Dual Diagnosis Treatment for Depression and Addiction

What is Depression?

While it is common for people to colloquially say that they feel depressed when they are experiencing feelings of sadness, depression is actually a mental illness that is far more severe than any transient feeling. It is crucial to stress the difference between these two uses of the word, because people with depression are less likely to seek treatment when they dismiss their mental health condition as a mere mood. This mental health condition is in fact quite serious — and can even be life-threatening.

Depression, known by psychiatrists and other mental health professionals as major depressive disorder (MDD) or major depression, falls into a class of mental health conditions known as mood disorders. There are a number of mood disorders, including mania, during which an individual experiences consistently elevated mood, and bipolar disorder, during which a person cycles back and forth between elevated and low moods. 

Depression is by far the most common mood disorder. People with depression experience consistently low moods, often finding themselves plagued by sadness even in circumstances they would normally find joyful. It is normal for people to feel downcast at times. However, when people find themselves unable to extricate themselves from this feeling for two weeks or more, then they are likely suffering from major depressive disorder.

People with depression can experience a wide range of symptoms, including sleep problems, loss of interest in daily activities, appetite problems, difficulty concentrating, loss of energy, and even suicidal thoughts. Many individuals with this medical condition find it difficult to work, maintain relationships, or take care of their own health more generally. 

As such, people with depression are likely to develop and suffer from other conditions as well. It is common for people with depression to be drawn to drugs and alcohol, given that these substances often offer temporary relief from the symptoms of depression. Self-medicating in this way, however, is likely in the long run to worsen the progression of the disorder. When other conditions are present, such as a substance use disorder, it can also complicate the treatment process.

Depression manifests itself in manifold ways depending upon the individual and their circumstances. A major depressive episode can last for a few weeks or a few years. It can also cause unpredictable behavioral changes. Depressive episodes also vary in intensity, with some people suffering lowered quality of life and others experiencing life-threatening symptoms. 

There are many types of depressive episodes. These include postpartum depression, seasonal affective disorder, and persistent depressive disorder. Each of these medical conditions varies somewhat in terms of its causes of origin and symptomatology. As such, treating the different subtype of depression requires specific methodologies, though most cases of depression can be effectively treated using a combination of counselings and antidepressant medication.

Most Common Types of Depression

While all forms of depression share similar characteristics, the various subtype of depression have distinct origins, side effects, and they also require unique treatment methods. Some types of depression may not even be obviously recognizable as depression. For this reason, it is absolutely essential to get a diagnosis from a medical professional. Clinical depression, no matter its form, is a serious condition, and a psychiatrist or outpatient center can offer the treatment that people with depression need in order to live happy and fulfilling lives. In most cases, treatment entails a combination of talk therapy and antidepressant medication.

The most common types of depression include:

Major Depression

Sometimes known as major depressive disorder, unipolar depression, or classic depression, major depression is characterized by low mood throughout daily life. It is common for people to experience loss of interest in all activities. These depressive symptoms are not due to any external factors. In fact, even people who appear to live perfect lives can easily suffer from major depression.

Bipolar disorder

Often known as manic depression or manic depressive disorder, bipolar disorder is a condition characterized by frequent ups and downs in mood. Individuals suffering from bipolar disorder alternative between depressed states and manic states. It should be noted, however, that manic states are not positive experiences. In fact, while someone experiencing mania might feel euphoric or enthusiastic, they are often out of control and lose touch with reality. Both manic and depressive states can be extremely dangerous.

Atypical Depression

Atypical depression is a form of depression that periodically lessens in intensity when an individual experiences positive events in their life. While that may sound like a positive, it actually makes this form of depression particularly difficult to diagnose. Those with atypical depression often go under the radar and fail to seek treatment.

Psychotic Depression

Psychotic depression occurs when an individual’s depressive symptoms have gotten so intense that they lose touch with reality. It is common for people suffering from psychotic depression to experience delusions as well as hallucinations. Some individuals have physical problems as well, which range from an inability to sit still to extreme lethargy.

Premenstrual Dysphoric Disorder (PMDD)

While premenstrual syndrome, or PMS, often leads to feelings of sadness and other problems with mood, individuals suffering from premenstrual dysphoric disorder experience far more severe symptoms. They may find it difficult to function normally in daily life or even have suicidal thoughts.

