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Opioids and Depression: Understanding the Link Between Painkillers, Addiction, and Mental Health

Medically Reviewed by
Virmarie Diaz Fernandez, MD FAPA
January 17, 2025

Opioid medications, while effective for pain relief, can be highly addictive. This is why doctors often avoid prescribing them for long-term use. Many individuals who develop an opioid use disorder (OUD) also experience co-occurring depression. At Eleanor Health, we recognize the complex relationship between opioids and depression and the factors that contribute to both conditions.

Depression and Addiction: Dual Diagnosis

When substance use disorders coexist with mental health disorders, it’s known as a dual diagnosis. Depression and OUD frequently occur together as a dual diagnosis. Although the reasons for this are not completely understood, several factors increase the risk:

  • Genetic Factors: A family history of mental health disorders or addiction may indicate a genetic predisposition to these conditions.
  • Environmental Factors: Trauma, stress, and early exposure to substance use disorders can trigger co-occurring disorders.
  • Brain Changes: Conditions like depression, anxiety, and PTSD, as well as substance use, can alter brain structure. These changes may increase vulnerability to developing other mental health or substance use disorders.

People with depression may be more likely to develop OUD after prolonged opioid use. Inversely, long-term opioid use can lead to depression in those without a prior diagnosis, particularly when opioids are used daily or nearly daily.

Depression and Opioid Addiction

While anyone can become addicted to opioids, those with depression are at a higher risk. Opioids can produce feelings of euphoria, leading some individuals to use them as a form of self-medication to alleviate depressive symptoms.

In other cases, opioid misuse—taking more than prescribed, using without a prescription, or using illicit opioids like heroin—can lead to depression.

Prolonged opioid use can diminish the drug’s effects, causing individuals to increase their dosage to achieve the same sensation. This pattern can alter how the brain processes pleasure, contributing to depression. Additionally, withdrawal symptoms such as insomnia, anxiety, and physical discomfort can exacerbate depressive feelings.

Treating Co-occurring OUD and Depression

Effective treatment for co-occurring OUD and depression involves addressing both conditions simultaneously. Focusing on one while neglecting the other can lead to incomplete recovery. A comprehensive approach that integrates both aspects is essential.

Holistic Health and Recovery

The relationship between depression and opioid use is complex. Addressing one condition independently can perpetuate a cycle where one fuels the other. Recovery requires a holistic treatment approach that considers all aspects of health—physical, mental, and emotional. At Eleanor Health, we create holistic treatment plans to meet the unique needs of each individual. Effective treatment often includes:

Illustration of a nurse with medication-assisted treatment

Medications for Depression and Substance Use Disorder: Both addiction and depression can be managed with medications that alleviate symptoms. Medications for OUD, such as buprenorphine, methadone, and naltrexone, help manage cravings and withdrawal, promoting successful recovery. Antidepressants can help manage depression, and your doctor will carefully select medications to avoid interactions with OUD treatments.

Therapy and Counseling: Medications are most effective when combined with addressing underlying trauma and emotional challenges. Therapy helps identify triggers and develop healthier coping strategies. Healing is challenging, but you won’t have to face it alone.

A man experiencing depression speaks with his psychiatrist
Individuals sit in a group for therapy

Peer Support: OUD and depression can lead to isolation. Building connections and community is vital for recovery. Peer support offers an opportunity to connect with others who understand your journey. At Eleanor Health, we pair members with trained peer recovery specialists for guidance and non-judgmental support.

Virmarie Diaz Fernandez, MD FAPA

Dr. Diaz Fernandez holds Board Certification from the American Board of Psychiatry and Neurology and is recognized as a Fellow of the American Psychiatric Association. She began her medical education at the University of Puerto Rico Medical School, where she completed her medical training and the first year of her Psychiatry Residency. She relocated to Gainesville, Florida, to complete her Psychiatry Residency at the University of Central Florida, serving as Chief Resident during her final two years. Her dedication to continuous professional development is reflected in her additional certifications in WPATH, Nutritional Psychiatry, Mindfulness, and Women’s Mental Health. Her clinical expertise spans both inpatient and outpatient settings, with a focus on minority mental health populations, including the LGBTQ+ and Latinx communities. She also has significant experience in working with survivors of human trafficking and providing Medication-Assisted Treatment (MAT). In her administrative career, Dr. Diaz Fernandez has served in pivotal roles such as Medical Director and National Medical Director, where she has shaped policies and quality measures to enhance mental health service delivery. Her leadership extends to education and mentorship, where she supervises and collaborates with mid-level providers, developing curricula and resources to enhance their professional growth. Her professional interests include interventional psychiatry, addiction, and community mental health, where she leverages her extensive expertise to make a meaningful impact on her patients and the broader community.

Depression Addiction & recovery Blog Mental Health

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