Determining whether a glass a day really will keep depression away

Determining whether a glass a day really will keep depression away

An article in Medical News Today captures readers’ attention with its title “A glass of wine a day may keep depression away” (Whiteman, 2013). This article describes how drinking red wine is not only good for physical health, but research now shows that it lowers the risk of depression (Whiteman, 2013). This appears to produce good news, however the claims are based on research with a very specific sample. This article refers to a seven-year longitudinal study analyzing over 5,500 men and women between the ages of 55 and 80 who engaged in a Mediterranean pattern of drinking (Gea et al., 2013). Mediterranean pattern drinking involves low-to-moderate consumption, of primarily wine, during meals (Garcia-Esquinas et al., 2018). The results indicate that low-to-moderate drinking, which equates to 5-15g of alcohol per day or two-to-seven glasses of wine each week, was associated with a lower risk of depression (Gea et al., 2013). The aim of this literature review is to address the questions of whether low-to-moderate consumption of alcohol does in fact decrease the risk of depression, as the title claims (Whiteman, 2013), and which factors may influence the validity of this claim. A variety of studies have shown that lifestyle, gender, degree of consumption and mental health status can all impact the generalizability of this claim (Fergusson et al., 2009; Garcia-Esquinas et al., 2018; Sarris et al., 2020; Sexton et al., 1999; Skogen et al., 2009). The Medical News Today article’s claim that “a glass of wine a day may keep depression away” (Whiteman, 2013) is context specific and limited to a subgroup of older adults who consume alcohol in a Mediterranean drinking pattern and should not be generalized to the entire population.

The study referenced in Whiteman’s article (2013) for Medical News Today had a goal of distinguishing moderate from problematic consumption’s role in unipolar depression. The researchers explained that depression and cardiovascular disease have related physiological mechanisms (Gea et al., 2013). Therefore, since moderate consumption of alcohol, particularly wine, has decreased the risk of cardiovascular disease in the past (Wollin & Jones, 2001) they looked to assess whether moderate consumption of alcohol would have the same positive results for depression (Gea et al., 2013). The results of this study indicated that individuals who consumed low-to-moderate quantities of alcohol in general or primarily wine were, 28% and 32%, respectively, less likely to develop depression compared to those who drank no alcohol at all (Gea et al., 2013). These results suggest that low-to-moderate alcohol consumption may play a protective role against depression when compared to those who did not drink any alcohol. However, it must be considered that other factors such as the participants lifestyle, gender, and existing mental health status will also influence these results.

An important factor to consider in determining whether alcohol consumption protects against depression is lifestyle (Garcia-Esquinas et al., 2018). The Medical News Today article by Whiteman (2013) is based on a study done on those living in the Mediterranean (Gea et al., 2013). A study done by Garcia-Esquinas and their colleagues (2018) analyzes the difference between the impact moderate alcohol consumption has on the mental health of those living in the Mediterranean and those living a non-Mediterranean lifestyle. The Mediterranean drinking pattern is compared to the non-Mediterranean pattern, which is typically characterized by drinking larger quantities as a way to relax (Garcias-Esquinas et al., 2018). This study analyzed 1,821 individuals and the results contradicted the claims in the Medical News Today article. This study found no significant relationship between moderate consumption and depression (Garcia-Esquinas et al., 2018). The study states that this contradiction may be due to the living situations of the participants in their study compared to that of the participants in the study conducted by Gea and their colleagues (2013). The participants in the latter study were primary-care patients (2013). The primary care patients were part of a rigorous health program (Gea et al., 2013). This implies they were strictly adhering to the Mediterranean drinking pattern as well as a healthier diet which led to more moderate consumption and resulted in lower levels of depression that were statistically significant (Garcia-Esquinas et al., 2018). A healthier diet and lifestyle will reduce the risk of cardiovascular disease and other chronic diseases and disorders as well, which could themselves act as risk factors for depression (Garcia-Esquinas et al., 2018). Therefore, by having a healthier diet the individuals in Gea’s study (2013) reduced the likelihood of various risk factors for depression. Because the protective effect of alcohol was only found for those who strictly adhered to a Mediterranean drinking pattern together with a healthy lifestyle (Garcias-Esquinas et al., 2018), it implies that Whiteman’s claim may only apply to those individuals who are consistent in following a healthy lifestyle and Mediterranean pattern of drinking.

The amount of alcohol consumed also influences the degree to which it protects againstdepression (Gea et al., 2013). The study referred to in the Medical News Today article (Whiteman, 2013) assesses low-to-moderate alcohol consumption (Gea et al., 2013), which is consistent with the Mediterranean drinking pattern (Garcia-Esquinas et al., 2018). There is a study that directly supports Whiteman’s claim. The study consisting of 38,930 participants found supporting evidence that low-to-moderate drinking patterns have a positive correlation with lower risk of developing anxiety and depression (Skogen et al., 2009). However, there are also studies that contradict this claim. One such study describes that while they did find that moderate consumption of wine is associated with improved cognitive performance, there is no direct link to decreased risk of depression (Cassidy et al., 2004). The improved cognition is perhaps due to high levels of antioxidants in the wine and increased rates of acetylcholine released into the hippocampus, which aids in memory, but that has no protective effect on mood (Cassidy et al., 2004). Another contradictory study based on 1,055 participants found evidence that supports the idea that alcohol use may in fact increase the risk of depression (Fergusson et al., 2009). The difference between the Fergusson study and the study conducted by Gea and colleagues (2013) is that the Fergusson study analyzed the relationship between alcohol abuse and depression (Fergusson et al., 2009) while Gea (2013) was assessing low-to-moderate consumption. It is possible that increased consumption leads to increased risk of depression compared to moderate consumption because an increased exposure may cause metabolic changes that can raise the risk of major depressive disorder (Boden & Fergusson, 2011). This supports the idea that the quantity of alcohol consumed is an important factor in mitigating depression. As the Medical News Today article suggests (Whiteman, 2013), consumption should not exceed a single glass a day otherwise the alcohol does not play a protective role against depression.

