Sharper picture of major depression and alcohol disorders

that may underlie both conditions."

The NESARC results demonstrate a strong relationship of MDD to substance dependence and a weak relationship to substance abuse, a finding that suggests focusing on dependence when studying the relationship of depression to substance use disorders. This research direction is supported by earlier genetic studies that identified factors common to MDD and alcohol dependence and at least one epidemiologic study that demonstrated excess MDD among long-abstinent former alcoholics, state the authors.

Coexisting substance dependence disorder and MDD predict poor outcome among clinic patients. A decade ago, many treatment leaders discouraged treating MDD in patients with substance dependence on the grounds that arresting substance dependence was the more immediate need and that its resolution well might also resolve MDD. Results from foregoing epidemiologic surveys and several clinical trials over time altered that picture, so that treating both disorders simultaneously is today common practice.

The NESARC also found strong relationships between MDD and anxiety disorders, with the strongest comorbidity for current diagnoses. In addition, MDD was strongly associated with personality disorders, but the magnitude of the association varied considerably among discrete personality disorder types. "Given the seriousness of MDD, the importance of information on its prevalence, demographic correlates, and psychiatric comorbidity cannot be overstated," note the authors. "This study provides the grounds for further investigation in a number of areas."

The Epidemiology of Major Depressive Disorder by principal investigator Bridget F. Grant, Ph.D., Chief, Laboratory of Epidemiology and Biometry, NIAAA, in collaboration with Deborah S. Hasin, Ph.D., of Columbia University and New York State Psychiatric Institute and their coauthors is available online to journalists at www.jamamedia.org

Contact: Ann Bradley
NIH/National Institute on Alcohol Abuse and Alcoholism

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