Depression and Substance Use Disorders

Depression is a common and serious mental health condition that affects how a person feels, thinks and behaves. It can cause lasting feelings of sadness and hopelessness as well as a loss of interest in activities enjoyed before. Depression can also make it harder to function day-to-day and lower one’s quality of life. For many, it’s like living in dark shadows where feelings of hopelessness feel ever present.

There are some differences between adults and teens as to how depression shows up.  Adults may have a more depressed mood along with feelings of worthlessness or guilt. Teens, on the other hand, may show more irritability, anger and frustration. Teens may tend to isolate a bit more as well.  Adults with depression may lose weight while teens may either gain too much weight or not enough.  Both adults and teens may experience problems with sleep.[1]

People with depression may also have substance use disorder, and vice versa. Together, these are referred to as co-occurring disorders. Having co-occurring depression and substance use can make both conditions worse and harder to treat. A loved one may use substances to cope with their depression, but this can lead to using more and more of the substance to get relief, which, in turn, causes withdrawal symptoms, addiction (also referred to as a substance use disorder), and overdose. On the other hand, substance use can trigger or worsen depression symptoms, such as low mood, anxiety, irritability and suicidal thoughts.

How is depression diagnosed?

There is no single test that can diagnose depression. Instead, healthcare providers will use a combination of methods to assess your loved one’s symptoms, medical history and possible causes of depression. The assessment may include a physical exam and lab tests. These can be helpful to rule out issues caused by thyroid problems or not getting enough vitamins, for example.

Additionally, your loved one will be asked questions about their feelings, thoughts, behaviors and patterns. Sometimes they are asked to fill out a questionnaire or a rating scale like the Beck Depression Inventory to measure whether the depression is mild, moderate or severe.

The criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, may also be used to evaluate your loved one. One of the most common forms of depression is Major Depressive Disorder[2].  Five or more of the following symptoms must be experienced for at least two weeks to be diagnosed:

To be diagnosed with depression, one of the symptoms must be a depressed mood or loss of interest or pleasure. Your loved one’s symptoms must cause significant distress or get in the way of their work or school, social life or other areas of functioning.

What kinds of substances are used by people who are depressed?

People with depression may use different substances for various reasons. Some may use them to cope with feeling sad, anxious, or hopeless. Others may use them to deal with stressors in their lives, such as trauma, abuse, grief or relationship problems. Some may use them to improve their mood or to temporarily increase feelings of pleasure.

Some of the more commonly used substances include:

What are treatment recommendations for co-occurring depression and substance use?

The best treatment for co-occurring depression and substance use is integrated treatment that addresses both disorders at the same time. Integrated treatment can improve outcomes and quality of life for people with co-occurring disorders by treating the whole person. Learn more about what to look for in terms of co-occurring disorders treatment here.

In addition to talk therapy, medications are often considered as part of the course of treatment. These include antidepressants and mood stabilizers. Antidepressants can be helpful for some people, although it’s important to note that it may take a few weeks for the effects to kick in.  Sometimes a benzodiazepine (e.g., Xanax, Ativan, Klonopin) may be prescribed to help until the antidepressant works, but these medications can be misused, so caution is needed when prescribing.

In some cases, young people under the age of 25 may experience an increase in suicidal thoughts or behaviors when taking an antidepressant.  It’s especially important to watch closely for any signs of suicidal thinking. Don’t be afraid to ask your loved one about it – asking questions won’t make them more likely to consider suicide.

Medications to treat substance use disorder may also be recommended as part of your loved one’s treatment plan, especially for nicotine, alcohol and opioid use. If your loved one is using heavy amounts of alcohol or benzodiazepines, medications may be used in a supervised medical detox to reduce the risks of seizures.

Increasingly, psychedelics, or mind-altering drugs, are being tested as potential ways to treat depression.  Ketamine, psilocybin and LSD may work although a great deal of research is underway to better understand who might benefit the most, what dosage is needed and the best formulation.

Some people may also benefit from light therapy as the days get darker and there is less sunshine.  It uses artificial light to help lift one’s mood. [4]

Another form of depression treatment is electroconvulsive therapy, intended for those who have not responded to other treatments. Under anesthesia, a short burst of electric current is passed through the brain causing a seizure to help restore mood.[5]

It’s also important not to forget about the benefits of exercise. Any form of exercise including walking and yoga can help someone feel better.  Many loved ones may not feel like moving, but may reconsider if you or another family member or friend offers to do it with them.

How can I motivate my loved one to get treatment?

Learn more about motivating a loved one to get treatment and how to best support them here.  If you need a sounding board, moral support or help developing a plan, please reach out to us. Co-occurring disorders are complicated, but your loved one can get well, especially with your encouragement, love and support.