The United States may be in the midst of an opioid addiction epidemic, but the problem is larger and broader than just opioids. Other types of substance use disorder (SUD) and related problems are also on the rise, such as mental health issues.

SUD itself is a form of mental illness or mental health disorder, any of which can lead to poor health, reduced quality of life, illness, and death.

Nearly 19% of Americans have a mental health issue or illness (46.6 million), but some are more serious than others. Almost 5% of people live with a serious mental illness (SMI), a disorder that so badly impacts one’s ability to think, feel, or behave that it interferes with at least one major life activity.

Two of the most serious SMIs are depression and substance use disorder (SUD). Worse, they sometimes co-occur.

What Is Depression?

Depression is associated with the color blue and it can color your perceptions of the world negatively. It’s not just feeling sad or down one day or two. Depression causes one’s mood to deteriorate for at least two weeks without improvement. It can make it more difficult to concentrate, learn and remember new things, or make good decisions.

Depression is one of the most common categories of any mental illness (AMI), with 7.2% of the U.S. population experiencing a major depressive episode annually.

Signs of depression may include:

  • Pessimistic feelings (feeling sad, worthless, helpless, hopeless, or guilty)
  • Loss of interest in once pleasurable activities
  • Changes in appetite or weight
  • Difficulty sleeping, sleeping too much or too little
  • Loss of energy
  • Suicidal thoughts
  • Feelings of irritability or restlessness or trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Unexplained aches or pains, headaches, cramps, or digestive problems

More serious side effects may include heart disease, dementia, and death.

There are at least six types of depression:

  • Major depression. When one experiences some of the above symptoms most of the time for two weeks or more. During a major depressive episode, one may not be able to function.
  • Persistent depressive disorder (PDD). A usually less severe form of depression but one that lasts a long time, at least two years. People with PDD can function but have low self-esteem and feel little joy, energy, or hope.
  • Seasonal affective disorder (SAD). Depression that typically sets in or grows worse as the days become shorter in the fall and winter.
  • Bipolar disorder (BPD). Formerly known as manic depression, this type of depression contains episodes of both depression as well as mania or irrational exuberance.

In general, more women live with depression than men. Some types of depressive disorders unique to women include:

  • Perinatal depression. This form of depression includes major and minor depressive episodes during pregnancy and up to one year after delivery (when it is also known as postpartum depression).
  • Premenstrual dysphoric disorder (PMDD). A severe form of premenstrual syndrome (PMS) characterized by depression, anxiety, and irritability.

What Causes Depression?

Depression is one of the most common mental disorders in the U.S. and it seems to have multiple possible causes. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Risk factors include:

  • A personal or family history of depression.
  • Major life changes (new job, new relationships, new locale).
  • Trauma from past events, both personal and observed.
  • Stress.
  • Physical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease.
  • Medications that are taken for different conditions that may cause or exacerbate depression.

Depression also may co-occur with or worsen these serious conditions.

How Do You Treat Depression?

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with:

  • Drugs. Specifically, antidepressants. They improve mood, but take time (two weeks or more) to take effect and may have dangerous side effects, such as an increase in suicidal thoughts, especially among those ages 25 and younger. They should not be combined with herbal remedies such as St. John’s wort.
  • Psychotherapy. Talk therapies such as cognitive-behavioral therapy (CBT) that address a person’s thoughts and feelings to create positive life changes.
  • Brain stimulation therapies. Treatments that use electricity to inhibit or stimulate the brain. The most well-known is electroconvulsive therapy (ECT), a modern version of electroshock treatment, but others include vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS).

If one therapy doesn’t work, another should be tried. Sometimes a combination of therapies may be necessary.

What Is Addiction?

Many experts believe that addiction, also known as substance use disorder (SUD), is a mental illness and also a chronic brain disease. It is a disease that affects 4% of the U.S. population annually, while 10% have had a SUD at some point in their lives.

Addiction hijacks and rewires the brain’s reward circuit to reinforce drug- and alcohol-seeking, encourage such behaviors, and make them compulsive. This not only makes quitting difficult; it makes relapses common.

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What Causes Addiction?

The causes or risk factors for SUD are similar to depression and other mental illnesses. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

  • Genetics. Approximately half of one’s risk of becoming addicted is due to biological factors, including one’s sex and ethnic background.
  • Environment. A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.
  • Age. Early exposure to addictive substances up to the age of 25 may increase the risk of SUDs because the brain is still developing mature decision-making capabilities, judgment, and self-control.
  • Other mental health issues.

