Deborah Serani, Psy.D.

woman depressed and suicidal

Depression doesn’t care if you’re rich or famous, poor or homeless.

It doesn’t care if you’re young or old, ordinary or superlatively gifted. Depression cuts across social economic status, is found in every culture and in every country around the world. It drapes itself over men, women and children – and thinks nothing of how it decays your mind, siphons your soul and crushes the glimpse of possibility, hope and freedom at every turn.

Depression is not an experience that fades with the next sunrise or can be shaken off with a newfound attitude. It won’t be cured by tough-love. Or rectified by ignoring it. And if you try to minimize its wrenching hold on your health, it’ll root itself even deeper. Depression can’t be willed away either. And it can’t be ranked alongside adjectives like blue, sad, dejected, down melancholy or unhappy. Depression demands you to see it for what it truly is – an illness. A beast.

Depression is strongly linked to addiction. The pain and anguish of a depressive disorder often leads to substance or alcohol abuse. Furthermore, the beastly depths of depression along with drugs or alcohol are the leading cause of suicide in adults. Alcohol and drugs reduce inhibition, cause impulsive behavior, and poor judgment. When the neurobiology of depression also exists, the frontal lobes of the brain (responsible for problem solving and healthy reasoning) become further impaired. The perfect storm of alcohol and/or drugs, and the corrosive effects of depression, is what makes this combination most lethal. Research reports that upwards of 30% of completed suicides involve the use of alcohol or drugs.

Though suicide is the most preventable kind of death, over 3000 people die by suicide each day. Mathematically measured another way, 1 million people each year die by suicide. Worldwide, more people die from suicide than all the deaths caused by accidents, natural disasters, wars and homicides around the world, combined. Another way to understand the enormity of suicide is that every 40 seconds someone dies by suicide. And every 41 seconds, loved ones are left behind trying to make sense of it all. As mentioned, suicide is a significant risk for anyone with a mental illness, but it’s exponentially higher for an individual who struggles with addiction and also has depression. Compared to the general population, those with alcohol abuse disorders are 10 times more likely to die by suicide and those who abuse drugs are about 14 times more likely to die by suicide. Typically, individuals who struggle with addiction and depression die by suicide using alcohol – and opiates, such as oxycodone, benzos or heroin.

Which Came First?
It’s often difficult to understand if depression leads to alcohol or substance abuse or if the addiction itself lead to changes in the brain that result in depression over time. Research reports not every person who struggles with a mood disorder experiences a secondary substance use disorder. However, 80% of teens and adults with alcohol or substance addictions experience difficulties with depression. This occurrence of having one or more mental illness disorders is called comorbidity. Both depression and addiction carry a significant risk for the development of the other. Scientific studies show that addictions can prolong the course of depression, and that depression can lead to substance abuse.

Questions like, “Did my depression kick-start my drinking?” or “Is my drug use making me depressed?” are excellent questions to ask. But the truth is, that asking why keeps you stuck in a loop of uncertainty. The chicken-egg question about the etiology of comorbid depression and addiction disorders is a circular exercise best left to researchers. Asking questions of “why” really offer no game-plan.

However, asking questions of “what” offers solutions. “What can I do to reduce my depression?” Or “What proactive tips can I use to tolerate distress better so I don’t use again?” “What support can I get to curb my drinking and reduce my depression?”

For most, the answer to the question “Did my depression cause my substance abuse or did my substance abuse cause depression?” isn’t as important as the urgency to treat both mental illness disorders.

Six Tips to Minimize Your Risk

  1. Get a diagnosis. It’s vital to identify if you’re struggling with depression and an addiction. There are many self-report screenings you can take online or schedule an appointment with an addiction or mental health specialist.
  2. Get specialized treatment. If you’ve been diagnosed with both a depressive disorder and an addiction disorder, seek an expert. This means finding a mental health specialist who understands all of the addictive and depressive pieces of your experiences.
  3. Make the commitment to treatment. Recovery from anything challenging takes time. Teach yourself that change isn’t achieved quickly and aim to work slow and steady in a positive direction. Psychotherapy requires you to be there weekly, work openly and trust the process.
  4. Stay connected to others. Depression and addiction
    often create withdrawing and isolating experiences. Studies suggest your recovery and risk for suicide are worse if you’re unmarried, single or disconnected from others. Make the effort to reach out to others. Attend groups. Socialize. If you feel overwhelmed, tired, or can’t break the detachment, ask others to check in on you.
  5. Be realistic about sobriety. Dealing with addiction means you’ll achieve recovery by finding sobriety. It’s important not to be idealistic about what being sober is all about. It may take time to tolerate feelings of distress because you’ve been blunted or numbed by alcohol or drugs. The steps to recovery may not be a straight line either. Having expectations about being sober will greatly help your recovery from depression.
  6. Create an emergency suicide plan. If a difficult moment begins or a crisis arises where you feel that you may self-harm, help can be just a phone call away. Keep a list of your mental health and addiction supports with their names and telephone numbers. This includes your doctors, therapists, AA meeting centers, family and friend contact numbers, as well as suicide-intervention hotlines. These should be on a sheet by all land lines, programmed into cell and cordless phones and bookmarked in personal computers and laptops.

Deborah Serani is a professor at Adelphi University and the author of the award-winning book “Living with Depression.”