The brain typically controls our behaviors and makes them make sense, but what happens when things are off? You find yourself feeling down and empty, wondering if anything will bring you light again.
The idea of trying a substance like opioids doesn’t seem like a logical path, but as the days of endless sorrow continue on, you get to the point of trying anything to make them go away. Once that first dose kicks in, you finally feel pleasure for the first time in what feels like decades. Will it always feel this way? Or will the depression come back even worse next time?
The cycle of opioid use often involves mental health. In the United States, an estimated 21.5 million adults have co-occurring substance use and mental health conditions. It does not matter which one came first, both conditions will benefit from treatment.
ReVIDA® Recovery identifies and treats the complexities of opioid use disorders and co-occurring disorders. We bring light to all subjects surrounding these topics for our communities. Today, we are discussing opioids and depression and how they influence one another.
Table of Contents
Understanding the Opioid System’s Role in Depression
Within the brain, there is a natural opioid system, charged with managing both endogenous and exogenous opioid sources. Endogenous opioids are naturally occurring, and include the peptides beta-endorphins, enkephalins, and dynorphins. They help regulate the stress response, mood, and motivational process.
G-protein-coupled receptors include mu, delta, and kappa. These receptors are directly affected by the above peptides. They cause effects directly to the central and peripheral nervous systems.
Exogenous opioid sources are introduced from the outside. This would include morphine, heroin, fentanyl, and other opioids. When this occurs, the natural opioid system becomes dysregulated. Studies have shown this dysregulation affects emotional processing, cognitive ability, and social interactions negatively. The result showed high symptoms of depression in those taking exogenous opioids.
Opioid Use Disorder and Depression: Uncovering the Connection
Opioid use disorder and depression go hand-in-hand, however, the question is which one came first? Both have evidence backing that they can occur simultaneously, but often one will happen before the other. Let’s look at the differences between these two scenarios and how they end up occurring together.
From Sadness to Dependence: How Depression Fuels Opioid Use Disorder
Depression is a mental health condition that affects millions of Americans each year. It is characterized by feelings of intense sadness, emptiness, and guilt. The person will feel very low, with hardly any energy or motivation to accomplish daily tasks. They may develop sleep difficulties, appetite changes, and possibly thoughts of self-harm or suicide. Depression occurs from a chemical imbalance in the brain, where less of the “feel good” chemicals (dopamine and serotonin) are made.
Many with depression do not receive proper mental health care for a variety of reasons. Stigma, cost, and convenience all play a role in this. Without proper care, the person may seek other ways to alleviate their symptoms, including self-medicating. This is where they turn to opioids.
Opioids bind to opioid receptors and essentially activate the brain’s reward system. Dopamine is released, making the person feel good. Despite the fact that opioids slow the central nervous system, the person will feel euphoric, putting their depression symptoms on the back burner. Over time, however, these effects are no longer as strong, causing the person to take more. Eventually, depression symptoms will worsen, while the person has developed an opioid use disorder.
Opioids and Mental Health: Why They Can Trigger Depression
On the opposite side of the spectrum, the person begins with taking opioids and then develops depression. As we mentioned above, opioids cause feelings of pleasure and euphoria, enticing the person to take them again. As use continues, the brain becomes accustomed to having opioids in the system. The same dose as before no longer produces the same effects, leading to an increase in how much is taken. The brain continues the cycle of getting used to each dose, known as dependence.
Once dependence occurs, the brain will signal once opioids are no longer present. This results in withdrawal – a set of uncomfortable symptoms that last between 72 hours and 7 days. Runny nose, joint pain, muscle tension, stomach cramping, and general discomfort are common during withdrawal. During this phase, the person will experience cravings for opioids to alleviate the symptoms. Depression symptoms can appear as the person feels guilty and ashamed for developing an opioid use disorder.
It is important to note that even those taking opioids as prescribed can develop depression. In many cases, opioids are prescribed for pain management in noncancer patients. One study highlighted the increased occurrence of new-onset depression in those taking opioids for longer than 30 days. The dose of the opioid proved to be a nonfactor, meaning any prescription dosage could lead to developing depression.
Risk Factors: Will You Develop an Opioid Use Disorder or Depression?
Though there is no specific gene, trait, scenario, or event that will cause opioid use disorder or depression, there are multiple factors that increase the chances. For opioid use disorder, these include:
- Having a family member with an opioid or substance use disorder
- Taking opioids at an early age
- Experiencing neglect, abuse, or poverty during childhood
- Having a mental health condition
Risk factors for depression include:
- Experiencing negative childhood experiences such as a chaotic environment
- Having a family member with depression or other mental health condition
- Taking substances such as alcohol, cocaine, or opioids
- Having other mental health conditions such as bipolar disorder or anxiety
These risk factors overlap in many categories, which is why opioid use disorder and depression often occur together. Co-occurring treatment will address both conditions simultaneously, providing the highest successful treatment outcome.
Opioid Use and Depression by the Numbers: A Statistical Breakdown
Both opioid use disorder and depression are prevalent throughout the United States. In 2023, 5% of the population reported feelings of depression, equating to almost 17 million people nationwide. The age group with the highest prevalence of depression was those between ages 18 and 24, at 21.5% in the year 2020.
In 2022, over 80,000 opioid-related overdoses took place, significantly higher than any previous year. In the same year, it was estimated that over 9 million people in the United States met the criteria for an opioid use disorder and required treatment. However, over 55% of those with an opioid use disorder received treatment, while 25% received medications for opioid use disorder.
Tennessee is no stranger to opioid use and depression themselves. In 2022, almost 20,000 non-fatal substance overdoses occurred as outpatient visits in Tennessee. Of these, over 8,000 were equated to opioids. This does not include the over 3,000 fatal opioid overdoses that occurred in the same year.
A survey from February 2023 showed that 37.3% of Tennessee residents experienced symptoms of depression and/or anxiety, higher than the national average which sits at 32.3%. Tennessee also ranked 45th in care options for mental health, among the lowest on the list of 52 states.
Treatment Options for Opioid Use Disorder and Depression in Appalachia
It does not matter if depression came first or the use of opioids, both conditions need to be addressed at the same time. One of the most proven methods for opioid use disorder is through medication-assisted treatment. This entails Suboxone treatment, along with rigorous therapies to break down the root causes behind opioid use. In some cases, depression medication may also be utilized in conjunction with Suboxone, ensuring all conditions are treated properly. Your care team will guide you through this process every step of the way – you never have to worry about being alone.
If you or someone you love is living with depression, opioid use disorder, or both, help is available today. ReVIDA® Recovery is dedicated to treating all aspects of opioid use disorders and their accompanying mental health conditions. Our program includes Suboxone treatment and outpatient therapy that fits a variety of schedules. Same-day appointments are available at many of our Tennessee and Virginia locations. Call us today at 423-631-0432 to learn more about our program offerings.
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