TREATING DEPRESSION AND ADDICTION
Introduction
It has been found that around one-third of people with a major depressive disorder also battled with substance use disorders. Similarly, long-term substance use disorder can deplete the brain of serotonin, leading to depression.
Learn the connection between depression and addiction in more detail in this post below and discover the best therapy and medication approaches to treatment.
What Is Depression?
Depression is a mood disorder characterized by persistent feelings of sadness, loss, or anger that impact life quality.
Although the term "depression" is often used by people to describe how they feel after a bad week or breakup, major depressive disorder is much more complicated. Major depressive disorder or clinical depression is a severe condition that can lead to a range of emotional and physical problems, especially if it is long-lasting and with moderate or severe intensity.
Due to the adverse effects on health and personal life, depression is considered a condition that requires medical treatment.
How Common Is Depression?
According to the Anxiety and Depression Association of America, around 16.1 million American adults suffer from major depressive disorder every year, or about 6.7% of the U.S. population age 18 and older.1
Depression is also common worldwide, with more than 264 million people affected by the disorder.2
Signs of Depression
Depression is more than feeling blue or down at times. It's not as simple as "snapping out" of it. Although the warning signs of depression can vary from person to person, the most common include:
- Hopelessness
- Lost interest in things the person once enjoyed doing
- Increased fatigue and sleep issues
- Anxiety
- Changes in appetite and weight
- Irritability
- Mood swings
- Suicidal behavior
How Is it Diagnosed?
Beck Depression Inventory
The Beck Depression Inventory is a 21-item, multiple-choice inventory that evaluates the main symptoms of depression. The 21 items on the inventory reflect a range of symptoms and attitudes common in clinically depressed individuals, such as pessimism, mood, guilt, self-accusation, sense of failure, suicidal ideas, social withdrawal, loss of appetite, etc.
Each of the 21 questions has a set of four possible answer choices, ranging in intensity. You would answer the questions depending on how you have been feeling in the past week.
ICD-10
ICD is a medical classification list created by the World Health Organization (WHO). ICD-10 is the tenth revision of that list. It contains codes for diseases and signs and symptoms, complaints, abnormal findings, social circumstances, and external causes of injury or diseases. General practitioners may use ICD-10 as a screening tool to assess depression.
DSM-5
DSM-5 is the standard classification of mental disorders used by clinicians, researchers, and public health officials in the United States. It serves as the principal authority for diagnosing mental health disorders, including depression.
A person's symptoms must fit the criteria outlined in the DSM-5 to be diagnosed with a major depressive disorder.3
How are Depression and Addiction Connected?
Dual Diagnosis
1/3 of people with major depressive disorder have substance use disorders. Addiction and depression have a close relationship. One study has shown that around one-third of people with a major depressive disorder also live with substance use disorder. Moreover, the comorbidity can lead to a higher risk of suicide and greater social and personal impairment.4
Depression Leading to Drugs
Depression means more than just occasional sadness. It can include overwhelming persistent feelings of hopelessness, anger, anxiety, self-blame, and low self-esteem.
As a result, there may be attempts to self-medicate with different medications to break free from these negative feelings. Unfortunately, this solution is only temporary, and substance abuse can worsen the symptoms of depression in the long-term.
Withdrawal Leading to Depression
When going through withdrawal, a range of symptoms can occur. Depression is one common symptom that may appear during detox.
Also, if depression was already present, the detox process can worsen existing depression symptoms.
During detox, all toxins are cleansed from the body. This process can put many of the body's systems into a distressed state. Abruptly stopping substance abuse may lead to a drop in serotonin levels in the brain and ultimately to the development of depression.
Some people describe the detox process as an empty and hopeless state where they feel the opposite of what they felt when using a drug.
DAD Effect
Depression, Addiction, and Denial Is a Growing Problem
The DAD effect is a term used to describe a condition that includes depression, followed by addiction and denial. Experts agree that it is a growing issue that needs to be addressed.
People dealing with depression are, at times, hesitant about seeking help. Instead, they may resort to self-medication, which is where the path to addiction can begin.
Although it is reported that one-third of people with depression also have a substance use disorder, only a small number seek treatment for both conditions. Over time, the two conditions can amplify each other and worsen the adverse effects.