Another factor that influences whether alcohol consumption lowers the risk of depression is gender. A study that contradicts the Medical News Today article (Whiteman, 2013) and the study it refers to (Gea et al., 2013) found that although moderate consumption of alcohol decreases risk of depression in women, it actually predicts the presence of depression in men (Sexton et al., 1999). To further support this contradiction, a 10-year longitudinal study of over 13,600 individuals provided evidence that females who drank moderately were less likely to report depressive symptoms than those who drank no alcohol at all (Gea et al., 2012). However, this was not the case for men. The results of these studies (Gea et al., 2012; Sexton et al., 1999) indicate that not only does the quantity of alcohol consumed play a role in whether drinking protects against depression, but gender is an important factor to consider as well.

The final factor to consider when assessing the validity of the claim in the Medical News Today article is the current mental health status of the individual consuming alcohol. It is important to note that the participants in the study Whiteman (2013) refers to did not have any diagnosis of depression or substance use disorder at the time the study began (Gea et al, 2013). Given that unipolar depression is the most common mental illness in the world (Gea et al., 2013),many individuals will not factor into the claims described by Whiteman (2013). Whereas Gea and their colleagues claim that low-to-moderate drinking decreases risk of depression in healthy individuals, a different study contradicts this claim. Sarris and colleagues (2020) state that heavy alcohol consumption will decrease the risk of depressive episodes in those who are previously diagnosed with major depressive disorder. This differs from the study Whiteman refers to that states that heavy drinking may increase the risk of depression (Gea et al., 2013 as cited in Whiteman, 2013). This indicates that the validity of the claim in the news article may depend on whether the individual consuming alcohol has previously been diagnosed with depression.

The Medical News Today article’s claim that “a glass of wine a day may keep depression away” (Whiteman, 2013) is shown to be context specific and limited to a subgroup of older adults who consume alcohol in a Mediterranean drinking pattern and should not be generalized to the entire population. While the article in Medical News Today is not wrong for claiming in its title that “a glass of wine a day may keep depression away” (Whiteman, 2013), the word ‘may’ is critical. The evidence shows that low-to-moderate consumption does lead to a decreased risk of depression but only for a small subgroup of individuals, namely older adults who adhere to a strict Mediterranean consumption pattern and are generally in good health. The literature provides evidence that factors such as quantity consumed, lifestyle, gender, and current state of mental health diminish the validity of the article’s catchy title. Drinking a glass a day does not protect everyone from depression and most individuals should drink responsibly to mitigate the impact that alcohol can have on their mental health.

References

Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction (Abingdon, England), 106(5), 906–914.

Cassidy, K., Kotynia‐English, R., Acres, J., Flicker, L., Lautenschlager, N. T., & Almeida, O. P. (2004). Association between lifestyle factors and mental health measures among community-dwelling older women. Australian and New Zealand Journal of Psychiatry, 38(11), 940–947.66: 260-266.

Fergusson D, Boden J, Horwood L (2009) Test of causal links between alcohol abuse or dependence and major depression. Arch Gen Psychiatry, 66, 260-266

García-Esquinas, E., Ortolá, R., Galán, I., Soler-Vila, H., Laclaustra, M., & Rodríguez-Artalejo, F. (2018). Moderate alcohol drinking is not associated with risk of depression in older adults. Scientific Reports, 8(1), 11512–11510.

Gea, A., Beunza, J, Estruch, R., Sánchez-Villegas, A., Salas-Salvadó, J., Buil-Cosiales, P., Gómez-Gracia, E., Covas, M.-I., Corella, D., Fiol, M., Arós, F., Lapetra, J., Lamuela-Raventós, R.-M., Wärnberg, J., Pintó, X., Serra-Majem, L., Martínez-González, M (2013). Alcohol intake, wine consumption and the development of depression: the PREDIMED study. BMC Medicine, 11(1), 192–192.

Gea A, et al. A longitudinal assessment of alcohol intake and incident depression: the SUN project. BMC Public Health. 2012;12:954. doi: 10.1186/1471-2458-12-954. Sarris, J., Thomson, R., Hargraves, F., Eaton, M., de Manincor, M., Veronese, N., Solmi, M., Stubbs, B., Yung, A. R., & Firth, J. (2020). Multiple lifestyle factors and depressed mood: a cross-sectional and longitudinal analysis of the UK Biobank (N = 84,860). BMC Medicine, 18(1), 354–354.

Sexton, H., Lipton, R. I., & Nilssen, O. (1999). Relating alcohol use and mood: results from the Tromsø study. Journal of studies on alcohol, 60(1), 111–119. https://doi.org/10.15288/jsa.1999.60.111

Skogen JC, Harvey SB, Henderson M, Stordal E, Mykletun A. Anxiety and depression among abstainers and low-level alcohol consumers. The Nord-Trondelag Health Study. Addiction. 2009;104:1519–1529. doi: 10.1111/j.1360-0443.2009.02659.x.

Whiteman, H. (2013). A glass of wine a day may keep depression away. Medical News Today. https://www.medicalnewstoday.com/articles/265401

Wollin SD, Jones PJ: Alcohol, red wine and cardiovascular disease. J Nutr. 2001, 131: 1401-1404.