Major Depressive Disorder

Major depressive disorder, or MDD, is characterized by at least 2 weeks of a low, depressed mood, along with 4 or more additional symptoms of depression, such as suicidal thoughts, a loss of physical energy, sleep disturbances, or feelings of low self-worth.²

MDD is one of the most common forms of mental illness. In 2013, nearly 16 million American adults, or almost 7% of the adult population, had at least one major depressive episode.⁶

Persistent Depressive Disorder

Also known as dysthymic disorder, or dysthymia, persistent depressive disorder is marked by low moods and depressive symptoms that continue for 2 or more years. Individuals with persistent depressive disorder may appear to be chronically gloomy, irritable, or moody, but these traits could actually be signs of a mood disorder. Symptoms may not be as severe as the signs of a major depressive episode, but the effects on quality of life can be just as severe.²

Bipolar 1 & 2 Disorders

Depressive episodes are a key component of bipolar 1 and bipolar 2 diagnoses, with hypomanic and major depressive episodes characterizing a bipolar 2 diagnosis specifically. Many individuals with bipolar disorder experience episodes of major depression that last for weeks or months, with less frequent cycles of energetic activity and elevated mood.² It can be difficult to diagnose an individual with bipolar disorder without tracking these mood changes over an extended period of time.

Postpartum Depression

Having a baby is a life-altering experience, but for many women, the transition to motherhood causes emotional difficulties. Up to 16% of women could have depressive symptoms after giving birth.⁷

New mothers with a history of depression or anxiety, women under financial or personal stress, and women with inadequate social support are especially vulnerable to postpartum depression. Hormonal imbalances after pregnancy, nutritional deficiencies, and exposure to chemical toxins may also play a role in this form of depression.

Seasonal Affective Disorder

Also known as seasonal affective disorder, or SAD, this condition is triggered by changes in light and temperature that accompany the seasons of the year. People with SAD may report lower moods, loss of energy, sleep disturbances, and weight changes at specific times of the year.

Depression & Substance Abuse

Research has revealed that many of the factors that contribute to depression also play a part in substance use disorders. This is known as co-occurring disorders, or a dual diagnosis. Depression and addiction frequently involve:

• Imbalances in brain chemistry.
• Family history.
• Past trauma.

In addition, the physical and psychological effects of addiction may mask the signs of depression or worsen the symptoms of this psychiatric illness.

Connection Between Alcoholism & Major Depression

There’s a strong connection between alcoholism and major depression.⁹

In a nationwide study of 43,093 adults 18 years old and over, researchers found that for those suffering from a current alcohol addiction, there was evidence that over 20% of them also met the criteria for that of a comorbid major depressive disorder.⁹

Survey respondents in search of treatment for an alcohol use disorder were over 40% more likely than the general population to have at least one mood disorder.⁹

Alcohol is a central nervous system depressant that may initially function as a stimulant, but that quickly intensifies feelings of lethargy, drowsiness, and depression. Alcohol use, which lowers inhibitions and impairs judgment, can also increase the risk that a depressed individual will attempt suicide.¹⁰

Alcohol and drug abuse can worsen the course of a depressive disorder by aggravating the symptoms of depression, increasing the likelihood of hospitalization, and interfering with the course of treatment. Individuals who are being treated for depression while using drugs or alcohol are unlikely to see positive outcomes from therapy unless the substance abuse is taken into account and treated concurrently.

Substance abuse can impair motivation and decreases the effectiveness of therapeutic interventions. In addition, alcohol or drugs can have dangerous interactions with the medications used to treat depression.

The most effective approach to treating depression is a program that integrates mental health and recovery services at the same facility, with a staff of professionals who are cross trained in both fields.

Investigating the Causes of Depression

Depression is one of the most common and most debilitating mood disorders, yet researchers still haven’t determined the exact cause of this condition. There are, however, several theories about the roots of depression.

Brain Structure

The brains of some individuals with depressive disorder are structurally different from those who do not have depression. MRI imaging studies reveal that the areas of the brain that are responsible for mood, cognition, metabolic function, and sleeping have a unique appearance in people who have serious mood disorders.¹¹

Environment & Childhood Experience

A disorderly home environment or a history of physical, sexual, or emotional abuse in childhood can increase the chances of developing depression in adolescence or adulthood.¹² Trauma therapy can be extremely useful for processing unresolved memories and healing the suppressed emotional wounds that can contribute to depression later in life.

Genetics

The neurological differences that distinguish people with depression are at least partly hereditary. Genetic research shows that people who have a close relative, such as a parent or sibling, with depression are 20 to 30% more likely to suffer from depression themselves.¹³

Unlike diseases that are linked to a specific, defective gene, such as cystic fibrosis, depression is more likely to be linked to several genes.

Situational Factors

Although the losses that we all experience do not necessarily cause depression, a severe setback can trigger a depressive episode. For instance, the death of a loved one or a bitter divorce could send a person into a period of grief and bereavement, which may turn into depression if the emotions surrounding that loss are not adequately resolved.

Unlike bereavement, depression is often accompanied by feelings of worthlessness, self-loathing, or suicidal thoughts.

Brain Chemistry

Neurologists and pharmacologists have long pursued the connection between brain chemistry and depression in an effort to offer solutions to this disabling condition. Depression has been linked to imbalances in the brain chemicals, or neurotransmitters, that regulate emotional states, moods, energy levels, and appetite, such as serotonin, norepinephrine, and dopamine.¹⁴

As with other types of chronic mental illness, there are usually several factors involved in the development of depression. A family history of depression, for example, may be combined with a history of past trauma or the breakup of a marriage to make an individual more vulnerable to depression.

