Depression and low mood

Alcohol, recreational drugs and depression

Alcohol and recreational drugs are ‘mood-altering substances’, in other words they have an effect on the mood and state of mind of anyone using them (in addition to other effects on the central nervous system). Their effect can be particularly heightened for people who have depression or experience low moods, and depression and anxiety can be made worse by consuming large quantities of alcohol.
In some instances, drinking alcohol may counteract the benefits of antidepressant medication or it can be unsafe to take the two together. Alcohol can also make people more likely to act impulsively, and there is a known link between alcohol use and suicide. Here young people talk about their experiences of alcohol and depression and also talk about recreational drug use.

Drinking alcohol
Young people we spoke with talked about their views and experiences of drinking alcohol and its effects on their moods and depression. Most of them said they did drink alcohol although a few said they only drank very little and very rarely. Some didn’t like the taste of alcohol, couldn’t afford to buy it or just generally weren’t keen on drinking and the drinking culture. One man who was training to be a doctor said he wouldn’t drink alcohol because he knows “how much damage it can do”. Another woman had stopped drinking because alcohol could trigger and enhance her anxiety attacks.

Many people felt that drinking alcohol was an important part of their lifestyle and went hand in hand with school, college or university culture. Some felt sometimes unspoken pressure to join their friends by drinking alcohol, or had thought it was ‘cool’ because their older friends were drinking. Mostly people said they drank alcohol because it was “a good laugh”, “fun” and a social thing to do in the park, pub or club with their mates.

Many hoped that drinking would lift their moods or help them “escape” feeling depressed. They described drinking to “cheer” themselves up, to “take mind off” worries and problems. One woman said she drank every night to help her sleep while another one described how she drank so she “didn’t have to think about how I felt”.

Effects of alcohol on mood and depression
Generally, people said they were fine as long as they stuck to what they felt was their “safe limit” or drank “moderately”. Drinking “too much” made depression much worse. They pointed out that initially a couple of drinks made them feel better but after a few more, they felt a lot worse. One woman described alcohol as “a natural downer” so she’d stopped drinking. Some said going out and drinking lifted their moods and they were fine “when drinking” but that they felt “million times worse” the next day.

A few people felt that hangovers heightened their feelings of depression and anxiety and a couple said they suffered from a moral hangover after a big night out. One woman described how drinking affected her moods;
 

“(I was) absolutely miserable and miserable about being miserable”.

Some people found it difficult to drink “moderately” as they said that after they “hit a point” it was hard to stop. Drinking “too much” made some feel “stupid” and “do silly things”. They would mix drink and drugs, pass out or get “in trouble”. For some there was also a link between drinking and aggression. Some people described how they got angry much more easily when drunk and ended up in fights or arguing with people. Many young people also said that when they were drunk they were more likely to self-harm and feel suicidal. See also our section on ‘Depression, self-harming and suicidal thoughts’.

 

Source: http://www.healthtalk.org/young-peoples-experiences/depression-and-low-mood/alcohol-recreational-drugs-and-depression

Alcohol and mental health

We often reach for a drink because we want to change the way we feel. Maybe we want to relax, to celebrate or simply forget our day at work. More concerning is that many people drink to try and mask anxiety or depression, or other mental health problems.
While alcohol can have a very temporary positive impact on our mood, in the long term it can cause big problems for our mental health. It’s linked to a range of issues from depression and memory loss to suicide(1).

1. Alcohol alters your brain chemistry

Our brains rely on a delicate balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting our thoughts, feelings and actions – and sometimes our long-term mental health. This is partly down to ‘neurotransmitters’, chemicals that help to transmit signals from one nerve (or neuron) in the brain to another.
The relaxed feeling you can get when you have that first drink is due to the chemical changes alcohol has caused in your brain. For many of us, a drink can help us feel more confident and less anxious. That’s because it’s starting to depress the part of the brain we associate with inhibition.
But, as you drink more, more of the brain starts to be affected. It doesn’t matter what mood you’re in to start with, when high levels of alcohol are involved, instead of pleasurable effects increasing, it’s possible that a negative emotional response will take over. You could become angry, aggressive, anxious or depressed.