Signs of Addiction

There are both physical and behavioral signs of addiction, including:

  • Slowed breathing
  • Smaller pupils
  • Sleepiness
  • Appetite or weight changes
  • Flu-like symptoms caused by withdrawal
  • Changes in appearance, hygiene, and clothing, such as wearing long sleeves
  • Personality changes
  • Avoidance of friends and family
  • Changes in friends, hobbies, activities and/or sports
  • Declines in work or school performance
  • Increasingly secretive behavior

Such indicators may be signs of substance abuse that require treatment. If a person has signs of addiction and depression, treatment is especially urgent.

How Do You Treat Addiction?

One of the first steps of addiction treatment is detoxification, which allows substances to leave the body and manages any withdrawal symptoms that may occur:

  • Anxiety
  • Excess sweating
  • Hand tremors
  • Dehydration.
  • Faster-than-normal heart rate
  • High blood pressure.
  • Trouble sleeping
  • Nausea and vomiting
  • Diarrhea

Sometimes one is not ready to stop using drugs or needs to detox or taper off slowly. There are drugs that may help prevent opioid addicts from using, but they do not remove the desire:

  • Opioid maintenance drugs. Methadone and buprenorphine (Suboxone) are weaker opioids that satisfy the body’s need for opioid drugs, preventing withdrawal pains. People do not experience euphoric highs if they use the recommended doses of the maintenance drugs.
  • Opioid antagonists. Another drug, naltrexone (Vivitrol), prevents opioids from getting the user high.

One of the main treatments for SUD is psychotherapy or talk therapy, cognitive-behavioral therapy (CBT) in particular. Psychotherapy helps by teaching people new ways of thinking and behaving and changing habits that may be contributing to addiction. Therapy can help people understand and work through difficult relationships or situations that may be causing their depression or making it worse.

Why Do Depression and Addiction Co-Occur?

No one knows for sure why a particular individual will experience both depression and a mental health issue, any more than it’s possible to predict who will develop a mental illness or SUD alone. In 2018, 9.2 million individuals aged 18 or older (3.7%) had both a SUD and any mental illness in the past year. More than one-third of them (1.3%) had a SUD and a serious mental illness, statistics that illustrate just how common co-occurring depression and substance abuse really are.

Correlation does not prove causation. However, the number of cases makes coincidence seem unlikely. Among possible explanations for dual diagnosis are:

  • SUDs lead to mental illnesses. Some drugs cause mental illness-like symptoms, and some researchers have long held that marijuana use may increase the risk of psychosis. The evidence is at best mixed.
  • Mental illnesses lead to substance use disorders. At least some people with mental health issues turn to drugs to relieve their symptoms, to self-medicate. For instance, people with schizophrenia have been known to smoke tobacco to reduce the severity of their mental disorder.
  • Mental illnesses and SUDs have the same causes. Both are chronic brain illnesses caused by genetic predispositions, environmental factors, and mental, physical, and emotional trauma.

Effective rehab for depression and addiction recognizes the links between mental illnesses and SUDs and treats both.

Signs of Depression and Addiction

The signs of drug addiction and depression are similar and may be confused for one another. This makes it difficult but vital to diagnose both disorders at intake in order to address the signs of depression and drug abuse. They haven’t always been diagnosed in this way.

What Is Dual Diagnosis?

As bad as depression and other mental health issues, SUD included, are on their own, they are worse when they happen at the same time. This phenomenon is called a co-occurring disorder or a dual diagnosis. Of individuals with lifetime major depression, 18% had a drug use disorder, so the rate of co-occurring depression and drug addiction is significant. The rates are even higher among people with bipolar disorder: 56%.

It works both ways. Those seeking treatment for SUD also have a high correlation with depression. For depression and alcohol addiction, the rates vary from 20% to 67%.

How Do You Treat Dual Diagnosis?

The best way to treat dual diagnosis is to treat both disorders at the same time in an integrated way. The old thinking was that the primary disorder had to be treated first. Since we cannot know for sure if one condition led to the other, or which one, treating one only increases the risk of a full relapse. It’s, therefore, better to pursue drug addiction and addiction treatment at the same time.

Mental health disorders are more common than society realizes. Addictions such as opioid use disorder (OUD) get the attention, but all sorts of mental illnesses are debilitating and cost society time, money, and lives. More resources must go into detecting and treating all mental illnesses before they become serious.

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