If you are among the 86 percent of American adults who have ever had a drink, chances are you’ve partaken just to relax or feel socially more at ease. Or perhaps, like so many people who feel anxious or sad, you were hoping to change your mood.

Whether you’re participating in Dry January or just recovering from holiday cheer, the start of the new year is the perfect time to take a fresh look at the role of alcohol in your life.

Alcohol is immediately rewarding — depending on how quickly you drink and how fast your blood alcohol rises — and is by turns relaxing, euphoriant and disinhibiting.

But most people don’t appreciate that while the pleasurable effects of alcohol are nearly instantaneous, the negative effects are delayed — often by several hours or even days. And that time lag makes it hard to see the connection between alcohol and its adverse effects.

A patient of mine, a man in his mid-40s whom I was treating for depression, had become inexplicably anxious and depressed with the return of insomnia after many weeks of solid improvement. I asked him about any stressors at work and home, but he insisted nothing upsetting had happened.

Then I inquired about his alcohol consumption and discovered the reason his mood was heading south. After cutting way back on his drinking at the start of treatment at my urging, he had resumed his usual habit of two to three glasses of wine at dinner as soon as he started to feel better. He didn’t tell me about it.

When I explained the alcohol had depressant effects and was the likely culprit in his relapse, he was skeptical. “It’s relaxing, doc, and helps me unwind after work,” he said. So I proposed an experiment: “Stop drinking over the weekend, and let’s see what happens to your mood on Monday.”

He was stunned — and convinced — by the results. His sleep normalized, and his mood was markedly better. It wasn’t just that he was unaware that alcohol had wrecked his mood and sleep; he was beginning to drink more each night to counter the very anxiety provoked by the previous night’s alcohol, setting up a self-sustaining cycle of depression, anxiety and drinking.

You don’t have to suffer from clinical depression or have an anxiety disorder to experience the negative effects of alcohol. They occur even with moderate levels of alcohol consumption typical of normal social drinkers who are free of any psychiatric illness.

How alcohol interferes with sleep
Ever notice how quickly you fall asleep after just a glass or two of wine — only to awaken a few hours later disturbingly alert and wired?

Alcohol has impressive sedating effects and targets the GABA receptor in the brain, which increases the activity of GABA — the brain’s major inhibitory neurotransmitter — and mediates the calming effect of alcohol. (Ambien, and benzodiazepines such as Klonopin and Ativan, also modulate the GABA receptor, but at a different site.) The problem for sleep is that alcohol is rapidly absorbed and typically cleared within two to five hours, so the sedation vanishes, leaving you hyper alert in the middle of the night.

Alcohol will put you to sleep, but it suppresses REM — or dream — sleep and arouses you later at night. This leads to poor-quality sleep and low daytime energy that you might self-medicate with caffeine, which exacerbates insomnia and demands more alcohol to fall asleep. And now you are stuck in a self-perpetuating downward spiral.

Another patient who had no clear psychiatric illness but drank liberally at night once asked whether he could get a prescription for Ambien for his insomnia. Drink less, I told him, and you’ll be sleeping through the night. He was unhappy with the advice, but pleased with the results.

Alcohol and your brain
What about the adverse effects of alcohol on everyday mood? There is strong empirical evidence that alcohol has depressant effects and, beyond a certain threshold that varies between individuals, can cause clinical depression.

Increased anxiety following a night of even moderate drinking is common, as the GABA-enhancing effect of alcohol quickly dissipates.

Did I forget to mention the potential impact of alcohol on cognition? There’s no question that heavy drinking is bad for the brain, but recent evidence suggests that even modest drinking — about four to five glasses of wine per week — is linked with slower executive function and reaction time.

A recent study of about 20,000 people found that alcohol consumption above 3.5 glasses of wine a week was associated with higher levels of iron in several brain regions and poorer performance on cognitive tests. The good news from other studies is that these cognitive effects are typically reversible after a person stops drinking.

So if you’re feeling anxious, down, tired or mentally foggy, try cutting out alcohol for a week or two. You might be pleasantly surprised.

And if you’ve already committed to Dry January, you might feel so good that you don’t want to rush back to alcohol in February. Even if you resume, you might decide to scale back your drinking now that you’ve seen for yourself some of the downsides of alcohol to your mental health.

Originally Published: https://www.washingtonpost.com/wellness/2023/01/12/how-alcohol-affects-depression-anxiety/

Richard A. Friedman is professor of clinical psychiatry and director of the Psychopharmacology Clinic at Weill Cornell Medical College.