Why is my doctor telling me I need treatment for my addiction when I thought treating the depression would solve my problem?

Anne's comment:

A large percentage of bipolar patients are dual diagnosis, meaning they have addiction issues in addition to their bipolar disorder. It is extremely important for dual-diagnosis patients to receive ongoing treatment for both aspects of their illness. Relapsing into alcohol or drugs causes the bipolar patient to destabilize, and an entire cycle of healing will have been negated.

Patients with a combination of addiction and depression are at higher risk for suicide, homicide, poor compliance, relapse, and greater hospitalization rates. Although some evidence exists to support the concept that many patients use substances to "self-medicate" an underlying depression, no evidence exists showing that antidepressant medication leads to abstinence. Although the "self-medication hypothesis" may seem right for some individuals, once an addiction develops it takes on a life of its own. It is unlikely that medicating it away can conquer addiction. Also, if you continue to use drugs or alcohol while receiving antidepressant medication, the medication is rendered essentially ineffective. Thus depression cannot be effectively treated without also treating the addiction.

How are alcoholism and depression connected?

A clear link exists between addiction and depression. The rates of depression are three times higher in male addicts and four times higher in female addicts than in the general population, and a third of all depressed patients suffer from an addiction. Men typically develop a substance abuse disorder first, whereas women typically develop a mood disorder first. The link between these conditions has biologic, psychologic, and social roots. Biologically, many addictive substances are depressants, whereas many other addictive substances when withdrawn cause depression. Additionally, both addiction and depression run together in families, placing individuals at risk genetically. Psychologically, certain personalities are prone to addiction and depression. People who have difficulty with impulse control, who are quick to anger, and who are abrupt seem to be more prone to addiction, perhaps

A clear link exists between addiction and depression.

as an attempt to help modulate their feelings. Unfortunately, these addictions are only transiently beneficial and generally backfire. Alternatively, people who are shy or reserved and who become very anxious in social settings are more prone to depression and addiction as well, again because they often use substances as a way of trying to feel more comfortable "in their own skin" as well as around others. Socially, people who struggle with depression and addiction find themselves socially isolated and unable to keep a job. Social isolation, job loss, and loss of access to health care and housing can lead to further worsening of symptoms of depression and addiction.

I have not been able to sleep well or concentrate at work since being mugged 3 months ago. Could I be depressed?

Psychological trauma, which occurs in response to a physical threat to life or bodily integrity, is one of many risk factors for depression. It can be exposure to military combat, violent assault, child abuse, domestic violence, accidents, or natural disasters. Witnessing a traumatic event or hearing about a trauma from a loved one can also cause trauma. Nearly everyone who experiences a traumatic incident will suffer from some of the symptoms of traumatic stress. However, only between 7% and 25% will suffer enough symptoms to meet the criteria for acute traumatic stress disorder. The range depends on the type of trauma experienced. Of those who develop acute traumatic stress disorder, 80% will go on to develop posttraumatic stress disorder. Not everyone exposed to severe trauma will develop posttraumatic stress disorder. Risk factors that confer a vulnerability to posttraumatic stress disorder include the following:

A psychiatric history A history of previous trauma Low intelligence Limited social supports

Separation from parents in childhood or early parental divorce

A family history of depression or anxiety

As a general rule, all psychiatric disorders, particularly posttraumatic stress disorder, are more apt to become chronic the longer symptoms persist and may take longer to abate with treatment. The rates of depression and alcoholism are extremely high among those suffering from posttraumatic stress disorder, and, left untreated, they essentially "fuel the posttraumatic stress disorder fire" through continued depression and substance abuse. Posttraumatic stress disorder and major depression have a number of symptoms in common, and major depression frequently develops secondary to posttraumatic stress disorder. It is important to be evaluated as soon as possible. Psychotherapy is an essential part of the treatment, and medication may be necessary, particularly if there are comorbid conditions.

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