The researchers also explored the order in which alcoholism or depression developed in both the probands and their relatives. For this purpose, the investigators determined the ages of onset of alcoholism and depression, which according to the DSM–III–R are defined as the ages at which three symptoms of alcoholism or the first major depressive episode, respectively, occurred. The analyses found that in approximately 50 percent of subjects with AAD, the onset of major depression occurred prior to the onset of alcohol dependence (see table 5). (For comparison, mania occurred first in about 42 percent of subjects with both mania and alcoholism.) This finding may indicate that even in this group of families with multiple cases of alcohol dependence, a substantial number of people develop alcoholism secondary to an underlying mood disorder. However, there was a notable gender effect in the order of disease onset: Males tend to develop alcohol dependence before the onset of the affective disorder, whereas this order tended to be reversed in females.
