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Depression and Substance Abuse

Depression affects millions of people every year keeping them from living normally.  Many individuals with depression also have a coexisting substance abuse problem. Because substance abuse alters impulse control and impairs judgment it worsens the symptoms of depression and can lead to a greater risk of suicide.   There are several different types of depression:

  • Major depression can be a single episode or recurrent. It effects sleep, appetite and can cause agitation, as well, as feelings of worthlessness and guilt.  These symptoms cause people to withdraw from family and friends.
  • Dysthymia is a persistent but mild depression.
  • Depression is linked to a substance abuse disorder. As with other drugs, alcohol is a central nervous system depressant and will therefore exacerbate depression.
  • Bipolar I and II disorders include mood swings that range from highs (hypomania or mania) to lows (major depression). It’s hard to differentiate between bipolar disorder and depression because most people don’t see their doctor when they have high or elated moods; they only seek medical treatment for the low, depressive moods.
  • Cyclothymic disorder involves slightly milder highs and lows than those of bipolar I or bipolar II disorders.
  • Seasonal affective disorder (SAD) is related to the change in the season and usually starts in the fall continuing through the winter months.  Treatment can include light therapy (phototherapy.)
  • Premenstrual dysphoric disorder this type of depression is triggered by hormonal changes about seven days prior to and three days after the onset of your period. After your period, the depressive feelings go away.

Many addicts may experience depression in the early stages of recovery.  Most symptoms of depression will go away after a few weeks, but for some these symptoms may go on for months or years.  Depression that lingers on for long periods of time may be due to dysfunctional neurotransmitters or neuroendocrine abnormalities.  Depression may also result from psychosocial, biological and environmental factors that can contribute to depression.  Depression can take all the joy out of life, everything appears to be overwhelming and one day turns into an ever ending cycle of mere existence.

According to the DSM-V, clinical depression is characterized by the presence of 5 or more of these depressive symptoms:

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad, blue, “down in the dumps,” or empty) or observations made by others (e.g., appears tearful or about to cry). (In children and adolescents, this may present as an irritable or cranky, rather than sad, mood.)
  • Markedly diminished interest or pleasure in all, or almost all, activities every day, such as no interest in hobbies, sports, or other things the person used to enjoy doing
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day
  • Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia (sleeping I’
  • More days than not, problems with sitting still, including constant restlessness, pacing, or picking at one’s cloths (called psychomotor agitationby professionals); or the opposite, a slowing of one’s movements, talking very quietly with slowed speech (called psychomotor retardationby professionals)
  • Fatigue, tiredness, or loss of energy nearly every day — even the smallest tasks, like dressing or washing, seem difficult to do and take longer than usual
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day (e.g., ruminating over minor past failings)
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (e.g., appears easily distracted, complains of memory difficulties)
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Selective serotonin reuptake inhibitors (SSRIs)

Medications that can help with depression are antidepressants, often referred to as SSRIs, serotonin reuptake inhibitors. Serotonin is one of the neurotransmitters that carry signals between brain cells.  SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin available.  Keeping these levels of neurotransmitters higher can improve communication between the nerve cells, which can then strengthen circuits in the brain and regulate mood.

Some commonly used SSRIs

  • Citalopram (Celexa, Cipramil)
  • Escitalopram (Lexapro, Cipralex)
  • Paroxetine (Paxil, Seroxat)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox, Faverin)
  • Sertraline (Zoloft, Lustral)

Anti-depressant medication can take up to three weeks before they become effective so that is why therapy is also suggested as part of the treatment plan.

Therapy

Some of the different therapies that are used to treat depression are:   Interpersonal, cognitive-behavioral, dialectical behavioral therapy, supportive and dynamic approaches.  Therapy can help the client identify and express feelings, deal with guilt and shame, help clients confront feeling of powerlessness, and deal with anger.  Negative thoughts can play a significant role in depression, so by changing these thoughts and beliefs through therapy the client can decrease their depressive feelings.

Alcohol or Drug Treatment Centers

Along with anti-depressant and therapy, inpatient or outpatient treatment for chemical dependency issues and dual diagnosis need to be addressed. Since the symptoms of depression are made worse by drinking or drug use, clients often enter the system through detox, or a psych. ward.  Once the client’s mood is stabilized concentration on recovery needs to follow.

References:  www.psychcentral.com  www.health.com  www.dualdiagnosis.com www.mayo.clinic.org

Johnina Noar, CADC-II
CD Counselor
AToN Center 888-535-1516