2. Alcohol can actually increase anxiety and stress rather than reduce it

Unfortunately reaching for a drink won’t always have the effect you’re after.
While a glass of wine after a hard day might help you relax, in the long run it can contribute to feelings of depression and anxiety and make stress harder to deal with. This is because regular, heavy drinking interferes with neurotransmitters in our brains that are needed for good mental health.
When we drink, we narrow our perception of a situation and don’t always respond to all the cues around us. If we're prone to anxiety and notice something that could be interpreted as threatening in the environment, we'll hone in on that and miss the other less threatening or neutral information.  For example, we might focus on our partner talking to someone we’re jealous of, rather than notice all the other people they’ve been chatting to that evening.

3. Alcohol depression = a vicious cycle

If you drink heavily and regularly you’re likely to develop some symptoms of depression. It’s that good old brain chemistry at work again. Regular drinking lowers the levels of serotonin in your brain – a chemical that helps to regulate your mood.
In Britain, people who experience anxiety or depression are twice as likely to be heavy or problem drinkers. For some people, the anxiety or depression came first and they’ve reached for alcohol to try to relieve it. For others, drinking came first, so it may be a root cause of their anxieties (2).
Drinking heavily can also affect your relationships with your partner, family and friends. It can impact on your performance at work. These issues can also contribute to depression.
If you use drink to try and improve your mood or mask your depression, you may be starting a vicious cycle…
Warning signs that alcohol is affecting your mood include:

• disturbed sleep
• feeling lethargic and tired all the time
• low mood
• experiencing anxiety in situations where you would normally feel comfortable.

Four ways to help prevent alcohol affecting your mood

1.    Use exercise and relaxation to tackle stress instead of alcohol.
2.    Learn breathing techniques to try when you feel anxious.
3.    Talk to someone about your worries. Don’t try and mask them with alcohol.
4.    Always be aware of why you’re drinking. Don’t assume it will make a bad feeling go away, it’s more likely to exaggerate it.

4. Alcohol is linked to suicide, self-harm and psychosis

Alcohol can make people lose their inhibitions and behave impulsively, so it can lead to actions they might not otherwise have taken – including self-harm and suicide (3).
According to the NHS in Scotland, more than half of people who ended up in hospital because they’d deliberately injured themselves said they’ve drunk alcohol immediately before or while doing it.  27% of men and 19% of women gave alcohol as the reason for self-harming (4). 

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Did you know?

Anxiety and depression are more common in heavy drinkers – heavy drinking is more common in those with anxiety and depression

Extreme levels of drinking (such as more than 30 units per day for several weeks) can occasionally cause ‘psychosis’. It’s a severe mental illness where hallucinations and delusions of persecution develop. Psychotic symptoms can also occur when very heavy drinkers suddenly stop drinking and develop a condition known as ‘delirium tremens’ – symptoms include body tremors and confusion.

5. Alcohol can damage your memory

Soon after drinking alcohol, your brain processes slow down and your memory can be impaired. After large quantities of alcohol, the brain can stop recording into the ‘memory store’. That’s why you can wake up the next day with a ‘blank’ about what you said or did and even where you were. This short-term memory failure or ‘black out’ doesn’t mean that brain cells have been damaged, but frequent heavy sessions can damage the brain because of alcohol’s effect on brain chemistry and processes.
Drinking heavily over a long period of time can also have long-term effects on memory. Even on days when you don't drink any alcohol, recalling what you did yesterday, or even where you have been earlier that day, become difficult.

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Did you know?

Alcohol disrupts the balance of chemicals in your brain that affect your mood.

Staying in control

Drinking within the government’s lower risk guidelines will help keep your drinking in control. Here are three ways you can cut back:
1. Try alternative ways to deal with stress. Instead of reaching for a beer or glass of wine after a hard day, go for a run, swim or to a yoga class, or a talk to a friend about what’s worrying you.
2. Keep track of what you’re drinking. Your liver can't tell you if you're drinking too much, but the MyDrinkaware drinks calculator can. It can even help you cut down.
3. Give alcohol-free days a go. If you drink regularly, your body starts to build up a tolerance to alcohol. This is why many medical experts recommend taking regular days off from drinking to ensure you don't become addicted to alcohol. Test out having a break for yourself and see what positive results you notice.
Source:  https://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/mental-health/alcohol-and-mental-health#depression

How to Get Rid of Depression

Depression is a clinical condition, a disease just as real as a cold or flu. Treatment for depression varies widely from person to person, but there are some approaches that seem to work more often than others. Read this guide to learn about them and consider which ones are worth trying yourself.

