Depression and drug, alcohol addiction: The relationship is complicated

Friday, August 19, 2016 | By jpemeraldcoast

In some ways, depression and addiction are part of what it means to be human. They are extensions — or perhaps more accurately, abominations — of why you care about life. You desire to be significant and important in someone’s eyes, or in just your own. This desire drives you to act nobly toward yourself and fellow humans, but it can also fuel the frustration of feeling inadequate and hopeless. It can be like drinking salt water when stranded on a boat — it makes the thirst only hurt more.

Addiction is the simple, but incorrect, solution to your problems. It’s not an answer because it’s just a Band-Aid. Without replacing the Band-Aid and cleaning the wound, even the Band-Aid becomes infected.

The connection between depression and substance abuse is complicated, but there clearly is a relationship. Treating these two disorders requires the right team of professionals who have the right expertise to see the subtle clues that lead to successful recovery. Treatment can take on different forms, including combinations of both medication and cognitive behavior therapy (CBT). There is no one-size-fits-all approach to treating depression and addiction. Chances of recovery are best when a team of trained professionals are in your corner, guiding you each step of the way.

There are medications for depression and medications for addiction. There are psychotherapy techniques that work against depression, and those that work against addiction. Each person’s journey is unique. Success against depression and addiction requires compassion, expert knowledge, patience, and reassurance.

Why Depressed People Are More Prone to Addiction

 The ancient Greek author Homer wrote of humans that, “Of all the creatures that breathe and move upon the earth, nothing is bred that is weaker than man.” This applies to addiction because the things that you become addicted to are not necessarily bad things about themselves. It’s the degree to which you depend on them, and thus the amount of control they have over you, that makes them destructive. All of your desires and wants boil down to your need to be significant, or more accurately to have meaning in your life.

Where do people derive meaning? Looking around at your friends and acquaintances or just looking inwardly at yourself, you can see that meaning can come from career, wealth, sex and other pleasures. You work hard to make a name for yourself or to pad your bank accounts, at the cost of being absent from your families. You desire sex and the primal fulfillment of getting that type of attention, but sometimes don’t realize that freedom can also come from commitment.

The stories that separate humanity from the rest of the animal kingdom are ones that sing of self-sacrifice, not just self-indulgence. No matter how many struggles you face, you can still choose to see yourself with dignity. That’s what it means to be human.

What causes depression? Often it can be attributed to many causes, including stress from work or school, the physical pain of an injury, the loss of loved ones, the disintegration of a marriage, loneliness, traumatic experience, and genetic predisposition.

Depression is characterized by a prolonged feeling of overwhelming sadness. It’s when there seems to be a hole in your soul that aches, refusing to let you move beyond it. Like humidity, you feel it everywhere you go, but you cannot see it. However, it’s there, weighing on you, pressing in from all sides, and it can cause you to seek some kind of relief — often in the form of substance abuse. Depressed women abuse alcohol at a higher rate than depressed men: two times higher. When depressed, women often overdo alcohol abuse compared to men. Teens who have experienced major depression, compared to those who haven’t, are two times as likely to start drinking alcohol.

People who are depressed feel the need to self-medicate by turning to things that give them meaning, even if only in the form of a momentary distraction. Shortcuts do not solve the problem, but at least they get your mind off the incessant taunting of unpleasantness. People try to take their mind off the pain of depression, whether through natural behaviors such as sex or through excessive amounts of a chemical. The problem, however, is that when the high wears off, the ache of depression only seems deeper. This drives people to need more distraction, more false promises. You chase the first high that our mind remembers, but that your brain neurologically can never again provide. And so: you up the dose and the intensity.

The Debate About Which Came First: Depression or Addiction

 Depression and addiction are like twin siblings. They can look and act like each other, but it’s often not easy to decipher who is who, and who came first. One reason is that the symptoms of withdrawal can look a lot like depression. Another is that many of the commonly abused substances suppress the central nervous system:

  • Alcohol (beer, wine, and liquor)
  • Benzodiazepines (Valium, Ativan, and Xanax)
  • Cannabis (smokable and edible forms)
  • Opiates (heroin, morphine, codeine, hydrocodone, and oxycodone)

In other words, being high can make you act like you’re depressed.

A study of depression and addiction in 18,924 teenagers produced interesting results, but also more unanswered questions. Teens who experimented with sex and drugs were more likely to be depressed a year later, but teens who were already depressed did not have a higher chance of experimenting with sex and drugs. The latter suggests that depression does not lead to addictive behavior, which is not the case in adults.

