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Depression and Substance Abuse

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Depression and addiction often go hand in hand. The National Alliance on Mental Illness (NAMI) found that in 2020, an estimated 17 million American adults experienced both substance use conditions and mental health concerns.1 Having more than one diagnosis, commonly called co-occurring disorders, can make it difficult to know where to begin when you are seeking help.1 Treatment is available for both depression and substance use, and NAMI and other addiction and mental health organizations and professionals recommend that they be treated together, commonly referred to as dual-diagnosis treatment.1 With such a significant presence, it’s important to understand how they might affect each other, what the symptoms might look like, and what treatment is available.

What is Depression?

According to the World Health Organization (WHO), depression is one of the most commonly diagnosed mental health conditions globally with around 280 million people affected.2 Persistent themes of any kind of depression are the presence of a sad or empty feeling, irritability, changes in appetite and/or sleep, and symptoms that interfere with your normal daily functioning.3 In severe depression, thoughts of suicide can be present.3 It’s important to note that 90% of people who died by suicide had a history or showed symptoms of depression.4 Below are some common forms of depression and how they differ from each other:3

  • Major Depressive Disorder (MDD): Depression that lasts more than two weeks at a time. MDD is often cyclical, meaning that episodes will go through fluctuations in severity.
  • Persistent Depressive Disorder (Dysthymia): Dysthymia is depression that lasts longer than two years.
  • Substance/Medication-Induced Depressive Disorder: Taking certain substances or medications can induce symptoms of depression. Often, this can occur during the withdrawal period from a substance.
  • Seasonal Pattern, commonly called Seasonal Affective Disorder: This type of depression is categorized by an onset of depressive symptoms during certain seasons or months of the year.

The NAMI found that around 21 million U.S. adults had a diagnosed major depressive episode in 2020.4 Depression seen alongside substance use concerns can increase its severity.5 Additionally, research shows that having a substance use disorder can increase the likelihood of developing anxiety and/or depression, and that having an alcohol use disorder is linked with higher rates of death by suicide.5, 6

Major Causes of Depression

The reason why some people develop depression and others don’t is not known.2 The probability of developing depression increases with certain risk factors such as biological and genetic factors, environmental, and psychological causes.3 Some statistics around the common causes of suicide and depression include:

  • Having first-degree family members, such as parents or siblings, with depression can double to quadruple your risk.3
  • Adverse life events like unemployment and stressful or traumatic events are shown to increase the risk of developing depression.2
  • Women are diagnosed with depression approximately 3 times more than men.3
  • Lesbian, gay, and bisexual adolescents are four times more likely to die by suicide than their heterosexual peers.4
  • The transgender population is 12 times more likely to die by suicide.4
  • Nearly 78% of people who die by suicide are male.4

Signs and Symptoms of Depression

Some of the symptoms of depression are normal and commonly felt among people who don’t have depression.3 It can be difficult to tell what is a clinical presentation of depression and what is a stressful or difficult life circumstance.3 A few factors that differentiate types of depression are frequency, how long the symptoms have been present, when the onset began, and the severity of symptoms.3 Although the differences in presentation and symptoms can vary between people, here are some common signs and symptoms that might be indicative of depression:3

  • Feelings of sadness, hopelessness, or emptiness more days than not.
  • Feeling irritated or annoyed more easily.
  • Loss of interest or pleasure in things you used to enjoy.
  • Difficulty focusing or making decisions.
  • Feeling overly worthless or guilty.
  • Decreased energy and motivation to perform normal duties.
  • Changes to appetite such as not feeling hungry, not eating enough, or eating too much.
  • Difficulty with sleep ranging from trouble getting to sleep, staying asleep, or sleeping too much.
  • In severe cases, suicidal thoughts.

If you think you might be depressed, it’s important to speak with your doctor or mental health provider. There are various treatment options available for depression including therapy, medication, and rehabilitation programs.2 Depression can feel isolating and hopeless, but you and your health provider can discuss treatment options that will work best for you.

Which Comes First: Depression or Substance Abuse?

