Depression is a mood disorder that may be defined as feelings of sadness, loss, or anger. Individuals who experience depression often have interference with daily activities because due to loss of interest or lack of energy. According to the Centers for Disease Control and Prevention, 1 from 2013 to 2016 8.1% of adults in the U.S age 20 and above faced depression for at least 14 days. According to the World Health Organization, 2 depression is also the main cause of disability globally.
Addiction is a psychological and physical disorder formed when an individual cannot stop themselves from consuming a harmful substance such as alcohol, prescription drugs, or illegal drugs. According to the Centers for Disease Control and Prevention, 3 in 2017 over 70,000 individuals in the U.S. lost their lives from a substance overdose. Annually, around 88,000 individuals in the U.S. also die from excessive use of alcohol.
Studies have shown a connection between addiction and depression. Approximately one-third of patients with Major Depressive Disorder (MDD) also have substance use disorders. According to multiple surveys, 4 half of the patients that experience a mental illness throughout their lives will also experience substance use disorder, 5 and the two disorders can feed into one another creating a cycle.
Depression can lead to drug use in an attempt to self-medicate depression symptoms. Similarly, withdrawal from a substance may lead to depression symptoms. Patients who struggle with depression and use drugs to cope can form an addiction to the substance and a dependency on it to feel “normal.”
A significant relationship between depression and addiction is shown in the DAD (Depression, Addiction, and Denial) effect. The DAD effect is a growing problem that occurs in individuals who struggle with depression, substance use disorder, and denial of their issues.
Doctors can diagnose depression via a series of medical examinations such as:
Beck Depression is a 21-item inventory that comes in different forms, including the computerized and card form. It’s a self-report rating inventory that functions by measuring symptoms of depression and characteristic attitudes.
DSM-5 is a standard diagnostic tool by the American Psychiatric Association. It serves as a significant authority for general psychiatric diagnosis. According to the DSM-5, an individual needs to experience five or more symptoms 6 between two weeks to be diagnosed with depression.
In the DSM-5, one of the symptoms should be a depressed mood or loss of interest in certain activities. Mental health experts typically ensure that the symptoms of depression are due to significant distress or impairment in occupational or social areas of life.
ICD-10 stands for the International Classification of Diseases, Tenth Revision. ICD is an international standard for diagnosing health conditions, including depression. The code F33.0 is the billable ICD-10 code that is conventionally used for healthcare diagnosis reimbursement of major depressive disorder.
There are certain signals for depression that range from simply affecting one’s mood to influencing the body. Some symptoms may be ongoing, while others may reoccur sporadically.
The common signs and symptoms of depression can include:
Diagnosing substance use disorder requires an appropriate evaluation of the condition. The assessment is carried by a psychiatrist, a licensed drug counselor, or a psychologist. Generally, laboratory tests like blood or urine examinations are used to assess drug use.
Addiction is different from drug use, and diagnosing the condition involves a different procedure. The accepted ways of diagnosing substance use disorders include:
The DSM-5 criteria for substance use disorders are based on clinical knowledge and research. DSM-F recognizes substance-related disorders from ten separate drug classes, including cannabis, alcohol, hallucinogens, inhalants, opioids, hypnotics, and more.
The DSM-5 also acknowledges that individuals are not all equally vulnerable to developing substance-related disorders. There are individuals with lower levels of self-control, making them prone to certain medical conditions when exposed to substances or drugs.
Clinicians can specify the severity of the substance use disorder, depending on the number of symptoms they recognize. A mild substance use disorder is characterized by 2-3 symptoms, while a moderate substance use disorder shows 4-5 symptoms. A severe substance use disorder is characterized by 6 or more symptoms.
ICD-10 is a significant standard to diagnose substance use disorders. The codes in ICD-10 typically follow the format “F1x.xxx”. According to the code, “F” depicts the code is from Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders of ICD-10-CM. In the code, 1 represents a behavioral or mental disorder due to substance use.
