressed mood, impaired cognitive function, and increased feelings of anxiety.
• Sleep disruption: Although alcohol may induce drowsiness and help some individuals fall asleep initially, it disrupts the sleep cycle. This can result in fragmented and poor-quality sleep, which is closely linked to anxiety symptoms.
• Negative impact on coping mechanisms: Some individuals use alcohol as a way to cope with stress or anxiety. However, relying on alcohol as a coping mechanism can become a maladaptive pattern, and the temporary relief it provides may be followed by increased anxiety.
• Interference with medication or medical treatment: For individuals taking medications or pharmacological treatments to manage anxiety, alcohol can interfere with the effectiveness of these medications in depression treatment. It may counteract the benefits of the medication or amplify its side effects.
• Increased risk of panic attacks: Excessive alcohol consumption is associated with an increased risk of panic attacks, which can be particularly distressing for individuals with anxiety disorders.
• Social consequences: Alcohol use can have social consequences, including impaired judgment and increased vulnerability in social situations. This may contribute to feelings of social anxiety or unease.
• Emotional dysregulation: Chronic alcohol use can lead to emotional dysregulation, making it more challenging for individuals to manage and regulate their emotions. This can contribute to increased anxiety symptoms.

How does alcohol affect the brain and behavior?

Alcohol affects the brain and behavior by interacting with neurotransmitter systems, altering neural activity, and influencing cognitive and motor functions. Here are some key ways in which alcohol affects the brain and behavior:

• Neurotransmitter modulation: Alcohol affects several neurotransmitter systems in the brain. It enhances the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that promotes relaxation. Additionally, it inhibits the effects of glutamate, an excitatory neurotransmitter. The combined effect leads to a general slowing down of brain activity.
• Central nervous system depression: Alcohol is a central nervous system (CNS) depressant. It suppresses neural activity in the brain, leading to sedation and a decrease in alertness. This depressant effect is responsible for the relaxation and euphoria often associated with moderate alcohol consumption.
• Impaired cognitive function: Excessive alcohol consumption can impair cognitive functions such as attention, memory, and decision-making. This can result in poor judgment, reduced inhibitions, and impaired reasoning, contributing to risky behaviors.
• Disruption of balance and coordination: Alcohol affects the cerebellum, a brain region involved in motor control and coordination. This can lead to impaired balance, coordination, and motor skills, increasing the risk of accidents and injuries.
• Changes in mood and emotion: While alcohol can initially induce a sense of euphoria, excessive consumption can lead to changes in mood, including irritability, aggression, and emotional instability. Chronic alcohol use is also associated with an increased risk of mood disorders. It may also lead to losing interest in activities or hobbies and an increased risk of self-harm.
• Impact on the reward system: Alcohol activates the brain's reward system by increasing dopamine levels. This reinforcement contributes to the pleasurable effects of alcohol and may contribute to the development of dependence in some individuals.
• Sleep disruption: Although alcohol may induce drowsiness, it disrupts the sleep cycle, leading to poor-quality sleep. This can contribute to feelings of fatigue and impaired cognitive functioning.
• Dehydration: Alcohol problems may put a person at risk for dehydration. Alcohol is a diuretic, promoting increased urine production and potentially leading to dehydration. Dehydration can contribute to physical symptoms such as headaches and fatigue.
• Negative impact on inhibitions: Alcohol can lower inhibitions and impair judgment, leading to behaviors that an individual might not engage in when sober. This can include risky sexual behavior, aggression, or other impulsive actions.
• Tolerance and dependence: With regular and chronic alcohol use, the brain can develop tolerance, requiring larger amounts of alcohol to achieve the same effects. Dependence may also develop, leading to withdrawal symptoms when alcohol consumption is reduced. 
• Risk of addiction: Alcoholism, like drug abuse, may put a person at risk of developing an addiction. Persistent and excessive alcohol use can lead to alcohol use disorder (AUD), a mental illness recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition. According to the National Institute on Alcohol Abuse and Alcoholism, AUD is an integration of alcohol abuse and alcohol dependence disorders in the DSM. It is characterized by a loss of control over drinking, continued use despite negative consequences, and a preoccupation with alcohol.

Does quitting alcohol help anxiety?

Yes, quitting alcohol can help alleviate anxiety. While alcohol may provide temporary relief, especially for those dealing with stress or social anxiety, it can exacerbate anxiety symptoms in the long run. Alcohol is a central nervous system depressant that can disrupt neurotransmitter balance, impact sleep quality, and contribute to emotional dysregulation. Stopping drinking or abstaining from alcohol allows the brain and body to recover, leading to improved mental clarity, better sleep, and a more stable emotional state. Quitting alcohol may also provide individuals with the opportunity to develop healthier coping mechanisms and address the underlying factors contributing to their anxiety, fostering long-term well-being. If stopping drinking alcohol seems difficult to accomplish, consider seeking help from family, support groups, and a mental healthcare professional. 