Method 1 of 3: Focus on Health and Fitness

1. 
   1
   Exercise. Physical exercise releases chemicals in the brain that help boost your mood. It's long been known that vigorous, regular exercise can serve to lessen and in some cases even cure depression in many patients. The best part of exercise as a treatment for depression is that it's basically free. On the other hand, some people suffering from depression find it almost impossible to get motivated enough to start a regular exercise routine.
   • Cardiovascular exercise is an ideal core exercise for treating depression, as the body can sustain cardio activity for a much longer period of time than resistance exercise, without any ill effects. Choose cardio exercise that's easy on your joints, such as swimming laps or cycling, if you possibly can.
     
   • If you'd like to try exercise a s a means of fighting your depression, but just can't seem to work up the will to do it, talk to a trusted friend or loved one and ask them to help you get out and start doing it. Explain that it won't be easy to motivate you, but that any help they can give will be sincerely appreciated.
     
   • Exercise for at least 30 minutes a day, 3 times a week to begin to feel a sustained effect on your mood. It may take a few weeks to really notice a change.
     • If you're exercising a lot and still feel just as depressed as before, you should try something else instead. However, for purely physical reasons, you should also continue with your fitness regimen as long as you're able to make yourself do so.
2. 
   2
   Control your diet. There's some research that suggests certain dietary guidelines can help people suffering from depression, by providing the body the correct chemical tools it needs to heal the chemical imbalances that often cause depression. The dietary approach doesn't work for everybody, but like exercise, it's a relatively inexpensive treatment that has no negative side effects to speak of.
   • Eat foods rich in depression-fighting nutrients. Studies have shown links between lowered rates of depression and the nutrients folate, vitamin B12, vitamin D, selenium, and Omega-3. Start by focusing on foods that are rich in some or all of these nutrients, such as dark green vegetables, legumes (beans), nuts, extra-lean meat, whole fruit, and yogurt.
   • Get plenty of antioxidants. Antioxidants seem to help the brain (and the rest of the body) stay in better shape overall by neutralizing free radicals, damaging particles that are seen as a leading cause of cellular degeneration over time. Although antioxidants aren't strictly indicated as a treatment for depression, they do allow your brain to function more smoothly overall. Look for foods high in beta carotene, vitamin C, and vitamin E, such as carrots, squash, citrus fruit, and nuts.
   • Eat complex carbohydrates to relax. Carbohydrates have a well-known stress-reduction effect when eaten, but some carbs are better for you than others. Avoid simple carbs like sugar and milled grain; opt for brown rice, whole grains, and legumes instead.
   • Get plenty of protein. Protein in foods like turkey and fish helps boost energy and alertness levels, improving overall mood.
3. 
   3
   Get some sunshine. Your body naturally produces vitamin D, which is known to help combat depression and mood swings, when your skin is exposed to the sun. This is why some counselors prescribe sunlight lamps for depression patients who live in areas with low winter sunlight: it stimulates the same effect as going outside and standing under bright sunlight. Make a commitment to do the real thing yourself, for at least 15 or 20 minutes, whenever you have the chance.
   • If you're going to be out in the sun for more than a few minutes, take sensible precautions by applying sunscreen to your bare skin and wearing sunglasses. Your skin will still manufacture vitamin D even if you wear sunscreen.
   • You don't necessarily have to do anything while you're outside. Just find a bench and sit for a while, or take a leisurely walk around your neighborhood.