Depression and substance use are commonly seen together, but it can be nearly impossible to determine whether one was caused by the other. Each person and their experiences are unique. A study done in 2020 found that the risk factors for both SUD and depression were similar and can lead to the development of both.5 The same study showed that 93% of people with a SUD also had symptoms of depression and 97% expressed feelings of severe anxiety.5 Similarly, depression was found in 24% of men and 48% of women with alcohol use disorder.7 Listed below are several reasons why depression and substance use may trigger each other:3

  • Self-medication: Suffering from depression increases the likelihood of substance use disorders.3 Individuals may attempt to alleviate symptoms of depression by using drugs or alcohol, which can temporarily relieve depression.8
  • Biochemical: Drugs and alcohol temporarily increase certain neurotransmitters, leaving you feeling high or intoxicated.8 The flooding of these transmitters disrupts them, making it difficult to produce chemicals naturally.8
  • Genetic predisposition: Having a family history of both depression and substance use puts you at an increased risk.3, 9
  • Effects of withdrawal: Depressive symptoms may be seen after the effects of intoxication or withdrawal. Sedatives, hypnotics, anxiolytics, and alcohol use are typically associated with depressive symptoms not present before use.9
  • Past trauma: Adverse childhood experiences such as abuse or neglect and other traumatic experiences may cause a person to be at an increased risk.3

Does a Co-Occurring Disorder Affect Treatment?

The National Alliance on Mental Illness recommends an integrated approach when treating co-occurring disorders.1 An integrated therapy approach pulls techniques from both alcohol and substance use rehabilitation and mental health therapies.1 Within your treatment plan, you and your provider will identify how to address and treat both depression and substance use concerns.1

Since the prevalence of co-occurring disorders is so high, treatment should be considered with all factors taken into consideration.1 By screening and assessing for co-occurring disorders, the outcome of treatment has been shown to improve.10 The Substance Abuse and Mental Health Services Administration (SAMSHA) promotes a “no wrong door” philosophy with both substance abuse and mental health treatment.10 This encourages substance use facilities to assess for mental health concerns and for mental health facilities to assess for substance use concerns.10 Being aware of the overlap can help improve the quality of life and quality of care of the individual.10

Treatment for Depression and Substance Abuse

Each person’s treatment process will look different. An integrated therapy approach can involve a combination of detoxification, inpatient rehabilitation, outpatient therapy, medication management, supported housing, and support groups.1

  • Detoxification: This process tapers or weans an individual from a substance under the supervision of trained medical staff.1
  • Inpatient rehabilitation: Facilities that offer extended stay resources like a hospital.1
  • Outpatient therapy: Usually offered through community mental health centers, hospitals, or other psychotherapists.1
  • Therapy: The most common therapy modalities used in the treatment of co-occurring disorders include cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), and motivational interviewing (MI).11
  • Supported housing: Housing facilities, sometimes referred to as sober living, offer temporary and permanent living arrangements with others who are in recovery for addiction.2
  • Support groups: Alcoholics Anonymous, SMART Recovery, and Narcotics Anonymous are common support groups.2
  • Medication management: Working with your medical and/or mental health provider to find the best medication(s) to treat all your symptoms.2

Medications known as antidepressants have been shown to be effective in treating depression, anxiety, and other mental health conditions.12 These medications promote an increase in serotonin, norepinephrine, or both.13 Selective serotonin reuptake inhibitors (SSRIs) work solely on encouraging serotonin production.13 Common SSRIs include fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft). Typically, SSRIs are the first medication used to treat depression.13

Serotonin-norepinephrine reuptake inhibitors, or SNRIs, work on both serotonin and a different neurotransmitter called norepinephrine.13 Better known SNRIs include venlafaxine (Effexor XR) and duloxetine (Cymbalta).13

The only way to determine which treatment options are best for you is to talk with your medical and/or mental health provider. You can talk with them about which program, like inpatient therapy, outpatient therapy, or rehabilitation, will be best considering your priorities and goals. Under the Affordable Care Act (ACA), mental health and substance use disorders are covered under insurance.14 The best way to know is to verify your insurance to see what and how much will be covered.

Dual Diagnosis Rehabs Near Me

When you come to AAC for substance treatment services, we see you as more than your addiction. You come to us with unique strengths, potential, and challenges; we believe that your abuse treatment should be personalized, too.

If you or a loved one is in need of help our helpline is open 24/7. Call Treatment centers are available throughout the United States. You can also contact free drug abuse hotline numbers.

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Kristen Fuller, MD, enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine and contributes to medicine board education. Her passion lies in educating the public on the stigma associated with mental health. Dr. Fuller is also an outdoor activist, an avid photographer, and is the founder of an outdoor women's blog titled, GoldenStateofMinds. In her free time, she enjoys hiking, backpacking, skiing, camping, and paddle boarding with her dogs in Mammoth Lakes, California, where she calls home.
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