Why do I get emotional when I drink?

Drinking alcohol can have varied effects on emotions, and individual reactions can differ based on factors such as personality, mood, and the context in which alcohol is consumed. Alcohol is a central nervous system depressant that affects neurotransmitter systems in the brain, including gamma-aminobutyric acid (GABA) and glutamate. While initial consumption might induce relaxation and euphoria, excessive drinking can lead to emotional dysregulation and intensified feelings. Alcohol can also dampen inhibitions and lower self-awareness, making individuals more prone to expressing or experiencing heightened emotions. 

If you’re experiencing symptoms of a major depressive episode for a few weeks, such as feeling hopeless, having no motivation, and being at risk of self-harm, consult your healthcare provider. They can give a proper diagnosis based on the diagnostic criteria in the DSM-5. If you have issues with stopping drinking, there are also mental health services and support groups that may be able to help. 

How long does alcohol anxiety last?

The duration of alcohol-induced anxiety can vary widely among individuals and is influenced by factors such as the amount of alcohol consumed, individual tolerance, overall health, and any underlying mental health conditions. Alcohol-induced anxiety is often associated with the hangover phase, which typically occurs after the immediate effects of alcohol wear off.

Hangover symptoms, including anxiety, can last anywhere from several hours to a full day, depending on the severity of the hangover and individual differences. In some cases, individuals may experience anxiety as part of acute alcohol withdrawal, commonly known as the "hangxiety" phenomenon.

Is alcohol like an antidepressant?

Some people consume alcohol to ease depressive disorders and other symptoms of mental health conditions like bipolar disorder. While alcohol might initially produce feelings of relaxation and euphoria, it is not a true antidepressant and should not be used as a substitute for proper mental health treatment. Self-medication for depressive disorders through alcohol or drug use may only make depression worse. Alcohol is a central nervous system depressant that affects neurotransmitters in the brain, including gamma-aminobutyric acid (GABA) and glutamate. It may temporarily alleviate symptoms of stress or anxiety, leading some individuals to perceive it as having antidepressant-like effects. Over time, alcohol may increase symptoms of depression and may negatively impact an individual’s physical health and mental well-being. 

Using alcohol for self-medication may put an individual at risk for developing alcohol use disorder. It not only affects their well-being but also results in the burden of care for caregivers. A study published in General Psychiatry of BMJ Journals shows that caregivers of patients with AUD may experience depression, anxiety, and poor life quality. If stopping drinking seems too difficult to do on your own, know that there is help through counseling and support groups such as Alcoholics Anonymous and Drinkaware. 

How much alcohol is OK daily?

It's important to note that the definition of "moderate" alcohol consumption can vary based on factors such as individual health, age, and medical conditions. The Centers for Disease Control and Prevention (CDC) and other health organizations define moderate drinking as follows:

• For men: Up to two standard drinks per day
• For women: Up to one standard drink per day

A standard drink is typically defined as containing about 14 grams of pure alcohol. This is roughly equivalent to:

• 12 ounces of beer with about 5% alcohol content
• 5 ounces of wine with about 12% alcohol content
• 1.5 ounces of distilled spirits (e.g., whiskey, vodka) with about 40% alcohol content

Mental Health Foundation states that regular consumption of more than 14 units weekly (equivalent to six pints of average-strength beer) is not advisable. It may be important to recognize that exceeding these guidelines, even on occasion, can have health risks and may impact mental illness. Excessive alcohol consumption or heavy drinking is associated with a range of negative physical health effects, including weight gain, liver disease, and cardiovascular issues. Alcohol problems may also increase the risk of accidents, injuries, and mental health problems. A study shows that psychiatric disorders are more common in people with AUD compared to the general population. Besides the mental and physical health concerns, it may also cause alcohol poisoning. 

How does alcohol affect mood disorders, such as major depressive disorder?

According to the American Psychiatric Association, heavy drinking can impact an individual’s mood. It can also affect the brain. Alcohol can worsen mood disorders like major depressive disorder by agitating or disrupting brain chemicals and increasing negative feelings, such as feelings of sadness and anxiety—and it may make depression worse. A 2020 study cites that heavy drinking habits can have a deleterious effect on depression treatment. Further, alcohol consumption can be associated with self-harm and suicidality. 

Major depressive disorder can be caused in part by genetics, illnesses, stress, trauma, medications, low socioeconomic status, and substance abuse. For depressed patients who are also facing alcohol problems or substance use disorder (substance abuse and substance dependence in the DSM), stopping drinking may be challenging, but it is generally possible. Consulting a mental health professional may be an initial step to achieving healing. Joining a self-help group may also be a good adjunct in treatment.