Depression and Drug Addiction: Why They Often Come Together and Why They Should Be Treated Together

How Often Do Depression and Addiction Occur Together?

A 2020 report from the U.S. National Institute on Drug Abuse (NIDA) says population surveys suggest that about half of people with a mental illness will also have a substance use disorder at some point in their lives, and vice versa. Among adolescents in community-based drug treatment, more than 60 percent also have another mental illness.

Commonly co-occurring conditions include depression, anxiety disorders and sleep problems, which make quitting harder: as mood worsens, so does the urge to use for short-term relief.

Why Do the Two Go Together?

NIDA describes three pathways. First, shared risk factors such as genetics, severe stress or trauma raise the risk of both mental illness and addiction.

Second, self-medication: people with depression or anxiety, even symptoms too mild for a diagnosis, may use drugs or alcohol to feel better. Drugs may help briefly but often make symptoms worse over time.

Third, drugs change some of the same brain areas involved in mental disorders, so drug use can trigger or worsen a mental illness. In practice it is often impossible to tell which came first.

Withdrawal Depression vs Depressive Disorder

Some drugs cause marked depression during withdrawal. NIDA notes that withdrawal from methamphetamine, the drug in ya ba and ice, can include fatigue, anxiety and severe depression. Some of these symptoms ease as the body adjusts.

But some people remain depressed long after stopping, or were depressed before they started using; this may be a depressive disorder that needs its own treatment. Telling the two apart requires a psychiatrist's assessment and follow-up after stopping. Families should not assume it is just withdrawal that will pass.

Signs That Call for Urgent Help

See a doctor if there is sadness, hopelessness or loss of interest in things once enjoyed nearly every day for more than two weeks, sleeping too little or too much, no energy, feelings of worthlessness, or using more often to numb feelings. You can start with the Thai Department of Mental Health depression screening or call the mental health hotline 1323.

If someone talks or acts in ways that suggest self-harm, such as talking about death, saying goodbyes or collecting pills, treat it as urgent: do not leave them alone and call 1323 right away. If there is immediate danger, call 1669.

Why Treat Both at the Same Time?

NIDA concludes that integrated treatment, caring for addiction and mental illness together by the same team, has been found to be consistently superior to treating each separately, and recommends assessing each condition at the same time so care fits each person.

Treat only the addiction and leave depression untreated, and people often return to drugs to manage their mood. Treat only the depression while drug use continues, and the drugs make recovery from depression harder. Caring for both together lowers the chance of relapse.

Common treatments include assessment and antidepressant medication by a psychiatrist, psychotherapy such as cognitive behavioural therapy (CBT) to cope with both negative thinking and cravings, and family therapy.

Care for Co-occurring Conditions at Petch Nava Hope Care

At Petch Nava Hope Care, a psychiatrist carries out a detailed assessment on admission and follows up regularly. Our multidisciplinary team of psychiatrists, physicians, psychologists and nurses treats co-occurring conditions such as depression, anxiety and sleep problems alongside addiction treatment.

If someone in your family has both a drug problem and depression, take our initial assessment or call the team. We will help you decide where and how to start. Everything is confidential.