Method 2 of 3: Use Therapy and Medication

1. 
   1
   Visit a counselor. Counselors are the first line of treatment professionals in the world of mental health. They're somewhat less trained than psychiatrists and psychologists, but they still spend years in graduate school and are highly skilled and knowledgeable in treating depression and other mental illness with the power of speaking therapy. Counselors are usually cheaper to visit than psychiatrists or psychologists as well, making them a good first choice.
   • As a patient, you have the right to shop around and find a counselor who makes you feel welcome and at ease. A bad counseling experience can put you off the whole idea for years, which could deprive you of valuable therapy. Remember that not all counselors are alike; find one you like and stick with him or her.
   • Counselors will generally prompt you to speak with careful questions, and then listen to what you have to say. It can be nerve-wracking at first to open up to your counselor, but most people find it hard to stop talking after a few minutes have passed. The counselor will listen for significant ideas and phrases, and discuss them in greater detail with you to help you work out mental and emotional hangups that may be contributing to your depression.
   • The effects of counseling are gradual. Expect to attend regular sessions for at least a few months before noticing any permanent effect. Don't give up hope before you've given it time to work.
2. 
   2
   See a psychiatrist or clinical psychologist. The difference between these two professionals is in their doctorates: Psychiatrists hold a medical doctorate, while psychologists hold a Ph.D. or a Psy. D. (Doctorate in Psychology). Both are exceptionally well-trained, and both can tend to patients. Psychologists rely on psychotherapy, and cannot generally prescribe medication; psychiatrists combine therapy with medication.
   • Whichever type of professional you see, therapy sessions will be a significant part of your treatment. They may have less common psychotherapy methods that will work better for you than a counselor's standard approach; again, feel free to meet and discuss this until you find a doctor you're comfortable with.
   • As with all therapeutic treatments for depression, the typical treatments you receive from a psychologist or psychiatrist will take some time to have a lasting effect. In extreme cases, these professionals may recommend unorthodox or experimental treatments. If you've tried everything and are at the end of your rope, speak to them about such treatments.
3. 
   3
   Try antidepressant medication. Antidepressants can normally only be prescribed by a medical doctor. Psychiatrists are best qualified to prescribe them, but your regular family doctor may also have some power to judge your mental state and write you a prescription. Antidepressants comprise a wide field of many different types of drugs, all of which have some effect on your brain chemistry, which is generally seen as the source of most clinical depression. The most common types are SSRIs, SNRIs, MAOIs, and tricyclics.
   • Because there are so many different types of antidepressant, your psychiatrist may have you try a few different medications until one seems to work. Some antidepressants backfire on some people, so it's very important to stay in close contact with your practitioner and note any negative or unwelcome change in mood immediately. Usually, switching to a different class of drug will fix the problem.
   • Antidepressants take time to work, because they slowly and gently modify the brain's chemical balance. Generally speaking, it will take at least three months to see any lasting effect from an antidepressant.

Method 3 of 3: Try Uncommon Treatments

1. 
   1
   Shock your depression away with electroconvulsive therapy. Electroconvulsive therapy, or ECT, is commonly seen as a ghastly and barbaric treatment used in horror movies and soap opera plots more than anything else. The truth is, despite the treatment's checkered past, modern ECT is experiencing a recent surge in popularity as a last-ditch treatment for people with severe, major depressive disorder. The procedure is completely voluntary, and the shocks are administered under mild anesthesia so that the patient experiences no discomfort.
   • ECT treatments are not used except in extreme and recurring cases of depression. They're much safer than they were 60 years ago, but there are still risks associated with them, partly because their antidepressant effect on the brain isn't yet fully understood. If your doctor doesn't suggest ECT, it's unlikely he or she will sign off on it when you suggest it.
   • The treatment begins with a mild anesthetic, followed by several shocks delivered to the brain. The antidepressant effect is powerful and immediate; however, in most cases, more sessions are required to achieve a permanent cure. Sessions gradually get spaced farther apart, and last for a year at most (at which point they're typically administered just once per month).
   • Side effects of ECT include temporary short-term memory loss, confusion, and dizziness. However, studies have shown no long-term side effects whatsoever, including cognitive effects. Therefore, it's seen as a legitimately viable option for people who can't seem to recover from depression any other way.
2. 
   2
   Try herbal therapy if you want. Studies haven't shown any conclusive links between herbs like St. John's Wort, which is a common folk remedy for depression, and increased rates of recovery from major forms of the disease. However, comprehensive studies of its effects on mild and moderate depression aren't available yet, and many people swear by it.
   • If you buy herbal supplements, be sure to by from a reputable seller. Supplements are only very loosely patrolled by the FDA, and as such, levels of purity and quality vary wildly from manufacturer to manufacturer.
   • St. John's Wort in particular has been shown to interact negatively with clinical antidepressants. Ask your psychiatrist before taking it if you're already on a clinical drug.
   Source: http://www.wikihow.com/Image:Get-Rid-of-Depression-Step-8-Version-2.jpg

Alcohol and Depression

Alcohol and us

More than 9 out of 10 people in the United Kingdom drink alcohol. For most of us it is part of our culture and we feel comfortable with it. Moderate drinking doesn't cause many problems. However, over the last 30 years, the UK has become wealthier and alcohol has become cheaper. We are starting to drink at a younger age and then drinking more. In the UK:

• About 1 in 3 men and 1 in 6 women will develop some sort of health problem caused by alcohol
• Around 1 in 11 men and 1 in 25 women are physically dependent on alcohol.

