The Link Between Depression and Addiction

There is a very close link between depression and addiction. Depression causes addiction.  Addiction causes depression.

30% to 40% of people who are suffering from depression are also addicted to prescription drugs.

When we’re low, we feel depressed, anxious, and at the point of panic. We feel terrible, and we’re desperate to feel good. We want to avoid our feelings of sadness, stress, anxiety, and panic. And sometimes, all we want is to break free from feeling bad.

For most, the low days come and go and can be balanced by things that give us a high. Grief or bereavement after the loss of someone close, is not the same as clinical depression. However, if these feelings continue for more than two months, then it could be a warning sign of things to come. So, what’s the difference between clinical depression and suffering from a case of ‘the blues’?

Clinical Depression

Clinical depression is a serious mental disability with severe consequences for the individual and his or her loved ones. The National Institutes of Health (NIH) states that clinical depression lasts for at least two weeks. The condition interferes with the ability to work, maintain healthy relationships and function socially.

People with depression may experience five or more of the following symptoms:

– Hopelessness

– Constant anxiety

– Lack of appetite/weight loss

– Increased appetite/weight gain

– Sleeping too much or too little

– Aches and pains

– Listlessness

– Feelings of guilt

– A sense of worthlessness

– Irritability

– Inability to concentrate

– No interest in activities or hobbies

– Suicidal thoughts or suicide attempts

According to the Centers for Disease Control and Prevention (CDC), depression affects about one in ten Americans. Individuals suffering from clinical depression are prone to a high risk of accidental injury and self-harm. They sometimes also harbor thoughts of suicide.

Depression weakens the body and can suppress the immune system. This makes the individual more susceptible to physical ailments and chronic illness. Add drugs or alcohol in the mix and the risk to physical and emotional health increases.

Many people who are suffering from depression use medication. Most people use medication over a period of time without any significant problems. Others, however, may experience damaging psychological and/or physical effects when their habit becomes an addiction.

A person with a habit can choose to stop, and can stop successfully. There is no psychological connection to the substance. With a habit, the individual is in control. With an addiction the individual is not.

Addiction

Doctors treat pain differently than they used to in the past. Today, there’s a pill for every pain or condition, including depression. This change has led to an increase in prescription drug abuse. Prescription drug addiction is a serious health problem in the U.S. In the last ten years, many individuals have started to use prescription drugs to medicate their pain away. A November 2012 study by the University of Nebraska – Medical Center College of Medicine, describes medication abuse as “an epidemic”.

An addict needs larger and more regular amounts of a drug or substance to get the same effect. After repeated use, higher and higher doses are needed to get the same effect. The individual is reluctant to stop the use of drugs because of the unpleasant withdrawal symptoms.

According to the DSM-IV: Repeated use of the drug of choice may result in tolerance to the drug. Once drug use is stopped or reduced, the person will experience withdrawal symptoms.

Depression Caused By Addiction

Addiction has both psychological and physical components. You will need help to control the aspects of the addiction because the drug has become a crutch. Addiction to substances can sometimes lead to serious problems at home, work, school and in social settings.

To someone who is clinically depressed, the basic tasks of day-to-day life may seem impossible. This is why individuals who are battling drug addiction have a tendency to be depressed as well. The reason for this is that alcohol is a central nervous system depressant. Alcohol tends to trigger depression symptoms like lethargy, sadness and hopelessness. Many depressed individuals use drugs or alcohol to change how they feel or to numb painful thoughts. As a result, the link between depression and addiction makes one fuel the other. One condition makes the other worse.

When a person is both depressed and addicted, the condition is called a co occurring disorder. Co-occurring disorders can be made up of any combination of a mental disorder (anxiety, depression, post traumatic stress disorder or PTSD) and addiction (drugs and/or alcohol). NIH’s Journal of Clinical Psychiatry reports that one-third of adults struggling with alcohol or drug abuse also suffer from depression.

Abuse of Depression Medication

There is a strong link between depression and addiction. The National Bureau of Economic Research reports that people who have been diagnosed with a mental illness such as post traumatic stress disorder (PTSD) consume 69% of the nation’s alcohol and 84% of all the cocaine in the country.

