Major Depressive Disorder (MDD) & Addiction

What is Major Depressive Disorder (MDD)?

Major depressive disorder (MDD), also known as depression or clinical depression, is a serious mental health disorder that can drastically affect a person’s daily life. For example, it can result in problems sleeping, eating, and working. MDD can be incredibly debilitating when left untreated.²

Depression is among the most commonly experienced mental health disorders in the United States. A person can experience depression at any point in life, though onset often occurs in adulthood.²

Nearly 6% of women experience a major depressive episode during pregnancy or in the first year following delivery. It is also estimated that 50% of all major depressive episodes actually begin prior to delivery or postpartum. Thus, all episodes are referred to collectively as peripartum.³

Depression and Addiction Risk Factors

Research indicates that depression is likely caused by a combination of factors. According to the National Institute of Mental Health, genetic, environmental, biological, and psychological factors all have the potential to contribute to the development of MDD.²

While it is not possible to predict exactly who will be impacted by depression, certain risk factors for MDD do exist. Factors may include:^2,4

• Family history of depression.
• Major negative life changes.
• High stress levels.
• Trauma.
• Certain physical illnesses (such as diabetes, cancer, or Parkinson’s disease).
• Side effects of certain medications.

Symptoms of Depression

Symptoms of depression include:⁵

• Depressed mood or, in children and adolescents, persistent irritability.
• Anhedonia, which is the inability to feel pleasure in most or all activities, or decreased interest in most or all activities.
• Sleep changes (sleeping too much or too little).
• Feelings of inappropriate/excessive guilt or worthlessness.
• Lack of energy.
• Difficulty focusing/concentrating or making decisions.
• Increase or decrease in appetite or significant, unintentional weight loss or gain.
• Psychomotor agitation or retardation, which can lead to repeated unintentional movements in the case of agitation or slowed speech, movement, or thinking in the case of psychomotor retardation.
• Recurring thoughts of death or suicide and/or suicide plans or attempts.

A clinical diagnosis of major depressive disorder requires that the individual experience at least 5 of these symptoms in a 2-week period (with at least 1 of the symptoms being reduced pleasure/interest or depressed mood).⁵ With the exception of thoughts of death; suicidal ideations, plan, or attempt; or weight changes, a symptom must be present nearly every day to be counted. Major depressive disorder symptoms must be a change from prior functioning and cannot be due to another medical or mental health condition or caused by a substance. Symptoms must also cause significant distress or impair functioning and cannot be an appropriate response to a significant loss.

Prevalence of Major Depressive Disorder

Depression is the leading cause of disability for individuals aged 15–44 in the United States.⁶ According to the 2022 National Survey on Drug Use and Health, nearly 22.5 million individuals in the United States, aged 18 or older, experienced at least one major depressive episode.⁷ And according to the American Psychiatric Association, 1 in 6 individuals will experience depression at some point in their lives.⁸

Women experience this disorder more frequently than men. Women more frequently have internalizing symptoms of depression (such as feelings of sadness or guilt), while men tend to have externalizing symptoms, such as reckless behaviors and substance misuse.^6,9

Children and teenagers also tend to experience certain symptoms of depression. In a younger child, depression can present itself with symptoms such as clinging to a parent, acting sick, refusing to go to school, and worrying about their parent(s) dying. In older children and teenagers, depression may manifest as irritability, sulkiness, problems at school, or drug/alcohol use.¹⁰

According to the World Health Organization (WHO), about 280 million people worldwide suffer from depression, and as a result, may suffer a myriad of short- and long-term effects.¹¹ Depression can make even simple tasks, such as getting out of bed, preparing meals, and going to work, a challenge. Commonly associated with symptoms such as loss of energy, difficulty concentrating, and a loss of interest in most activities, depression can turn daily chores into large hurdles that must be overcome to successfully meet daily personal, work, or academic expectations.

Treatment of Major Depressive Disorder

According to the American Psychiatric Association (APA), of all mental disorders, depression is among the most treatable, as between 70% to 90% of people who have depression eventually find relief with treatment.⁸

Major depressive disorder treatments may involve one or both of the following: ^8,12

• Therapy: Cognitive-behavioral therapy (CBT) has been demonstrated to be effective for treating depression. CBT focuses on the present situation and how to solve current problems. CBT helps individuals recognize and change maladaptive thinking and behaviors. Family and interpersonal therapy may also be used to help address issues in the individual’s closest relationships.
• Medication: Brain chemistry may be a contributing factor to a person’s depression, so medications that target abnormalities in a person’s brain chemistry may help to bring about symptom relief. Antidepressant medications can help an individual feel better within 1–2 weeks, though it may take up to 3 months for them to feel all of the benefits.

