Depression and Addiction Together: Understanding Dual Diagnosis

Depression and addiction have a complicated relationship. The disorders can happen together. One can lead to the other. They also might exist together while being unrelated.

The combination of depression and addiction has a devastating effect on millions of Americans. This combination goes by several names. It is called dual diagnosis and co-occurring disorders. Some scientific papers call it comorbidity. It is a vital issue no matter what you call it.

This post will help you understand depression and addiction. We’ll look at different aspects of depression. We’ll also see how depression and addiction happen together. Finally, we’ll help you understand the best treatment options for co-occurring disorders. Use this information to help yourself or someone you love get the help they deserve.

Understanding Depression

Depression is a broad term. It describes a few different mental health issues. This section explains the basic facts about depression. This will help you better understand the disorder. It also covers different treatments for depression.

depression and addiction


Depression is more than feeling sad. After all, everyone gets a little down sometimes. Depression occurs when these feelings get out of control. Also, the feelings must last for at least two weeks. The disorder has a range of symptoms. Some of them are fairly mild. Others are much more severe. Some of the most common symptoms include:

  • Loss of interest in activities you used to enjoy
  • Trouble sleeping
  • Sleeping too much
  • A sad and depressed mood that lasts longer than two weeks
  • Feelings of worthlessness
  • Feelings of guilt
  • Weight gain or loss unrelated to dieting
  • Problems concentrating
  • Thoughts of suicide or death

About 6.7% of adults face depression every year. Also, 16.6% of people will deal with the disorder at some point in their lives. For some people the disorder is chronic. That means it will always be a part of who they are. Others can recover completely.

It’s important to realize that being sad is different from being depressed. Everyone gets sad sometimes. For example, losing a job or a loved one, or a relationship ending all create feelings of sadness. People in these situations may even describe themselves as depressed.

There’s a few things to look for when telling the difference between depression and sadness or grief. A person maintains their self-esteem when they are sad or grieving. Those with a depressive disorder feel worthless. They don’t like themselves. Also, painful feelings come in waves with sadness and grief. Those with the disorder have constant sad feelings for two or more weeks.

Types of Depression

Depression is a term that covers several disorders. The description listed above describes major depression. However, the disorder takes many different forms.

This disorder happens if you have depression symptoms for two years or more. It covers two different conditions, dysthymia and chronic major depression.

The symptoms are the same as those for the regular disorder. The difference is that the feelings have been around for a long time. As a result, it requires a slightly different approach for treatment.

This disorder is also known as manic depression. A bipolar person has mood swings that go to extremes. They go from very high energy “up” periods, to very low energy depressive periods.

Bipolar disorder requires a different treatment approach. Studies show that traditional medications don’t work for those with bipolar disorder. However, there are several drugs that specifically treat the disorder. Some examples include lithium, Seroquel, and Latuda.

This disorder happens when someone has major depression during winter months. Moods get worse in the fall and winter. They improve during the spring and summer. This cycle can make it difficult to maintain a job. It also messes with relationships.

Medications can help people with Seasonal Affective Disorder. There’s also a special light therapy. It involves sitting in front of a bright light box for 15-30 minutes a day.

This disorder has all of the symptoms of major depression. However, it has a few of its own. These include hallucinations, delusions, and paranoia. Hallucinations happen when you see or hear something that isn’t there. Delusions are false beliefs. Paranoia is wrongly thinking that others are out to get you.

This type of depression benefits from antidepressant drugs. They are usually combined with antipsychotic drugs for best results.

Postpartum depression happens to some women after childbirth. It occurs in the weeks and months following delivery. Scientists aren’t sure why it happens. However, studies show that regular antidepressant drugs are effective in treating it.

This type of disorder is a bit different. It means that there’s an overall pattern of depression in someone’s life. However, positive events can cause temporary mood improvement. There’s a few other symptoms as well, such as:

  • Oversensitive to criticism
  • Sleeping more than usual
  • Increased appetite
  • A heavy feeling in your arms and legs

Regular antidepressants are the first-line option for atypical depression. The most common type of drug is an SSRI. This stands for selective serotonin reuptake inhibitor. However, some people respond better to an older type of drug called an MAOI.

Treatment Options

There are four main types of treatment for depression and depressive disorders. They are medication, psychotherapy, and ECT/TMS. We’ll look at each of these treatment options in greater detail.

Many drugs can treat depression. There are a few different types of drugs. Also, each type of drug covers several specific drugs. It’s important to follow your doctor’s advice when taking these meds. The main types are:

  • SSRIs – Selective Serotonin reuptake inhibitors. These are the most common drug doctors recommend for depression. They work by changing how the brain processes serotonin. That’s a chemical the brain produces naturally. It helps regulate mood. Some examples include Lexapro, Prozac, Paxil, and Zoloft
  • SNRIs – Serotonin and norepinephrine reuptake inhibitors. These are the second most common type of drug doctors prescribe for the disorder. They work like SSRIs but also affect norepinephrine. Some examples include Cymbalta, Pristiq, Fetzima, and Effexor
  • NDRIs – Norepinephrine-dopamine reuptake inhibitors. These drugs work to correct the balance of norepinephrine and dopamine in the brain. They are also used to treat anxiety. The most common NDRI is Wellbutrin.
  • MAOIs – Monoamine oxidase inhibitors. These drugs have more intense side effects. Therefore, doctors usually only recommend them when other drugs have failed. Also, they have lots of interactions with foods and other meds. They can’t be taken with SSRIs.

