Depression is quite common, affecting about one in 10 people at some point during their life. It affects men and women, young and old. Studies have shown that about 4% of children aged five to 16 in the UK are anxious or depressed.[1]

Depression is more than simply feeling unhappy or fed up for a few days. Many of us go through times in life which are sad. If these feelings of sadness become persistent though, lasting long after or being unrelated to a particular event you may be experiencing depression.

Depression affects people in different ways and can cause a wide variety of symptoms including losing interest in things you used to enjoy, feeling hopeless and irritable or becoming very tearful. Additionally, there are often accompanying physical symptoms such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and having unexplained aches and pains.

Sometimes there’s a trigger for depression such as life-changing events, like experiencing bereavement, losing your job or having a baby. You may be more likely to experience depression if you have a family member with depression. But depression often comes without any warning and without any obvious cause.

According to the Diagnostic and Statistical Manual of Mental Disorders, clinical depression lasts for at least two weeks, interfering with your ability to work, maintain healthy relationships and function socially.

People with depression may experience five or more of the following symptoms on a daily basis:

• Feelings of hopelessness
• Anxiety
• Loss of appetite/weight loss
• Increased appetite/weight gain
• Sleeping too much or too little
• Tearfulness
• Ache and pains
• Loss of energy

• Feelings of guilt
• A sense of worthlessness
• General irritability
• Difficulty concentrating on daily tasks
• A loss of interest in activities or hobbies
• Suicidal thoughts or suicide attempts

Causes

Depression can occur for a variety of reasons, and it has many different triggers.

For some people a life event, such as divorce, bereavement, illness, redundancy and job or money worries, or having a baby can be a trigger

Often people will talk about a combination of factors that lead them to fall into depression rather than one event. Depression is very much an isolating illness and that social isolation only serves to further its progression.

Studies have also suggested that you’re more likely to get depressed if you live in difficult social and economic circumstances and that you are more vulnerable to developing depression as you get older.

Some of the potential causes of depression are:

• Stressful life events

Sometimes we all need time to process difficult life events, it is important during difficult times to continue to reach out to your friends, family members, and community. Your risk of becoming depressed is lessened if you manage to maintain a good support network.

• Thought Patterns

You will be more vulnerable to depression if you have certain patterns of thought such as persistently self-critical thoughts.

• Genetics.

The genes you inherit from your family may play a part in the development of depression.

If someone in your family has had depression in the past it is much more likely that you will develop depression in comparison to the general population.

• Giving birth

The hormonal and physical changes, as well as the added responsibility of a new life, can lead to postnatal depression.

• Isolation

Mental illness can be a very isolating experience. Becoming cut off from your family and friends can also increase your chance of developing depression in the first place.

• Addiction

Sometimes people turn to substance misuse as a way of coping with or ‘self-medicating’, unfortunately, this can cause a cycle of addiction and poor mental health that is hard to break.

• Illness – You may have a higher risk of depression if you have a longstanding or life-threatening illness, or are living with chronic pain. Head injuries can also cause profound emotional problems.

Symptoms

The symptoms of depression can be complex and vary widely between people. If you’re depressed, you may be experiencing persistent feelings of sadness, hopelessness and lack of interest in things you used to enjoy. If you have depression it is likely that these feelings will start to impact your personal life, your social life, and your work life.

There are many symptoms of depression and you’re unlikely to have all them but you may have some combination of:

Psychological symptoms

Such as:

• persistent low mood or sadness
• feeling hopeless and helpless and despairing
• having low self-esteem and low self-worth
• feeling tearful
• feeling guilt-ridden
• feeling irritable and intolerant of others
• having outbursts of anger
• having little motivation or interest in things
• feeling confused and finding it difficult to make decisions
• not getting any enjoyment out of life
• feeling anxious and preoccupied
• wanting to engage in unhealthy behaviours to find some relief
• having suicidal ideation

Physical symptoms

Including:

• moving or speaking slowly
• changes in appetite
• fluctuations in weight
• unexplained aches and pains
• low energy/lethargy
• loss of sex drive
• hormonal changes/changes to menstrual cycle
• disturbed sleep patterns

Social symptoms

The social symptoms of depression include:

• low performance at work
• avoiding contact with friends
• avoiding social events
• neglecting you interests
• struggling in the family setting

Depression often presents gradually so it can be tricky to identify when you have crossed the line. You may find yourself trying to cope for some time before you realise that something is seriously wrong and that you are unwell.

