Co-occurring disorders: depression and addiction

This Page was last reviewed and changed on December 3rd, 2021

Verified by Dr. Mateen Durrani
MBBS; DPM(lre); MSc(Lon); BSPsych(Lon)

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Content Overview

Depression and addiction are two of the most common mental health disorders in the world. Clinical depression is a disorder that affects how someone feels, thinks and behaves. Addiction is a chronic disease that causes people to compulsively use substances or engage in certain activities despite negative or potentially harmful consequences. Sadly, depression and addiction are often co-occurring conditions and dealing with them together can be incredibly challenging.

This page explains what depression is, why and how commonly it occurs, the relationship between depression and addiction, and most importantly, the help available for anyone who is struggling with these co-occurring conditions.

What is depression?

Depression is a mood disorder. It affects how someone feels, thinks and behaves. Symptoms of depression often include a persistent feeling of sadness, irritability or anger that can last for several weeks at a time. Other common symptoms include feelings of hopelessness or guilt, changes in appetite, loss of interest in favourite activities, extreme fatigue, lack of energy, sleeping too much or not enough, difficulty concentrating and wanting to be alone all the time.

What are the different levels and types of depression?

There are various levels of depression that affect different people in different ways. Some people may experience a mild depression, which is like a background feeling that makes everything in their life just a little bit harder. For others, the feeling can be far more acute and powerful and at its most extreme can even lead to suicidal thoughts or self-harm.

woman texting on phone

In addition to different levels of depression, there are different medically recognised types of depression. These include the following.

Major depressive disorder

Also known as unipolar depression, this condition is characterised by a combination of symptoms that interfere with a person’s ability to carry out daily life. These may include changes in mood, changes in sleeping and eating patterns, fatigue or loss of energy and feelings of guilt and low self-worth, as well as thoughts about death.

Bipolar disorder

Also known as manic depression, bipolar disorder is a condition that causes extreme shifts in mood, from periods of mania to deep lows which can be accompanied by symptoms like disorganised thinking, psychosis and even suicidal ideation. Bipolar disorder swings between these two states but it is not necessarily triggered by external events.

Dysthymia

This type of depression is often characterised by ongoing irritability rather than the more acute highs and lows associated with major depressive disorder or bipolar disorders. A person may experience this state for years at a time before it is recognised as depression.
This form of depression can be very challenging because some people may continue thinking and acting like things are fine when clearly they’re still struggling inside even if they don’t show any signs or symptoms outside.

Persistent depressive disorder

This type of depression can make a person feel hopeless and pessimistic. The symptoms of persistent depressive disorder may be only slightly different from dysthymia but it is more intensely severe depression, lasts far longer than two years and can affect every aspect of a person’s life.

Seasonal affective disorder

Also known as SAD, this is a type of depression that typically occurs during the autumn or winter months when there are fewer hours of daylight. It can be linked to changes in mood, behaviour, sleep patterns and eating habits.

Psychotic depression

This form of depression can cause a person to experience delusions and hallucinations. While it is not as common as other types, it can often have very severe depression symptoms.

Postnatal depression/postpartum depression

This type of depression can occur in women shortly after giving birth. Postnatal depression should not be confused with postnatal blues, which many women experience and last only a few days or weeks. While they may be related disorders, postpartum depression is far more severe, and depression symptoms may last up to one year following childbirth.

Premenstrual dysphoric disorder

This type of depression affects some women during the days leading up to their period. It is often accompanied by extreme mood swings, irritability and other symptoms like fatigue or loss of energy which can make it difficult for a person to carry out daily activities such as work or school.

What causes depression?

As with many mental disorders, there isn’t one single cause behind why some people experience depressive disorders while others do not. However, certain factors often play a role in its development:

  • Genetics – Depression has been linked to genetics, so if you have a family history of depression you might also be at higher risk for developing it yourself. This doesn’t necessarily mean you will get depressed; it just means that there may be an increased chance.
  • Brain chemistry – Scientists have long proven that there are certain parts of the brain, as well as various neurotransmitters and chemicals, that play a role in how someone feels. When there are physical changes in the brain or chemicals become unbalanced, it can lead to various mental health conditions, including depression.
  • Environmental factors – Stressful events like the loss of a loved one, financial issues, unemployment or social isolation can also contribute to depression, especially if these things happen suddenly or with no warning. In the case of young people and children’s mental health, bullying, educational pressures or an unstable home life can all be potential risk factors.
  • Medical conditions – Being unwell can be a major source of stress and worry, especially if treatment is leading to financial problems or the person is worried about being a burden on family members. This kind of stress can also potentially lead to a low mood and the development of depression.

How can depression be treated?

Effective treatment for depression depends on the type of depression a person is suffering from, its severity and its underlying causes and triggers. For some mild cases, talking therapy can be enough to help with disease control and prevent depression symptoms from returning later. In other situations, psychotherapy or Cognitive Behavioural Therapy (CBT) may be used to treat less severe cases, while antidepressants such as monoamine oxidase inhibitors may benefit those with major depression.

There are also other treatment options, including alternative therapies and holistic treatments, that have been shown to be effective in helping people to manage the symptoms of depression. For example, counselling might help younger children come up with strategies for coping better when they’re feeling down, while meditation techniques have been shown to reduce symptoms in some people. In these cases, the therapist may suggest trying out certain complementary medicinal options such as acupuncture or herbal supplements.

To effectively treat depression, it is not enough to just get rid of depressive symptoms. The underlying triggers such as stress, anxiety, addiction and other mental health concerns also need to be addressed to stop the issue flaring up again in the future.

