The conversation regarding the growing opioid abuse situation in the United States is a hot topic these days. However, little discussion is happening that discusses the strong link between opiate abuse and depression. 43.8 million Americans experience mental illness in a given year. That’s nearly 1 in 5 people. Depression affects 6.9% of adults in the US, making it second only to anxiety disorders1. Statistics indicate more than half of all adults suffering from substance addiction also suffer from a mental disorder. Sadly, this means that often the abuse of opiates and depression go hand-in-hand.

Does opiate use lead to depression or does depression lead to opiate abuse?

It can actually go either way. Suffering from either an opioid addiction or a depressive disorder can increase the risk of the other. Opioid abuse is linked to higher rates of anxiety, depression, and bipolar disorders2.

Some research suggests that opiate abuse isn’t required to influence the risk of suffering from depression. Mere use may be enough to put someone at risk of mental illness. A study at St. Louis University found that 10% of over 100,000 patients prescribed opiates developed depression after using the medication, as prescribed, for more than a month. None had a prior diagnosis of depression3.

Depression and pain

It is also true that pain often exists hand-in-hand with depression. Those suffering from chronic pain may develop depression and the reverse is often true. Thus it would not be uncommon for someone experiencing physical pain to be prescribed opioids for relief.

More than half of all opioid prescriptions are written for people suffering from depression, anxiety, and other mood disorders. There is also statistical evidence that people with mood disorders are at increased risk of addiction6.

Why this happens is not well understood. It is believed that opioids change the brain’s reward and pleasure receptors and hormones. There is evidence that people with depressive disorders experience lower levels of pain relief when prescribed opiates. This may predispose them to use greater quantities than prescribed3

Opiates and depression - by the numbersCan you use opiates to treat depression?

Two recent clinical trials tested the use of opioids to treat depression4. As it happens, before modern antidepressants were developed, it was common to treat depression with opiates. Unfortunately, many of those treated ended up with an addiction disorder.

In one of the recent studies, an ultra-low dose of buprenorphine significantly reduced suicidal ideation after 4 weeks of treatment in 62 patients. However, this reduction in suicide risk correlated only slightly with improvement in overall symptoms of depression4. A second study used higher doses of buprenorphine found that higher doses were significantly less effective5.

It would be risky to make assumptions based on such small and short-term studies. Given the high risk of addiction, using opiates to treat depression is a very risky proposition.

Treating both the addiction and depression concurrently is required

Given that both addiction and depression disorders can impact the pleasure receptors, best chances for recovery from both illnesses is to treat them at the same time. It’s well documented that depression can cause addiction, and that addiction can cause depression. Leaving one untreated doesn’t resolve a primary reason for the disorder. Failure to deal with both disorders concurrently leaves the patient at great risk of relapse. Thus treatment for both co-occurring disorders, also known as a dual diagnosis, is important.

Dual Diagnosis treatment

Individuals suffering from both addiction and depression need dual diagnosis treatment for their co-occurring conditions.  A properly structured dual diagnosis treatment program includes supervision by medical, psychiatric and addiction professionals. Treatment may include counseling, medical support, medication, and peer support as part of an individualized treatment plan. Long-term follow-up and support are important factors for success.

Are you suffering from an addiction to opiates and depression?

The individualized program we offer at The Arbor is designed to support people suffering from dual disorders. Our continuum of care includes multiple treatment and support programs. Your personalized treatment plan is designed to offer long term support that meets your changing needs as you progress with sobriety and relief from depression.

Talk to one of our counselors today.

References

1 https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
2 https://www.ncbi.nlm.nih.gov/pubmed/21999943
3 http://www.annfammed.org/content/14/1/54
4 http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2015.15040535
5 http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2015.15070921
6 https://www.scientificamerican.com/article/most-opioid-prescriptions-are-for-people-with-depression-other-mood-disorders/

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