It’s no secret that opioid abuse is a growing problem in the United States. An estimated 2.4 million people in the United States abuse prescription painkillers, and almost half a million people suffer from heroin abuse.1 But people abusing opioids also often face the additional burden of depression. Left untreated, this often hidden mental illness can make recovery even more difficult.

The relationship between opioid abuse and depression is bi-directional, meaning that suffering from one increases the risk of the other. Opioid abuse is defined as using a prescription opioid for non-medical reasons or using it longer or in greater amounts than what was prescribed by a doctor, and opioid abuse has been linked to higher rates of depression, anxiety, and bipolar disorders.2

But some research suggests that simply using prescription opioids can put one at higher risk or depression. In one study at St. Louis University, researchers found that 10% of over 100,000 patients prescribed opioids developed depression after using the medications for over a month. These patients were taking the medication for ailments such as back pain, headaches, arthritis, etc. and had not received a diagnosis of depression prior to treatment.3

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Many prescription opioid abusers may turn to using heroin, as it often more available and cheaper. Heroin is an incredibly strong opiate, with roughly one-fourth of users becoming addicted to the drug Heroin use in the United States has roughly doubled in the last ten years.4 This addiction can lead to the feelings of hopelessness, despair and guilt often associated with depression, and researchers have estimated that 48% of people dependent on the drug will also experience depression. Heroin users are also at increased risk of suicide, with death by suicide among users reaching 35% percent. 5 For those who have this dual diagnosis, treatment should be tailored to address both conditions.

Researchers think that depression may stem from how opioids cause changes in the brain’s reward and pleasure system as well as hormone levels. They also suggest that opioids are less effective if a person suffers from depression, which can lead to increased use to achieve the desired effect.6  Researchers recommend that physicians or other medical professionals screen patients for symptoms of depression prior to giving them an opioid prescription.

Signs of depression can include:7

  • Lack of interest in activities
  • Depressed mood or irritability
  • Changes in sleep patterns
  • Changes in appetite
  • Feelings of guilt or despair
  • Lack of energy
  • Trouble concentrating
  • Suicidal thoughts

Signs of Opioid Addiction can include:

If you’re not sure whether you’re abusing opioids, you can ask yourself the following questions:8

  • Do you take opioids for longer or in larger amounts than your prescription?
  • Have you tried to cut back your use unsuccessfully?
  • Do you spend a lot of time using, obtaining, or recovering from the drug?
  • Do you experience cravings to use the drug?
  • Does the drug use interfere with work, school, or home life?
  • Do you continue using even though the drug causes problems in relationships?
  • Do you use the drugs in situations where it is physically hazardous to do so?
  • Do you need more of the drug to create the desired effect?

Finding Treatment

Comprehensive treatment is available for both depression and opioid abuse. Medications like methadone, naltrexone, and buprenorphine can help treat opioid dependence, and antidepressants can do a great deal to reduce depressive symptoms.9 Research shows that medication frequently is more effective when an individual seeks counseling and behavioral support as well. Many people find that intensive outpatient or inpatient treatment is necessary to curb addiction and learn healthy coping strategies for depression.

When seeking treatment for opioid abuse and depression, you first may need to seek immediate medical attention to address the withdrawal symptoms of opioids, which can include nausea, vomiting, stomach pain, sweating, sleep problems, involuntary movements, nervousness, and intense cravings.10  Also, talk to your doctor about programs that address the dual diagnosis simultaneously. Effective inpatient or outpatient treatment programs typically include:11

  • Peer group support for addiction and depression
  • Intensive individual counseling
  • Medication options for both opioid replacement and depression
  • A treatment plan tailored to your individual needs
  • Onsite medical assistance and support
  • Family psychoeducation and counseling
  • Follow up support

If you take prescription opioids or are considering them, talk to your doctor about the risks of depression and your mental health history. Non-opioids medications may be an option, and your doctor may also recommend counseling in conjunction with any pain medication. If you experience chronic pain, you may be at increased risk for depression regardless of whether you take opioid medication for the pain.

Recovery and healing are possible, and your best chances for both are to seek immediate treatment that address both the drug abuse and depressive symptoms. Take that first important step today and reach out to someone who can help you move towards a fuller and healthier life.

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Last Updated: Nov 25, 2018