Your GP should be the first port of call in getting a diagnosis for your depression. The GP may diagnose you with:

• mild depression – has some impact on your daily life,
• moderate depression – has a significant impact on your daily life, or
• severe depression – makes it almost impossible to get through daily life; a few people with severe depression may have extreme symptoms.

Why is addiction more common in those with depression?

For most people, most of the time, sad times in life come and go. But for those who suffer from depression, the emotional low periods don’t go away so easily.

Substance misuse is prevalent among those who are battling a depressive disorder. Often people turn to drinking as a way of experiencing relief but because alcohol is a central nervous system depressant, the use of this drug tends to trigger depression symptoms like lethargy, sadness and hopelessness. As a result, depression and substance misuse feed into each other, creating a seemingly inescapable cycle.

This co-occurring depression alongside addiction is sometimes referred to as Dual Diagnosis. The Journal of Clinical Psychiatry reports that one in three adults who struggle with alcohol or drug abuse also suffers from depression.

When suffering from depression you may have started to take alcohol and drugs in order to escape negative emotions. But substances can only mask feelings temporarily and addiction may soon become its own problem.

The warning signs of addiction onset are:

• Tolerance.  You will require larger amounts to achieve the same effects.
• Withdrawal. You experience physical detox symptoms (nervousness, nausea, tremors, cold sweats or agitation) when you try and reduce your intake or stop using.
• Relapse. You find it impossible to stop and stay stopped.

Depression and addiction, when they co-exist, each intensify the symptoms of the other. There are specific programmes available to help those with dual-diagnosis through which you will be able to address your emotional and mental health issues as well as your addiction at the same time. Through medication, therapy, peer support, education and relapse prevention for both addiction and depression, recovery is possible.

Support, encouragement and motivation are essential tools in the battle against depression and substance abuse. Clinical depression can drain your energy and make you feel like rehab might not work. But the combination of individual counselling, peer group support and family counselling can give you the strength you need to continue your recovery journey in spite of the challenges you face. You can recover.

Treatment Options

A dual diagnosis of depression and addiction is complex. There is no single best treatment option as each case is unique. The addiction and underlying mental health issues can be managed and treated through rehab, medication, and therapy, or most effectively by a combination of all three.

Rehab

Dual Diagnosis programmes will offer a holistic approach including;

• Supported medical detox
• Medication for co-occurring illnesses
• 12 Step work
• Group therapy
• One-to-one therapy
• Regular sessions with a key worker
• Skills workshops
• Holistic treatments
• Relapse prevention
• Group activities
• Gender Groups
• An Introduction to meditation

You may be preoccupied with using or fearful of relapse. You might experience a surfacing of emotions like anger and the depression you have long tried to suppress. In rehab you will be supported through this process. Rehab can help you if you are;

• Dwelling on things that have happened in the past or worry about things that will happen in the future. – learning to live in the present moment.
• Having an unstable mood – learning to foster peace of mind.
• ‘Black and white’ thinking’ – learning how to be less ‘all or nothing’.
• Struggling to be assertive – learning to communicate effectively.

Rehab can really help you with building resilience, focusing on the positive and learning to deal with difficult thoughts and feelings.

You can look at interpersonal relationships and connect with others in an accepting, nonjudgmental way and break through the isolation of depression and addiction.

Rehab can:

• Teach you mindfulness skills, living in the present moment
• Help you cope with difficult situations and feelings as they come up
• Help you process your feelings in healthy and effective ways
• Help you to love and accept yourself and your feelings
• Empower you to nurture your relationships
• Give you great (and safe) self-care tools

> Our rehab programme for Depression and Addiction

Medication

Medication therapy is a core component of recovery for many Dual Diagnosis patients who are faced with depression and addiction. Antidepressant drugs have helped many individuals who struggle with depression cope with symptoms and become able to recover from addiction.

