It may come as no surprise that opioid use and depression often come together as a package.
People who use opioids for nonmedical purposes are 3.1 times more likely to have depression than those who do not [1]. Conversely, people who have depression are 2.8 times more likely to use opioids [1]. In this article we will examine why opioid use and depression are likely to co-occur and what that means for your addiction care.
What does it mean to have depression?
Depression, or Major Depressive Disorder, is a psychiatric condition characterized by sad mood and/or lack of interest in previously enjoyable activities [2]. Beyond just feeling down, individuals with depression have difficulty functioning on a daily basis due to these symptoms and other emotional/physical changes (such as irritability and tiredness). Depression is a common yet debilitating disorder, experienced by around 7% of US adults yearly [2].
What is the link between opioid use and depression?
Using opioids has been linked to subsequent depression, and depression has been associated with longer periods of opioid use [3]. Why are the two so tightly linked?
Although there are many possibilities, one important link is the negative impact of opioid misuse on many aspects of life: difficult relationships and financial stress, for example, can be catalysts for depression. Another possibility is that individuals with depression use opioids to “self-medicate” their psychological pain. The link also exists on a neurological level: researchers speculate that some of the same neural pathways are involved in both depression and addiction, such that one condition increases the risk for the other [4].
Because the relationship between depression and opioid use is bi-directional, it is possible for the two to create a positive feedback loop such that the presence of one worsens the other. For this reason, it is often recommended to address depression and opioid use at the same time.
Quit opioids with online help from Workit Health.
Since buprenorphine is an opioid, will using it make my depression worse?
Buprenorphine (the main ingredient in Suboxone) is commonly used to treat opioid use disorder, and it is indeed an opioid. However, it does not have the same chemical properties and neurological effects as commonly misued prescription opioids and illicit opioids. In fact, buprenorphine is now being researched as an experimental treatment for depression [5]. Which is not to say that one should use buprenorphine as an antidepressant – at least until further research is conducted – but it is not scientifically linked to worse depression.
What should I do if I have opioid use disorder and depression?
It is possible and recommended to treat opioid use and depression simultaneously. Integrated treatment programs that treat both conditions together are thought to be particularly effective. Many antidepressant medications are safe to take with Suboxone. Some psychotherapies, such as Cognitive Behavioral Therapy, teach skills that are relevant for both depression and substance use [6].
Workit Health provides a convenient Medication Assisted Treatment program with Suboxone and online counseling. Because counseling is integrated into the program, Workit can provide strategies and resources for dealing with co-occuring depression and opioid use disorder.
References
[1] Martins, S. S., Keyes, K. M., Storr, C. L., Zhu, H., & Chilcoat, H. D. (2009). Pathways between nonmedical opioid use/dependence and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence, 103(1-2), 16–24.
[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
[3] Scherrer, J. F., Salas, J., Copeland, L. A., Stock, E. M., Ahmedani, B. K., Sullivan, M. D., … & Lustman, P. J. (2016). Prescription opioid duration, dose, and increased risk of depression in 3 large patient populations. The Annals of Family Medicine, 14(1), 54-62.
Sullivan, M. D. (2016). Why does depression promote long-term opioid use?. Pain, 157(11), 2395-2396.
[4] Lalanne, L., Ayranci, G., Kieffer, B. L., & Lutz, P. E. (2014). The kappa opioid receptor: from addiction to depression, and back. Frontiers in psychiatry, 5, 170.
[5] Fava, M., Memisoglu, A., Thase, M. E., Bodkin, J. A., Trivedi, M. H., De Somer, M., … & Ehrich, E. (2016). Opioid modulation with buprenorphine/samidorphan as adjunctive treatment for inadequate response to antidepressants: a randomized double-blind placebo-controlled trial. American Journal of Psychiatry, 173(5), 499-508.
[6] Kelly, T. M., & Daley, D. C. (2013). Integrated Treatment of Substance Use and Psychiatric Disorders. Social Work in Public Health, 28(0), 388–406.
