Is there a link between depression and substance misuse?

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According to research, about half of people who experience SUD also have a mental health condition. Co-occurring conditions may include:

• depression
• anxiety
• personality disorders
• schizophrenia
• attention deficit hyperactivity disorder
• bipolar disorder

Although substance misuse and mental health conditions frequently occur together, one does not necessarily cause the other. Experts suggest three possibilities that may explain the link:

Substance misuse and brain changes

Substance use can cause changes to the brain’s structure and function. These changes can make people more likely to develop a mental health condition.

Self medication

Some people with mental health conditions may use alcohol or drugs to self-medicate. However, although certain drugs may temporarily relieve a person’s symptoms, they can worsen them in the long term.

Changes in the brain associated with mental health conditions may also increase the rewarding effects of some substances. This may make a person more likely to experience substance misuse.

Common risk factors

Those at a higher risk of mental health conditions may also be at risk of substance misuse. There are shared risk factors, including environmental factors such as trauma and stress.

During the COVID-19 pandemic in 2020, the number of people living with mental health conditions and rates of substance misuse increased. As a result, much of the recent research into depression and SUD considers COVID-19 as a factor.

One study found that adults — especially young adults — reported considerably elevated rates of mental health conditions during 2020. Levels of suicidal ideation and substance misuse also increased.

The increased reports of substance misuse demonstrate the harm communities experienced as an indirect result of COVID-19. According to the American Medical Association, every state in the United States reported a spike or increase in overdose deaths or other problems during the pandemic. The increase in deaths may be related to more people seeking drugs, such as fentanyl, as a form of self-medication for mental health conditions.

Another study from 2020 also found that COVID-19 directly relates to an increased risk of psychiatric disorders. It suggests that almost 6% of people diagnosed with COVID-19 will go on to develop a psychiatric disorder that they did not have before.

According to the CDC, 13% of U.S. adults reported starting or increasing their substance use to cope with stress or emotions related to COVID-19.

Depression symptoms can differ from person to person. However, common symptoms may include:

• hopelessness
• feelings of guilt
• lack of interest in activities
• changes in appetite and sleep
• lack of concentration
• suicidal thoughts
• physical aches and pain
• feeling agitated
• less physical activity

Symptoms of substance misuse also vary depending on the person, their existing mental health conditions, and the substance they are using.

Continued use of a substance can negatively affect a person’s health and personal life, causing:

• impaired daily functioning, such as skipping hygiene routines
• decreased physical health, such as sudden weight loss or interrupted sleep
• financial strain
• mood swings
• decreased participation in hobbies
• increased isolation and reduced social interaction

Typically, people experiencing substance misuse also have one or more of the addiction criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). These include:

• strong urges or cravings to use substances
• withdrawal symptoms when stopping the use of substances
• repeated failed attempts to stop or control substance use
• a tolerance to substances
• using substances in larger amounts for longer periods of time than intended

To diagnose SUD, a licensed health or mental health professional must identify a person as having one or more of the 11 criteria outlined by the DSM-5.

If a person meets 1–2 criteria, doctors consider them to have mild SUD. Their condition is moderate if they meet 3–5 criteria and severe if they meet 6 or more.

According to the NAMI, for a mental health professional or doctor to diagnose a person with depression, they must have experienced a depressive episode that lasted longer than 2 weeks and included symptoms such as:

• suicidal intentions or thoughts
• loss of pleasure or interest in activities
• fatigue
• change in weight or appetite
• feelings of guilt or low self-worth
• sleep disturbances
• feeling slow or agitated
• difficulty making decisions or concentrating

If a person has symptoms of both SUD and depression, a doctor may diagnose them with both conditions at the same time. However, other people will receive the diagnoses separately.

A mental health professional will generally treat a person’s SUD and depression together. As symptoms of the conditions may overlap, so will their treatments. Certain medications and therapies can treat both SUD and depression, and treating the conditions simultaneously may be more effective.

A doctor should tailor a treatment plan to a person’s specific conditions and symptoms. Treatments may include:

Behavioral therapy

One popular option is cognitive behavioral therapy. This is a form of talk therapy where the mental health professional aims to help a person learn new ways to cope with difficult situations by challenging irrational thoughts and changing existing behaviors.

Medication

A doctor may prescribe antidepressant medications to treat depression. Examples include:

• serotonin and noradrenaline reuptake inhibitors and selective serotonin reuptake inhibitors, such as duloxetine (Cymbalta), escitalopram (Lexapro), and fluoxetine (Prozac)
• tricyclic antidepressants, such as amitriptyline (Elavil), desipramine (Norpramin), and doxepin (Sinequan)
• monoamine oxidase inhibitors, such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan)

If a person has SUD, a doctor may prescribe medication specific to the type of substance they misuse. These can include:

• methadone, buprenorphine, and naltrexone for opiod use disorder
• naltrexone, acamprosate, and disulfiram for alcohol use disorder

While treatments and medications can help people with depression and SUD, living with either one or both of these conditions can be difficult. People may find it useful to seek help from organizations and support groups. Some options include:

• The National Institute of Mental Illness
• The National Suicide Prevention Lifeline at 1-800-273-TALK (8255)
• The Crisis Text Line — text HELLO to 741741
• Dual Recovery Anonymous, which offers 12-step meetings across the world for people affected by substance abuse and mental health disorders
• Alcoholics Anonymous
• Narcotics Anonymous
• SMART Recovery
• Women for Sobriety

The Substance Abuse and Mental Health Services Administration also offers a Behavioral Health Treatment Services Locator to help find mental health and substance use health treatment facilities and programs across the U.S.

About half of all people who experience substance misuse also have a mental health condition, such as depression. Although there is a link between the two, one does not necessarily cause the other.

Recent research focuses heavily on the increase in both mental health conditions and substance misuse due to factors related to the COVID-19 pandemic. While living with these conditions can be difficult, a doctor can recommend treatments including medication, therapy, or both.