Hospitalisation is key in the treatment and rehabilitation of many patients suffering major depression and substance-use disorder
Up to a third of patients suffer from depression and substance-use disorder simultaneously. A quarter of people diagnosed with major depression are shown to have a substance-use disorder, most commonly alcohol abuse or dependence, while one third of patients suffering alcohol dependence have a co-morbid major depression.
According to Brisbane Private Hospital psychiatrist David Storor, the role of inpatient detox and rehabilitation is crucial to the treatment of depression and Alcohol Use Disorder (AUD), aiding greatly in determining which is the primary condition needing treatment.
"Major depression and alcohol abuse and dependence are common disorders that frequently co-occur. However, it is important to attempt to establish a chronology because this has significant bearing on treatment," he said. "Inpatient detox and rehabilitation within a hospital setting provides a good opportunity to better evaluate the relationship between the depression and the alcohol excess and safely initiate appropriate treatment."
Dr Storor said given the relative frequent occurrence of these problems in society, it is not surprising that many patients present with depression and a co-morbid alcohol disorder. At Brisbane Private Hospital's alcohol and prescription drug unit, Damascus, patients are cared for by a multi-disciplinary team including psychiatrists and allied health professionals as well as physicians and gastroenterologists who can provide assessment and management of poor physical health in relation to drinking.
Dr Storor said the majority of patients at Damascus present with a primary AUD with psychiatric co-morbidity - the most common being depression, and the first step is abstinence. "After a detox period of about four to five days, the patients enter a two week, group based rehabilitation program facilitated by allied health professionals, which focuses on motivational interviewing, relapse prevention, life skills treatment strategies, cognitive behaviour therapy and mindfulness strategies," he said.
"Post-discharge, patients are seen for day patient sessions on a weekly to fortnightly basis for a period of several months. This gives the psychiatrist an opportunity to review the patient regularly and monitor treatment and medication for both the alcohol problem and depression." Dr Storor said as with the majority of psychiatric disorders, treatment is focused on three areas: biological, psychological and social.
"Social interventions focus on the family, the workplace and lifestyle factors," he said. "The main stay of psychological treatment of patients with depression and an AUD is formulating a plan for relapse prevention. Taking the alcohol out of a dependant's life creates a vacuum which must be filled with more healthy and adaptive behaviours."
The biological treatment of depression in the setting of alcohol excess is not straight forward as it is difficult to establish whether someone has had an effective trial of an antidepressant if they continue to drink to excess - this is why our first step at Damascus is detox.