Depressive Disorders & Drug Addiction
Depressive disorders are psychiatric disorders where the major feature is depressed mood or sadness.
The type of depression that occurs in these mental health disorders is different from the everyday ups and downs that most people experience. Instead, the symptoms are persistent and severe. They must meet specific behavioral diagnostic criteria. For a diagnosis of major depressive disorder (MDD), you would have to satisfy at least five of nine potential diagnostic criteria that occur together over a two-week period (minimally).
Many people often say, “I’m depressed,” but this is not the same thing as syndromes that are actual forms of mental illness. MDD is a debilitating disorder.
People who are diagnosed with depressive disorders have a high risk of also engaging in substance abuse. The two conditions intertwine and worsen each other.
Whenever someone has a depressive disorder and a co-occurring substance use disorder, the disorders cannot be treated in isolation. Anyone with any type of mental health disorder must be treated as a whole person in order to recover properly. This means treating the substance abuse, the depressive disorder, and any other conditions at the same time.
Overview of Depressive Disorders
At one time, the American Psychiatric Association (APA) classified depression and bipolar disorder in the same category, as mood disorders. However, in the latest edition of the APA’s diagnostic manual, the DSM-5, these disorders are placed in separate categories. They are now conceptualized as different categories of mental illness.
The common feature of all depressive disorders is the presence of a sad, irritable, or empty mood that is accompanied by other symptoms that can be both physical and mental. These symptoms impact the person’s ability to function.
Two of the disorders in this classification represent the classic types of disorders people think about when they think of depression. The other disorders represent special cases of depressive-type disorders.
Major Depressive Disorder (MDD)
When most people are talking about clinical depression, they are discussing MDD. This is a formal diagnosis that occurs when a person satisfies five of nine potential diagnostic criteria. At least one of the diagnostic criteria must include significant sadness for most of the day nearly every day over a two-week period, or a loss of interest or the inability to experience pleasure most of the day every day for a two-week period.
MDD is not diagnosed when people have everyday ups and downs that occur in life. It is typically not diagnosed when people are suffering from bereavement — the type of depression that can occur when one experiences an important loss like the death of a spouse.
According to APA, the symptoms of MDD include:
- Very profound sadness or decreased mood nearly every day for at least a two-week period.
- Displaying a significant decrease in interests nearly every day or not being able to experience pleasure in things that would normally give you pleasure nearly every day (for at least a two-week period).
- Significant changes in sleeping patterns, such as sleeping too much (hypersomnia) or too little (insomnia).
- Significant changes in appetite or weight. This can be signified by weight gain or loss without going on a diet or trying to gain weight.
- Cognitive problems that can include issues with memory or attention nearly every day for most of the day.
- Feelings of fatigue, loss of motivation, or reduced energy that last most of the day.
- Significant feelings of irritability or agitation for most of the day.
- Feeling as if you are stuck in the mud and/or have significantly slowed thinking abilities.
- Significant feelings of guilt and worthlessness or the desire to hurt yourself.
The symptoms you display cannot be a part of another mental health disorder (another psychological disorder) and cannot be due to some medical condition like a thyroid problem or stroke. The depression cannot be the direct result of your use of drugs or alcohol.
Clinicians can diagnose depression on a continuum from mild to severe, depending on the number of symptoms a person displays and how severe they are. There are no medical tests that can diagnose any depressive disorder. The disorders are diagnosed based on an interview and observations made by the clinician.
The overall prevalence of major depressive disorder in any given year is about 7 percent, but different groups have higher rates. For example, it occurs about twice as often in women as men.
Persistent Depressive Disorder
This is a more chronic form of depression where the symptoms are not as severe can still be diagnosed. It was formerly referred to as dysthymia.
When a person displays a depressed mood for most of the day for at least two years with several other symptoms, including decreased appetite (or overeating), insomnia (or hypersomnia), lethargy or fatigue, feelings of low self-worth, concentration difficulties, and/or feelings of hopelessness, they may be given this diagnosis.