How does alcohol affect us?

Immediate effects of

Alcohol tastes good to most adults although not, usually, to children (although drinking is starting younger). It can help you to relax, which can make it easier to talk to other people, especially if you are a bit shy. The downside is that it can make you unfit to drive, to operate machinery and affects your ability to make decisions. It also dulls your perception to a greater or less extent, depending on the amount of alcohol consumed.

If you go on drinking, your speech starts to slur, you become unsteady on your feet and may start to say things you may regret the next day.

If you drink even more, most people start to feel sleepy, sick or dizzy. You may pass out. The next day you may be unable to remember what happened while you were drinking.

Becoming dependent on alcohol

Alcohol can be a very effective way of feeling better for a few hours. If you are depressed and lacking in energy, it can be tempting to use alcohol to help you keep going and cope with life. The problem is that it is easy to slip into drinking regularly, using it like a medication.  The benefits soon wear off and the drinking becomes part of a routine. You start to notice that:

• instead of choosing to have a drink, you feel you have to have it
• you wake up with shaky hands and a feeling of nervousness
• you start to drink earlier and earlier
• your work starts to suffer
• your drinking starts to affect your relationships
• you carry on drinking in spite of the problems it causes
• you find you have to drink more and more to get the same effect (tolerance)
• you start to ‘binge drink’ (see below) regularly
• other things have less importance than alcohol.

Long-term effects

Alcohol can lead to:

• psychosis -  hearing voices when there is nobody there
• dementia - memory loss, rather like Alzheimer's dementia
• physical - damage organs, such as the liver or brain.

What is the connection between depression and alcohol?

We know that there is a connection – self-harm and suicide are much more common in people with alcohol problems. It seems that it can work in two ways:

• you regularly drink too much including (including ‘binge drinking’) which makes you feel depressed OR
• you drink to relieve anxiety or depression.

Either way:

• Alcohol affects the chemistry of the brain, increasing the risk of depression.
• Hangovers can create a cycle of waking up feeling ill, anxious, jittery and guilty.
• Life gets depressing – arguments with family or friends, trouble at work, memory and sexual problems. 

How much alcohol is too much?

Some drinks are stronger than others. The easiest way to work out how much you are drinking is to count the ‘units’ of alcohol in your drinks. 1 unit is 8 grams /10 ml of pure alcohol - the amount in a standard 25 ml measure of spirits, a half pint of 3.6% beer or lager, or a 100 ml glass of 12% wine (see table below).

If a man and woman of the same weight drink the same amount of alcohol, the woman will end up with a much higher amount in the organs of her body. So the safe limit is lower for women (14 units per week) than for men (21 units per week).

Drink Aware has further information on 'what is an alcohol unit?'

What about younger people?

Young people in the UK drink to have fun, to have the experience of losing control, to socialise more easily with others, to feel sexier – and because their friends do. Around a third of 15-16 year olds binge-drink three or more times a month - more than in most other European countries.  Alcohol seems to have the same depressant effect in younger people as it does in adults. Around a third of young suicides have drunk alcohol before their death, and increased drinking may have been to blame for rising rates of teenage male suicide.

What about older people?

As we get older, we tend to lose muscle and to put on fat. Alcohol isn't absorbed by fat, so it ends up in the non-fatty tissues of the body. So, an older person who is the same weight as a younger person will tend to have more alcohol in their vital organs (non-fatty tissues) such as brain, muscles and liver. This means that alcohol will affect an older person more.

‘Binge’ drinking

The published weekly safe limits assume that you spread your drinking out with at least 2 alcohol-free days per week. This may not be the case – you drink a lot on one night, but still remain within your ‘safe’ limit if you don’t drink for the rest of the week.  There is now evidence that even a couple of days of heavy drinking can start to kill off brain cells, as happens with people who drink continuously.

