Opioids & Depression: Everything You Need to Know

There is a complex relationship between opioids and depression. 

Initially, opioids provide temporary relief from the symptoms of depression — symptoms that include feelings of sadness and hopelessness. This happens because opioids stimulate the release of neurotransmitters like dopamine and serotonin, both of which are associated with feeling good physically and mentally.[1]

However, this effect is only short-term. Over time, a higher and higher dose of opioids is needed to achieve that same relief from depression. Eventually, the drugs don’t help the problem at all. 

Additionally, long-term use of opioids can worsen symptoms of depression, putting people at risk even more so than using high doses of opioids irregularly.[2] 

A Complicated Relationship

In some cases, opioid use disorders (OUD) can contribute to the development of a depressive disorder even if no signs were present prior to the use of opioids. This is because opioids can disrupt the normal functioning of the brain and alter the balance of neurotransmitters. 

The reasons for using opioids can also impact mental health symptoms. For example, people who use opioids to manage chronic pain may be at an increased risk for developing depression due to the limitations caused by their ongoing pain. This can be exacerbated by opioid use and the isolation that it brings with it.

Research has also found that people with depression may be more vulnerable to the addictive effects of opioids. That temporary relief from depression symptoms can be a compelling reason to keep using the drugs, and over time, dependence and then OUD can develop.

How & Why Do Opioids Cause Depression? 

The relationship between opioids and depression is complex and not yet fully understood, but research suggests that long-term opioid use can alter the brain's chemical balance and lead to the development of depression.[3]

One of the ways opioids can contribute to depression is by altering the levels of neurotransmitters in the brain. Opioids work by binding to specific receptors in the brain and spinal cord, which can increase the release of neurotransmitters like dopamine and serotonin.[4] These neurotransmitters are associated with feelings of pleasure, reward, and well-being, providing a mood boost that can range from pleasant to euphoric.

However, over time, the brain can become desensitized to the effects of opioids, which can lead to a decrease in the levels of the “feel good” neurotransmitters released in response to the opioids binding to the receptors. This can result in a state of dysphoria, or feelings of unease, dissatisfaction, and sadness, which can contribute to the development of depression.

Additionally, chronic pain itself can be a risk factor for the development of depression on its own. People who use opioids to manage chronic pain may be at an increased risk for both depression and opioid use disorder due to the combination of triggers.

To add to the risk, opioid use can disrupt the body's natural sleep/wake cycle, which can lead to sleep disturbances and fatigue. Low energy and lethargy that comes with a lack of restorative sleep are also associated with depression. 

Statistics on Opioid Use Disorder & Depression 

• The risk of developing a new depression disorder is 40% higher in people who use opioids regularly as compared to those who use opioid drugs occasionally.[5]

• Johns Hopkins Bloomberg School of Public Health researchers report that people who struggle with bipolar disorder and major depressive disorder may be more likely to use opioids nonmedically and potentially develop an opioid use disorder.[6]

• Trauma can contribute to the development of co-occurring depression and opioid use disorders. One study found that 19% of participants who were living with PTSD were misusing opioids with a probable OUD.[7]

• Misuse of painkillers in people using prescription opioids to manage chronic pain occurs in about 30% of users, according to a JAMA Psychiatry study. About 12% of people taking prescription painkillers for pain go onto develop an OUD.[8] Another study found that rates of depression are higher in patients who are treating chronic pain with prescription opioids as compared to those who treat the problem with alternative methods.[9]

What Is the Link Between Opioid Use Disorder & Depression? 

For many people, taking opioids nonmedically is their attempt to manage symptoms of depression. They may not have access to appropriate mental health care or may not find that traditional therapies are working or working quickly enough. Because of this, they may take the drugs as a way to manage the symptoms on their own. 

Even with no history of substance misuse, self-medication rates are high among people struggling with depression.[10] This use is always nonmedical use. Without the supervision of a physician, it is easy to misuse the substances, take more than is safe, and avoid taking medications that are actually proven to treat symptoms of depression. 

