Depression

Healing From Depression and Addiction

Recovery from both conditions is easier when we recognize the warning signs.

Posted Feb 01, 2021

Martin Dimitrov/Getty Images
Depressed woman sits by a window.
Source: Martin Dimitrov/Getty Images

Addiction is termed a “cunning, baffling, and powerful disease,” but when symptoms of depression co-exist with addiction, the diagnosis and treatment is sometimes even more baffling and certainly more complex.

Depression is one of the most common co-occurring disorders and can make recovering from a substance use disorder—a significant undertaking on its own—especially challenging. Much like the question of the chicken and the egg, determining whether the addiction came first or whether the depression came first is often impossible to answer. Each condition can contribute to the onset, or worsening, of the other. But in an integrated treatment approach, it is important to assess, address, and treat both of these conditions in order to relieve a person’s suffering. 

How Depression Can Fuel Addiction

Mental health conditions, including depression, increase the risk that people will “self-medicate” by using alcohol or other substances (like opiates or benzodiazepines or cocaine) as a temporary “fix” or “escape” from sadness, depression, stress, or other difficult feelings. A person may experience negative life events, such as job loss or the death of a loved one, and then subsequently cope with negative emotions by drinking alcohol or using drugs. And certainly, with the social isolation, economic struggles, and general frustration people are feeling with the persistent COVID-19 pandemic, there has been an increase in the use of substances to cope with depression.

But self-medication only “works” for a short period of time. When they see that their use of drugs or alcohol no longer quells their depression symptoms, they will often use more in order to achieve that desired relief, and then they face the real possibility of developing a substance use disorder. Depressants like alcohol and benzodiazepines may further compound depression symptoms, leading to a downward spiral.

The same scenario happens with opiates. People in emotional pain find that opiate painkillers may temporarily numb their feelings of sadness and distress. In the long term, of course, these drugs have a high potential for dependency, and not only will hinder recovery from depression but will also introduce a new set of challenges, including withdrawal, risk of overdose, and numerous negative economic and personal consequences that often accompany opioid use disorder.

How Addiction Causes Depression

Alternately, people can suffer from a substance use disorder long before receiving a depression diagnosis. The “high” or “euphoria” that a person experiences from using certain substances is related to the release of neurotransmitters (serotonin, norepinephrine, and dopamine) in the brain. These neurotransmitters are the chemical messengers necessary to maintain mood or euthymia.

The repeated use of substances can shut off the brain’s ability to sustain these neurotransmitters at adequate levels and can lead to depression or dysthymia. When neurotransmitters are depleted, a person may experience feelings of sadness or emptiness, lack of energy, lack of motivation to carry out daily tasks, decreased appetite, decreased sex drive—all symptoms of depression. 

When to See a Medical Professional

Those who struggle with one or both of these conditions should seek help early to boost their chances of a full and sustained recovery. If someone is experiencing symptoms of depression (including prolonged sadness, feeling like everything is an effort, poor appetite, difficulty sleeping) for two weeks or more, this is likely more than just “normal sadness.”  

However, one does not necessarily need to consult a psychiatrist to immediately start antidepressants. A visit to their primary care provider to discuss their symptoms and feelings and to rule out any complicating medical issues is a good place to start. But it is important to be honest with their provider about any substances—prescribed or not—that they are taking so that the full scope of the problem can be assessed and appropriately addressed.

Abstaining from alcohol and other addictive substances that can mimic or worsen depressive symptoms is often the first and hardest step in the recovery process. Stopping alcohol, benzodiazepines, opiates, and some other drugs “cold turkey” can be dangerous, leading to seizures, hallucinations, severe dehydration, delirium tremens (“DTs”), and other complications, including death. Detoxification under the care of a medical professional or detox team is often necessary. It is only after the addictive substance is out of a person’s system that the co-occurring depression can be properly assessed and treated.

How to Treat Depression With a Substance Use Disorder

The great news is that there is treatment available for co-occurring depression and substance use disorders. Sometimes, just removing the addictive substance from the picture is all it takes to relieve the depressive symptoms. For some, after just a week or two of abstinence, the depression starts to lift, and energy, sleep, appetite, and sense of hopefulness return. 

Others, of course, may require treatment with a combination of antidepressant medications plus clinical therapy and rehabilitation. The choice of antidepressant is based on a number of factors, including the client’s past history of medications tried, a family member’s response history, as well as the specific depressive symptoms the client is reporting. Some antidepressants are more sedating (preferred for those with sleep problems), while others are more activating and stimulating, while others are better at addressing anxious and irritable moods. Pharmacogenomic Testing (PGT) is also being utilized more widely to help prescribers understand how a client’s specific genetic make-up can impact the way he or she metabolizes antidepressant medications.

But medications alone are not sufficient to treat co-occurring depression and addiction. Individual and group therapies—in combination with medication management—are necessary to treat the whole person and achieve lasting symptom relief and personal wellness. A therapist can help people better understand the core issues that contributed to their depression and/or addiction and help them find strategies and develop new practices to help them sustain recovery. Additionally, adjunctive therapies and practices—such as yoga, meditation, acupuncture, and exercise—can be helpful in treating mood and addictive disorders and in sustaining health.

The Stigma of Depression and the Hope of Recovery

This focus on healing the whole person, physically, mentally, and emotionally, is crucial in recovery. Being happy, identifying goals, and feeling like one is on a positive trajectory in life should be the norm. Unfortunately, there is still stigma—often internalized—that prevents people from seeking treatment for mental health and substance use disorders.

Depression often carries with it a sense of hopelessness. A person might say, “There's no hope for me; I’m not worth it; I don’t deserve to feel better.” And then they slip deeper into that dark pit, and it’s even harder to get out of. 

Treatment for depression and addiction can raise the floor of that pit. While treatment cannot change the past, it is heartening to see people realize that there is help and hope out there, and they can allow others to help them out of the pit and take steps toward a brighter future.