Severe Depression and Suicide Adds to the Nightmare of the Opioid Crisis

Substance use disorders interact with mental health disorders in many ways, but one of the most troubling trends is the number of deaths resulting from depression combined with substance abuse.

Depression can feed into substance abuse and vice versa, creating a cycle of addiction and dependency that is very hard to break. While the opioid crisis is causing devastation throughout the United States, the risk opioids pose to people with depression is often overlooked.

Depression certainly affects every person with the condition differently, there is one major common thread among all cases: Opioid addiction will exacerbate an existing case of depression, potentially opening the door to self-harm and suicide.

Substance Abuse, Addiction and Depression

The Anxiety and Depression Association of America (ADAA) reports that about 20 percent of people suffering from depression or other mood disorders also contend with substance abuse. Conversely, about 20 percent of people struggling with substance abuse also deal with anxiety and mood disorders. Compared to the rest of the population, people who use illicit drugs are twice as likely to have mood disorders such as anxiety and depression.

Understanding Depression

While most people automatically associate the word “depression” with “sadness,” the condition goes much deeper than that. Depression can certainly cause sadness or make stressful and emotional subjects more difficult to manage, but it also entails:

• Feelings of hopelessness
• Lack of motivation
• Lethargy
• General malaise

People who receive treatment for depression typically manage their symptoms with antidepressant medication.

One of the biggest dangers of interactions between opioid medications and depression is self-medication. A person with depression may use the euphoric, relaxing feelings generated by opioids to escape the negative symptoms of depression. This will quickly lead to dependency and tolerance, and the individual will require more and more of the drug to feel the desired effects.

When a dose of opioids wears off, the withdrawal symptoms can make the symptoms of preexisting depression even worse. Depression can also exacerbate physical pain symptoms and make it more difficult to recover from an injury or illness.

Severe Depression and Suicide

People with depression are at an increased risk of suicide. Depression can cause feelings of hopelessness that drive people to commit suicide or other self-destructive acts.

Unfortunately, people with undiagnosed anxiety and mood disorders are at even greater risk. When these individuals receive prescriptions for opioid-based medications, the drugs can interfere with their undiagnosed mental illness in dangerous ways.

Opioids, Painkillers, Heroin and Suicide Risks

Researchers have linked opioid abuse to higher rates of anxiety, depression and bipolar disorder. A St. Louis University study suggests that about 10 percent of more than 100,000 patients who received opioid prescriptions developed depression within one month of taking the medication. Every patient in the study received a prescription for a physical health issue such as headaches, arthritis or chronic pain, and none of them had preexisting mental health disorders.

When addiction forms out of a legitimate prescription, the person taking the pills will eventually build a tolerance to the drug and require more at each dose to feel the same effects. The effects will eventually wear off, and withdrawal will sets in, causing a host of unpleasant symptoms.

When opioid addiction converges with depression, the individual will likely feel highly pronounced withdrawal symptoms that can exacerbate depression, compelling the person to find more of the drug as soon as possible. This is what creates the pipeline to heroin abuse.

From Prescription Painkillers to Heroin

A person with an opioid addiction may begin with pills, but they are very difficult to obtain on the black market once prescription refills run out. A single pill of any major opioid painkiller can cost as much as $25 or more on the street, while a single dose of heroin is less than $5 on average. When facing severe withdrawal symptoms from opioid addiction, heroin becomes a very attractive, cheap and accessible alternative.

Overdose Risks

Opioid prescriptions quadrupled between 1999 and 2015, and now more than half of all opioid painkiller prescriptions are going to individuals who also have mood disorders. This is a very worrying trend, due to the dangerous interactions possible between depression and opioid abuse.

The risk of overdose is very high with opioids, and a person who has developed a tolerance may decide to double a dose or take more than recommended to feel enhanced effects. Additionally, a person who turns to heroin may not be ready for the potency of the first dose, and may suffer an overdose, in turn. People with depression are more likely to take larger doses of opioids at a time, increasing the risk of overdose dramatically.

One challenge facing suicide researchers and prevention advocates is calculating the true number of suicides in relation to drug overdoses. It’s relatively easy for a person to accidentally overdose on heroin or another opioid and have it mistaken for a suicide.

Conversely, if a person intentionally overdoses, investigators may mistakenly chalk it up as an accidental overdose if there is no evidence indicating the person intended to commit suicide.

Suicide and Addiction Statistics

People with depression tend to feel pain more acutely than those without the condition, and opioid abuse can play a role in this, as well. Since depression interferes with the body’s natural opioid chemicals, a person with depression is less-equipped for handling conditions like chronic and acute pain.

Depression can make recovery after an illness or injury more difficult, and many people conflate the symptoms of depression with actual chronic pain. Co-occurring depression may very well be one of the major reasons behind the skyrocketing number of opioid painkiller prescriptions and suicides in the U.S.

The Centers for Disease Control and Prevention reported that suicide rates are climbing in the United States. The age-adjusted scale for suicide rates in the United States is 12.93 per 100,000 residents, and there are more than 42,000 suicides in the U.S. each year. This averages out to about 117 suicides every day, 22 of which are combat veterans.

Men are 3.5 times more likely to commit suicide than women, and in 2014, seven out of every 10 suicides involved white males. Suicide also takes a heavy economic toll on the country, costing taxpayers about $44 billion annually.

The rate of deaths involving alcohol, drugs and suicide increased by 52 percent from 2000 to 2014. Essentially, these statistics indicate that not only are suicide rates rising, but the rate of completed suicides is also rising, due in part to over-prescription of opioid-based medications among Americans struggling with anxiety and mood disorders.

Suicide Statistics In California

Although the suicide rate in California has consistently been lower than the national average for the past several years, there has been a noticeable uptick in the number of California suicides.

In 2009, males accounted for about 75 percent of all suicides in the state. The suicide rates also vary widely in the different regions of California, with the highest rate in the northern, rural part of the state and the lowest in the southern and central portions of California.

Dual Diagnosis Treatment

One of the best ways of curbing the number of opioid-related suicides is by making substance abuse treatment more accessible. It’s crucial for a person struggling with addiction and a mental health disorder to receive treatment for both conditions at the same time. Addressing one but not the other will not work, so dual diagnosis treatment is incredibly valuable in this regard.

In dual diagnosis treatment, the patient receives counseling and therapy for his or her mental health issues in conjunction with substance abuse treatment. By tackling both issues simultaneously, the individual will have a greater chance of overcoming addiction while developing new methods for coping with the mental health disorder. It’s vital for anyone in this position to recognize the severe risks of depression with opioid addiction and seek treatment as soon as possible.