In our Ask a Clinician series, FOLX Copywriter Adryan Corcione (they/them) dives into commonly asked questions from our community and beyond related to virtual healthcare topics and much more especially as they relate to the queer and transgender communities. Disclaimer: any information in this column is purely educational and is not to be used as medical advice.
For the fourth installment, they interviewed FOLX clinician Jess Schwab (she/they), DNP drawing upon their experience serving transgender, nonbinary, and other gender nonconforming patients providing gender affirming care. We discussed how alcohol impacts mental health, particularly depression. This article was clinically reviewed by fellow FOLX clinician Kaity Stewart, CNM PMHNP-BC.
What is depression?
Depression is a mood disorder with symptoms including deep sadness, loss of interest in activities, sleep difficulties, weight changes, fatigue/low energy, difficulty with concentration, feelings of worthlessness, and thoughts of self harm. It’s a multidimensional medical condition that can be impacted by family history, socioeconomic factors, and other medical conditions. Depression, substance use, and other mental health conditions can also impact your physical health, including your central nervous system.
Does alcohol make depression worse?
Unhealthy alcohol use is a spectrum of alcohol use ranging from “risky use” to alcohol use disorder (AUD). Alcohol use disorder is a diagnosis that a medical professional makes when someone’s alcohol use meets a specific, defined criteria. Data from the third National Epidemiologic Survey on Alcohol and Related Conditions showed 14 percent of adults currently met the criteria for AUD; additionally, nearly 3 in 10 adults met the criteria for alcohol use in an unhealthy/risky manner. Any amount of alcohol use that causes physical, emotional, and/or interpersonal consequences or distress can be defined as risky use.
Unhealthy alcohol use has many medical, social, psychiatric, and behavioral consequences. Depression is both a risk factor and side effect of unhealthy alcohol use. One 2019 study found that risky drinking was associated with a higher risk for depression than non-risky alcohol consumption. It makes sense that those struggling with depression may be more likely to use alcohol as a means of coping. However, there is also evidence that the use of alcohol can cause/worsen depression because alcohol actually has depressant effects on the nervous system.
Additionally, it’s important to note that the LGBTQ+ community has higher rates of alcohol abuse (as well as substance abuse overall) compared to our cisheterosexual counterparts. According to a 2020 study analyzing results from the U.S. Transgender Survey, transgender people report having higher rates of alcohol use disorder to cope with anti-trans discrimination.
How does drinking alcohol cause or worsen depression?
There are a few factors to consider when it comes to the effects of alcohol on mental and emotional health.
Many people turn to drinking to self-medicate and help manage symptoms of depression, not realizing that this coping mechanism can worsen depression. This is because alcohol alters the levels of brain chemicals (neurotransmitters) that impact our feelings and behavior. Two of the neurotransmitters involved in both alcohol use and depression are dopamine and serotonin. Dopamine is involved in the brain’s reward system and serotonin helps to balance mood. For this reason, alcohol can make people temporarily feel better or less inhibited, but continued use can cause the brain to decrease its production of these chemicals, leaving a person feeling lower than their normal baseline and craving alcohol to return to a more tolerable mood.
Treatment of alcohol use disorder can significantly improve depressive symptoms. One study followed 120 people before and after attending a detox and rehab program for alcohol use. At the beginning of the study 63.8 percent of participants met the clinical criteria for depression. Six months after leaving detox, only 30.2 percent of participants met the criteria for depression.
There is also evidence that alcohol consumption can cause increased levels of neuroinflammation. Inflammation is a natural immune response within the brain and body, but can be over-activated by alcohol and lead to changes in mood and behavior.
Additionally, let’s discuss the gut-brain connection and brain chemistry. Alcohol consumption can alter the balance of healthy and unhealthy microbes in your gut. There is a growing base of research that shows that changes in the gut microbiome are associated with depression, anxiety, and alcohol craving among other psychiatric disorders. Essentially, an unbalanced gut can lead to a decline in your well-being. Alcohol use impairs the intestinal barrier and causes changes in the lining of the gut. This can cause changes in the way your body processes nutrients and lead to a shortage of certain important nutrients. One of these important nutrients is called thiamine. Thiamine is important for helping turn food into energy and maintaining a healthy nervous system. Low levels of thiamine can lead to fatigue, irritability, problems with memory and concentrations, sleep problems, loss of appetite and weight loss. Severe alcohol use and long term low vitamin B1 can lead to major nerve, brain, and heart disease.
What do I do if alcohol makes my depression worse?
First, practice self compassion and go easy on yourself. Being a human is hard and none of us come into this world with all the tools we need to navigate the day to day realities of life. It takes a lot of courage to be honest with yourself about your feelings and the ways you’ve been managing those feelings. Substance use and alcohol overuse has had a lot of social stigma attached to it as well. Being honest about your use of substances with a kind and compassionate heart is a great start to being ready to address this use going forward.
If you’re experiencing feelings of depression, know you’re not alone. There are resources available to you. We first recommend you seek out support from a licensed behavioral health professional for support with major depression or any other mental health condition you’re seeking support for. There are also specific treatment programs to help you stop drinking alcohol (that can also address withdrawal symptoms and other associated health problems) if that’s something you’re interested in pursuing. Engaging in social contacts that support your cutting back or avoidance of alcohol is also powerful. Exercise is actually a great way to counteract both the effects of alcohol and can be a healthier substitute as exercise increases endorphins and other positive healthy brain chemicals.
Depression treatment can look different for different people. If you have access to a trusted healthcare professional, reaching out to them is a great way to begin managing depression and alcohol use. They may refer you to therapy—such as cognitive behavioral therapy—and/or psychiatry. There are also many psychiatric medications like antidepressants available that can help manage depression as well as medications that can decrease alcohol cravings. We also recommend speaking to a loved one (such as a friend, family, or community member) and sharing your feelings with them.
Lastly, there are a variety of support groups for those who struggle with alcohol and other drugs. Some of them promote sobriety while others have a harm reduction approach. Many of these groups are free to attend.
Anything else you’d like to add?
So many members of our community, including myself, have had harmful experiences with healthcare providers when seeking care for vulnerable issues. On top of that, the cultural stigma of mental health challenges including depression and all substance use, along with a lack of accessibility to LGBTQIA+ supportive health resources can create feelings of shame and depression within anyone who is struggling. These factors can make it really hard to reach out for help. Please know that everyone here at FOLX genuinely wants to help you in a supportive and non-judgemental way.
FOLX is launching a behavioral health pilot in early 2023. Sign up for the latest updates on our upcoming behavioral health pilot program here. Additionally, if you’re an existing FOLX member, our clinicians are here to support you and are happy to hear from you via the Athena Patient Portal. Please reach out to us! If you need help finding recovery resources in your area, email email@example.com to be connected with our member referral network.
If you need to speak with someone immediately about what you're experiencing or are experiencing thoughts of self harm, you can contact the Trans LifeLine. If you are experiencing an active mental health crisis, call 911.