Beyond the Winokur concept of depression spectrum disease: which types of alcoholism are related to primary affective illness?

Background: This study explored the familial relationship between alcoholism and depression. The familial prevalence of major depression and alcoholism among alcoholic probands and controls was examined. Method: Alcoholic patients were classified on the basis of absence or presence of major depression preceding or following alcohol dependence. Research Diagnosis Criteria (RDC) family history method was performed on 62 males and 49 females with alcohol dependence, on 50 healthy controls and on first degree relatives from all subjects. Results: Female alcoholics had most commonly primary depression (74%) and alcoholic men had predominantly pure alcoholism (55%) and alcoholism with secondary depression (29%). Subjects with comorbid alcoholism and depression had earlier onset of alcohol dependence. The first degree relatives of probands with primary depression and secondary alcoholism had greater risk of alcoholism compared with the relatives of probands with alcoholism and secondary depression and with the relatives of pure alcoholics. In families of probands with primary depression and secondary alcoholism, increased prevalence of depression was observed. Limitation: The study has a relatively small population and only family history method to collect familial data of alcoholism and depression was used. Conclusion: Our results support Winokur’s depressive spectrum hypothesis from another perspective. In our sample, male and female probands with primary depression and secondary alcoholism had the highest familial prevalence of both alcoholism and depression.