Co-Occurring Disorders: Depression and Addiction

Depression is a type of mood disorder that can severely affect how a person thinks and feels, and one’s ability to function in all aspects of their daily life.^{3, 4} There are several types of depression, which can develop because of various circumstances and the potential for depression and addiction to co-occur is common.³

In 2020, more than 20 million people experienced major depressive episodes (MDEs), a number that has been rising steadily for the past 10 years.¹ Additionally, many of those who are diagnosed with a major depressive disorder (MDD) also have a co-occurring substance use disorder (SUD), which can make recovery more challenging.²

This page will discuss depression, its signs and causes, the relationship between depression and addiction, and possible treatment paths.

What Is Depression?

Depression commonly refers to major depressive disorder (MDD), or clinical depression, a mental health disorder that causes impairment in cognition, daily functioning, and mood.³ A person with depression typically has feelings of sadness or disinterest in activities that were once enjoyable and may experience changes in appetite and sleep.⁴

Depression is different than grief or sadness. People with depression experience sustained, decreased moods and loss of interest for periods exceeding 2 weeks, which may not have an underlying trigger or cause. People with depression may also feel a sense of worthlessness or have thoughts of ending their lives.⁴

Nearly 8.4% of all US adults report experiencing a major depressive episode in 2020 and of those people, there was a higher prevalence among female adults compared to males.⁵ While a MDE can be mild, statistics show that severe episodes are more common.⁵ More than 14 million people experienced depressive episodes with severe impairment to their everyday functioning in 2020.⁵

Signs of Depression

If you are concerned that you or a loved one may be experiencing major depressive disorder, then it may be time to see a mental health professional. Only a medical professional can diagnose MDD and other types of depression; however, knowing the criteria used to diagnose depression may help you decide when it’s time to seek help. Signs of depression include:⁶

• Depressed mood that occurs almost daily (feeling sad, empty, hopeless, or appearing tearful).
• Significant decreased interest or pleasure in all or almost all activities for most of the day, nearly every day.
• Significant weight changes, accompanied by a daily increase or decrease of appetite.
• Significant changes in sleep, insomnia, or oversleeping nearly every day.
• Restless movements or a feeling of “leaden” limbs, which prevents movement nearly every day.
• Feelings of worthlessness or excessive guilt nearly every day.
• Extreme tiredness or energy loss nearly every day.
• Inability to think clearly, concentrate, or make decisions nearly every day.
• Recurrent thoughts of death, considering suicide with or without a plan, or a suicide attempt.

Even if you are experiencing all the symptoms listed, your depression could still be due to another underlying mental health condition, a substance use disorder, or a medical condition. For example, bipolar disorder or a thyroid disorder can often cause depressive episodes alongside other symptoms.^4,6 Seeing a mental health professional is important to make sure you get the correct diagnosis.

Causes of Depression

Like many medical conditions, depression can potentially be caused by several factors. Factors that may put you at greater risk for developing depression are:⁴

• Brain chemistry. Whether you were born with depression, or your brain has undergone changes from alcohol or other substance use, certain chemical levels in the brain can increase depressive symptoms.
• Genetics. Families can have genes that make them more likely to develop depression. If any of your first-degree relatives had depression or committed suicide, you may be more at risk.
• Personality and coping skills. If you tend to have low self-esteem, get overwhelmed or stressed frequently, or are generally pessimistic, you are more likely to experience depression.
• Life experiences. Exposure to violence, abuse, neglect, poverty, or other stressful life events can become triggers for some people to develop depression.

Relationship Between Depression and Addiction

Many people suffer from co-occurring substance use and mental health disorders.⁷ Neither substance use disorders (SUDs), nor depression necessarily cause one another; however, aspects of each disorder can contribute to the worsening of symptoms in the other.⁸ The 3 primary factors that lead to co-occurring disorders are:⁸

• Past trauma and increased stress are some of the common risk factors for both the development of a mental health disorder and a substance use disorder.
• Mental health disorders like depression can contribute to substance use disorders as individuals will often turn to drugs and alcohol to cope with their mental health symptoms.
• Substance misuse can contribute to mental illness as brain chemistry over time can change with substance misuse.

