Addiction And Depression: What’s The Connection?

One in four adults with mental illness will also struggle with substance abuse.

This statistic from the National Institute of Health (NIH) merely reflects the number of reported cases which unfortunately neglects the considerably higher number of unreported cases. Every year millions suffer from undiagnosed and untreated mental illness. This discrepancy is largely attributed to a lack of awareness and access to healthcare along with fear of stigmatization. 

Greater than 1 in 6 adults in the United States is likely suffering from mental illness (NIH) and of that number, 1 in 4 will likely become addicted to substances. If this number sounds incredibly high, you are correct. The correlation between mental illnesses such as anxiety and depression occurring in conjunction with addiction is staggering and only continues to grow.

By understanding the intersectionality of these conditions, we can better diagnose and treat those suffering from addiction and depression. We can also examine why people self-medicate, how self-medication leads to addiction, and where to seek help for addiction and depression. 

What Does Depression Look Like in the Brain?

The human brain is filled with hormones responsible for initiating, executing, and maintaining crucial biological functions. Hormones in the brain play a vital role in regulating growth, fertility, metabolism, and behavior. Of these biological functions perhaps, none is more important than the regulation of our moods, which are primarily influenced by chemicals in the brain known as neurochemicals.   

In discussing addiction and depression the most commonly referenced neurochemicals are serotonin, dopamine, and oxytocin. These chemicals are typically discussed as an explanation for a vague nonspecific condition known as a chemical imbalance. While that explanation is partially true the complexities of neurochemical imbalances are far more complicated.

Although there is no concrete way to determine every cause of depression, scientists believe there exist 5 major causes of which one or more factor into a diagnosis of depression. The most common issues are:

• Genetic vulnerabilities
• Difficulty with mood regulation
• Certain medical conditions
• Side effects of specific medication
• Traumatic life events (Harvard Health)

Examining each of these risk factors reveals an identical parallel in shared risk factors for addiction. The most recent addiction science and research confirms that:

• There is a genetic predisposition to addiction
• Many addicts report using drugs or alcohol to help manage their moods
• Medical conditions that produce symptoms including pain and distress have a higher incidence of substance abuse among patients
• People suffering from addiction sometimes used substances to counteract the side effects of prescribed medications and some became addicted to the medications prescribed.
• Millions of addicted individuals report experiencing significant trauma or traumatic events before becoming addicted.

These risks are nearly identical.

Symptoms of Depression

Oftentimes serious conditions, such as depression are reduced to no more than a feeling of sadness or apathy. While many of us endure periods of less pleasant emotional states, depression is marked by prolonged experiences of these feelings punctuated by months and even years of ongoing sadness.

Depression is more than feeling low; other symptoms of depression include:

• Fatigue
• Weight loss or weight gain
• Disinterest in people and/or activities that used to bring joy
• Interruption of concentration
• Difficulty establishing or maintaining motivation
• Insomnia or excessive sleep patterns.

Beyond these symptoms, it can be difficult for people suffering from depression to communicate what their symptoms are. Explaining the severity of their experience without fear of judgment or misunderstanding can be a daunting weight in preventing individuals from reaching out for help.

When depression sufferers use substances to mitigate their symptoms, success in mitigation can easily lead to dependence and abuse. Substance use can temporarily cover many of the symptoms of depression and create the illusion that the user’s chosen substance is acting as a treatment or cure. The side effects of substance use can include euphoria, increased energy, relaxation, and the lowering of inhibitions.

While these effects seem a welcome treatment for depression, their efficacy is temporary and often instrumental in the long-term worsening of symptoms. There exists a circular causation between addiction and depression and yet the prevalence of self-medicating with substances continues to persist among those suffering from this condition.

What is Self-Medicating?

Due to stigmas both internalized and societal, many mental health sufferers feel discouraged from reaching out for help. Fear of judgment or condemnation keeps people with depression from seeking professional treatment which inevitably leads to a quest for do-it-yourself relief, otherwise known as self-medication.

Many people suffering from addiction report their substance use began when they found drinking or drug use offered relief from the depression symptoms which typically left them frozen or down. Stimulants or uppers such as Methamphetamines, speed, and cocaine offered energy, focus, and motivation which they previously lacked. Depressants or downers such as alcohol, Xanax, or pain killers offered relief of worry or spiraling thoughts that previously consumed the person suffering from depression.

While the use of illicit substances presents obvious complications, it is also true that those abstaining from drugs and alcohol will self-medicate in other ways. Some common forms of nonsubstance self-medication include consuming too much caffeine, engaging in risky behavior, or using sleeping aids to deal with depression-induced insomnia.

One of the biggest risks with self-medicating is that the “medication” or substance becomes a crucial part of day-to-day function requiring use in larger quantities and with increased frequency ultimately leading to both mental and physical addiction.

Depression is most often linked as co-occurring with addiction however many mental illnesses lead to similar causational relationships. Examples of this include anxiety sufferers smoking marijuana because it calms them down and people suffering from eating disorders abusing stimulants because it suppresses their appetite.

