Anyone can have a bad day. Sometimes it’s work matters, relationship problems, or issues at home. For most people, the low periods come and go in a reasonable, ordinary fashion and can be handled by engaging in things that make us happy. However, for people who suffer from depression and addiction, the low periods don’t go away easily.
But does depression cause addiction or vice versa? These two mental health conditions often present together, which can make it difficult to figure out which to treat first.
What is Depression?
Clinical depression is a serious mental disability with severe consequences for the individual and their loved ones. The Centers for Disease Control and Prevention (CDC) estimates that 10% of Americans are struggling with this psychiatric disorder.
According to the CDC, these groups have the highest risk of depression:
- Middle-aged adults between the ages of 45 and 64
- African Americans and Hispanics
- Individuals who are not able to work or who are continuously unemployed
- People who don’t have private medical insurance or public health benefits
Substance abuse is common to people who are battling a depressive disorder. Many depressed individuals turn to drugs or alcohol as a way to lift their moods or to numb painful thoughts. Due to this, depression and substance abuse feed into each other, and one condition will often make the other worse.
When a person has both depression and an addiction, it is called a dual diagnosis. It can be any combination of a mental disorder, such as depression, and a substance use disorder (SUD). In fact, more than 50% of people with a serious mental illness also have an addiction disorder.
- 37% of alcohol abusers and 53% of drug abusers also have at least one serious mental illness
- Out of all the people diagnosed as mentally ill, 29% abuse alcohol or drugs.
The “DAD” Effect
Depression, Addiction, and Denial. This is the DAD effect, and it’s a growing concern that most experts agree on. According to A.J. Marsden, PhD., assistant professor of psychology at Beacon College in Leesburg, FL, “Avoiding emotions, such as sadness, keeps us from processing what is going on. It keeps us from being able to accept and move past the event.” In other words, negative emotions, like sadness, can improve your judgment and motivation. People who process their sadness show greater perseverance.
But still, not everyone is able to deal with sadness and negative emotions. That is where the road to addiction can begin. Depression and addiction frequently go hand in hand, but finding out which came first isn’t always clear. In many instances, drugs or alcohol are turned to for relief from the mental pain of depression. At other times, depression develops as a result of the emotional and physical damage caused by the addiction.
Common in both substance abuse and mental health disorders is denial. It’s hard to admit how dependent you are on alcohol or drugs. It’s hard to realize how much they are affecting your life.
Likewise, the symptoms of a disorder such as depression can be frightening. Many people try to ignore them, hoping they will go away. They might be ashamed or afraid of being viewed as weak if they admit there is a problem. To make things worse, people who are depressed and handling it by abusing drugs or alcohol are more likely to be in danger of committing suicide.
What Happens First: Substance Abuse or the Mental Disorder?
Substance abuse and mental health problems like anxiety and depression are closely connected. Even though one doesn’t directly cause the other, abusing substances such as marijuana or methamphetamine can cause extended psychotic reactions. Alcohol can make depression and anxiety symptoms worse. Plus:
- Drugs and alcohol are often used to self-medicate the symptoms of an undiagnosed mental illness. Sadly, medicating with drugs or alcohol causes side effects that in the long term, only worsen the symptoms they were used to relieve.
- Alcohol and drug abuse can make symptoms of a mental disorder worse or even trigger new symptoms. Abuse of drugs or alcohol can interact with medications such as antidepressants, anti-anxiety medications, or mood stabilizers
- Alcohol and drug abuse can increase the underlying risk for mental disorders. If you are at risk for a mental health disorder, abusing substances may push you over the edge. There is also some evidence that people who abuse opioid painkillers are at greater risk for depression.
Signs and Symptoms of SUD
Abused substances include:
- prescription medications, such as opioid painkillers, ADHD medications, and sedatives,
- recreational or street drugs, such as methamphetamines, marijuana, and cocaine, and
- alcohol, including beer, wine, and liquor.
A substance abuse problem does not depend on which substance you use. It has to do with how your drug or alcohol use affects your life and relationships. If it’s causing problems in your life, you have a substance use problem.
A SUD Questionnaire
To help recognize the signs of a substance abuse problem, answer the following questions. The more times you answer “yes,” the more likely it is that you or a loved one has a substance abuse problem.
- Have you ever thought that you should cut down on your drinking or drug use?
- Do you find it’s necessary to use more and more drugs or alcohol to get the same effects on your moods or attitude?
- Have you tried to cut back but couldn’t?
- Do you lie about how often or how much you drink or use drugs?
- Are you using prescription medication at a rate faster than expected?
