The relationship of depression and alcoholism has given rise to a large number of studies with alcoholic patients screened for depression but only little information is available on the comparison of depressed patients with and without co-existing alcoholism, indicating similarities in symptom patterns but lower intensity of depression in alcoholic depressives. One thousand two hundred and thirty-one subjects were evaluated for inclusion in an open multicentre trial for one year long treatment with tianeptine, a new antidepressant. Patients had to fulfill DSM III criteria for major depression single episode, recurrent (without melancholia or psychotic features) or dysthymic disorder. Upon inclusion, 23% of those depressed patients also had a DSM III diagnosis of alcohol abuse or dependence. Results confirm the overall lower intensity of depression in the alcoholic-depressed subgroup with a symptom pattern corresponding more to retarded depression in the pure depression subgroup. On the contrary, alcoholic depressives had a higher rate of precipitating life-events and more social difficulties than non-alcoholic depressives. No differences were found regarding duration of the actual illness episode, medical and psychiatric history.

We compared patients with DSD or depression spectrum disease (family history positive for alcoholism or antisocial personality disorder in a first degree relative) to other depressives. DSD patients were likely to be diagnosed as having antisocial or borderline personality disorder, to be alcoholics, amphetamine abusers, or hysterics. They had more chronic depressive features, including hostility and self-pitying, bad-tempered, labile, and irritable mood, and they were nervous, worrisome, immature, overly dependent, and had tempestuous relationships. Their depressions were usually described as “reactive”, but their social outcomes were more likely to be poor.