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Am J Psychiatry 1997; 154:948-957
Copyright © 1997 by American Psychiatric Association
Comparison of induced and independent major depressive disorders in 2,945 alcoholics
MA Schuckit, JE Tipp, M Bergman, W Reich, VM Hesselbrock and TL Smith
Department of Psychiatry, University of California, San Diego, USA.
OBJECTIVE: Depressive episodes among alcohol-dependent men and women are
heterogeneous in causation and clinical course. This study tested three
hypotheses regarding the rates and clinical characteristics of two
potential subtypes of these affective states: those that appear to be
substance-induced mood disorders and those that are independent major
depressive episodes. METHOD: Semistructured, detailed interviews were
administered to 2,945 alcohol-dependent subjects as part of the
Collaborative Study on the Genetics of Alcoholism. With the use of a time
line method for determining the type of mood disorder among probands,
relatives, and comparison subjects, individuals with histories of the two
types of mood disorders were compared. RESULTS: Major depressive episodes
with an onset before the development of alcohol dependence or during a
subsequent long abstinence period (i.e., independent depressions) were
observed in 15.2% of the alcoholics, while 26.4% reported at least one
substance-induced depressive episode. According to a logistic regression
analysis, the subjects with independent (as compared to substance-induced)
major depressive episodes were more likely to be married, Caucasian, and
female, to have had experience with fewer drugs and less treatment for
alcoholism, to have attempted suicide, and, on the basis of personal
interviews with family members, to have a close relative with a major mood
disorder. CONCLUSIONS: These results support the contention that it is
possible to differentiate between what appear to be substance-induced and
independent depressive episodes in alcoholics. Such differentiation might
be important for establishing prognosis and optimal treatment.
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