- Have friends or family members shown concern about your drinking or drug use?
- Do you ever feel bad, guilty, or ashamed about your drinking or drug use?
- Have you said or done things while drunk or high that you regretted later?
- Has your alcohol or drug use caused problems for you at work, school, or in your relationships?
- Has your alcohol or drug use gotten you into legal trouble?
Common Signs and Symptoms of Depression
Depression is one of the most common mental health disorders that co-occur with substance use disorder. Some common symptoms include:
- Depressed mood
- Feeling hopeless and guilty
- Less activity or more agitation
- Changes in sleep, appetite, and weight
- Thoughts of suicide
- Lack of energy
- Physical aches and pains without a clear physical reason
- Problems concentrating
- Anger, physical pain, and reckless behavior (particularly in men)
- Lack of pleasure in anything
Types of Depression
Major Depressive Disorder (MDD)
Major symptoms of MDD are a lack of interest in things you used to enjoy and a sad or depressed mood. To be diagnosed with MDD, one or both must be present along with three or four of the others. And the symptoms must be severe enough to interfere with daily life.
Persistent Depressive Disorder (PDD)
Sometimes called dysthymia, this is a type of depression that lasts at least two years or longer. Symptoms may get better or worse but they must be present throughout that time.
Bipolar disorder is a condition in which depressive symptoms alternate with manic or hypomanic symptoms. In the depressive phase, you may have any number of general depression symptoms. In the manic and hypomanic phases, you may have symptoms like talking fast, grandiose ideas, and elevated mood among others.
Seasonal Affective Disorder (SAD)
SAD is a depressive disorder that begins during the winter months and eases in the spring. It may have to do with the amount of natural light available during the day. SAD has symptoms like social isolation, weight gain, and oversleeping. SAD comes back every year.
Perinatal and Postpartum Depression
Perinatal depression occurs when a woman is pregnant. Depression that occurs after birth is called postpartum depression. This type of depression has the symptoms of MDD and the most common are anxiety, sadness, and fatigue. Sometimes the symptoms are serious enough to interfere with the mother’s ability to take care of her child.
Complications of Treating Depression and Addiction
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 9 million adults have mental health and substance abuse problems. Unfortunately, only about 7% get treatment for both disorders. When addiction is combined with depression, these conditions tend to strengthen each other.
And if one is treated without the other, the chances for recovery become much less likely. According to Romas Buivydas, Ph.D., LHMC, Vice President of Clinical Development at Spectrum Health Systems, “When substance abuse is combined with depression, the risk of self-inflicted death grows exponentially.”
Another complication is that people struggling with addiction are usually not aware that they are also suffering from depression. Their addiction has completely taken over their lives. Even when there is treatment available, alcohol and drugs get in the way of mental health treatment. And depression is a leading predictor of relapse back to substance abuse.
Treating Depression and Addiction
The best treatment for this dual diagnosis is a combined approach where both the mental disorder and the substance abuse problem are treated at the same time. It doesn’t matter which problem came first. Long-term recovery depends on getting treatment for both disorders at the same time, by the same treatment provider or team.
Treatment is essential in managing depression. The most effective treatment depends on the type of depression and the factors that are unique to you as an individual.
Treatment for your depression may include:
- Medication: The front-line medications for any type of depression are antidepressants. For individuals with manic depression, a mood stabilizer might also be prescribed.
- Lifestyle changes: Getting sober and practicing healthy living strategies.
- Peer support: Attending peer groups to discuss problems and strategies.
- Self-help: Continuing treatment for your dual diagnosis and applying what you learn to your daily life.
- Individual or group therapy: Counseling one on one with your therapist or in a group session with others who are also coping with depression.
Substance Use Disorder
Treatment with trained addiction specialists is vital to a successful recovery from substance abuse. It is not recommended to go “cold turkey” with no supervision.
Treatment for your substance abuse may include:
- Detoxification: Detox is the process of letting your body clear out the drugs you were using and go back to normal. Detox can cause some extremely uncomfortable symptoms and it is helpful to have medical professionals monitor you.
- Withdrawal symptom management: While in detox, you will experience withdrawal symptoms. During this time you may need assistance to relieve the symptoms so you can complete the withdrawal process. Withdrawal can cause dehydration, nausea, and vomiting. Water and antiemetics can ease the symptoms.
- Behavioral therapy: There are several behavioral therapies that are used in the treatment of SUD as well as mental disorders.
- Support groups: Support groups such as AA (Alcoholics Anonymous) and NA (Narcotics Anonymous) are helpful during and after substance abuse treatment to continue your progress and learn from other people who are going through the same things.