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

  • Jules Angst
  • Alex Gamma
  • Jérôme Endrass
  • Wulf Rössler
  • Valdeta Ajdacic-Gross
  • Dominique Eich
  • Richard Herrell
  • Kathleen Ries Merikangas



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).


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.


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.


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.


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


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Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Jules Angst
    • 1
  • Alex Gamma
    • 1
  • Jérôme Endrass
    • 1
    • 4
  • Wulf Rössler
    • 1
  • Valdeta Ajdacic-Gross
    • 2
  • Dominique Eich
    • 2
  • Richard Herrell
    • 3
  • Kathleen Ries Merikangas
    • 3
  1. 1.Zurich University Psychiatric HospitalZurichSwitzerland
  2. 2.Zurich University Psychiatric Hospital, Social Psychiatry Research GroupZurichSwitzerland
  3. 3.Department of Health and Human ServicesSection on Developmental Genetic Epidemiology, Intramural Research Program, National Institute of Mental Health, National Institutes of HealthBethesdaUSA
  4. 4.Psychiatrisch-Psychologischer DienstJustizvollzug Kanton ZürichSwitzerland

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