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Depression and Addiction:

Diagnosis, Signs, Types, and More

Depression and addiction are conditions that require immediate diagnosis and treatment by a health professional.

Depression and Addiction

Article Contents

What are Depression and Addiction?

Depression

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, from 2013 to 2016 8.1% of adults in the U.S age 20 and above faced depression for at least 14 days. 1 According to the World Health Organization, depression is also the main cause of disability globally.2

Adults 20 and Above Faced Depression for at least 14 Days From 2013 to 2016
8.1%

Addiction

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, in 2017 over 70,000 individuals in the U.S. lost their lives from a substance overdose.3 Annually, around 88,000 individuals in the U.S. also die from excessive use of alcohol.

LEARN MORE

● Stress and Addiction ●
● Anxiety and Addiction ●
● Burnout and Addiction ●
● Addiction in the Armed Forces ●

Relationship between Depression and Addiction

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, half of the patients that experience a mental illness throughout their lives will also experience substance use disorder, and the two disorders can feed into one another creating a cycle.4, 5

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.

Video transcriptions Text
00:01
is Duke University
00:09
there's a common pattern and adolescents
00:14
where people will have one psychiatric
00:17
problem and then as they get older they
00:18
might have another and sometimes the
00:20
second one is substance abuse or alcohol
00:23
abuse so we wanted to see if kids who
00:26
had had depression during adolescence
00:30
and had been successfully treated would
00:33
be less likely to develop alcohol or
00:36
drug use disorders later we follow them
00:39
for five years after their treatment and
00:42
found that if they had responded to the
00:47
depression treatment they were much less
00:50
likely to develop a substance use
00:53
disorder a drug use disorder we didn't
00:55
find any effect for alcohol use
00:58
disorders we think that perhaps was
01:01
because of the age period where they
01:04
were at the end of our study they were
01:06
between 17 and 23 so there were college
01:09
age and that's the highest age range for
01:13
alcohol use disorders and so it's more
01:18
more frequent more common at that age
01:20
than there have been a younger or older
01:21
ages and so the any benefit of
01:25
depression treatment might not have
01:27
shown up in that age range because the
01:29
alcohol use disorders are so common at
01:33
that time that's just a guess the winner
01:36
we don't really know why it didn't work
01:38
for that the other funding that we have
01:40
it was really I think very interesting
01:42
was when the teenagers got over the
01:46
depression about half of them stayed
01:49
well for the whole five-year period but
01:52
about almost half of them had a second
01:56
episode of depression and what we found
01:59
out was that for those who had both
02:01
alcohol disorders and another depression
02:05
the alcohol disorder usually came first
02:08
almost always came first so what that
02:11
says to me is that if you have had or
02:14
your child has had depression during
02:16
adolescence it's really important for
02:18
them not to get into an alcohol problem
02:22
because
02:23
that raises the risk that they'll have
02:24
another depression so I think that's
02:28
another way to another area that needs
02:31
further investigation what is it about
02:35
alcohol that lowers the threshold for a
02:40
second depression produced by duke
02:43
university online at duke.edu

Diagnosing Depression

Doctors can diagnose depression via a series of medical examinations such as:

Beck Depression Inventory

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

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 between two weeks to be diagnosed with depression.6 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

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.

Depression Signs and Symptoms

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:

  • Loss of interest
  • Fatigue
  • Changes in sleep patterns
  • Anxiety
  • Restlessness
  • Changes in food consumption patterns
  • Uncontrollable emotions like anger and aggressiveness
  • Irritability
  • Hopeless outlook

Diagnosing Substance Use Disorders

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:

DSM-5

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

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.

Tests

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.

Signs and Symptoms of Addiction

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:

