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
ORIGINAL PAPER

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  

References

  1. 1.
    Akiskal H, Bourgeois ML, Angst J, Post R, Möller HJ, Hirschfeld R (2000) Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 59:S5–S30PubMedCrossRefGoogle Scholar
  2. 2.
    Allgood-Merten B, Lewinsohn PM, Hops H (1990) Sex differences and adolescent depression. J Abnorm Psychol 99:55–63PubMedCrossRefGoogle Scholar
  3. 3.
    Angst J (1992) L’hypomanie. A propos d’une cohorte de jeunes. Encephale 18:23–29PubMedGoogle Scholar
  4. 4.
    Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, Skeppar P, Vieta E, Scott J (2005) The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 88:217–233PubMedCrossRefGoogle Scholar
  5. 5.
    Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rössler W (2003) Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 73:133–146PubMedCrossRefGoogle Scholar
  6. 6.
    Bierut LJ, Saccone NL, Price JP, Goate A, Foroud T, Edenberg H, Almasy L, Conneally PM, Crowe R, Hesselbrock V, Li TK, Nurnberger J, Porjesz B, Schuckit MA, Tischfield J, Begleiter H, Reich T (2002) Defining alcohol-related phenotypes in humans. Alcohol Res Health 26:208–213PubMedGoogle Scholar
  7. 7.
    Brady KT, Lydiard RB (1992) Bipolar affective disorder and substance abuse. J Clin Psychopharmacol 12:17S–22SPubMedGoogle Scholar
  8. 8.
    Brown ES (2005) Bipolar disorder and substance abuse. Psychiatr Clin N Am 28:415–425CrossRefGoogle Scholar
  9. 9.
    Caspari D (1999) Cannabis and schizophrenia: results of a follow-up study. Eur Arch Psychiatr Neurol Sci 249:45–49CrossRefGoogle Scholar
  10. 10.
    Chengappa KNR, Levine J, Gershon S, Kupfer DJ (2000) Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry. Bipolar Disord 2:191–195PubMedCrossRefGoogle Scholar
  11. 11.
    Derogatis LR, Cleary PA (1977) Factorial invariance across gender for the primary symptom dimensions of the SCL-90. Br J Soc Clin Psychol 16:347–356PubMedGoogle Scholar
  12. 12.
    Fogarty F, Russell JM, Newman SC, Bland RC (1994) Mania. Acta Psychiatr Scand 376:16–23Google Scholar
  13. 13.
    Geller B, Cooper TB, Sun K, Zimmerman B, Frazier J, Williams M, Heath J (1998) Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry 37:171–178PubMedCrossRefGoogle Scholar
  14. 14.
    Ghaemi N, Sachs GS, Goodwin FK (2000) What is to be done? Controversies in the diagnosis and treatment of manic-depressive illness. World J Psychiatry 1:65–74Google Scholar
  15. 15.
    Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R (2003) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71:7–16PubMedCrossRefGoogle Scholar
  16. 16.
    Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, Pickering RP, Kaplan K (2004) Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Results from the National Epidemiologic Survey on alcohol and related conditions. Arch Gen Psychiatry 61:807–816PubMedCrossRefGoogle Scholar
  17. 17.
    Hantouche EG, Akiskal HS, Lancrenon S, Allilaire J-F, Sechter D, Azorin J-M, Bourgeois M, Fraud J-P, Châtenet-Duchêne L (1998) Systematic clinical methodology for validating bipolar -II disorder: data in mid-stream from a French national multi-site study (EPIDEP). J Affect Disord 50:163–173PubMedCrossRefGoogle Scholar
  18. 18.
    Hirschfeld RMA, Williams JBW, Spitzer RL, Calabrese JR, Flynn L, Keck P, Lewis L, McElroy S, Post RM, Rapport DJ (2000) Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire. Am J Psychiatry 157:1873–1875PubMedCrossRefGoogle Scholar
  19. 19.
    Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 54:313–321PubMedGoogle Scholar
  20. 20.
    Lewinsohn PM, Klein DN, Seeley JR (2000) Bipolar disorder during adolescence and young adulthood in a community sample. Bipolar Disord 2:281–293PubMedCrossRefGoogle Scholar
  21. 21.
    Lewinsohn PM, Klein DN, Seeley JR (1995) Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 34:454–463PubMedCrossRefGoogle Scholar
  22. 22.
    Maier W, Merikangas KR (1992) Contransmission and comorbidity of affective disorders, anxiety disorders and alcoholism in families. In: Mendlewicz J, Hippius H (eds) Genetic research in psychiatry. Springer, New York, pp 210–224Google Scholar
  23. 23.
    Merikangas KR, Angst J, Eaton W, Canino G, Rubio-Stipec M, Wacker H, Wittchen HU, Andrade L, Essau C, Whitaker A, Kraemer H, Robins LN, Kupfer DJ (1996) Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. Br J Psychiatry 168:58–67Google Scholar
  24. 24.
    Merikangas KR, Stevens DE, Fenton B, Stolar M, O’Malley S, Woods SW, Risch N (1998) Co-morbidity and familial aggregation of alcoholism and anxiety disorders. Psychol Med 28:773–788PubMedCrossRefGoogle Scholar
  25. 25.
    Modestin J, Nussbaumer C, Angst K, Scheidegger P, Hell D (1997) Use of potentially abusive psychotropic substances in psychiatric inpatients. Eur Arch Psychiatry Clin Neurosci 247:146–153PubMedCrossRefGoogle Scholar
  26. 26.
    Preuss UW, Schickit MA, Smith TL, Danko GP, Buckman K, Bierut L, Bucholz KK, Hesselbrock MN, Hesselbrock VM, Reich T (2002) Comparison of 3190 alcohol-dependent individuals with and without suicide attempts. Alcohol Clin Exp Res 26:471–477PubMedCrossRefGoogle Scholar
  27. 27.
    Preuss UW, Schuckit MA, Smith TL, Danko GP, Dasher AC, Hesselbrock MN, Hesselbrock VM, Nurnberger JI (2002) A comparison of alcohol-induced and independent depression in alcoholics with histories of suicide attempts. J Stud Alcohol 63:498–502PubMedGoogle Scholar
  28. 28.
    Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK (1990) Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) study. JAMA 264:2511–2518PubMedCrossRefGoogle Scholar
  29. 29.
    Soyka M, Albus M, Immler B, Kathmann N, Hippius H (2001) Psychopathology in dual diagnosis and non-addicted schizophrenics—are there differences? Eur Arch Psychiatr Neurol Sci 251:232–238CrossRefGoogle Scholar
  30. 30.
    Winokur G, Turvey C, Akiskal H, Coryell W, Solomon D, Leon A, Mueller T, Endicott J, Maser J, Keller M (1998) Alcoholism and drug abuse in three groups—bipolar I, unipolars and their acquaintances. J Affect Disord 50:81–89PubMedCrossRefGoogle Scholar

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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