Letters to the Editor
Alcoholism, Seasonal Depression, and Suicidal Behaviour
Dear Editor:
Several studies in different countries have reported a high prevalence of alcohol-use disorders among people who commit suicide (for example, 56% in New York [1] and 43% in Northern Ireland [2]). Such figures far exceed the prevalence of alcohol-use disorders in the general population (3,4). Because comorbid alcoholism and depression are associated with increased suicidality (5), global suicide prevention strategies should include a focus on alcohol-use disorders that aggressively treats comorbid depression (3).
Seasonal affective disorder (SAD), a condition wherein depressions in fall and winter alternate with periods of no depression in the spring and summer, is one of the most treatable causes of suicidal behaviour. Further, recent data suggest that seasonal depression is closely related to alcoholism (6,7), and some patients with alcoholism have a seasonal pattern to their alcohol abuse. These patients may be self-medicating SAD with alcohol. Family studies also suggest a relation between alcoholism and SAD (7,8). It has been proposed that if some patients with alcoholism attempt to self-medicate SAD with alcohol, or if SAD predisposes this population to alcohol relapse, then treatment of SAD with light therapy may help to prevent alcohol relapse (7). Although suicidal ideation occurs less frequently in patients with SAD than in those with nonseasonal depression (9), suicidal ideas are nonetheless commonly found in this population (9). SAD can be effectively treated with light therapy that relieves suicidal ideation, consistent with overall clinical improvement. Thus, light therapy for patients with SAD might both decrease suicidal ideation and prevent relapse into alcoholism. Worsening suicidal ideation is uncommon in patients treated with morning light therapy. However, clinicians should always be vigilant for symptoms of suicidality. In addition, pharmacologic and psychological treatments can help SAD patients who abuse alcohol. Contemporary treatment may prevent suicidal behaviour in patients with comorbid SAD and alcoholism.
References
1. Conwell Y, Duberstein PR, Cox C, Herrman JH, Forbes NT, Caine ED. Relationship of age and axis I diagnosis in victims of completed suicide: a psychological autopsy study. Am J Psychiatry 1996;153:1001–8.
2. Foster T, Gillespie K, McClelland R. Mental disorders and suicide in Northern Ireland. Br J Psychiatry 1997;170:447–52.
3. Foster T. Dying for a drink. Global suicide prevention should focus more on alcohol use disorders. BMJ 2001;323:817–8.
4. Schuckit MA. Alcohol-related disorders. In: Sadock BJ, Sadock VA, editors. Kaplan and Sadock’s comprehensive textbook of psychiatry. Volume 1. Philadelphia: Lippincott Williams and Wilkins; 2000. p 953–71.
5. Cornelius JR, Salloum IM, Mezzich J, Cornelius MD, Fabrega H Jr, Ehler JG, Thase ME, Mann JJ. Disproportionate suicidality in patients with comorbid major depression and alcoholism. Am J Psychiatry 1995;152:358–64.
6. Sher L. Relationships between seasonality and alcohol use: a genetic hypothesis. Med Hypotheses 2002; 59:85–8.
7. Avery DH, Bolte MA, Ries R. Dawn simulation treatment of abstinent alcoholics with winter depression. J Clin Psychiatry 1998;59:36–42.
8. Allen JM, Lam RW, Remick RA, Sadovnick AD. Depressive symptoms and family history in seasonal and nonseasonal mood disorders. Am J Psychiatry 1993;150:443–8.
9. Lam RW, Tam EM, Shiah IS, Yatham LN, Zis AP. Effects of light therapy on suicidal ideation in patients with winter depression. J Clin Psychiatry 2000;61:30–2.
Leo Sher, MD
New York, New York
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