Disruptive Mood Dysregulation Disorder

This condition, which was first recognized as recently as 2013, affects mainly children. According to the National Institute of Mental Health, children suffering from DMDD are liable to have frequent temper tantrums, an inability to regulate their own moods, and consistent irritability. Many also have particular difficulty making transitions. This condition is difficult to treat and can disrupt a child’s ability to function and progress normally.

Seasonal Affective Disorder (SAD

Sometimes known as seasonal depression, SAD is a condition whereby a person gets depressed during the winter months. Many begin to experience symptoms with the advent of fall, however. It is theorized that depressed mood is caused by lack of sunlight, shorter days, and possibly the reduction of social opportunities occasioned by winter.

Persistent Depressive Disorder

Sometimes known as dysthymia or chronic depression, persistent depressive disorder refers to depression that lasts for two or more years. While persistent depression sometimes has less severe symptoms that other forms of depression, it is common for these symptoms to wax and wane over a long period. It is also common for individuals with persistent depression to experience episodes of major depression concurrently, a severe condition known as double depression.

Perinatal Depression

Perinatal depression is depression that occurs during pregnancy or in the first month after giving birth. The latter form is a well-known subtype known as postpartum depression. This condition can be dangerous for mother and child alike.

Situational Depression

Known by medical professionals as adjustment disorder with depressed mood, situational depression is a form of depression that occurs as a response to specific situations. These situations range from the death of a loved one to the loss of a job. While it is normal to feel upset when these events occur, situational depression is often a disproportionate response that can make it difficult to function normally in daily life.

Symptoms of Depression

Clinical depression presents itself via a wide range of symptoms and side effects. Not all people with depression seem obviously sad, even if they are feeling depressed. It is common for people suffering from major depressive disorder to experience physical symptoms as well. The way depression expresses itself is affected by a range of other risk factors. These include the existence of other co-occurring mental health conditions. Individuals suffering from anxiety and depression, or substance use disorders and depression, often have side effects that those suffering solely from one mental illness do not. While it would be impossible to list every symptom of depression, given the condition’s many subtype, the most common symptoms of depression include:

  • A sense of hopelessness or pessimism about the future
  • Loss of interest in daily activities and even valued hobbies
  • Lethargy, fatigue, and a sense of being slowed down
  • Problems sleeping, ranging from oversleeping to insomnia
  • Appetite changes, which can lead to weight fluctuations
  • Irritability and restlessness
  • Consistent sad mood, sometimes referred to as feelings of emptiness
  • Severe anxiety
  • Feelings of worthlessness or guilt
  • Feelings of helplessness and losing ones sense of personal agency
  • Physical symptoms that are unaffected by common treatments, including aches, pains, digestive problems, cramps, and headaches

Causes of Depression

Depression is rarely caused by one single factor. Research indicates that a range of causes, including genetics, neurological differences, environmental circumstances, and behavioral patterns all play roles in triggering clinical depression. In some cases, the causes are more clear. Certain types of depression, such as perinatal depression or situational depression, have more clear cut causes. Situational depression, for instance, is a form of depression that is explicitly caused by a specific external event, such as the loss of a loved one or a divorce. However, even in these cases, what causes a person to react so disproportionately is often difficult to pinpoint. Health professionals generally look for specific risk factors, rather than citing one single cause. Risk factors include:

  • A family history of depression. Research indicates that genes play a major role in depression. It should also be noted, however, that being raised in a household in which parents or loved ones are depressed can also affect a child’s mental health later on.
  • Childhood trauma. Child abuse and other traumatic events predispose a person to depression.
  • Another medical condition. Individuals who suffer from serious or life-threatening conditions often develop depression. This is sometimes a response to feelings of helplessness they might have. Depression is also highly correlated with chronic pain.
  • Substance use disorders. People who abuse drugs and alcohol are more likely than other populations to develop mood disorders like depression. Unfortunately, depression itself, when left untreated, can lead people to turn to drugs and alcohol as forms of self-medication. The result is a vicious cycle that can lead to the rapid worsening of both conditions.

Diagnosing Depression

Depression can be difficult to diagnose, especially when the signs and symptoms of clinical depression are mistaken for mere sadness. Close friends and family members are often the first people to notice that something is wrong. However, in order to get an accurate diagnosis, it is essential to make an appointment with a psychiatrist or your primary care physician. Medical professionals can help identify your issue as major depressive disorder, bipolar disorder, or any number of other mood disorders. They can also help people with depression receive the treatment they need.