  • Extreme mood changes like happiness, sadness, and anxiety
  • Changes in sleep patterns
  • Weight gain or weight loss
  • Inability to stop substance use
  • Obsession with substance
  • Financial difficulties due to uncontrollable intake
  • Withdrawal symptoms like diarrhea, seizures, sweats, seizures, sweats, and uncharacteristic behavior.
  • Increasing tolerance for the substance
Video transcriptions Text
00:07
Depression is the leading cause of disability in the world.
00:11
In the United States,
00:12
close to 10% of adults struggle with depression.
00:15
But because it's a mental illness,
00:17
it can be a lot harder to understand than, say, high cholesterol.
00:21
One major source of confusion is the difference between having depression
00:25
and just feeling depressed.
00:27
Almost everyone feels down from time to time.
00:31
Getting a bad grade,
00:32
losing a job,
00:33
having an argument,
00:34
even a rainy day can bring on feelings of sadness.
00:38
Sometimes there's no trigger at all.
00:39
It just pops up out of the blue.
00:42
Then circumstances change,
00:43
and those sad feelings disappear.
00:46
Clinical depression is different.
00:48
It's a medical disorder,
00:49
and it won't go away just because you want it to.
00:52
It lingers for at least two consecutive weeks,
00:55
and significantly interferes with one's ability to work,
00:58
play,
00:59
or love.
01:00
Depression can have a lot of different symptoms:
01:03
a low mood,
01:04
loss of interest in things you'd normally enjoy,
01:06
changes in appetite,
01:08
feeling worthless or excessively guilty,
01:10
sleeping either too much or too little,
01:13
poor concentration,
01:15
restlessness or slowness,
01:17
loss of energy,
01:18
or recurrent thoughts of suicide.
01:21
If you have at least five of those symptoms,
01:23
according to psychiatric guidelines,
01:25
you qualify for a diagnosis of depression.
01:28
And it's not just behavioral symptoms.
01:31
Depression has physical manifestations inside the brain.
01:35
First of all,
01:36
there are changes that could be seen with the naked eye
01:39
and X-ray vision.
01:40
These include smaller frontal lobes and hippocampal volumes.
01:44
On a more microscale,
01:46
depression is associated with a few things:
01:49
the abnormal transmission or depletion of certain neurotransmitters,
01:53
especially serotonin, norepinephrine, and dopamine,
01:56
blunted circadian rhythms,
01:58
or specific changes in the REM and slow-wave parts of your sleep cycle,
02:03
and hormone abnormalities,
02:05
such as high cortisol and deregulation of thyroid hormones.
02:10
But neuroscientists still don't have a complete picture
02:12
of what causes depression.
02:15
It seems to have to do with a complex interaction between genes and environment,
02:20
but we don't have a diagnostic tool
02:21
that can accurately predict where or when it will show up.
02:26
And because depression symptoms are intangible,
02:28
it's hard to know who might look fine but is actually struggling.
02:32
According to the National Institute of Mental Health,
02:34
it takes the average person suffering with a mental illness
02:37
over ten years to ask for help.
02:41
But there are very effective treatments.
02:43
Medications and therapy complement each other to boost brain chemicals.
02:47
In extreme cases, electroconvulsive therapy,
02:50
which is like a controlled seizure in the patient's brain,
02:53
is also very helpful.
02:55
Other promising treatments,
02:56
like transcranial magnetic stimulation,
02:59
are being investigated, too.
03:01
So, if you know someone struggling with depression,
03:04
encourage them, gently, to seek out some of these options.
03:08
You might even offer to help with specific tasks,
03:11
like looking up therapists in the area,
03:13
or making a list of questions to ask a doctor.
03:16
To someone with depression,
03:17
these first steps can seem insurmountable.
03:20
If they feel guilty or ashamed,
03:23
point out that depression is a medical condition,
03:25
just like asthma or diabetes.
03:27
It's not a weakness or a personality trait,
03:30
and they shouldn't expect themselves to just get over it
03:33
anymore than they could will themselves to get over a broken arm.
03:36
If you haven't experienced depression yourself,
03:39
avoid comparing it to times you've felt down.
03:42
Comparing what they're experiencing to normal, temporary feelings of sadness
03:46
can make them feel guilty for struggling.
03:49
Even just talking about depression openly can help.
03:52
For example, research shows that asking someone about suicidal thoughts
03:57
actually reduces their suicide risk.
03:59
Open conversations about mental illness help erode stigma
04:03
and make it easier for people to ask for help.
04:06
And the more patients seek treatment,
04:08
the more scientists will learn about depression,
04:10
and the better the treatments will get.

Most Common Depression Types

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
  • Persistent Depressive Disorder (Dysthymia)
  • Bipolar Disorder
  • Seasonal Affective Disorder
  • Atypical Depression
  • High Functioning Depression
  • Psychotic Depression
  • Situational Depression
  • Postpartum Depression
  • Premenstrual Dysphoric Disorder

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 Co-Occurring with Common Addictions

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, the number of Americans living with a substance abuse disorder is around 24.6 million.9 Five million of those individuals have a co-occurring mental health disorder. Here are some common addictions that co-occur with depression:

Dual Diagnosis of Depression and Addiction Treatment

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 a dual diagnosis.

Cognitive Behavioral Therapy (CBT)

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.

Dialectical Behavioral Therapy (DBT)

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 Therapy

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.

Medications

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:

  • Antipsychotic medications
  • Antidepressant medications
  • Anti-Anxiety medications
  • Mood stabilizers
  • Detox medications


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

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.

Inpatient

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.

Outpatient

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.

Resources

  1. https://www.cdc.gov/nchs/products/databriefs/db303.htm
  2. https://www.who.int/en/news-room/fact-sheets/detail/depression
  3. https://www.cdc.gov/drugoverdose/data/statedeaths.html
  4. https://pubmed.ncbi.nlm.nih.gov/22986797/
  5. https://pubmed.ncbi.nlm.nih.gov/23731427/
  6. https://doi.org/10.3389/fpsyt.2018.00450
  7. https://cde.drugabuse.gov/instrument/e9053390-ee9c-9140-e040-bb89ad433d69
  8. https://www.ncbi.nlm.nih.gov/books/NBK559078/
  9. https://www.samhsa.gov/data/sites/default/files/NSDUHmhfr2010/NSDUHmhfr2010.htm
  10. https://doi.org/10.2147/NDT.S282208

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