Alcohol has an identity problem. It often makes drinkers feel more outgoing and upbeat, at least initially. Yet, as a drug, it’s classified as a depressant. Alcohol and depression, therefore, have a complicated relationship. And a dangerous one.

The link between alcohol and depression is not healthful. According to an article published in Mental Health and Substance Use, individuals with an alcohol use disorder, or AUD, are up to three times more likely to suffer from an anxiety disorder, and nearly four times more likely to suffer a major depressive episode than those without AUD. A study in the American Journal of Psychiatry found that depressed alcoholics were 59 percent more likely to commit suicide than nonalcoholic depressed patients.

In addition, having a mental illness makes treating substance dependence much more difficult. “The dilemma for those with depression is that a drug that produces a transient elevation of mood may make the person think, ‘this is helpful,'” says Dr. Eric C. Strain, director of the Center for Substance Abuse Treatment and Research and professor of psychiatry and behavioral sciences at Johns Hopkins University. “But the risk is that they will develop physical and [psychological] dependence, and over time, the pleasurable effects diminish.”

The bottom line, says Strain: “It’s a bad idea to drink when you’re depressed.”

[See: Am I Just Sad — or Actually Depressed?]

A Causal Relationship

There may even be a genetic or biological factor involved. “Anxiety, depression and drinking seem to go hand in hand,” says William Pollack, associate professor of psychology in the department of psychiatry at Harvard Medical School. “There is a kind of axis along which anxiety and depression fit, and there is a co-occurrence with alcoholism.”

According to a study published in Addiction, individuals dealing with either depression or alcohol use disorder are two times as likely to develop the other. The study concluded that this risk is more than just coincidental; there seems to be “a causal linkage between alcohol use disorders and major depression, such that increasing involvement with alcohol increases risk of depression,” it states. “Potential mechanisms underlying these causal linkages include neurophysiological and metabolic changes resulting from exposure to alcohol.”

Another study, published in Current Psychiatry Reports, finds that when a patient is both depressed and experiencing AUD, treatment outcomes are worse than when each occurs individually. Part of that is undoubtedly because alcohol can impair the effectiveness of some antidepressant medications and cause other problems. The Mayo Clinic lists several reasons why mixing alcohol and antidepressants is a bad idea:

— It can increase feelings of depression or anxiety, making symptoms more difficult to treat.

— It can worsen side effects.

— A class of antidepressant called monoamine oxidase inhibitors, or MAOIs, when combined with certain types of alcohol (and food), can cause a dangerous rise in blood pressure.

— Combining antidepressants and alcohol may impair physical coordination, judgment and reaction time, which can make driving or other activities more dangerous.

— Some antidepressants cause drowsiness, as does alcohol. When combined, they can cause extreme sleepiness, which can also be dangerous when driving or working.

— Patients may stop taking antidepressants or other medications in order to drink. That can make depression worse.

[See: Coping With Depression at Work.]

Other Drugs Can Also Cause Depression

Alcohol isn’t the only drug that can hamper effective treatment for depression. Some medications, in fact, may actually cause depression. The authors of a study in the journal Psychiatry wrote that, “Drug-induced depression is a significant clinical, medicolegal, and public health problem.” They found that the drugs isotretinoin (used to treat severe acne) , alpha-interferons (cancer and other conditions), corticosteroids, varenicline (the smoking-cessation drug Chantix), progesterone inserts, and finasteride (for both prostate enlargement and hair loss) appear to carry the highest risk of inducing depression.

But other medications may also pose a threat. “If someone is depressed and taking other prescription medications, you should be aware that some meds can alter mood one way or another,” Strain says. He adds that people can also have “idiosyncratic reactions” to prescription drugs that others might not. “If you find a medication has made your mood go down or made you feel very happy or more energetic, it is wise to go back to your physician and tell him about this reaction,” he says.

He also wonders if the current opioid epidemic is somehow related to depression. “I always worry if abusable drugs may be more abusable if you are depressed,” he says. “I worry that prescription opiates can make people transiently feel pleasurable and that morphs into abusing the meds.”

[See: 7 Health Risks of Binge Drinking You Can’t Ignore.]

Alcohol is the more common problem, however. Can someone with depression safely have even the occasional cocktail or glass of wine with dinner? It’s certainly possible — but not advisable. “If you have a rough day and want a drink, that is understandable, but you need to be careful,” Strain says. “Alcoholics say there is always a reason to drink. When something bad happens, you need a drink, and when something good happens, you celebrate with a drink as well. There are healthier ways to cope with a low mood than having a drink. The value of alcohol is minimal in general. Even if you are only mildly depressed, I would be very cautious.”

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Alcohol and Depression: a Risky Combination originally appeared on usnews.com