The relationship between the two disorders is bi-directional. This means that people who suffer from depression are more likely to abuse substances and vice versa. People who are depressed may drink or use drugs to ‘feel good’ or to escape from feelings of guilt or despair. But alcohol, which is a depressant, can increase feelings of sadness or fatigue. Also, after the effects of the drug wear off, they can feel depressed as they struggle to cope with how the addiction has impacted their life.

About one-third of adults who abuse drugs also suffer from depression. Among individuals with recurring major depression, about 16.5% have an alcohol use disorder and 18% have a drug use disorder.

Because drug use symptoms can mimic the symptoms of depression, it can be difficult to diagnose depression when a person is actively using. Each depressed person will deal with the disorder differently.

Treatment For Co-Occurring Disorders

Comprehensive treatment is the best course of action for both depression and drug addiction. Antidepressants can help to reduce depressive symptoms while medications are available to treat addiction to alcohol and opioids. An individual with co occurring disorders should not just rely on medication to get better but should also seek counselling and behavioral support.

The first step to getting on the path to sobriety would be detoxification or detox. This is necessary to address the withdrawal symptoms of drugs or alcohol. It may be wise to temporarily stop taking medication so that a doctor can conduct an accurate diagnostic assessment. There are programs that address co occurring disorders at the same time. Trying to end substance abuse on its own without treating addiction may worsen depression and increase the risk of relapse.

Sometimes, people with co occurring disorders can cope well with counseling, medical support, and peer support for addiction. Others may find that intensive inpatient or outpatient treatment programs work best. Effective treatment programs typically  use group counseling, one-on-one counseling, medication assisted treatment (MAT), personalized treatment plans, onsite medical assistance, family support, and follow up support to prevent relapse.

An individual should communicate with a physician, go for counselling, and join peer support groups. Such treatment programs will help the person to develop protective coping skills to reduce the risk of relapse or developing depression.

Recovery from substance abuse means addressing and healing the underlying core issues that caused the depression and anxiety in the first place. According to a 2017 study published in the Psychiatric Services Journal, over 8.3 million American adults suffer from depression and anxiety. The 2016 Surgeon General’s report on addiction cites over 27 million people abused drugs and more than 66 million abused alcohol in 2015.

Treatment for depression depends on the severity of the condition. Doctors may prescribe eating healthy, exercising and avoiding certain situations to treat mild depression. More severe depression can be treated with medication, therapy or both.

Which comes first? The results vary from person to person. Some people develop alcoholism or drug addiction first while others develop depression first. A person who first abuses drugs or alcohol may consequently develop depression. Or, the person may be addicted to drugs which affects their life negatively. These effects may contribute to the person developing depression.

A study published in the National Institutes of Health’s U.S. Library of Medicine states that alcohol can induce depression. It alters the levels of serotonin (5-HT) and its metabolites to lowered levels. Alcoholics have lower levels of serotonin and metabolites in their cerebrospinal fluid. In the study, researchers increased the serotonin levels in crats that had low serotonin levels. When serotonin levels went up, symptoms of depression went down.

Conversely, people who are depressed may abuse a substance in an effort to self-medicate and treat the problem. Typically, this is only a temporary solution, as drug abuse worsens the depression over time.

How Does The Link Between Depression And Addiction Affect Treatment?

Treatment for depression and substance abuse generally includes the use of both medication and therapy. Antidepressants may be used to stabilize mood swings. When necessary, other medications can be used to moderate withdrawal from substances of abuse. Therapy and counseling make up the key components of treatment and addresses issues related to both disorders.

Co-occurring disorders require a comprehensive treatment program that effectively addresses both disorders. Do not treat one disorder without treating the other. Individuals who aren’t treated for both at the same time have significantly higher rates of relapse.

People suffering from co occurring disorders may not be aware of either condition. By treating only the drug addiction disorder, it is likely the person will go back to using when he or she feels depressed. When the depression is treated in isolation, substance abuse will likely continue.  This may lead to a relapse in depressive symptoms.