Further interesting results were that experimenting with sex and drugs had different effects on boys than girls regarding depression. For girls, whether they just experimented or had heavy use, both increased their chances of becoming depressed. In boys, however, only heavy use was associated with increased depression later. Just experimenting had no effect.

The higher vulnerability in girls compared to boys is consistent with trends between depression and alcoholism in men and women. An intriguing result about what depression does to girls was that it made those who were already experimenting more likely to become heavy users, while it made those who were already abstaining less likely to experiment. It seems that depression can lead girls toward or away from experimenting with risky behavior, depending on what they were doing before the onset of depression.

But regardless of whether we always know which came first, depression or addiction, experts agree that a person should be treated for both to varying degrees (the following sections detail why). Statistical studies show trends, but trends only tell us what usually happens. Depression and addiction are ruinous to your life no matter if your problem fits the usual situation or is one of the exceptions. The end result is the same: if you’re suffering, you need help. The good news is that there is help for both the usual case and the exception.

What Depression Does to the Brain

 During depression, the body releases a hormone called cortisol. This is the same hormone that is released when you are under stress. Thus, prolonged depression is a form of stress. High levels of cortisol in the blood physically change the structure of the brain in the following ways:

  • The prefrontal cortex is the front part of the brain and is responsible for controlling planning and forethought. Cortisol causes the prefrontal cortex to shrink.
  • The hippocampus is located near the middle of the brain, and it controls memory. Prolonged exposure to cortisol causes the neurons in the hippocampus to shrink, impairing your memory.
  • The amygdala is also at the center of your brain. It controls how you perceive pleasure and fear. Prolonged high levels of cortisol cause the amygdala to enlarge, which makes your response to pleasure and fear disproportionate, resulting in compulsive behavior.

The good news for your brain is that the shape changes after depression are reversible. With the help of antidepressants, the neurons inside of your brain can grow more arms and longer arms with which they communicate with other neurons. The number of neurons also increase, along with the number of glial cells, which are helpers for the neurons. These reversals occur in the adult brain, which was previously thought to not change once you reach adulthood.

What Drugs Do to the Brain

 Falling into addiction is often misunderstood as the lack of will power or discipline. However, addiction is more than just a thought process. Drugs physically alter how the brain works, causing it to overreact and influence thought patterns. Drugs mimic naturally-occurring neurotransmitters, the messages brain cells release to communicate with each other, and activate the reward circuit in the brain. This causes you to desire the drug again intensely. Other drugs can cause brain cells to release abnormally large amounts of chemical signals that cause an overreaction. Brain scans of people with drug addictions show that activity in regions of the brain that control judgment, decision-making and behavior control are changed compared to normal people.

Methamphetamine abuse is known to cause microglial cells in the brain to grow in number. Microglial cells are not neurons but are the cells that help and protect neurons. However, when there are too many of microglial cells and they are too active because of methamphetamine abuse, they actually harm neurons. The good news is that this change in microglial cells is partially reversible. Some, but not all, brain regions were restored to normal levels of microglial cells after months to years of abstaining from methamphetamine use.

How Anti-Addiction Medications Help

 There are medications that have been proven to help people overcome addictions. They work in one of several ways:

  1. Replacement therapy: There are medications that are similar to opiates, such as heroin. They are not as strong and are less addictive, helping the patient to live longer but do not remove the addiction.
  1. Medications that cause discomfort: The anti-alcohol drug Antabuse causes you to feel nauseous after drinking alcohol. By causing the feeling of a hangover shortly after alcohol is ingested, Antabuse helps to deter you from drinking.
  1. Vaccines: Vaccines can be injected, after which they prevent the drug from ever reaching the brain.
  1. Blocking the cravings: Medications can prevent you from experiencing the physical symptoms of withdrawal, which are often the cause of relapse.

Though anti-addiction medications can themselves be addictive, their chances of success are best when coupled with psychotherapy. Each of the four methods by which anti-addiction medications work is not guaranteed to be effective on its own. For example, replacement drugs can be even more addicting than the original drugs. Medications that cause discomfort are hard to keep taking, so you can decide to stop using them. You might also turn to a new substance that does not require the preventive treatment that causes discomfort.

Additionally, vaccines work, but not for everyone. For some, vaccines need to be injected every day, which is a hassle that can deter long-term use. Lastly, medications that block physical cravings due to withdrawal don’t block emotional cravings. You can choose to relapse just to fulfill an emotional need. The take-home message is that your best chance of success against addiction is a holistic approach designed and guided by a team of health professionals.

When Depression & Addiction Need to Be Treated Separately

It’s bad enough that the subsequent highs are never as good as the first high, which causes you to need more and more. The high that comes after an addictive behavior is followed by a low, which feels lower after every high. The result is a vicious cycle that makes you pay more but get less.