• Drinking over 8 units in a day for men, or 6 units for women is known as binge drinking.
• In any one day it is best for a man to drink no more than 3-4 units and for a woman to drink no more than 2-3 units.

Binge drinking also seems to be connected with an increased risk of early death in middle-aged men and probably depression.

Guide to units of alcohol

This table gives a rough guide to the amount of alcohol (measured in units) found in the quantities commonly seen in different drinks.

All alcohol sold in the UK above 1.2% ABV (Alcohol By Volume) should state how strong it is in percent.  The higher the percentage (%) the more alcohol it has in it. Pub measures are generally rather smaller than the amount you might have at home.  These amounts will vary according to the brand of drink and size of glass.

Beer, Cider & Alcopops	Strength ABV	Half Pint	Pint	Bottle/ can 330 ml	Bottle/ can 500ml	Bottle 1 litre
Mild strength beer, lager or cider -  Eg Draught beer, Heineken, Woodpecker	3 - 4%	1	2	1.5	2	-
Normal strength beer, lager or cider - Eg Stella, Budweiser, Kronenbourg, Strongbow	5%	1.5	3	1.7	2.5	-
Extra strong beer, lager or cider -  Eg Special Brew, Diamond White, Tennants Extra	7.5 - 9%	2.5	5	3	4.5	7.5-9
Alcopops - Eg Bacardi Breezer, Smirnoff Ice, Reef, Archers, Hooch	5%	-	-	1.7	-	-

Wine and Spirits	Strength ABV	Pub Measure	Small Wine Glass (125 ml)	Large Wine glass (250 ml)	Bottle 750 ml
Table Wines	12-14%	1.5 to 2	1.5 to 1.8	3 to 3.5	9 to 10.5
Fortified wines (sherry, martini, port)	15-20%	0.8 to 1			14
Spirits (Whisky, vodka, gin)	40%	1		-	30
Cocktails	Variable		2-5 units

How much am I drinking?

Most of us under-estimate the amount we drink – we don't usually keep an eye on it by counting units regularly. To check what is really happening, keep a diary of your alcohol intake over the course of a week. This can give you a clearer idea of how much you are drinking. It can also help to highlight any risky situations - regular times, places and people when you seem to drink more.

Diary table

Day	How much?	When	Where	Who with?	Units	TOTAL
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total for week

Warning signs

• You regularly use alcohol to cope with anger, frustration, anxiety or depression.
• You regularly use alcohol to feel confident.
• You get hangovers regularly.
• Your drinking affects your relationships with other people.
• Your drinking makes you feel disgusted, angry, or suicidal.
• You hide the amount you drink from friends and family.
• Other people tell you that, when you drink, you become gloomy, embittered or aggressive.
• You need to drink more and more to feel good.
• You stop doing other things to spend more time drinking.
• You start to feel shaky and anxious the morning after drinking the night before.
• You drink to stop these feelings.
• You start drinking earlier in the day.
•  People around/with you look embarrassed or uncomfortable.

What if I am drinking too much?

• Set yourself a target to reduce the amount of alcohol you drink.
• Avoid high-risk drinking situations (check out your diary).
• Drink lower-strength, though full-taste, drinks, like 4% beers or 10% wines.
• Work out other things you can do instead of drinking.
• Involve your partner or a friend. They can help to agree a goal and keep track of your progress.
• Talk it over with your GP. For many people this simple step helps them to cut down their drinking.
• Caution: if you are drinking heavily, do not stop suddenly ... consult your GP.

Some people can stop suddenly without any problems. Others may have withdrawal symptoms - craving, shakiness and restlessness. If this happens, ask your GP for help.

Helping depression and stopping drinking

Helping depression

We know that most depressed drinkers will start to feel better within a few weeks of cutting out alcohol. So, it is usually best to tackle the alcohol first, and then deal with the depression afterwards if it has not lifted after a few weeks.

After a few alcohol-free weeks, you will probably feel fitter and brighter in your mood.  Friends and family may find you easier to get on with. If your feelings of depression do lift, it's likely that they were caused by the drinking.

