Depression is a medical condition with potentially debilitating symptoms that can impact the way a person thinks, feels, and functions in their daily life.¹When someone is depressed, they may notice a change in their interests and energy levels, and may withdraw from activities they used to enjoy.¹Furthermore, research suggests that those with depression may be more at risk of developing a substance use disorder (SUD), and vice versa, making depression a common co-occurring mental health disorder.^{2, 3}

Dealing with either depression or substance use disorders individually can be struggle enough, but when they co-occur, it can present an increasingly challenging hurdle. Luckily, integrated treatment that treats both conditions simultaneously can increase the overall quality of care as well as improve recovery outcomes.¹²Understanding what depression is, how it interacts with substance use disorder, and how to find integrated treatment can help you achieve recovery from both conditions. Other common co-occurring disorders include bipolar, anxiety, and ADHD.

What Is Depression?

Clinical depression is a common mental health issue that can significantly interfere with a person’s daily functioning. In 2020, approximately 21 million U.S. adults experienced at least one major depressive episode in the past year.⁴

While symptoms can vary greatly, depression may be characterized by symptoms such as sadness, emptiness, hopelessness, or irritability that last for more than two weeks.^{1, 5} The symptoms of depression can be quite debilitating. Those diagnosed with depression may find it hard to complete tasks, engage with others, get out of bed, complete daily activities, and engage in basic self-care.⁵

Several factors may influence a person’s risk for developing depression. Having a family or genetic history of depression, experiencing major life changes, stress, or trauma, or struggling with certain illnesses or disabilities can make depression more likely to develop.¹

Types of Depression

Depression may present slightly differently from one person to the next. Different types of depression include the following:^{1, 5, 7}

Major depressive disorder (MDD) can be an incredibly debilitating condition, making it difficult to function in several areas of daily life. To meet the diagnostic criteria, one must experience several characteristic symptoms, in addition to either persistently depressed mood or a loss of interest or pleasure, within a 2 week period, with such symptoms being a change from previous levels of functioning.
Persistent depressive disorder (also called dysthymia) is a type of depression that, in addition to major depressive episodes, may include episodes of relatively milder symptoms than those seen with MDD. This combination of depressive symptoms must persist for two years or more before a person receives such a diagnosis (or at least one year in children and adolescents).
Depression with psychotic features is characterized by severe symptoms of clinical depression where the person also experiences symptoms of psychosis, such as hallucinations (this may include hearing or seeing things that are not there) or delusions (such as believing something despite evidence or information that suggests it is not true).
Seasonal affective disorder (also commonly referred to as seasonal depression) is a form of depression that varies with the seasons. This means there are times during the year when someone is more likely to become depressed, such as during the winter months when there are fewer hours of sunlight. For many, the depression associated with seasonal affective disorder begins to resolve during the spring and summer months.
Depression with peripartum or postpartum onset occurs when a woman experiences clinical depression during pregnancy (perinatal or peripartum onset) or after giving birth (postpartum onset). For depression with peripartum onset, the woman must experience symptoms during pregnancy, whereas, for postpartum onset, the woman must experience symptoms between birth and 4 weeks following delivery.

Signs and Symptoms of Depression

Due to the wide variance in the types of mood and depressive disorders, symptoms may present themselves differently from person to person. Though there are some commonalities in terms of changes in mood and behavior across the various conditions, the specific diagnostic criteria vary for different types of depressive disorders.⁷

For example, to receive a diagnosis of MDD, a person would need to experience five of the following nine symptoms during the same two week period, with at least one of these symptoms being depressed mood or loss of interest/pleasure: ⁵

Depressed mood daily or almost daily for two weeks.
Loss of interest or pleasure in activities that were previously enjoyed.
Significant, unintentional changes in body weight (e.g., a loss of more than 5% body weight without dieting), or marked changes in appetite on most days.
Insomnia or hypersomnia (sleeping too much).
Externally observable psychomotor agitation (repeated, purposeless movements) or retardation (unusually slowed movements) on most days.
Reduced energy levels or increased fatigue.
Feeling of excessive/inappropriate guilt or worthlessness.
Difficulty concentrating or making decisions.
Recurrent thoughts of death, suicidal ideation, or suicide attempts.

