TORONTO - Severe depression and binge drinking are more likely to go hand-in-hand among women than men, a Canadian study has found, suggesting that a more gender-specific approach may be needed in diagnosing and treating this common mental illness.
"If you're treating a person for depression, especially if it's a woman who's suffering from major depression, it would be a good idea to look at their drinking pattern -- and especially looking at how much they drink per occasion,'' said lead author Kathryn Graham, a senior scientist for the Centre for Addiction and Mental Health.
"I think men are more likely to be asked about their drinking than women are by physicians, so this would be a particular trigger to at least caution them (women) about not drinking too much per occasion.''
Graham, an adjunct professor of psychology at the University of Western Ontario, said the 14-month study found that a pattern of frequent but low-quantity drinking was not associated with depression. "In fact, those who usually drink less than two drinks per occasion and never drink as much as five drinks are less depressed . . . than former drinkers.''
"With drinking, what you find is that for frequency (how often) there's no relationship with depression; for volume (the number of drinks), there's a modest relationship,'' Graham said from London, Ont.
"Where the relationship is much larger is how much you drink per occasion and especially if you drink a lot per occasion. That's what they mean by binge drinking.''
The study, published in the January issue of the journal Alcoholism: Clinical and Experimental Research, involved lengthy telephone surveys of more than 6,000 men and 8,000 women aged 18 to 76, randomly chosen from across Canada between January 2004 and March 2005.
Participants were asked about their behaviour in the previous year and in the week before the study: how often they drank alcohol; how much they drank per occasion; how often they downed five drinks or more; and what their maximum number of drinks was at any one time.
The researchers also asked respondents about episodes of depression during the previous year and in the week prior to the survey: whether they had experienced recent periods of "the blues'' or suffered serious bouts that lasted a minimum of two weeks.
Analysis showed that the overall relationship between depression and alcohol consumption is stronger for women than for men -- but only when the person's symptoms correspond to a clinical diagnosis of major depression. "It has to have enduring feeling and a big impact,'' Graham said.
No gender difference was found when respondents identified having "recent depressed feelings,'' a measure commonly used in research on this topic.
Prof. Sharon Wilsnack of the University of North Dakota School of Medicine and Health Sciences called the research "an important study'' because it looks at the link between depression and alcohol use separately for women and men.
"It is clear from the study's results that it is a mistake to analyze relationships between depression and alcohol consumption without specifying which manifestations of depression are linked to which drinking patterns,'' Wilsnack said in a statement.
"This pattern of associations is more consistent with women using alcohol to counteract depression -- by high-quantity drinking and intoxication -- than with chronic alcohol consumption tending to make women depressed,'' said Wilsnack. "However, a vicious circle could possibly begin with drinking in response to depression.''
No study has been able to tease out a definite cause-and-effect relationship between depression and alcohol, Graham said. "We don't know if you're depressed because you drink too much or you drink too much because you're depressed.''
Still, some link does seem to exist: It's known that among people treated for alcohol problems, the rate of depression goes down when they abstain from drinking and conversely, feelings of depression can occur when someone has a hangover, she said.
"For sure drinking four or five drinks or more on an occasion is not going to help depression and it may actually be contributing to depression,'' particularly in women, Graham speculated. "That would be a drinking pattern that should be avoided.''