For individuals with severe depression that does not respond to other treatments, brain stimulation therapies such as electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS) may be beneficial.¹³

Other complementary approaches that may help alleviate symptoms of depression include:⁸

• Regular exercise.
• Adequate quality sleep on a regular basis.
• Healthy diet.
• Avoiding alcohol.

These approaches may help as part of a comprehensive treatment plan but should not be used in place of other methods of care recommended by the individual’s healthcare provider.¹²

The Link Between MDD and Addiction

Depressive disorders such as MDD commonly co-occur with substance use disorders (SUD). In fact, it is estimated that up to 40% of patients with depression have a history of SUD or alcohol dependence at some point in their life.¹⁴

Comorbidity, as defined by the National Institute on Drug Abuse (NIDA), refers to two or more disorders that occur in the same individual at the same time or one after the other. NIDA reports that roughly half of the people who experience a mental illness will also experience a substance use disorder during their lifetime (and vice versa).¹⁵

Research indicates that one explanation for the comorbidity of mood disorders, like major depressive disorder with substance use disorders, is self-medication, meaning individuals with depressive disorders use substances to cope with the difficult symptoms associated with depression. One review of 2 decades of literature on the subject found the prevalence of self-medicating with alcohol and drugs to be between 21.9% and 24.1% among those diagnosed with either a mood or anxiety disorder. While this may temporarily relieve symptoms, over time, using drugs and alcohol in this manner can actually worsen symptoms and lead to the development of a SUD.¹⁶

Possible Complications of Depression & Addiction

Depression can lead to many serious consequences, and left untreated, can be devastating for those who have it and their families.¹² Feelings of hopelessness and worthlessness may lead the individual to engage in self-defeating behaviors and unhealthy lifestyle choices (e.g., drug and alcohol use, neglect of personal health, and self-harm).

Depression is associated with certain physical health problems including:^2,17-19

• Physical aches and pains, headaches, cramps, or digestive problems without a clear physical cause that do not go away with treatment.
• Obesity.
• Diabetes.
• Heart disease.

Other possible complications linked to depression include:^15,20-21

• Substance misuse.
• Other mental health conditions (e.g. anxiety disorders).
• High risk of suicide.

Treatment for Co-Occurring MDD and Addiction

For people with co-occurring mental health and substance use disorders, integrated care that treats all disorders simultaneously provides better results.

For some individuals, detox may be the first step in a more comprehensive treatment plan. Medically managed detox means the body rids itself of substances safely and as comfortably as possible under the supervision of doctors, nurses, and other healthcare providers, who can monitor the patient’s physical health and emotional state, intervening if necessary.²² 

Medications may be used in conjunction with these various forms of therapy to treat alcohol or opioid addiction. And some medications may help treat multiple problems. For example, some medications are approved to treat some substance use and mental health disorders.²³

Unfortunately, the social stigma of depression and other mental illnesses is just one of many reasons people fail to obtain proper treatment for the disease. If you or a loved one suffer from depression and/or addiction, treatment can help and insurance generally covers at least part of the cost.

If you or a loved one are struggling with depression and addiction, call American Addiction Centers (AAC) . Speak to a caring and knowledgeable admissions navigator, who will listen to you, answer your questions, and explain your options. All AAC facilities, located throughout the United States, offer co-occurring disorder treatment to help with depressive and substance use disorders. Let us help you begin your recovery journey today.

Other Helpful Resources

If you or a loved one are experiencing symptoms of depression or thoughts of suicide, please call a suicide helpline or 911 immediately if you are having thoughts of harming yourself.

• The National Suicide Prevention Lifeline is available 24 hours a day at 988.
• The National Alliance on Mental Illness features listings of local programs and support groups as well as a helpline.
• The Substance Abuse and Mental Health Services Administration (SAMHSA)’s behavioral health treatment services locator allows users to search for treatment options in their area. SAMHSA also has a 24-hour helpline to provide treatment referrals and information about mental health and substance use disorders at 1-800-662-HELP (4357).

Frequently Asked Questions About Depression