Persistent depressive disorder is considered to be a chronic form of depression that is not as severe as MDD. The prevalence in any given year is about 0.5 percent.
Other Depressive Disorders
The two major disorders in the depressive disorder category are major depressive disorder and persistent depressive disorder.
According to APA, the other syndromes in the depressive disorders category are:
- Disruptive mood dysregulation disorder. This is a syndrome of temper outbursts that are inconsistent with the person’s developmental level. These occur at least three times a week. It is most commonly diagnosed in children with a reported prevalence of about 2 to 5 percent.
- Premenstrual dysphoric disorder. This disorder occurs when the depressed mood symptoms occur repeatedly during the premenstrual cycle and stop around menstruation or shortly thereafter. Obviously, this disorder is only diagnosed in women. It has about a 2 to 6 percent prevalence rate.
- Substance- or medication-induced depressive disorder. This occurs when an individual is under the influence of alcohol or drugs and displays symptoms consistent with clinical depression.
- Depressive disorder due to another medical condition. This is when depression is tied to a specific medical condition, such as a stroke or head injury.
Several other minor depressive disorders that are short in duration and have few symptoms are also listed.
In some cases, people with depression may exhibit anxiety, psychosis, seasonal fluctuations, and other issues. APA allows for specific diagnoses of these specialized conditions through the use of what are called specifiers or additional diagnostic determinations that describe any additional symptoms the person is displaying.
Depressive Disorders & Substance Use Disorders
There is always the potential for anyone with any psychological diagnosis to also have a co-occurring substance use disorder.
People diagnosed with MDD or persistent depressive disorder are also an increased risk to have a substance use disorder. Research studies suggest that 30 to 40 percent of these people will also have co-occurring issues with substance abuse.
People with depressive disorders are also very commonly diagnosed with other types of mental health disorders, like eating disorders, trauma- and stressor-related disorders, and others.
Although you might be tempted to think that someone with depression is self-medicating their depression with alcohol or drugs, researchers believe that if you have an increased vulnerability to develop any type of mental health disorder, your risk is also increased to develop any other psychiatric disorder, including a substance use disorder. The risk is reflected in a combination of factors, including genetics and experience.
Getting Treatment Help
The following substances are abused by people with depressive disorders (in order of prevalence):
- Prescription medications (most often medications for anxiety or prescription pain medications like opioid drugs)
- Central nervous system stimulants
APA, the American Society of Addiction Medicine (ASAM), and other professional organizations have long taken the stance that when a person has any type of comorbid diagnoses (co-occurring diagnoses), the most effective approach is to treat the conditions at the same time.
If both depression and addiction are present, simultaneous treatment is needed. The depression cannot be treated when the substance use disorder is not held in check, and the substance abuse cannot be treated if the person’s depression is not addressed.
In complicated cases like MDD with co-occurring substance abuse, an integrated treatment program (employing different specialists from different fields who work together) is used. The team members address the client’s problems from their specialty and communicates with each another in order to ensure that the person progresses in the treatment.
Integrated treatment for a depressive disorder and substance abuse would include:
- Medically assisted treatments. Medications to treat depression and to address withdrawal symptoms or cravings associated with the drug of choice may be used.
- This can be used to address issues with substance abuse and with depression. Most often, cognitive behavioral therapy is used. The person’s beliefs and attitudes are addressed and then restructured to help them change their behavior.
- Support groups. Peer support meetings, like Alcoholics Anonymous or Narcotics Anonymous, are not run by therapists or other mental health professionals. Peers simply meet together as they share similar struggles, and they can learn from one another in this group environment.These groups often have a very structured approach and provide significant support and encouragement to members.
- Alternative therapies. These types of therapies can augment a traditional treatment program. Examples include art therapy, music therapy, and psychodrama.
- Continued treatment. Ongoing participation in treatment is associated with better long-term outcomes. For substance use disorders, the minimum suggested time in treatment is five to seven years.This doesn’t mean you have to participate in intensive treatment this entire time. Generally, the level of treatment will decline over time.