Mental health professionals may undergo certain examinations to determine drug use. These tests may not directly indicate substance use disorder, but they indicate the presence of a significant level of the substance in the blood or urine. A major test for substance abuse is the DAST-10. 7 It helps in giving a quantitative index of the degree of consequences linked to drug abuse.
Addiction comes with certain signs and symptoms that may range from mild to severe. Note that the symptoms can be psychological, social, or physical. Significant symptoms of substance use disorder include:
Depression can be divided into different categories depending on its severity. Some individuals may experience mild and temporary episodes of depression, while others go through severe and recurrent episodes.
Common depression types include:
Major depression and persistent depressive disorder are two extensive types of depression. Major depressive disorder (MDD) is a very severe form of depression that involves feelings of hopelessness, worthlessness, or sadness. The World Health Organization (WHO) ranked MDD as the third cause of disease globally and its projected to rank first by 2030. 8
Some of the specifiers of major depressive disorder include atypical features, anxious distress, mixed features, seasonal patterns, melancholic features, and more.
Persistent depressive disorder, or dysthymia, is milder than MDD. Dysthymia is chronic, and individuals with the condition may experience a feeling of hopelessness, lack of productivity, and low self-esteem.
Depression occurring at the same time as an addiction is called a co-occurring disorder or dual diagnosis. According to a study published by SAMHSA, 9 the number of Americans living with a substance abuse disorder is around 24.6 million. Five million of those individuals have a co-occurring mental health disorder.
Here are some common addictions that co-occur with depression:
Psychiatric professionals and addiction therapists with specialized training for co-occurring disorders follow appropriate treatment procedures. There are seven broad treatment options that mental health experts may follow to treat dual diagnosis.
Cognitive behavioral therapy is a psychotherapeutic treatment that helps individuals learn how to acknowledge and change problematic thought patterns. It’s an effective treatment for patients with a dual diagnosis of depression and addiction because it helps one control the negative influences behind such behaviors.
DBT is a type of cognitive behavioral therapy that combines techniques like acceptance, mindfulness, and emotion regulation. It’s an approach to therapy that helps individuals to learn how to cope with certain emotions. DBT teaches patients the best ways to deal with stress and improve their relationship with others by living at the moment.
EMDR or Eye Movement Desensitization and Reprocessing is a psychotherapy treatment for relieving psychological stress. It’s an effective treatment for dual diagnosis and post-traumatic stress disorder (PTSD). An EMDR therapy session helps the patient process and overcome traumatic experiences.
A mental health professional may recommend the use of certain medications to treat the dual diagnosis of depression and addiction. It’s essential to follow a professional’s prescriptions and avoid self-medication. Some of the common prescriptions for dual diagnosis include:
Ketamine is a drug that can cause dissociative and hallucinogenic effects when consumed in high doses. It’s also regarded as a rapid-acting antidepressant as it can quickly improve one’s mood, though the effect diminishes over some time. Ketamine may help treat bipolar depression, but further research is required on the full expanse of this drug. 10
Apart from ketamine, other hallucinogenic drugs may also be effective in alleviating treatment-resistant depression. Self-medication is not advisable when dealing with mental conditions like depression and addiction, so it’s always essential to consult the doctor.
Detox is a process that may take place in an outpatient or inpatient facility. The purpose of detox is to allow the body to heal after a long period of substance use. Detox rids the body of the drug and stabilizes the individual for appropriate long-term treatment.
Detoxing may be a dangerous process, especially when it involves opioids. For this reason, mental health experts and other medical practitioners typically perform a medical examination to ensure that it’s safe to undergo detox.
The inpatient treatment involves providing round-the-clock care for the patient in a medical faculty. It may involve medication management, cognitive behavioral therapy, group therapy, and nutritional therapy. Most inpatient treatment centers focus on depression, major depression, and high functioning depression.
The outpatient treatment program allows patients to keep going to work and performing other necessary daily activities. It doesn’t require one to stay round the clock in a medical faculty and it’s most suitable for individuals who don’t require medical detox.