In other cases, opioid use disorder comes first. People who misuse painkillers or street drugs like heroin may find themselves experiencing symptoms of depression after long-term use. This can be due to a number of factors, including these:

• A drop in release of feel-good chemicals like serotonin and dopamine over time, as the body develops a tolerance to the effects of opioid medication
• The impact of keeping the secret of drug use and OUD from people around them
• The isolation that comes with spending so much time alone due to active drug use 
• A sense of hopelessness that comes with feeling like they are on a treadmill of drug use to manage depression symptoms, especially as they require higher and higher doses to get a similar response

What Are the Signs & Symptoms of Opioid-Induced Depression?

It can be difficult to identify depression that is induced by opioids, because it shares many symptoms with major depressive disorder. 

However, the signs that indicate depression that may be exacerbated or caused by misuse of opioids include the following:

• Extreme weight loss: While changes in diet are common in depressive disorder, loss of weight will be an issue for people who are self-medicating with opioids. Weight gain is more rare due to the impact of opioids on appetite.[11] Additionally, malnutrition and constipation indicate opioid misuse as well.

• Nodding out: Though low energy, sleepiness, napping at odd times of the day, and other sleep disruptions are common for people with depression, sitting up with the head lolling down is nodding out, not napping. It’s a common occurrence among people who take high doses of opioids. 

• Suicide attempts with pills or other drugs: Suicide attempts may often characterize a depressive disorder, but when someone repeatedly overdoses on painkillers or street opioids, it can indicate a suicide attempt. Similarly, if multiple overdoses occur, it can clearly indicate an ongoing problem with opioid misuse. 

• Stealing, dishonesty, and other cover-up attempts: If depression co-occurs with changes in behavior like stealing money, credit cards, or valuables from family; repeatedly lying about their whereabouts or drug use; or trying to cover up how they’re feeling and what they’re doing, it can indicate misuse of substances in addition to a depressive disorder. 

Additionally, there will usually be the signs of depression that come with grief, trauma, and major depressive disorder, including low mood, lack of energy, and changes in sleeping and eating patterns. 

What Treatment Options Are There for Opioid Misuse & Depression?

Opioid use disorder and depression are both serious medical conditions that require appropriate treatment when they occur individually or on their own, but when they co-occur at the same time, it is essential to seek treatment that addresses both problems fully. 

Some treatment options that can address both OUD and depression simultaneously include the following:

• Medications: There are medications available that can help with both opioid use disorder and depression. For OUD, medications such as methadone, buprenorphine, and naltrexone can help to manage withdrawal symptoms and cravings. When depression predates addiction, addressing the depression disorder chemically with medication can decrease cravings for opioids and other substances.[12]  

• Therapy: Psychotherapy, or talk therapy, can be effective for treating both OUD and depression. Cognitive behavioral therapy (CBT) is an effective talk therapy that empowers patients to take responsibility for their situation and choices while developing coping skills to manage both OUD and depression.

• Support groups: Support groups can be a helpful part of treatment for both opioid use disorder and depression. Groups such as Narcotics Anonymous (NA) and Depression Anonymous (DA) provide support and encouragement from people who understand what it’s like to live with these issues. 

• Integrated treatment: Also known as dual diagnosis treatment and co-occurring disorders treatment, some medical and mental health facilities offer treatment programs that address both substance misuse and mental health issues such as depression simultaneously through a range of integrated treatment methods.[13]

• Aftercare support: The biggest challenge to recovery arguably comes after treatment is stabilized and the person must return back to the world and build a new life. During this period, ongoing support of mental health professionals and peers in recovery are important.

Get Started With Treatment for Opioid Use Disorder & Depression Today

If you or someone you love is attempting to treat a depression disorder by self-medicating with opioids or if opioid misuse has triggered depression, treatment is available. With comprehensive care that addresses opioid use disorder and depression simultaneously, you can achieve recovery on all fronts. 

Reach out to us here at Bicycle Health to learn how we can help. We offer Medication for Addiction Treatment (MAT) to effectively manage opioid use disorder, and therapy to address co-occurring disorders like depression.