ORIGINAL PAPER

European Archives of Psychiatry and Clinical Neuroscience

, Volume 256, Issue 7, pp 452-457

First online:

Is the association of alcohol use disorders with major depressive disorder a consequence of undiagnosed bipolar-II disorder?

  • Jules AngstAffiliated withZurich University Psychiatric Hospital Email author 
  • , Alex GammaAffiliated withZurich University Psychiatric Hospital
  • , Jérôme EndrassAffiliated withZurich University Psychiatric HospitalPsychiatrisch-Psychologischer Dienst, Justizvollzug Kanton Zürich
  • , Wulf RösslerAffiliated withZurich University Psychiatric Hospital
  • , Valdeta Ajdacic-GrossAffiliated withZurich University Psychiatric Hospital, Social Psychiatry Research Group
  • , Dominique EichAffiliated withZurich University Psychiatric Hospital, Social Psychiatry Research Group
  • , Richard HerrellAffiliated withDepartment of Health and Human Services, Section on Developmental Genetic Epidemiology, Intramural Research Program, National Institute of Mental Health, National Institutes of Health
  • , Kathleen Ries MerikangasAffiliated withDepartment of Health and Human Services, Section on Developmental Genetic Epidemiology, Intramural Research Program, National Institute of Mental Health, National Institutes of Health

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Abstract

Background

There is emerging evidence that there is a spectrum of expression of bipolar disorder. This paper uses the well-established patterns of comorbidity of mood and alcohol use disorder to test the hypothesis that application of an expanded concept of bipolar-II (BP-II) disorder might largely explain the association of alcohol use disorders (AUD) with major depressive disorder (MDD).

Method

Data from the Zurich study, a community cohort assessed over 6 waves from ages 20/21 to 40/41, were used to investigate the comorbidity between mood disorders and AUD. Systematic diagnostic criteria were used for alcohol abuse, alcohol dependence, MDD, and BP-II. In addition to DSM criteria, two increasingly broad definitions of BP-II were employed.

Results

There was substantially greater comorbidity for the BP-II compared to major depression and for alcohol dependence compared to alcohol abuse. The broadest concept of BP-II explained two thirds of all cases of comorbidity of AUD with major depressive episodes (MDE). In fact, the broader the definition of BP-II applied, the smaller was the association of AUD with MDD, up to non-significance. In the majority of cases, the onset of bipolar manifestations preceded that of drinking problems by at least 5 years.

Conclusions

The findings that the comorbidity of mood disorders with AUD was primarily attributable to BP-II rather than MDD and that bipolar symptoms usually preceded alcohol problems may encourage new approaches to prevention and treatment of AUD.

Keywords

alcohol use disorders alcohol abuse alcohol dependence bipolar II disorder major depression comorbidity