What approaches have you found most helpful for concurrent severe major depressive disorder and alcohol use disorder? 

I'm a strong believer in AA for alcoholics, to address the addiction and also the depression, as the social support offered there can be very helpful. A person agreeing to "work the steps" with a sponsor has more in-depth character restructuring and available support than most therapists can provide...

I hate to sound flippant, but always the most helpful intervention is to listen, understand, and engage motivationally. We aren't going to be able to help if we don't deeply understand. We don't want to treat a PHQ-9 score or a response on an AUDIT-C. Try to understand the story of how depression be...

Depending upon what’s been tried already, I found TMS to be extremely helpful, i.e., greater than 75% of the time. It certainly addresses the severe major depressive diagnosis, but also has an improved effect on a patient’s desire to imbibe in addiction-type behavior. Also, having a good psychiatris...

The question doesn't address whether the depression is refractory or the patient is suicidal, so taking the question at face value, I would say that it would be important to treat the depression with antidepressants (explaining to the patient the danger of excessive alcohol and antidepressant use an...

Starting natrexone even after a first visit can help engage people in treatment for their other conditions. AA is not sufficient or for everyone, despite its many benefits. Women in particular may find both the structure and the principle of "let go, let God" disempowering. Using medication to convi...

As a psychiatrist & psychoanalyst, I have found that even someone attending AA, taking an SSRI, and seemingly participating in therapy enthusiastically...you can guess the rest is prevaricating about their drinking & only discovers when some disaster occurs! Maybe that's just the way it must first g...