Taking medication used to treat depression can be negatively affected by alcohol. In fact, alcohol and medication do not mix. Drinking while on medication does not make the person feel less depressed.

Non Narcotic Treatment Options

There are also non narcotic treatment options for depression. The major ones include:

1. Transcranial Magnetic Stimulation 

Transcranial magnetic stimulation (TMS) is a procedure that stimulates nerve cells in the brain with short magnetic pulses. A large electromagnetic coil is placed against the scalp which generates focused pulses that pass through the skull and stimulate the cerebral cortex of the brain, a region that regulates mood. The FDA approved TMS in 2008.

2. Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) is a cognitive behavioral treatment which emphasizes individual psychotherapy and group skills training classes to help people learn and use new skills and strategies to develop clean living. This form of therapy includes skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.  DBT addresses all kinds of mood disorders. DBT was developed by Marsha Linehan, PhD, ABPP.

3. Mindfulness-Based Cognitive Therapy

A University of Oxford study found that mindful-based cognitive therapy (MBCT) works as effectively as antidepressants to prevent a relapse of depression. According to studies by the National Institutes of Health, MBCT and mindfulness-based stress reduction (MBSR) programs “have broad-spectrum antidepressant and anti-anxiety effects and decreases general psychological distress.”

4. Yoga

According to a recent newsletter by Harvard Medical School, yoga helps to relieve depression. In a 1993 study, 50 female university students with severe depression practiced Shavasana yoga for 30 minutes daily for 30 days. There was a significant reduction in their depression score mid- and post-treatment.

5. Hanna Somatic Education

Hanna Somatic Education trains the mind and body to gently address chronic pain, restores freedom of movement, and relieves stress. Somatics teaches the brain to relearn muscle motions. It works specifically with sensory-motor amnesia. This technique was developed by Thomas Hanna,

6. Binaural Beats

This technique uses binaural beats, or audio therapy to reduce anxiety.

7. Eye Movement Desensitization and Reprocessing Therapy

Eye movement desensitization and reprocessing (EDMR) is a psychological therapy that uses eye movements and other procedures to process traumatic memories. Studies show this to be an effective intervention for post-traumatic stress disorder (PTSD).  The Department of Veterans Affairs and other organizations recommend EMDR for PTSD treatment. This was originally designed by Francine Shapiro.

8. Biofeedback

Biofeedback uses electric sensors to train a person to have better control over mind and body. The person is able to see on a screen how certain thoughts produce subtle changes in his or her body, and the impact relaxing or tensing certain muscles on the thought process. The person is trained to manipulate his thoughts to control the body.

Biofeedback helps a variety of physical and mental health issues. These include high blood pressure, chronic pain, irritable bowel syndrome, and Raynaud’s disease. This technique is especially helpful for people when medication has not worked.

9. Transcendental Meditation

Transcendental Meditation is a technique that promotes a state of relaxed awareness.  It is practiced 20 minutes two times a day while sitting comfortably with the eyes closed.

10. Tai Chi

A study by researchers at UCLA indicates that the combination of slow movement, breathing, and meditation benefits the elderly. Tai Chi, when combined with depression treatment claims to improve better memory and cognition.

Depression And Addiction

Recovering from depression or substance abuse alone is difficult. Recovering from co-occurring disorders at the same time is even harder.

Help is available for addiction and depression. People suffering from depression and drug addiction can seek help to find a pathway to sobriety. Dedicated treatment center professionals with a passion for recovery are available to help them lead a clean and happier life.

To find out if your loved one or friend has a substance use disorder, ask them:

• Do you use drugs or alcohol for longer or in larger amounts than you anticipated?
• Have you tried to reduce your intake of drugs or alcohol unsuccessfully?
• Is a lot of your time spent using, obtaining, or recovering from drugs or alcohol?
• Do you experience cravings to drink or use?
• Do you feel the need to use drugs or alcohol no matter what?
• Have you found that you need more and more of the substance to achieve a ‘high’?