Getting Help for Depression & Co-Occurring Addiction

Living with a family member or spouse who is in a depressive episode can be both painful and stressful. It’s natural for loved ones to feel helpless, frustrated, and even emotionally drained by their experiences dealing with depression. Approaching a relative or friend about depression and substance abuse is very hard, but it can also prevent serious harm to the individual.

Without help, it’s likely that the addictive disorder and the depression—both chronic illnesses—will continue to get worse until the individual becomes severely ill. It’s even possible that an intervention by loved ones may help to prevent a suicide attempt and save the individual’s life.

People struggling with depression often feel isolated, profoundly lonely, and powerless. Offering support and practical solutions could make an enormous difference in the way a depressed person feels about the future.

Mental health professionals can be valuable partners in the process of intervening on behalf of someone who has depression. With the guidance of a therapist, families can learn about the facts behind depression and develop a better understanding of how to relate to someone who has this disorder.

If substance abuse is a factor, a therapist or intervention specialist can provide guidelines on how to effectively get help for someone with depression.

Therapies & Interventions

The treatment of depressive disorders with co-occurring addiction can be challenging. Depressive symptoms such as low motivation, low self-worth, and a flat emotional affect may imitate the effects of chemical intoxication or withdrawal.

In order for the treatment team to distinguish between the effects of depression and substance abuse, the client must undergo a thorough psychiatric assessment.¹⁵ Although major depressive disorder is one of the most serious, debilitating types of mental illness, it’s also very treatable with the right combination of therapeutic strategies. With the help of qualified, licensed mental health professionals, depressed individuals can be treated, and their families can recover hope for the future.¹⁶

Medications for Depression

The most widely prescribed medications for depression are drugs in the SSRI category, such as:

• • • Fluoxetine (Prozac).¹⁷
    • Citalopram (Celexa).¹⁸
    • Sertraline (Zoloft).¹⁹

These drugs correct chemical imbalances by increasing the level of serotonin, a neurotransmitter that affects mood, to the brain. SSRIs are now considered to be frontline pharmaceutical treatment for depression, as they have relatively mild side effects compared to older antidepressant medications.

Cognitive Behavioral Therapy (CBT)

CBT addresses the dysfunctional thoughts and actions that affect people with mood disorders like depression.²⁰ Rather than delving into the roots of depression, CBT focuses on identifying and transforming self-defeating ideas and repetitive self-talk, such as “I’m worthless,” “I’ll never feel better,” or “I might as well drink, my life is so bad.”

Such negative thoughts can be replaced by more positive messages, while maladaptive coping skills can be replaced with more effective approaches to life’s stressors and triggers.

Motivational Interviewing (MI)

Unlike older, confrontational approaches to rehab and recovery, MI takes a positive, encouraging perspective, engaging the client in the recovery process through an active collaboration with the therapist.²¹

MI, as a therapeutic strategy, can be highly effective for individuals with depression, who have difficulty finding and maintaining internal sources of motivation. ²¹

Trauma Therapies

If a history of trauma is a factor in a client’s depression or substance abuse, trauma therapies like Seeking Safety and eye movement desensitization reprocessing (EMDR) can help. These therapies help to reprocess troubling memories and resolve old sources of emotional pain, so the client can move on through the process of recovery and rehab.

Family Systems Therapy

Family systems therapy treats the client’s household unit as a whole, and the diseases of depression and addiction as family problems rather than individual disorders. Therapeutic goals for families include:

• • • Educating loved ones about depression and addiction.
    • Improving communication among family members.
    • Setting realistic boundaries.
    • Establishing an environment at home that supports sobriety.

Treating Co-occurring Depression & Substance Abuse

When substance abuse occurs with a depressive disorder, treatment should focus on both disorders at the same time. Treatment plans should be developed that take the client’s depressive symptoms—such as low motivation, low energy levels, and feelings of hopelessness—into account, while addressing the addictive behavior.

In the initial stages of recovery, inpatient treatment at a residential recovery facility may be recommended, especially if the individual expresses suicidal thoughts or has a history of suicide attempts.

In an inpatient setting, clients can go through detox and rehab with the 24-hour support and supervision of a staff of clinicians and therapists. Once the client is ready to progress to the next stage of recovery, a partial hospitalization program or outpatient program will offer a higher level of independence and self-determination.

Clients should be monitored closely at every stage of rehab to ensure that their level of treatment is appropriate for their current psychological status.

Throughout substance abuse treatment, core interventions such as individual therapy, group therapy, 12-Step programming, and family or marriage counseling provide a stable support network and a foundation for psychological healing.

Starting the Path to Recovery

Depression can have devastating effects on an individual’s wellbeing and on the lives of loved ones. Fortunately, the feelings of sadness, worthlessness, and despair that mark depression can be greatly reduced through research-based therapies.

Many clinically depressed individuals have also shown considerable improvement in their symptoms through pharmacotherapy. To maximize the outcomes of treatment, clients should have a range of resources available that address their psychological, medical, and psychosocial needs.

Statistics confirm that alcohol addiction and drug addiction are more common among people with depression than in the population as a whole. Individuals with both mental illness and substance abuse disorders require integrated treatment plans that encompass their mental health needs as well as their need for detox and rehabilitation.

References:

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16. American Psychological Association. Depression: how psychotherapy and other treatments can help people recover.
17. MedlinePlus. (2018). Fluoxetine.
18. MedlinePlus. (2018). Citalopram.
19. MedlinePlus. (2017). Sertraline.
20. American Psychological Association. What is cognitive behavioral therapy?
21. Substance Abuse and Mental Health Services Administration. (1999). Enhancing motivation for change in substance abuse treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration.