Consumption of Alcohol, Nicotine, and Caffeine Among Depressed Outpatients Relationship With Response to Treatment JOHN WORTHINGTON, M.D., MAURIZIO FAVA, M.D. CHRISTINA AGUSTIN, B.A., JONATHAN ALPERT, M.D., PH.D. ANDREW A. NIERENBERG, M.D., JOEL A. PAVA, PH.D. JERROLD F. ROSENBAUM, M.D. The authors present findings from the first investigation of the use of alcohol, nicotine. and caffeine in nonsubstance-abusing outpatients with major depressive disorder. The patients (N =94) were assessed for their intake of alcohol. nicotine. and caffeine. and then treated openly for 8 weeks with 20 mg/day offluoxetine. The degree of alcohol consumption at baseline was a significant predictor of poorer response to the antide- pressant. This relationship remained significant even after adjusting for severity of de- pression at baseline. Even moderate levels of alcohol consumption appear to negatively affect pharmacologic treatment in depressed outpatients. (Psychosomatics 1996; 37:518-522) M ajor depressive disorder (MOD) is a medical illness with a lifetime preva- lence of 21 % in women and 13% in men. 1 It is the number one cause of lost workdays, costing more than $43 billion annually, with an esti- mated annual cost of actual treatment of $12 billion. 2 Unfortunately, only a small proportion of those who have MOD ever receive treat- ment. .1,4 Acommon phenomenon observed among depressed persons is that of self-medication, using legal and illegal drugs of various kinds. 5 - 7 While an estimated 14% ofthe U.S. general population have a history of alcohol abuse or dependence, 8 20% of men and 10% of women with primary unipolar depression have an addi- tional diagnosis of alcoholism. 9 There is a well- known connection between cigarette smoking and MOD. The point prevalence of smoking in depressed outpatients is 49% vs. 30% for normal control subjects. 7 The data from the St. Louis 5t8 node of the Epidemiologic Catchment Area (ECA) survey 10 confirm both that MOD is more common among smokers than among non- smokers (6.6% vs. 2.9%) and that smokers with a lifetime history of MOD are less likely to have succeeded in smoking cessation than are smok- ers without such a history (14% vs. 28%)." Finally, caffeine is the most widely used drug in the world. 12 About 85% of Americans ingest caf- feine daily, and the average caffeine intake is approximately 200 mg/day.I3·14 Excessive caffeine Received January 31, 1995; revised March 24, 1995; accepted June 2, 1995. From the Depression Research Pro- gram, Clinical Psychopharmacology Unit, Massachusells General Hospital and Harvard Medical School, Boston, Massachusells. Address reprint requests to Dr. Worthington, Clinical Psychopharmacology Unit. WAC-815, Massachu- sells General Hospital. 15 Parkman SI., Boston, MA 02114. Copyright © 1996 The Academy of Psychosomatic Medicine. PSYCHOSOMATICS