Finding the right approach to pharmacological treatment can take time and patience, but with the help of qualified staff who are trained in Dual Diagnosis treatment, prescription drugs can provide valuable support.

SSRIs are the most commonly prescribed class of antidepressants. These drugs fight depression symptoms by decreasing serotonin reuptake in your brain.

SSRIs include:

• sertraline
• fluoxetine
• citalopram
• escitalopram
• paroxetine
• fluvoxamine

Common side effects of SSRIs include:

• nausea
• trouble sleeping
• nervousness
• tremors
• sexual problems

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs help increase serotonin and norepinephrine levels in your brain. This may reduce depression symptoms. These drugs include:

• desvenlafaxine
• levomilnacipran
• venlafaxine

Common side effects of SNRIs include:

• nausea
• drowsiness
• fatigue
• constipation
• dry mouth

Tricyclic antidepressants (TCAs)

TCAs are often prescribed when SSRIs or other antidepressants don’t work.

TCAs include:

• amitriptyline
• amoxapine
• clomipramine
• desipramine
• doxepin
• imipramine
• nortriptyline
• protriptyline
• trimipramine

Common side effects of TCAs can include:

• constipation
• dry mouth
• fatigue

The more serious side effects of these drugs include:

• low blood pressure
• irregular heart rate
• seizures

Tetracyclic antidepressant

Maprotiline is used to treat depression and anxiety. It also works by balancing neurotransmitters to ease symptoms of depression.

Common side effects of this drug include:

• drowsiness
• weakness
• lightheadedness
• headache
• blurry vision
• dry mouth

Dopamine reuptake blocker

Bupropion a mild dopamine and norepinephrine reuptake blocker.

Common side effects include:

• nausea
• vomiting
• constipation
• dizziness
• blurry vision

5-HT1A receptor antagonist

The drug works by balancing serotonin levels and other neurotransmitters.

Side effects can include:

• nausea
• vomiting
• trouble sleeping

5-HT2 receptor antagonists

Two 5-HT2 receptor antagonists, such as trazodone.

Common side effects include:

• drowsiness
• dizziness
• dry mouth

5-HT3 receptor antagonist

Common side effects include:

• sexual problems
• nausea

Monoamine oxidase inhibitors (MAOIs)

MAOIs are older drugs that treat depression. They work by stopping the breakdown of norepinephrine, dopamine, and serotonin.

MAOIs include:

• isocarboxazid
• phenelzine
• selegiline
• tranylcypromine

MAOIs also have many side effects. These can include:

• nausea
• dizziness
• drowsiness
• trouble sleeping
• restlessness

Noradrenergic antagonist

Mirtazapine is used primarily for depression. It alters certain chemicals in your brain to ease depression symptoms.

Common side effects include:

• drowsiness
• dizziness
• weight gain

Therapy

Depression and anxiety drain your energy making it difficult to take the steps that will help you to feel better.

But while overcoming depression isn’t quick or easy, it’s far from impossible. Reaching out for help when you are experiencing depression and anxiety can be difficult but getting support and breaking the cycle of isolation is essential in overcoming depression. Equally, it is eminently possible to recover from a life of addiction and to be not only clean and sober but also able to experience happiness, love, and serenity.

Through engaging with the therapeutic process you will be able to leave behind the whirlwind and desperation of addiction. You can start to relax as you learn effective and healthy emotional regulation skills.

Recovering from a dual diagnosis can be challenging, unsurprisingly so after a life of drinking and using. You may be preoccupied with using or fearful of relapse. A first you might experience a surfacing of emotions like anger about the things which have happened in the past, perhaps things which fueled or justified your using.

The therapy process is very much unique to each person. It is likely though that you will establish goals for your therapy and work on the steps you need to take to get there.

Whether it’s individual, group or family therapy, what you talk about with your therapist will be confidential. Your therapist should provide you with a safe space, attentive listening and appropriate feedback and support. Good therapy should be tailored to you and your experiences.

Through therapy you can begin building resilience to help you deal with difficult thoughts and feelings, and start to flourish.