There are reasons why depression and addiction need to be treated separately. If you were not depressed before you became addicted, the rehab process can become very confusing. You won’t recognize the problems that your classmates deal with because you never had depression problems before the addiction. Thus, the solutions that work for others won’t make sense to you. A few weeks into the rehab program and you will feel like you don’t belong in that group. In those cases, treating your addiction is the main focus, not your depression.

Sometimes, depressed people who have had previous substance problems choose not to take medication for their depression because of a fear of relapse into addiction. Though the symptoms of depression might be crushing, these people prefer to bear the pain than risk the danger. Under this situation, the only thing that can be treated with medication is the addiction. The depression is addressed solely by behavioral and social approaches. It’s important to remember that the decision to try or avoid antidepressants while dealing with addiction is a decision that should be made with your doctor or psychiatrist.

Why Depression & Addiction Need to Be Treated Together

People who deal with both depression and addiction are more likely to drop out of a rehab program. They are related, but they present challenges that compound upon each other. Thus, treating both depression and addiction together helps make the struggles of each more bearable. This, in turn, makes the likelihood of success higher.

CBT can help to change your negative thought patterns into positive ones, like paving a new path in the grassy field by walking on it more often. 12-step programs can provide the social and emotional support you need to address the depression and addiction. However, sometimes your brain chemicals are so off track that it’s hard for your mind to walk in a straight line. This is when medication is very helpful. Medications reduce the intensity of your withdrawal symptoms and the hopeless feeling of depression.

CBT works by helping you change your attitudes and behaviors. This is done by helping you train yourself to be aware of thoughts, beliefs, images, and attitudes that are present. This state of awareness of what is going on in your mind allows enough distance for you to dissociate yourself from their thoughts. This dissociation helps you see that you are not your thoughts, but that you can judge and control them. This realization can change the way you respond to the thoughts that you have, even if those thoughts had previously controlled you.

CBT was invented by a psychiatrist named Aaron Beck. He coined the term “automatic thoughts,” which he defined as thoughts that were filled with emotions and that appear in people’s minds without them realizing it. The emotional force of automatic thoughts threw people’s behaviors around without them knowing it. By teaching his patients to objectively observe the internal dialogue inside their minds, Beck helped them realize that they were participants, not puppets of their mind.

CBT works well in treating depression in adults of all age groups. Positive results lasted at least six years after the psychotherapy sessions, even without the use of antidepressants during this time. Patients who received CBT had 40% less relapse than those who just had clinical management.

The Benefits Co-Occurring Treatment for Depression & Addiction

One reason why it’s important to know if depression came before addiction is because those who had depression before the addiction often need longer treatments for the depression. The underlying root causes of the addiction are mental and emotional problems that keep you dependent on the addiction. However, if you suffered from depression only after the addiction, then you need a different strategy for treatment.

A diagnosis that was not thorough can be misleading for both you and the other health professionals who work with you. A misdiagnosis can lead to a lot of wasted time before the right root causes of depression and addiction are identified. Treating both depression and substance abuse at the same time increases the likelihood that all bases are covered, which ensures your best chances of success.

In a study of recovery from heroin addiction, researchers found that the best chances of success against the co-occurrence of depression and addiction were when medications for both were used together. Withdrawal symptoms from heroin included depression, dysphoria, and anxiety. Taking the antidepressant alone (citalopram or memantine) controlled the withdrawal symptoms, but were not able to reduce the rate of relapse into addiction.

Taking the anti-addiction medication alone (naltrexone) did not do anything for reducing the withdrawal symptoms, which made it harder for the patient to continue on the rehab program, but it did reduce the relapse rate overall. Finally, taking both anti-depressants and anti-addiction medications made following the rehab program more manageable and resulted in a significant rate of success.

The symptoms of withdrawal can be terrible to bear. The physical cravings stir emotional cravings and can wreak havoc on your body and mind. Fortunately, with the help of trained professionals, medication for both depression and addiction can go a long way in aiding you in the recovery process.

Taking Steps to Get Help

Not every person dealing with depression and addiction looks like a homeless person talking to themselves on the corner of Main Street and Skid Avenue. Rather, they could be anyone.

Unless they have experienced mental health problems and addictions, people don’t understand what it’s like to not have control of the cognitive functions they took for granted. At JourneyPure Emerald Coast, we understand. Our specialty is helping people overcome both depression and addiction. Take the next step and reach out to us. We are waiting to help you, and together, we will succeed. Contact us today.

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