Unfortunately, denial becomes a coping mechanism to avoid facing the truth. Continued denial can have destructive consequences, from health issues to broken relationships.
DAD Effect and High-Functioning Depression
Depression can look very different in different people. Not all depressed people are lazy, antisocial, or a bad friend. Many people with depression can do an excellent job at maintaining everyday tasks, sometimes even exceptionally.
These people are high-functioning individuals and are driven by the impulse to accomplish their goals. The drive to achieve something sustains action and motivates them to get things done.
High-functioning depression, also called dysthymia, can be harder to detect as these individuals say everything is all right all the time. It is reported that around 6% of the U.S. population has had an episode of dysthymia at some time. Moreover, at least three-quarters of people with high-functioning depression also have a chronic physical or other mental disorder, including substance use disorders or an anxiety disorder.5
Depression Co-Occurring with Common Addictions
Alcohol
Alcohol use disorder and depression often occur together. Not seeking treatment can lead to one condition worsening the symptoms of the other, and vice versa. For instance, alcohol abuse can worsen existing symptoms of depression. In the same way, a person dealing with depression may turn to alcohol to feel better. The good news is that with proper treatment, it's possible to heal from both conditions safely.
Cocaine and Amphetamines
Depression is common among people who have used cocaine for a long-time. One study has found that depression in chronic cocaine users is more common than in the general population.6
The reason cocaine use can lead to depression is brain chemistry. When cocaine is used, the feel-good dopamine increases in the brain, resulting in euphoria and happiness. However, prolonged use of cocaine can reduce dopamine levels and make it harder to experience pleasure.
It is also possible for a depressed person to start using cocaine in a mistaken attempt to feel better.
Opioids
People with a mood disorder are twice as likely to use opioids than people who do not have a mental health issue.7 Moreover, they are also three times more likely to misuse these drugs.8
Similarly, opioid use can lead to the development of depression. One study at St. Louis University found that 10% of over 100,000 people who were prescribed opioids developed depression after using the medications for over a month.
Researchers believe that depression occurs due to the changes opioids make in the brain's reward and pleasure system and hormone levels.
Sedatives
Long-term use of sedatives can lead to symptoms of depression, including feelings of hopelessness, fatigue, or suicidal thoughts.
Treating a Dual Diagnosis of Depression and Addiction
CBT
CBT is a type of psychotherapy that can be an excellent treatment option for depression. It is a mix of two types of therapies; cognitive, which examines how a person's negative thoughts lead to depression, and behavioral, which looks at how a person behaves and reacts in situations that trigger depression.
During CBT sessions, a therapist will guide you to identify negative thinking patterns or distorted perceptions that may be causing depression. Once those negative patterns are identified, the next step is to replace them with more constructive ones.
CBT often requires 10 to 20 sessions.
EMDR
Eye Movement Desensitization and Reprocessing (EMDR) therapy is an interactive psychotherapy technique that can effectively relieve psychological stress.
During an EMDR session, the client relives traumatic experiences while the therapist directs their eye movements.
The theory behind the method's effectiveness is that remembering a traumatic moment is less distressing when you are distracted.
Medications
In addition to therapies such as CBT and EMDR, treatment for addiction and depression also includes medications.
The most commonly prescribed medications for treating depression are antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). They are often prescribed due to their effectiveness and low potential for abuse.
SSRIs such as citalopram, paroxetine, sertraline, and escitalopram stabilize mood by increasing serotonin levels in the brain.
Moreover, various medications may also be used for a safe withdrawal from substances of abuse.
This information should not replace a visit to a doctor or treatment center. If you are concerned that you or a loved one is struggling with addiction while also experiencing symptoms of depression, ask for professional help today.
Resources
- https://adaa.org/about-adaa/press-room/facts-statistics
- https://www.who.int/news-room/fact-sheets/detail/depression
- https://www.medscape.com/answers/286759-14692/what-are-the-dsm-5-criteria-for-diagnosis-of-major-depressive-disorder-clinical-depression
- https://pubmed.ncbi.nlm.nih.gov/18281835/
- https://www.health.harvard.edu/newsletter_article/dysthymia
- http://www.biomolther.org/journal/view.html?volume=26&number=5&spage=425&year=2018
- https://www.jabfm.org/content/30/4/407
- https://pubmed.ncbi.nlm.nih.gov/29660645/
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