A 55-year-old woman complains of inability to sleep through the night, although she falls off to sleep relatively easily. You note that you have seen her for several falls at home leading to contusions, and on one occasion for a laceration of the scalp requiring sutures in repair. She admits that she has lost the ability to enjoy occasions that, in the past, were fulfilling to her. You notice vascular ectasias about the face and upper trunk anteriorly. Laboratory studies show elevated serum glutamic pyruvate transaminase and gamma-glutamyl transpeptidase levels. You suspect she is alcoholic and
also that she is depressed. Which of the following is the wisest strategic approach to this patient?
(A) Because she is female, the chances of her being both depressed and alcoholic are slight. Therefore, you should choose one or the other and treat accordingly.
(B) Alcoholic depressed patients fail at abstinence unless the depression is treated first.
© The alcoholism should be arrested before the depression is treated.
(D) Suicide is of low probability because patients with the two diagnoses are less likely to attempt suicide.
(E) Antidepressants are to be avoided in alcoholics,even if their depression persists after months of abstinence.
The answer is C. Alcoholism should be treated first if the two diagnoses exist, if one assumes that the suicide risk is assessed and accounted for. In many cases, the depression will abate after the patient has abstained from alcohol for a significant period. However, the depression is also treated if it persists after 1 month of alcohol abstinence. When the two diagnoses coexist, there is an increase in the incidence of attempted and successful suicides.Both alcoholic men and women have an increased incidence of depression.