Co-Occurring Depression & Substance Use Disorder

Depression and substance use disorders can often occur together. This article will explore the connection between these two mental health conditions, symptoms, risk factors, and treatment for co-occurring depression and drug or alcohol addiction.

Understanding Co-Occurring Depression and Addiction

A co-occurring disorder, also called a dual diagnosis, is when a person has a substance use disorder alongside another mental health condition at the same time.¹

In the U.S., an estimated 50% of individuals who struggle with drug or alcohol addiction will also experience mental illness in their lifetime,² and in 2020, about 17 million Americans (6.7% of the general population) were diagnosed with co-occurring mental health and substance use disorders.¹

Research indicates there may be multiple factors that account for this high prevalence of co-morbidity, and the specific link between depression and addiction is extremely complex.

It’s often difficult to know which disorder developed first because both disorders can be inconsistent and nuanced, with symptoms that wax and wane over time.³

What Is Depression?

Depression is a state of sadness or hopelessness often characterized by apathy, irritability, pessimism, fatigue, appetite changes, anxiety, and sleeping problems, as well as other manifestations.

Many of us experience a state of depression every now and again. Someone with a depressive disorder, however, experiences prolonged and excessive feelings of irritability, sadness, or emptiness that severely affect their ability to function.⁴

Depressive disorders are some of the most common mental health disorders,⁴ and in 2020 alone, an estimated 21 million Americans age 18 and up suffered from a major depressive episode.²

There are several different types of depressive disorders, including:⁵

• Major depressive disorder (moderate to severe depression that lasts for more than two weeks).
• Persistent depressive disorder, also known as dysthymia (mild depression that lasts at least two years).
• Seasonal affective disorder (depression that occurs during the winter months).
• Perinatal or postpartum depression (depression that begins during pregnancy or within a year of giving birth).

Does Depression Cause Substance Use Disorder?

People with drug or alcohol problems frequently experience symptoms of depression while intoxicated with a substance or as part of the symptoms of withdrawal. For some, depressive withdrawal symptoms can be prolonged and gradually fade over time. If depressive symptoms aren’t improved or resolved with abstinence, it could be a depressive disorder that co-occurs together with a substance use disorder.³

There is typically no single cause of either depression or addiction, and having a depressive disorder and a substance use disorder does not mean one condition caused the other. In fact, it is rarely as simple as that. The relationship between addiction and co-occurring disorders like depression is complex and bidirectional, meaning that one disorder can impact, and often worsen, the course of the other.³

Researchers generally agree that the development of co-occurring depressive and substance use disorders is often due to a combination of shared risk factors.³

Common risk factors for depressive disorders and substance use disorders include:^1,3,6

• Genetics and family history.
• Issues with similar regions of the brain, including those that mediate reward, decision making, impulse control, and emotions.
• Environmental influences, such as the use of drugs or alcohol in childhood or early adolescence, prolonged and excessive stress, particularly during childhood; and mental or physical trauma.

In some cases, mental illness can contribute to developing drug and alcohol addiction, and vice versa. Depression and other mental health conditions are associated with uncomfortable symptoms, and individuals may use drugs and alcohol to alleviate those symptoms.¹

 This is sometimes referred to as “self-medication.” However, alcohol and drugs typically worsen a person’s health and should not be equated with medications, which improve a person’s health.

Although drugs and alcohol may temporarily mask symptoms of depression, continued substance use can become a maladaptive coping mechanism that might lead to a substance use disorder, and, ultimately, exacerbate symptoms of both conditions.^1,3

Are Antidepressants Safe for Those With Substance Use Disorders?

Antidepressants encompass a large variety of medications. Generally, antidepressants prescribed by a doctor to treat symptoms of depression are considered safe and effective.⁷

The major types of antidepressants include:⁸

• Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft).
• Selective serotonin noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), desvenlafaxine (Pristiq), duloxetine (Cymbalta), and levomilnacipran (Fetzima).
• Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), and tranylcypromine (Parnate).
• Tricyclic antidepressants(TCAs), such as amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, trimipramine.
• Atypical antidepressants, such as bupropion (Wellbutrin), mirtazapine, nefazodone, and trazodone.

