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Depression and Drug Abuse: What is the Connection?

depression-and-drug-abuseMajor depressive disorder is not the same thing as normal feelings of depression that everyone experiences. Major depressive disorder is a mental health disorder that consists of a number of different symptoms; thus, it is a syndrome where depression or depressed mood is one of the major clinical features.

There are several risk factors for major depressive disorder, such as:

  • Having a first-degree relative with a history of major depressive disorder: This is believed to be related to some unidentified genetic factor that contributes to the risk for depression.
  • Gender: Females are diagnosed with major depressive disorder 1.5-3 times more often than males are.
  • Adverse experiences in childhood: These experiences include abuse, loss of a parent, poor support from parents, etc. Such experiences increase the risk for depression in adolescence and adulthood.
  • Major life changes, stress, and trauma: These are associated with an increase in the risk to develop major depressive disorder.
  • A chronic or serious medical condition: There are many different medical conditions that are associated with an increased risk of developing major depressive disorder, including cancer, cardiovascular disease, stroke, Parkinson’s disease, diabetes, arthritis, and a host of others.
  • A substance use disorder: Individuals with chronic substance abuse issues develop major depressive disorder at higher rates than people who have no substance abuse problems.
  • Other psychological disorders: Major depressive disorder is comorbid with a number of other psychological disorders, including anxiety disorders, personality disorders, and eating disorders.

Signs of Major Depressive Disorder

Major depressive disorder affects nearly 14.8 million adults in any given year. While depression can develop in any age, the median age for diagnosis of major depressive disorder is 32 years old. The lifetime prevalence for major depressive disorder in women is 20-26 percent, whereas it is 8-12 percent in males.

In order to be diagnosed with major depressive disorder, an individual must present with five or more of nine potential symptoms over at least a two-week period. The symptoms cannot be better explained by some other mental health disorder (many psychological disorders have depressed mood as part of their presentation), a medical condition (e.g., hypothyroidism), or the effects of medication or drugs. The symptoms must significantly interfere with the person’s normal functioning and occur nearly every day.

The symptoms include:

  • Feeling guilty or worthless
  • Having depressed mood most of the day
  • Sleep difficulties (either insomnia or hypersomnia)
  • Demonstrating significantly diminished interests or an inability to experience pleasure
  • A significant loss of energy or feelings of fatigue
  • Recurrent thoughts of death or committing suicide
  • Significant physical slowing or irritability and restlessness
  • Significant weight loss not occurring as a result of dieting, or an increase in appetite

Major depressive disorder is potentially fatal due to the inclusion of recurrent thoughts of self-harm as a possible symptom of the disorder. Obviously, the more symptoms a person displays, the more serious the disorder is.

Major Depressive Disorder and Substance Use Disorders

In general, it can be stated that the rates of substance use disorders are nearly twice as high in individuals diagnosed with major depressive disorder than in individuals not diagnosed with the disorder. Although any type of substance use disorder can be potentially comorbid with major depressive disorder, there are several substance use disorders that more commonly occur with major depression:

  • Alcohol use disorders
  • Cannabis use disorders
  • Cocaine use disorders
  • Substance use disorders to prescription medications, such as narcotic pain medications, benzodiazepines, or barbiturates, particularly in individuals with serious medical disorders or other psychological disorders

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Whenever an individual is diagnosed with more than one psychological disorder, it is important to ensure that all of the disorders are treated concurrently. Someone with dual diagnosis of major depressive disorder and a substance use disorder would need to have both of these issues addressed at the same time. It has been shown that treating one and ignoring the other produces no positive results. For instance, in someone with major depression and an alcohol use disorder, if the alcohol use disorder is treated and depression ignored, the individual often does not have the energy or motivation to maintain sobriety. Likewise, treating only the depression and not addressing the alcohol use disorder will leave the individual open to feelings of guilt, failure, and depression from engaging in the substance use disorder. Using an integrated treatment program for these individuals is the most successful route.

Integrated treatment approaches the individual’s current situation from multiple perspectives by using a multidisciplinary team of physicians, therapists, counselors, and other mental health workers. Treatment is tailored to the specific situation.

Treatment options include:

  • Residential (inpatient) treatment for individuals who need to go through a medical detox from drugs or alcohol or for severely depressed individuals who are suicidal
  • Individual and group therapy to address the client’s specific issues that fuel depression and substance use disorder
  • Physician-assisted medical management of symptoms for both depression (e.g., using antidepressants) and substance use disorder (e.g., using medications to help the individual negotiate any withdrawal period and other difficulties)
  • Support group participation, such as getting involved in a 12-Step group or some other specialty group, such as a depression support group
  • Medical treatment for any medical conditions that are present
  • Relapse prevention to ensure that the person develops the skills necessary to avoid potential relapse in the future
  • Family counseling, if needed
  • Vocational counseling to help the individual maintain employment or feel more productive
  • Case management to assist the individual with housing or other needed supports
  • Long-term aftercare support and case management to assist the individual down the road

The goal of treatment is to help the individual be as autonomous as possible. The treatment team typically consists of physicians (psychiatrists, addiction medicine physicians, and other specialists as needed), psychologists, social workers, counselors, case managers, vocational rehabilitation counselors, and any other specialists that fit into the overall treatment plan for the individual.

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