About half of people who experience a mental illness like depression will develop a substance use disorder (SUD) at some point in their life.² The opposite is true as well.

What Type of Depression Is the Most Common?

The following types of depression are the most common:³

• Major depressive disorder is defined by symptoms of depression nearly all the time for at least 2 weeks, which inhibit your ability to work, sleep, eat, or otherwise function as you normally would.³
• Persistent depressive disorder (dysthymia) consists of symptoms that are similar but less severe than MDD, which persist for at least 2 years or more.³
• Perinatal depression includes both prenatal (during pregnancy) and postpartum (after giving birth) depression. Depression during or after pregnancy can be a continuation of another depressive diagnosis or can stand alone.³
• Seasonal affective disorder also referred to as seasonal depression, typically begins during the fall and winter months and goes away during spring and summer.³
• Depression with symptoms of psychosis is a severe form of depression that includes psychotic symptoms, such as hallucinations or delusions during depressive episodes.³
• may include depressive episodes alongside manic episodes (extremely elevated mood with increased activity); however, the depressive symptoms are sometimes more frequent or debilitating than mania, so misdiagnosis is possible without looking at a complete history.³

Medications for Depression

Medications known as antidepressants play a large role in treating depression and are commonly used in conjunction with behavioral therapy. Mental illnesses are lifelong conditions but finding a medication that works for you can provide stability.³

There are several categories of antidepressants each with its own individual side effect profiles. Selective serotonin reuptake inhibitors (SSRIs) are the most common medications used to treat symptoms associated with depression.³ On average, antidepressants take six weeks to work so it is important to be patient and communicate with your provider about how you are feeling, any potential side effects, and additional medications you’re taking.

Common categories of antidepressants include:⁹

• SSRIs (selective serotonin reuptake inhibitors) including sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), and others.
• SNRIs (serotonin and norepinephrine reuptake inhibitors) including duloxetine (Cymbalta) and venlafaxine (Effexor).
• TCAs (tricyclic or tetracyclic antidepressants) including amitriptyline (Elavil), nortriptyline (Pamelor), and Imipramine (Tofranil).
• Atypical antidepressants, which are less likely to be prescribed for depression alone but include trazodone (Desyrel), mirtazapine (Remeron), and bupropion (Wellbutrin).
• MAOIs (monoamine oxidase inhibitors), which can interact dangerously with other antidepressants and other medications, so it is important to know what you are taking. They include selegiline (Emsam), phenelzine (Nardil), and others.

Treatment for Co-Occurring Depression and Addiction

Co-occurring disorders like depression and addiction should be treated at the same time with individualized treatment that meets a person’s unique needs.² Before entering treatment, it’s important that a person be fully evaluated for other mental health and substance use disorders to ensure proper treatment.²

Alongside medication, several behavioral therapies can be used to treat co-occurring conditions like depression and addiction:²

• Cognitive behavioral therapy (CBT) helps change the way you think about things to help you change the way you behave or react in difficult situations.
• Dialectical behavioral therapy (DBT) is designed to reduce self-harming behaviors that are common in depression, like suicide attempts, suicidal thoughts, or drug use.
• Assertive community treatment (ACT) helps you reach out to your local community and creates a unique treatment approach that fits your needs.
• Contingency management (CM) is a reward-based system that helps you create new habits and overcome unhealthy behaviors like substance misuse.
• Therapeutic communities (TC) help by creating a long-term community of support to help you maintain adherence to treatment and sobriety after rehab.

Though the need for co-occurring disorder treatment is increasingly recognized, many people still face barriers to proper treatment. Only 18% of SUD treatment programs and 9% of mental health treatment centers can serve people with co-occurring disorders.⁷ While there needs to be an increase in treatment capabilities, there is hope for those who need it.

Find Addiction and Depression Treatment Centers

If you or a loved one is ready to seek rehab for a substance use disorder, explore your options and reach out to a rehab center using our rehab directory tool today!