If you have a history of substance misuse and are concerned about taking medications to treat depression, discuss the benefits and risks of antidepressant use with your doctor.

Symptoms of Co-Occurring Depression & Addiction

Symptoms for co-occurring depression and addiction will vary depending on the individual. While there may be some overlapping symptoms associated with both conditions, doctors will typically evaluate a patient for each disorder separately.

When diagnosing mental disorders, such as depressive or substance use disorders, clinicians rely on criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V).

 Symptoms of major depressive disorder include:⁹

• A depressed mood for most of the day nearly every day.
• Feeling overwhelmed with feelings of sadness, worry, frustration, hopelessness, guilt, and worthlessness.
• Loss of desire to participate in most daily activities or hobbies that were once pleasurable.
• Low energy and fatigue.
• Poor concentration, memory, and difficulty making decisions.
• Changes in amount or quality of sleep.
• Changes in appetite or weight.
• Significant physical slowing or irritability and restlessness. Recurrent thoughts of death and suicidal thoughts, planning, or attempts.

Many people occasionally experience these feelings of sadness or worry and may exhibit some of the criteria for depressive disorders.

The main difference between major depression vs. everyday depression, according to the DSM-V, is that symptoms of a depressive disorder are persistent (with 5 or more of the above symptoms present during the same 2-week period) and debilitating, impacting a person’s ability to function.

Symptoms of substance use disorder include:⁹

• Cravings or strong urges to use drugs or alcohol.
• Continuing to use substances despite their negative effects on relationships, physical and mental health, and functioning.
• Using substances in hazardous situations.
• Requiring more of a substance over time to feel the same effects (i.e., tolerance).
• Experiencing withdrawal symptoms when not taking the substance (i.e., dependence).
• And more.

It’s important to note that only a medical professional can diagnose major depressive disorders, substance use disorders, or co-occurring disorders.

Depression & Alcohol Abuse

Major depressive disorder is the most common co-occurring mental health disorder among people with alcohol use disorder.⁴ Individuals are twice as likely to develop depression if they also alcohol.¹⁰

Depression can intensify symptoms of alcohol use disorder and vice versa. Individuals with co-occurring depression and substance use disorders frequently have more severe mood symptoms, worse functioning, and higher risk of suicidal thoughts than those without a substance use disorder.²

Depression & Drug Misuse

Similar to co-occurring alcohol use disorder and depression, people with co-occurring depression and drug use disorders tend to have more intense symptoms for both conditions. This may include more severe mood symptoms, worse overall functioning, and a higher risk of suicide or suicidal thoughts.²

People with drug use disorders are nearly twice as likely to have any mood disorder and also at increased risk of having major depressive or persistent depressive disorders.³

How to Treat Co-Occurring Depression & Substance Use Disorder

Research suggests that, because of the complex, bidirectional relationship between depressive and substance use disorders, treating co-occurring disorders together (concurrently) using an integrated approach is more effective than treating each condition separately.¹

In an integrated approach, physicians, psychiatrists, therapists, counselors, case managers, and other specialists all work as a team to address both disorders at once, setting the same goals and keeping the treatment plan consistent.

At Sunrise House Treatment Center, we specialize in the treatment of co-occurring disorders and offer different types of rehab.

Our inpatient rehab facility in New Jersey uses a combination of evidence-based and alternative therapies to address the psychological issues underlying addiction and depression and teach patients more positive ways to cope.

Our therapies include:

• Cognitive behavioral therapy (CBT).
• Individual and group counseling.
• Treatment medications (as needed).
• Trauma-based therapy.
• 12-Step programs.
• Family therapy.
• Mindfulness.
• Music therapy.

If you or someone you love is struggling with depression and addiction, there is hope, and we can help you begin the journey toward recovery.

For more information on paying for addiction treatment and using insurance to pay for rehab, or if you’re ready to start the admissions process, call us at today.