If the depression is still with you after four weeks of not drinking, talk to your GP about further help. It may be useful to talk over your feelings, particularly if your depression seems linked to some crisis in your life. Common issues are relationship problems, unemployment, divorce, bereavement or some other loss. Counselling may be helpful.

If the depression does not lift and is particularly severe, your GP may recommend a talking treatment called ‘cognitive therapy’ or suggest antidepressant medication. In either case, you will need to reduce or stay away from alcohol and go on with the treatment for several months. There are some medications used to reduce the craving for alcohol, but these don’t seem to help many people and are usually prescribed by a specialist.

Stopping drinking

If you are worried by the idea of stopping or cutting down your drinking, or if you just can’t cut down, it might help to talk with a specialist alcohol worker. Your GP can tell you about the local services - you can then refer yourself or ask your GP to refer you.

Treatments for alcohol problems and depression do help, especially if you can regularly see someone you can trust - your own doctor, a counsellor or a specialist alcohol worker or a specialist psychiatrist. Changing your habits and style of life is always a challenge and can take some time.

Dos and Don’ts of drinking safely

• Do sip your drink slowly – don’t gulp it down.
• Do space your drinks with a non-alcoholic drink in between.
• Don’t drink on an empty stomach. Have something to eat first.
• Don’t drink every day. Have two or three alcohol-free days in the week.
• Do switch to lower strength or alcohol free drinks.
• Do (for wine) avoid those ‘large’ 250 ml glasses in bars and restaurants.
• Do provide interesting non-alcoholic drinks as well as alcohol if you are having a party.
• Do ask your doctor or chemist if it is safe to drink alcohol with any medicine that you have been prescribed.
• Do check your drinking every few weeks with your drinking diary.
• Do keep to the drinking target (amount of alcohol per week) you have set yourself.
• Don't binge drink – again, check the diary.

Finding help

If you just can’t stop drinking, or can’t keep it to a safe level, you can get help from:

• your general practitioner
• voluntary agencies that specialise in alcohol problems, such as Turning Point or Addaction
• specialist treatment in the NHS - your GP who will also know how to contact specialist services
• self help groups, such as Alcoholics Anonymous or AlAnon.

References

• Davidson K.M. (1995) Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status. British Journal of Psychiatry 166: 199-204.
• The NHS Information Centre Lifestyle Statistics: Statistics on alcohol: England, 2012. The Health and Social Care Information Centre: London
• Department of Health (2012) Alcohol needs research assessment project (ANARP). The 2004 national alcohol needs assessment for England, Department of Health: London.
• Mcintosh C. & Ritson B. (2001) Treating depression in substance misuse. Advances in Psychiatric Treatment vol 7, 357-364
• Raistrick D. (1996) Management of alcohol misuse within the context of general psychiatry, Advances in Psychiatric Treatment 2:125-132
• Raistrick D, Heather N and Godfrey C (2006) Review of the effectiveness of treatment for alcohol problems. National Treatment Agency, London.
• Treating depression in alcohol misuse (2008) Drugs & Therapeutics Bulletin, 46: 11-14.

Organisations that can helpAl-Anon Family Groups UK and Eire:
Provide understanding, strength and hope to anyone whose life is, or has been, affected by someone else's drinking. It is a fellowship of relatives and friends of alcoholics who share their experience, strength and hope in order to solve their common problems.
Addaction: A specialist drug and alcohol treatment charity. Their addiction services are free and confidential.

Alcoholics Anonymous: Contact details for all English AA meetings. There is a quiz to determine whether AA is the right type of organisation for an individual, and a frequently asked question section about AA and alcoholism. http://www.alcoholics-anonymous.org.uktel/: 0845 769 7555. email: help@alcoholics-anonymous.org.uk

Alcohol Concern: National agency on alcohol misuse which works to reduce the incidence and costs of alcohol-related harm and to increase the range and quality of services available to people with alcohol-related problems.

Alcohol – know your units

Drinkline – National Alcohol Helpline Tel: 0800 917 8282: Offers help to callers worried about their drinking and support to the family and friends of people who are drinking. Advice to callers on where to get help.
NHS Choices: have information on alochol, including a unit caculator and an iphone app.
Turning Point: is a national health and social care provider, with information and advice for friends and family. Tel: 020 7481 7600 or for friends and family: tel: 020 7481 7600.
Source: http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/alcoholanddrugs/alcoholdepression.aspx