What is addiction?

Addiction occurs when someone becomes dependent on a particular substance or behaviour. This includes gambling, shopping or smoking cigarettes, but it could also be regularly drinking excessive amounts of alcohol or taking recreational drugs.

Addictive behaviours can be hard to overcome for many different reasons. For some people, issues in their lives trigger addiction and substance use as a way of coping. For others, the physical withdrawal symptoms of trying to give up a particular substance can completely override their self-control. It is important to understand that many people with addiction recognise the impact that it is having on their lives and the people around them but they just find it impossible to stop.

Addiction does not only affect people’s mental health. Depending on the substance, it can lead to physical health problems. For example, someone who regularly drinks too much alcohol can develop liver disease, high blood pressure and an increased risk of stroke and heart attack, while smoking is the leading cause of premature death in young adults and the cause of conditions such as lung cancer and heart disease.

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What are co-occurring disorders?

A co-occurring disorder is when someone has both a mental health condition and addiction at the same time. For example, if you have depression, it’s possible that you might also drink to excess or take drugs in an effort to lessen your symptoms. This could put you at higher risk for developing another mental illness such as anxiety or bipolar disorder.

If this sounds familiar, there are things that may help including seeking professional support from a counsellor, psychologist or psychiatrist as well as joining organisations such as Alcoholics Anonymous (AA), whose 12-step programme can be adopted by anyone struggling with various types of addiction.

Depression and addiction are intrinsically connected, and it is common for people to suffer from both. Someone can develop major depression as a result of addiction or they could become addicted to alcohol or drugs because it helps them cope with their negative feelings. This creates a situation in which the two disorders begin to fuel each other, making the symptoms of both conditions worse.

How do they affect one another and a person’s mental health?

Depression can be incredibly difficult to live with on its own, which is why it’s important to seek help. However, if you are also struggling with addiction, this will only make things more complicated.

Depression can cause changes in a person’s behaviour which can lead to addiction in the future. For example, if your mood is low you might find that drinking or taking drugs makes it easier for you to manage the way you feel. Over time this becomes a habit, and even though it might make things worse in the long run, these substances initially help lift your spirits.

Similarly, many people with addictions recognise the damage that is being done to their lives and their loved ones, and this often leads to depressive feelings such as guilt, anger, low self-esteem and a lack of energy or motivation. Ultimately, it can become a vicious circle with both conditions feeding off each other unless effective treatment is sought.

How is the co-occurring condition diagnosed?

Both mental health and addiction disorders should be diagnosed by a qualified medical professional such as a doctor, psychiatrist or another healthcare worker. Diagnosing depression alongside an addiction can sometimes prove difficult because the symptoms of each condition vary depending on how serious they are, what substances have been taken and for how long someone has been abusing them.

However, there are certain criteria that need to be met before doctors will make their diagnosis. For example, if you’ve experienced low mood (or even loss of interest in regular activities) for more than two weeks, and these feelings don’t go away with lifestyle changes such as eating well and exercising, then it’s likely that your doctor may suggest speaking to counsellors who specialise in treating both conditions simultaneously.

What are the treatment options?

Two people talking in therapy

There are a number of treatments available to help people with co-occurring disorders, and treatment plans can vary depending on the severity of each condition. For example, if you’ve been diagnosed with depression alongside an addiction then your doctor might suggest that you try Cognitive Behavioural Therapy, mindfulness or other brain stimulation therapies in order to deal with both conditions simultaneously. These brain stimulation therapies may include repetitive transcranial magnetic stimulation or electroconvulsive therapy, but the treatment really does differ from case to case.

Similarly, anti-depressants such as fluoxetine may be prescribed for those individuals who need them. However, they come with various risks including suicidal thoughts, which is why it’s so important for anyone taking medication to have regular medical check-ups.

Those struggling from severe addictions alongside depression will likely require more in-depth care which may include the following.

Detox

This is the initial stage of alcohol and drug treatment and it enables somebody with an addiction to clear their system of a substance so they can overcome the initial withdrawal and focus on long-term recovery. Detox programmes vary depending on what substances have been taken, how long someone has been addicted for and their current physical health.

While detox can be effective to a certain extent, it only addresses the physical side of alcohol or drug addiction, so is not a long-term solution. Undergoing detox without medical supervision is also potentially dangerous, as some people may experience severe withdrawal symptoms such as high blood pressure, fever or seizure.

Outpatient/day rehab

This type of addiction treatment enables people to continue rehab while living at home. An outpatient programme can be tailored for each individual depending on their specific needs, which might include counselling sessions with a therapist or attending support groups such as Narcotics Anonymous (NA), where they will meet other individuals who are also struggling from addiction. While many people choose this option because it is the least intrusive, effective addiction treatment often requires a more holistic approach.

Inpatient/residential rehab

For those individuals with more serious addictions – especially if they’ve also been diagnosed with mental disorders like depression – then an inpatient care facility like our UKAT addiction treatment centres may prove the most beneficial. Inpatient treatment allows people to live in the rehab centre full time so that they can participate in a holistic recovery programme with comprehensive medical care and attention. This is particularly important for people with depression, who may need some extra assistance and supervision as the rehab process can be quite intense.

At UKAT, we understand that every person is different and your treatment plan will address your specific addiction as well as other factors such as depression or related disorders that you are suffering from. Effective treatments will help to address the underlying causes of your addiction, teach you coping methods and break the vicious cycle that gives fuel to co-occurring disorders.

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