The Link Between Depression and Addiction

Depression and addiction may co-occur due to having shared risk factors. Though it may be difficult to determine which, if either, occurred first, nor does the co-occurrence mean that one necessarily caused the other, the presence of each condition can definitely influence the course of the other.^{8, 9}

One theoretical explanation as to why co-occurring disorders develop is that a person may begin drinking alcohol or using other substances in an attempt to manage some of the troublesome symptoms of the comorbid mental health condition.¹⁰In a somewhat different theoretical direction, substance use and addiction may themselves alter the way the brain in ways that make mental illness development more likely.¹⁰

Though the precise timing and directionality and timing of the co-occurrence of depression and SUD may not always be easy to determine, it doesn’t need to be for effective treatment to commence. Individually, each condition may have separate approaches to management, however their co-occurrence calls for a comprehensive and integrated approach to the treatment of both conditions.

Treating Co-Occurring Depression and Addiction

An integrated approach to co-occurring disorder or dual diagnosis treatment that simultaneously addresses both disorders may improve the quality of care as well as health outcomes of those who receive such care. Some examples of the improved treatment outcomes and overall quality of life promoted by an integrated model of care include:¹²

Reducing or quitting continued substance use.
Relief from depression and other improvements to mental health.
Improved functioning in daily life.
Decreased rates of hospitalization.
Improved management of therapeutic medications.
Greater chance for successful treatment completion and recovery for both SUD and depression.

There is seldom one universal treatment experience, since effective treatment programs commonly tailor a combination of therapeutic approaches to best fit a patient’s needs. There are several types of behavioral therapies and other elements of care that can be integrated into such a tailored treatment program for managing co-occurring depression and SUD, including: There are⁶

Cognitive-behavioral therapy (CBT) focuses on identifying and changing unhelpful thoughts and behavioral patterns.
Dialectical behavior therapy (DBT) can help teach people how to regulate their emotions, increase effective communication in relationships, tolerate distress, and practice mindfulness. This therapy can also help reduce self-harm behaviors as well as suicidal thoughts and behaviors.
Motivational interviewing is a technique often used to understand a person’s desire to change and the goals they have. Motivational interviewing is effective in enhancing engagement in treatment and can increase a person’s confidence in their ability to change. This approach can be used to elicit behavior changes in a person with co-occurring depression and addiction.¹⁴
Pharmacological treatment involves the use of medications to manage symptoms. Some antidepressants may result in reduced depressive symptoms and substance use behaviors among people with co-occurring depression and SUD.¹³Oftentimes, medications for addiction treatment (MAT) are paired with counseling and therapy to maximize their effectiveness.
Mutual support programs are group-based and include groups focused on co-occurring disorders. Some examples include Dual Disorders Anonymous, Dual Recovery Anonymous, Dual Diagnosis Anonymous, and Double Trouble in Recovery.¹⁴

Finding Depression and Addiction Treatment Near Me

If you’re seeking recovery from substance use disorder and depression, there are several steps you can take to find a dual diagnosis treatment program near you. It may be helpful to first consult with a doctor or other trusted medical professional regarding your recovery needs and treatment options. The Treatment Locator is a helpful tool made available by the Substance Abuse and Mental Health Services Administration. This tool can help you find treatments for specific conditions by location and learn more about the treatment options available.

Addiction helplines, including the one owned and operated by American Addiction Centers (AAC), are another resource. Our admissions navigators stand ready to help answer any questions you may have about depression, addiction, or finding treatment. If you’re ready to start your journey to recovery, reach out to us today at .