Depression and Addiction

Addiction can occur simultaneously with a number of other mental health conditions like post-traumatic stress disorder (PTSD) and bipolar disorder.  When a person has an addiction and another mental health issue, it is called “dual diagnosis.”  There is a strong link between addiction and depression in particular. 

What is depression?

Many people misuse the word “depressed.”  A person may say they are “depressed” when they really mean that a life event has made them feel sad or low temporarily.  Depression is a specific diagnosis that must be determined by a psychiatrist, therapist, and/or other medical professional.  Symptoms of depression include disinterest in activities that used to bring the person pleasure, feeling empty or lonely, sleeping too much or too little, difficulty concentrating, low self-esteem/feeling worthless, profound sadness, weight loss or gain, low energy, and thinking about suicide or death in general.  If these symptoms last for a period of longer than 2 months (or if the symptoms are so intense that they disrupt the person’s life), a diagnosis of depression may be made.  However, before making a diagnosis, the doctor will make sure that the patient’s feelings are not the result of a medication or other drug as well as not caused by having recently lost a loved one. Types of depression include major depressive disorder, postpartum depression (which can occur in men as well as women following the birth of a child), and seasonal affective disorder.  Individuals who have bipolar disorder often struggle with depression for long periods of time. 

How common is depression?

According to a 2010 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention, as many as 9% of Americans had depression from 2006 to 2008.  Although not all of these individuals were also suffering from addiction, the data give some perspective to the prevalence of depression, which is particularly concerning because it is a risk factor for addiction and relapse.

Does one cause the other?

In some cases, a depressed person may turn to a substance or behavior in an attempt to self-treat their persistently negative feelings.  In other cases, the cycle of addiction or the substances themselves can produce depression.  For some situations, it may be difficult to determine which happens first.

How are depression and addiction treated?

When a person enters an outpatient or residential rehab program, the staff should determine whether the person has one or more co-occurring mental health conditions and develop a treatment plan accordingly.  In terms of pharmacological options, a physician may prescribe an antidepressant but would be unlikely to suggest a medication that could have strong potential for abuse by someone with a history of addiction.  Psychotherapy is also likely to be advised; seeing a therapist can help an addict better understand the relationship between addiction and depression, especially as it applies to his or her specific situation.  Recognizing that drug use or engaging in an addictive behavior is related to feelings of depression is the first step toward being able to mentally intervene before actually using a substance or coping with sex, gambling, video games, or other behaviors. 

Treatments for addiction and depression continue to be studied.  In August 2011, the journal Neuron published research that implicated a specific stress-related protein in addiction risk and depression-like symptoms in mice.  The results of the study provide another step forward in understanding and treating these problems in humans.