How Self-Medicating Leads to Addiction

As you can imagine, the person who uses speed to feel awake as a break from their constant depression fatigue quickly loses the initial rush from the first few does and suddenly requires an increased amount the maintain that same feeling. Taking more speed happens quickly as the individual begins to justify excessive use. As the need to take more and more increases the control over quitting or abstaining decreases and eventually these individuals find themselves trapped in a cycle of addiction they never intended to start.

At the point of recognition, many substance abusers have gone too far into this pattern to admit powerlessness or loss of control. For individuals suffering from depression, substance abuse begins to worsen the symptoms of depression initiating a dangerous cycle of dependence upon which the substance abuser believes if he or she could only use more drugs the depression would go away.

For individuals who have not previously experienced depression, entering a pattern of addiction to substances may induce this condition, triggering a similar cycle to the one described above.

Drugs and Your Brain: What’s Going On?

Most discussions surrounding drugs and neurochemicals, focus primarily on the chemicals dopamine and serotonin. While these two chemicals are responsible for completely separate brain functions, lack of either one of these could lead to depression as well as addiction.

Dopamine is our “reward” chemical, it is activated to make us feel happy when we win a game, get a good grade, or hear our favorite song. It also governs some muscle movement and mood regulation. Serotonin is the “happiness” hormone and while it serves to regulate our mood it is also responsible for body temperature and appetite. Both of these chemicals can create pleasant feelings which then develops a positive association with whatever activity or substance produced them.

For example, drugs such as cocaine activate a flood of dopamine to the brain creating an intense feeling of euphoria. While the brain is accustomed to receiving small doses of dopamine for activities such as exercising, listening to music, and spending time in the sun, cocaine creates a large influx of this chemical, effectively rewarding the brain for drug use and instilling the idea that drugs create happiness.

As with any continued pattern of behavior, our brains quickly adapt to function within the new expectations. Bodybuilders, for example often train their stomachs to expect a certain level of protein and food mass, if they fall below those expectations the body feels weak or sluggish and fails to perform as well; this is similar to the effects of repeated drug use. As the brain becomes accustomed to large and sudden deliveries of dopamine, it becomes very difficult for substance users to function without using it. As the threshold of expectation shifts to anticipate larger amounts of dopamine, the body struggles to create enough of this chemical to mimic the initial euphoria of the first use. (Pubmed & NIH).

Once a person decides to stop using, they have officially removed the brain’s primary source of dopamine. While they may find small doses in meditation, dancing, or snuggling with a pet, these activities will fail to produce a large amount of dopamine the body now requires to feel content and motivated. This experience is frequently referred to as a “come down” and it is one of the number one reasons those suffering from addiction will return to use. Despite the negative consequences of using substances, individuals experiencing “comedowns” report feeling hopeless and depressed until they use again. This cycle often continues until the user has reached desperation or intervention.

Addiction-led Depression

Not only does the cocaine “come down” influence depression, but the continued use disrupts the body’s ability to produce dopamine for non-substance related activities. Drug use increases the amount of dopamine required to feel happiness while failing to produce enough dopamine to enforce other methods of obtaining happiness. This dysregulation creates an ideal environment for which depression and addiction may thrive.

Drug-Provided Dopamine and Brains with Depression

In a scenario where a regularly healthy brain is dragged into depression through drug use, it is difficult to imagine the severity of a situation in which the user experienced depression prior to beginning substances. An individual suffering from depression is already experiencing a lack of dopamine and serotonin and because they’ve already struggled to reach the threshold of dopamine needed for happiness, drug-induced dopamine influx seems like a solution rather than a problem.

As previously mentioned, this “solution” will backfire as the threshold increases and more and more drugs are needed to maintain the initial relief of substance use. Once removed, the drugs are unavailable to provide that dopamine flood. Those struggling with existing depression are now left with intensified dysregulation and feelings of hopelessness, often leading to relapse or continued use. 

This simplified version of events paints a broad depiction of substance use and depression however, neuroscientists are still studying the interactions of neurochemicals, drugs, and mood regulation in the brain.

How to Spot the Link Between Addiction and Depression

Depression is a marked mood change, characterized by lack of energy, being withdrawn, lethargy, insomnia, and/or general apathy or dissatisfaction with life. If someone you love displays any of these symptoms it is important to offer understanding and openness by expressing your observations and concerns.

Early intervention with therapy or therapeutic medicines could prevent depression sufferers from turning to addictive substances in search of relief.

If you suspect a friend or family member may be self-medicating with addictive substances or experiencing depression as a result of substance use assess the situation by looking for symptoms such as:

• Change in mood or behavior varying day to day or moment to moment
• Increased energy beyond what is typical of that individual, followed by periods of intense lethargy
• Risk-taking
• Unexplained or sudden financial instability
• Change in social circle or atmosphere including socialization with those who abuse drugs or alcohol
• Incongruent emotional responses such as inappropriate laughter or unexplained tears
• Isolation or avoidance of formally close relationship

Many individuals suffering from addiction and depression will also experience denial. Because substance abuse may feel like treatment for depression some will justify their use as healthy or helpful. It is rare that an individual will be ready to admit to and get help for an addiction to substances, but you are not completely powerless in helping your loved one find recovery. 

• Approach the subject without judgment
• Offer understanding and empathy while listening
• Assure your loved one that you are ready to provide help when they are ready to receive it