The American Psychiatric Association uses a book called the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, to identify mental illnesses. Depression is diagnosed based on a list of signs of symptoms. If an individual is experiencing 5 or more of the following symptoms within a 2-week period, they are likely to receive a diagnosis of depression (at least one of the symptoms must be from the first two on the list).

  1. Depressed mood most of the day, nearly every day.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
  4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
  5. Fatigue or loss of energy nearly every day.
  6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  8. Recurrent thoughts of death, recurrent suicidal ideational without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Who is at Risk for Depression?

While anyone can be diagnosed with depression, certain populations are at higher risk for developing the condition. Factors that increase the likelihood that an individual will suffer from clinical depression include:

  • A family history of depression or mood disorders
  • Substance abuse
  • Social isolation
  • Other illnesses
  • Taking medications that cause depression as a side effect
  • Dramatic life events, like a job change or move
  • Experiencing the death of a loved one
  • Interpersonal conflict

Treating depression often involves treating the symptoms of depressed mood as well as dealing with the circumstances and risk factors that led to it in the first place. However, it is important to note that people can experience depression without suffering from any of these risk factors. No matter what the cause of a person’s depression is, they should understand that treatment works and it is indeed possible to get relief. Reaching out to a treatment facility or a healthcare professional is always the first step.

Depression Statistics

According to the American Psychiatric Association, depression affects 1 in 15 adults every year, and 16.6% of people will experience an episode of depression at some point in their lives. It is the second leading cause of disability among American adults, after lower back pain. Not only do depressive episodes lead to misery, problems at work and school, and interpersonal issues, it can often be fatal. According to the Centers for Disease Control and Prevention, 9.4% of people visiting emergency rooms have depression listed on their medical record. In the United States, depression also claims 47,173 lives every year when people choose to take their own lives. However, the actual number of lives that depression takes indirectly every year is more difficult to measure, since major depressive disorder is also a contributing factor for cardiovascular conditions, other physical health problems, and substance abuse.

Medications Used to Treat Depression

Treating clinical depression generally involves a combination of medication and psychotherapy, such as cognitive-behavior therapy. There are a wide variety of medications available for someone struggling with depression. Working with a psychiatrist to find the right one is often a process that takes time. These medications include:

  • Selective serotonin retake inhibitors (SSRIs). SSRIs, which emerged in the late 1980s, are currently the most common medications used. SSRIs prevent serotonin, a neurotransmitter responsible for feelings of well-being, from being reabsorbed. By increasing the supply of serotonin in the brain, these drugs relieve many of the symptoms of depression. This class of medication includes citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), and sertraline (Zoloft)
  • Serotonin and norepinephrine retake inhibitors (SNRIs). This newer class of antidepressants prevents the reabsorption of both serotonin and norepinephrine, the latter of which is a chemical that makes people alert and engaged. The most common SNRIs are venlafaxine (Effexor), desvenlafaxine (Pristiq and Khedezla), duloxetine (Cymbalta), and levomilnacipran (Fetzima).
  • Tricyclic antidepressants (TCAs). TCAs, which were discovered in the 1950s, have largely been phased out in favor of SSRIs and SNRIs. However, they are still sometimes prescribed in cases of treatment-resistant depression. Common TCAs include amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil)
  • Monoamine oxidase inhibitors (MAOIs). MAOIs work by blocking an enzyme called monoamine oxidase. The result is an increase in serotonin, norepinephrine and dopamine. Common MAOIs include phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).

Dual Diagnosis Treatment For Depression and Addiction at NuView Treatment Center

NuView Treatment Center understands that individuals who suffer from depression alongside a substance use disorder often require more care. Depression can lead people to turn to addictive substances, and substance abuse can in turn exacerbate the symptoms of depression. Treating one condition to the exclusion of the other often leads nowhere, since a depressive episode can trigger a relapse, and continued substance abuse can also trigger a depressive episode. The relationship between these conditions is complex, often making both diagnosis and treatment difficult.

As one of the best dual diagnosis treatment centers, dual diagnosis patients can receive the integrated care they need at NuView Treatment Center. NuView assesses each individual patient to provide them with a treatment plan that addresses their unique needs. We offer a wide range of treatment modalities to ensure that patients improve physically, mentally, and emotionally. Our dual diagnosis rehab program offers psychotherapy, group therapy, CAM therapy, and medication-assisted therapy. By entering our treatment program for depression and addiction, individuals can get the long term relief they need.

If you are experiencing depression, hopelessness, suicidal thoughts, or struggle with alcohol or drug abuse, we are here to help. Recovery is possible.

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