Substance Abuse & Depression

Major depression, one of the most common mental illnesses, affected 4.1 million adolescents and 21 million adults in 2020.^{1(pg.31, right column)} Of those with mental health disorders, 17 million adults also suffered from substance use disorder (SUD).^1(pg.34) And as a result of inadequately treated depression, 1.2 million American adults attempted suicide in 2020.^{1(pg.35, suicide attempts)}

Untreated depressive disorders put millions of people at risk for suicide and other dangers every year, including substance misuse.^{1(pg.33, substance use among adolescents with MDE)} This page will explore the facets of depressive disorders, their relationship to substance misuse and addiction, and potential treatment.

What Is Depression?

Depression, often referred to as major depressive disorder (MDE), is a serious mental illness that causes negative mood changes, thought, and behavior.^2(overview) MDE is the prototypical form of a depressive disorder, but there are other types of depression.^3(pg.155)

Feelings of loneliness, sadness, or low motivation can occur within a healthy spectrum of human emotions. But, people with depressive disorders experience them longer or more severely than would be expected.^{2(signs and symptoms)} In addition, depressive disorders often affect a person physically and cognitively.^{3(pg.160-161 diagnostic criteria)} To continue functioning despite depression, people may partake in unhealthy coping skills (such as substance use) before seeking treatment.

Types of Depressive Disorders

Each variation of depressive disorder follows a specific pattern of symptoms.^3(pg.155) Depressive disorders found in the Diagnostic and Statistical Manual of Mental Health (5^th edition) (DSM-5) include:

• Major depressive disorder is characterized by recurring major depressive episodes that last two weeks or more. They are characterized by several depressive symptoms for the entirety of the episode. The episodes may occur at any time, with or without a known trigger, but without a clear alternative cause.^{3(pg.160-161 diagnostic criteria)}
• Persistent depressive disorder (dysthymia) is diagnosed when a person experiences constant symptoms of depression for at least two years.^3(pg.168)
• Premenstrual dysphoric disorder is identified when a person experiences several depressive symptoms in the days before her menstrual cycle. But the symptoms diminish after it begins.^{3(pg.171=172 diagnostic criteria)}
• Substance/Medication-Induced Depressive Disorder is depression caused by substance use or medications. Or, as a result of withdrawal from a substance.^{3(pg.175 diagnostic criteria)}
• Depressive Disorder due to another medical condition is common with many medical conditions. Physiological mechanisms of the other condition, may affect the brain and contribute to depression^{3(pg.181, diagnostic features.)}

Each type of depressive disorder can manifest on a spectrum of varying severity.^{3(pg.162, severity/course specifier)} A mental health professional is needed to determine the severity of each disease and course of treatment for a person’s best chance of recovery.

Signs and Symptoms of Depressive Disorders

Depression can appear in many forms.^3(pg.163) Some people may predominantly experience it, while others may be most affected by the loss of pleasure.^3(pg.163) While there is a wide spectrum of symptoms, people with depressive disorders may experience any of the following:^3(pg.161)

• Feelings of sadness, emptiness, or hopelessness that last many days for most of the day
• Loss of pleasure or interest
• Significant intended weight changes (gain or loss)
• Needing much more sleep or insomnia
• Constant bodily movement or experiencing much slower and fewer movements
• Lower energy
• Feeling worthless or having inappropriate guilt
• Diminished cognition or thinking ability
• Thinking of death, imagining suicide, and planning or attempting suicide
• Anxiety or excessive worry^{3(164-165 associated features…)}
• Psychosis^{3(164-165 associated features…)}
• Irritability^{3(164-165 associated features…)}

Depending on the person and particular disorder, other symptoms may be experienced. Always tell your doctor or other clinicians about all the symptoms you experience to get the correct diagnosis and the best treatment plan.

Causes for Depressive Disorders

As one of the most common mental disorders in the United States, depressive disorders have been extensively researched.^{2(risk factors)} Examples of factors that contribute to the development of depression include:^{4(what causes depression)}

• Genetic factors: Certain genes passed on through family lines can contribute to the development of depression. A family history of depression puts you at greater risk.
• Biological factors: Having certain medical conditions, or taking certain medications, can contribute to depression through physiological factors or increase the risk from the stress of the condition.
• Environmental factors: Major life changes, traumatic or stressful events, or substance misuse may contribute as well.

Though there are certain risk factors, depression can sometimes develop unexpectedly. About 16 million Americans are affected by depression every year, and more than 15% of adults experience it at some point in their life.^{4(who gets depression)}

Substance Use Disorders and Depression

Substance use disorders and mental illnesses, such as depression, often occur together.^{5(part 1: the connection between substance use disorders and mental illness)} Three main mechanisms can contribute to the development of co-occurring disorders (dual diagnosis) with substance use disorder.^{5(why is there comorbidity between substance use disorders and mental illness)}

• Similar risk factors contribute to both depression and addiction. Genes, factors that modify genes at certain stages of development, stressful or traumatic life events, and effects on similar brain regions can all increase a person’s risk of either disorder.^{5(common risk factors can contribute to both mental illness and substance.)}
• Depression may contribute to substance use (and addiction). After the development of depression, there may be changes in the brain that make a person more vulnerable to developing substance use disorder. Or some people may engage in substance misuse as a way of coping with their depression, which can lead to addiction.^{5(mental illness can contribute to drug use)}
• Substance use and its consequences can increase the likelihood of developing depression. Physiological brain changes occur when a person uses drugs or alcohol chronically. These changes can predispose a person to developing depression or other mental illnesses.^{5(substance use and addiction can contribute to the development of mental illness)}

People who have co-occurring disorders often have more severe and persistent conditions than those with only one diagnosis.^{5(what are some approaches to diagnosis)} To give a person the best chance of recovery, they must engage with an integrated treatment plan that treats both their conditions at once.^{5(what are the treatments for comorbid substance use disorder and mental health)} Due to the risk of more severe outcomes, most treatment centers provide thorough assessments at enrollment to ensure no diagnosis is missed.^{5(what are the treatments for comorbid substance use disorder and mental health)}

Co-Occurring Disorders Treatment

Treatment plans for alcohol or opiate addiction and depression use many tools for recovery. Whether in an inpatient or outpatient alcohol rehab or drug rehab program, treatment is likely to involve medication and behavioral therapy to address aspects of both disorders. ^{5(what are the treatments for comorbid substance use disorder and mental health)} The types of medications and therapies involved depend heavily on the type of substance misused and the severity of depression.^{5(what are the treatments for comorbid substance use disorder and mental health)}

If you or a loved one are struggling with depression alongside addiction, there is hope for recovery. Addiction treatment centers such as Virtue Recovery Center offer individualized treatment plans according to your needs, including alcohol detox and opiate detox. Call Virtue Recovery Center or contact them online to get answers to your questions and get started on your path to recovery.

Resources:

1. Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
2. NIMH. (2022, September). Depression.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5^th edition).
4. CDC. (2022, September 14). Mental health conditions: depression and anxiety.
5. NIDA. (2020, April). Common comorbidities with substance use disorder research report.