The link between heroin use and depression could be exemplified by the story of a Philadelphia man named Steve, whose plight was chronicled by students from the Lewis Katz School of Medicine at Temple University.
Steve, who was described as homeless, depressed, and infected with HIV and hepatitis C, started using marijuana at age 12 and graduated to opioids by age 18. Now, he uses heroin and fentanyl.
“I never asked for life,” he said, “and I’ve never felt I had anything to live for. Drugs are what give me gratification.”
Steve is not alone. His case and thousands of others show that there is a palpable relationship between depression and heroin use, a relationship that is often described as bidirectional.
Someone engaging in opioid abuse like heroin is at a greater risk for developing depression, anxiety, or bipolar disorder. Similarly, someone who is diagnosed with major depressive disorder is more likely to engage in opioid or alcohol abuse.
When someone exhibits two or more disorders or illnesses, this is called comorbidity. What’s more, it is not unusual for someone with a substance abuse issue to have a co-occurring mental health disorder as well. According to this 2017 report, more than half of all U.S. opioid prescriptions were written for people with mental health disorders such as depression, anxiety, and other mood disorders.
In 2015, an estimated 43.4 million people age 18 and older experienced some form of mental illness. Of those, 8.1 million had a substance use disorder (SUD) and another mental illness, according to the National Institute on Drug Abuse (NIDA).
Without special therapy designed to treat both conditions, one disorder can exacerbate the other, leading to profound health complications and even death. This is why professionally administered care in the form of dual diagnosis treatment is required for people who have a substance abuse disorder and mental health issue.
What Is Depression?
As one of the most common mental health disorders in the U.S., depression or major depressive disorder (MDD) affects an estimated one in 15 adults (6.7 percent) in any given year, according to the American Psychiatric Association (APA).
The APA’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the principal authority for psychiatric diagnoses, defines MDD as a “serious medical illness that affects how you feel, think and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activities.”
Depression can also manifest as an array of emotional and physical problems and can hamper a person’s ability to function at home and work.
To declare a depression diagnosis, the DSM-5 states that the following criteria are needed. Someone must experience five or more symptoms during the same two-week period, and at least one of the symptoms should be (1) depressed mood or (2) loss of interest or pleasure:
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down)
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness, nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
For a depression diagnosis, these symptoms must cause someone clinically significant distress or impair them in social, work, or other areas of human activity. The symptoms must also not be a result of substance abuse or another medical condition.
What Causes Depression?
Four factors can determine whether someone develops depression, according to the APA. They include:
- Biochemistry: The differences in certain chemicals in the brain may contribute to symptoms of depression.
- Genetics: Depression can occur in members of the same family.
- Personality: When someone exhibits low self-esteem, pessimism, or is easily overwhelmed by stress, they are likely to develop depression.
- Environmental factors: When someone is continuously exposed to violence, neglect, abuse, or poverty, particularly when they are children, it may make them more susceptible to depression.
When someone engages in substance abuse, the symptoms of depression are exacerbated. The following section explains what constitutes substance use disorder.
When Substance Abuse is Present
The harmful or hazardous use of psychoactive substances, including illicit drugs or alcohol, is considered substance abuse, according to the World Health Organization (WHO).
Before a person develops a substance abuse issue, they first gain a tolerance toward their substance of choice, meaning they no longer respond to a drug so that a higher dose is needed to achieve the same effect, according to NIDA.
The next stage is dependence, which occurs when a person only feels normal when the substance of choice is in his system. Once that substance is removed, they experience physiological disturbances which are known as symptoms of withdrawal.
Finally, addiction or SUD is marked by the compulsive-seeking of drugs or alcohol and use despite harmful consequences.
The DSM-5 has outlined 10 or 11 criteria, depending on the substance, that marks what it regards as a SUD.
A person who meets two or three of the criteria has a “mild” disorder; four or five is considered “moderate,” and six or more rates as “severe.” Any of these conditions or effects must occur within a 12-month period.
The criteria consist of the following:
- The substance is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful effort to cut down or control the use of the substance.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Craving, or a strong desire or urge to use the substance, occurs.
- Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home.
- The use of the substance continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
- Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
- The use of the substance is recurrent in situations in which it is physically hazardous.
- The use of the substance is continued despite the knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance, as defined by either of the following:
- A need for markedly increased amounts of the substance to achieve intoxication or desired effect
- A markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for that substance (as specified in the DSM-5 for each substance).
- The use of a substance (or a closely related substance) to relieve or avoid withdrawal symptoms.
The Effects of Heroin
Heroin is an illicit opioid derived from morphine, a natural substance extracted from the seed pod of opium poppy plants. It can be injected snorted, sniffed, or smoked. Like other drugs from its class, heroin possesses this unparalleled ability to take over the brain. How? Because the drug attaches to opioid receptors in the brain, stimulating the release of dopamine. This action produces intense feelings of pleasure and incentivizes users to associate heroin with reward. So they take more of it.
On the flip side, however, their heroin or opioid intake restricts breathing. When someone succumbs to an opioid overdose, they develop a frothy fluid in their lungs and around the nose and mouth, which is called pulmonary edema. Opioids like heroin can kill because they can cause someone to stop breathing completely in overdose. The effects are further exacerbated when someone takes heroin that has been adulterated with toxic or more potent psychoactive chemicals like fentanyl, which often produces lethal results.
The long-term physical consequences of heroin use include:
- Abscesses (swollen tissue filled with pus)
- Lung complications, including pneumonia
- Infection of the heart lining and valves
- Constipation and stomach cramping
- Liver and kidney disease
- Collapsed veins from drug injection
- Damaged tissue inside the nose from sniffing or snorting heroin
- Sexual dysfunction for men
- Irregular menstrual cycles for women
Long-term effects of heroin use can produce psychological effects like insomnia and yes, depression or antisocial disorder.
How Depression and Addiction Interact
Whether someone has depression and develops a drug or alcohol problem or vice-versa, the mental health issue can worsen the consequences of substance abuse, increasing the likelihood of a lethal outcome.
When both disorders are left untreated, “suicide also becomes a much more likely hazard,” wrote Dr. David Sack for Verywell Mind.
“Those who use substances are already at greater risk of taking their own life… When substance use is combined with depression, a leading cause of suicide, the risk of self-inflicted death grows exponentially,” Sack added.
Consider this point from Dr. Sack in a Psychology Today report: …those with depression have about a 10 percent lifetime suicide risk; those with a substance use disorder have about the same. When combined, the suicide risk skyrockets to about 1 in 4.
What’s more, if someone in recovery for substance abuse has depression, the mental health disorder can serve as a relapse trigger. Drugs and alcohol use can also interfere with depression treatment. That’s if someone with both disorders gets any treatment at all.
Treating Both Conditions With Dual Diagnosis
There is a chicken or egg effect when it comes to heroin and depression. However, someone with depression who develops a substance addiction will need to remain in treatment longer than someone whose depression came from their heroin use, according to this PsychCentral article.
Nevertheless, if you have both disorders, dual diagnosis treatment simultaneously addresses heroin use and depression.
How Dual Diagnosis Treatment Can Help You
Dual diagnosis offers specialized treatment that assesses the severity of your addiction and depression symptoms. The process of getting you well starts with medical detoxification, where you are weaned off heroin using approved medications. What’s more, the debilitating withdrawal symptoms that come from opioids are medically treated.
The other objective of dual diagnosis treatment is to alleviate the symptoms of depression while addressing the psychological underpinnings of the addiction. This is accomplished through residential treatment, an intensive program where care is delivered through an array of evidence-based and alternative therapies including cognitive-behavioral therapy (CBT).
A residential program allows you to live at the facility where you will receive treatment. This setting provides the optimal environment for your recovery. You can also continue receiving therapy and care on a part-time basis through an outpatient program once your residential course is complete.
In outpatient, you will learn strategies and receive an education that allows you to improve your well-being and sustain your sobriety.
After your treatment is completed, you can connect to a recovery community that provides support, mentorship, and inspiration.