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The Link Between Depression And Substance Abuse: Which Came First?

Dr. Anna Pickering

Medically reviewed by

Dr. Anna Pickering

April 2, 2019

Depending on the individual, a person can be genetically vulnerable to both depression and substance abuse, whereas another individual, without the genetic predisposition toward depression or substance abuse, might first experience depression related to a life-altering event, and later turn to drugs or alcohol to numb their pain.

Over the course of the past few decades, researchers have been able to determine a link between depression, substance abuse, and genetics by studying family groups and comparing rates of depression and drug use within families of those suffering from mood disorders like depression or the disease of addiction, with those who were not. As a result of this process, researchers were then able to isolate specific gene combinations associated with vulnerability to both depression and substance abuse.

Risk factors including gender have also been determined. Women are more at risk for co-occurring disorders like substance abuse and depression, as they typically suffer double the rates of anxiety and depression, which increases their risk for subsequent substance abuse. Studies have also demonstrated that a woman who abuses alcohol has four times the likelihood of developing clinical depression.

Women also differ from men when it comes to co-occurring incidences of depression and substance abuse, in that they are more likely to abuse drugs and alcohol as a result of a depressive episode, while men are more likely to develop an addiction, then become depressed as a result.

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Why Drugs And Depression Don’t Mix

Abusing drugs while depressed typically exacerbates the symptoms of depression, sometimes with devastating consequences. Suicide attempts increase sixfold where substance abuse is a factor.

The reason for this exacerbation of symptoms when using drugs from alcohol to opioids to stimulants like cocaine and amphetamine all relate to an area of the brain known as the limbic system. The limbic system  regulates everything from mood to behavior to sleep, and even sex drive.

When a substance like alcohol or cocaine is introduced to this system, the brain responds by attempting to restore balance, increasing receptors here and decreasing or eliminating them there, as it adjusts to the foreign substance. These changes are partly why those who are detoxing from substance abuse experience such severe and sometimes overwhelming side effects.

This same system that appears altered in patients suffering from chronic depression is then further knocked off balance by the use of these psychoactive substances, decreasing stability of normal brain function.

Diagnosing Co-occurring Substance Abuse And Depression

Diagnosing co-occurring substance abuse and depression, referred to as a “dual diagnosis,” can be challenging if the person experiencing addiction isn’t aware they are also suffering from depression. Often patient interviews reveal risk factors and behaviors prior to drug use associated with depression that can help assess the likelihood someone may be suffering with both the disease of addiction and the mental disorder.

Signs and symptoms of both substance abuse and depression are nearly identical, so making this determination takes some level of detective work. In other cases, it may be obvious that drug use may be the impetus for subsequent clinical depression or a depressive episode.

Signs And Symptoms Of Co-occurring Substance Abuse And Depression

The common side effects of depression, like losing interest in a hobby, anxiety, aggravation, and changes in sleep cycles overlap those of substance abuse. If these signs and symptoms occurred prior to the substance abuse, it can be ascertained a person likely suffered from depression. If these symptoms appeared following the initial use of drugs and alcohol, the depression may be drug-induced.

Signs and Symptoms of Depression and/or Substance Abuse:

  • Anxiety
  • Tiredness or changes in sleep
  • Feelings of guilt
  • Significant changes in appetite
  • Loss of interest in hobbies
  • Non-specific aches and pains
  • Weepiness
  • Aggravation
  • Self-destructive thoughts or actions

Risk factors are additional key indicators used by doctors and treatment professionals in developing a comprehensive treatment plan that may include treatment of both the substance abuse and a mood disorder like depression.

Shared Risk Factors For Substance Abuse And Depression

We know today genetic predisposition, gender, and even changes to the limbic system of the brain are all linked to both depression and substance abuse. Additional factors for these co-morbid conditions include environmental and socioeconomic conditions.

A person who has recently experienced significant life changes like a divorce or death in the family, or one exposed to drug use and family dysfunction early on, those who are poor and without adequate health care, as well as those subjected to physical or sexual violence, are more likely to experience depression and substance abuse.

Understanding these risk factors can not only help treatment professionals diagnose depression and a drug use disorder, it can help us better assess and address issues that could prompt a depressive episode or drug use, and an excellent preventative tool.

Shared Risk Factors for Substance Abuse and Depression:

  • Genetic predisposition
  • Brain changes or disturbances
  • Environmental Factors
  • Significant Life Changes
  • Stress
  • Poor Socioeconomic Conditions
  • Gender

Treatment For Dual Diagnosis Of Depression And Substance Abuse

Treating the dual disease and disorder of addiction and depression can vary from the more traditional model of addressing the addiction first, then the depression to more progressive treatment plans that take into account the relapse risk of untreated depression in those recovering from a substance use disorder. Today, treatment professionals understand the need for more aggressive and comprehensive approaches to addressing both the mental disorder and the addiction simultaneously. Often this involves cognitive-behavioral therapy in conjunction with medications sometimes used to manage withdrawal symptoms from substance abuse alongside corresponding selective serotonin reuptake inhibitors (SSRIs) antidepressant medications.

Recovery From Depression And Substance Abuse

If you are suffering with chronic depression and are heavily reliant on drugs or alcohol to cope, you are not alone. can connect you with the online resources, professional support, and comprehensive treatment options to meet your individual needs. Contact us today for a new lease on life.

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