Most doctors recommend some type of therapy along with medication to treat depression. There are many types of therapy that can help. Some of the most common types are:

  • Psychoanalysis – the very first talk therapy, this method attempts to bring unconscious actions and behaviors to the surface.
  • Psychodynamic – this method is similar to psychoanalysis. However, the treatments aren’t as frequent. Also, treatment doesn’t last as long. It has more limited goals than psychoanalysis.
  • Cognitive – this therapy looks to turn around thought patterns that cause depression and anxiety. It helps patients recognize harmful and irrational thoughts and replace them with helpful ones.
  • Behavior – where cognitive therapy focuses on thoughts, behavior therapy focuses on actions. It helps you overcome depression by changing your behavior. It is often joined with cognitive therapy. This combination is called cognitive-behavioral therapy, or CBT.
  • Interpersonal – this is a brief and focused therapy that helps people understand their relationships with friends and family. It helps resolve conflict and improve communication.

It’s important to know that therapists may use any of these methods. They might also use a combination of methods. The best therapy for depression is one that is tailored to your specific needs.

Doctors usually recommend lifestyle changes in addition to medication and therapy. The modern world has created lots of wonders. However, some of those things can make depression and anxiety worse. Some common lifestyle changes include:

  • Abstaining from alcohol and drug use
  • Regular exercise
  • Eat a balanced diet
  • Establish a regular sleep schedule
  • Meditation
  • Stress management techniques

Sometimes medication, therapy, and lifestyle changes aren’t enough. This situation is usually called drug-resistant depression. However, there are other options.

Electroconvulsive therapy, or ECT, gets a bad reputation. This comes from the ways it was used in the past. However, it’s an increasingly popular choice for drug-resistant depression.

ECT involves running an electric current through the brain. This alters the brain chemicals related to mood. It’s relatively safe. Additionally, it’s one of the most effective methods for treating depression.

rTMS, or Repetitive Transcranial Magnetic Stimulation, is another option. It involves using a device on the skull to produce a magnetic field, similar to an MRI. This causes a flow of electricity to targeted areas of the brain. That causes brain cells called neurons to be either more or less active. It is FDA approved and considered safe, with few side effects.

Co-Occurring Disorders: Depression and Addiction

Now that you have a better understanding of depression it’s time to talk about depression and addiction. This is known as co-occurring disorders or a dual diagnosis. That’s because substance addiction is a mental illness, just like depressive disorder.

Dual diagnosis can be tricky to deal with. After all, depression and addiction are usually related. However, the relationship is different in everyone. Sometimes the substance abuse comes first. Other times the depressive disorder leads to substance abuse. There’s no set order.

The disorders relate in other ways too. Sometimes people use drugs or alcohol to self-medicate. Other times they use substances for reasons not related to mental health. We’ll look at some of the most common dual diagnosis combos. Then we’ll talk about treatment for the dual diagnosis of depression and addiction.

Alcohol is the most abused drug in the country. It’s widely available and legal. Depression can lead to alcoholism. Alcoholism can lead to depression. Also, many of the signs of alcoholism in women match signs of depression.

Thankfully, there are options for treating both issues at once. One of the most effective methods is CBT. Studies found that using CBT increased the benefits patients got.

Scientists think that this is because cognitive therapy helps people spot their triggers. That means they do a better job of handling and avoiding things that make them want to drink.

Alcoholism and depression make each other worse. Alcohol is a depressant. That means that it lowers the bodies normal functions. This can lead to depressive behavior. It can also make an existing issue worse.

Alcohol also has unique effects on women. That means there are more health risks for women that drink. Studies find that women that have more than one drink a day are more likely to develop a mental heath issue like depression.

Opioid abuse is one of the biggest problems in the US. It affects women as well as men. Opioid abuse has a bi-directional relationship with depression. That means that suffering one increases the risk of the other.

Researchers think that opioids make depression worse. This is because they change how the brain’s reward center works. That makes it harder for a person to be happy. It also causes them to use more drugs. They do this to try and feel better. However, using more only makes the situation worse.

Treatment for Dual Diagnosis

Treating co-occurring disorders demands a specialized approach. Treating one and not the other rarely works. It’s key that both issues get the treatment the person needs. After all, treating substance use issues without addressing depression is a recipe for relapse. In the same way, treating depression without dealing with addiction can undermine the progress someone makes.

It’s also important to treat both disorders at the same time because of the way they are treated. Most drugs for depressive disorders aren’t addictive. However, some of them are.

That means doctors need to understand a person’s dual diagnosis to offer the most effective treatments. It does no good to give someone with a substance use disorder an addictive medication.

Knowing that someone has a dual diagnosis also helps therapy. It helps your therapist come up with effective behavior modification techniques.

Best Practice for Treating Co-Occurring Disorders

There are a few things that you should look for to get the best results for dual diagnosis treatment. Best practices means using the most effective ways to help someone. First, the best treatments are evidence based.

Evidence-based treatment looks at how well treatments have worked in the past. Doctors compare similar cases and find similarities. They don’t only look for what worked. They also look for what didn’t work so they can stop using those methods. Using evidence-based treatment increases the chances of a successful recovery.

Next, women specifically benefit from gender-specific treatment. Society places many unfair burdens on women. Women also have important physical differences. Gender-specific treatment options take these things into account.

As a result, gender-specific treatment for dual diagnosis and co-occurring disorder is generally more effective than general treatment options. It creates a more supportive environment. It also deals with the ways that women’s bodies respond differently to drugs and alcohol than men.

Additionally, gender-specific treatment can offer insights in therapy. It can help you understand what pressures and issues you deal with. This gives you a better chance of overcoming your mental health and addiction issues.

Don’t let dual diagnosis and co-occurring disorders hold you back. There are treatment options. Evidence-based and gender-specific treatment offers one of the best chances to recover from depression and addiction together. The combination of these two mental health issues ruins lives. Take action now to get yourself or someone you love the help they deserve.