Research shows that people who enter treatment for heroin dependence are three to four times more likely to have major depressive disorder than people in the general population.

Article at a Glance:

  • Heroin addiction and depression can drive one another.
  • People may start using heroin to seek relief from the pain of depression, but heroin use ultimately makes depression worse.
  • Through its effects on levels of essential brain chemicals, heroin can trigger depressive symptoms in people who did not previously have them.
  • Fortunately, with the right treatment, people can recover from both addiction and depression.

Heroin Use & Depression

By the time morphine and heroin were synthesized in the 1800s, people had been using opium for thousands of years. No one knows how exactly people discovered that the milk of opium poppies could provide relief from pain, but people have used potent opium-derived painkillers ever since.

The reason these drugs work is that they mimic naturally occurring brain chemicals. Research has revealed that physical and emotional pain activate the same neurochemical responses in the brain. Whether a person breaks their foot or their heart, the brain releases endogenous opioids to counteract pain signals and alleviate the subjective experience of pain.

When people become depressed, they fall into a state of chronic emotional pain and often experience accompanying physical aches. These may include:

  • Headaches
  • Joint pain
  • Limb pain
  • Back pain
  • Gastrointestinal problems

One potential reason this occurs is that low levels of serotonin and norepinephrine not only cause people to feel depressed but also make them more sensitive to pain. Many people who struggle with depression say that being depressed makes everything feel more difficult and painful.

Chronic emotional and physical discomfort cause some people to turn to heroin for depression. By mimicking natural endorphins, heroin binds to receptors in the brain and blocks the sensation of pain, causing people to feel anything from slight relief to total euphoria. For some people, using heroin can give them the first sense of relief they’ve experienced in years.

Unfortunately, the relationship between heroin and depression is not what most people hope it would be. By the time addiction sets in, people no longer use heroin because it feels good, but because it keeps them from feeling bad. By using heroin to feel better, people sustain their depressive symptoms for long periods.

Does Heroin Use Cause Depression?

Research shows that people who enter treatment for heroin dependence are three to four times more likely to have major depressive disorder than people in the general population. There is no doubt that heroin use and depression are strongly linked. The question is, does depression make you use heroin, or does heroin make you depressed?

Experiencing depression after heroin use isn’t just a matter of returning to previous levels of discomfort after the drug’s effects wear off. Research shows that heroin can contribute to the development of chronic depression by causing long-term chemical imbalances in the brain and body. It can even change the physical structure of the brain, eroding white matter in brain regions that regulate decision-making and responses to stress. Both depression and heroin use can cause people to develop chronically elevated levels of cortisol, which causes inflammation and a host of physical and medical problems.

For people who become physically dependent on heroin, depression can become severe. Acute withdrawal symptoms cause both physical discomfort and unpleasant psychological effects.

Heroin Withdrawal and Depression

While heroin’s physical withdrawal effects, which can include fever and nausea, are well known, the psychological effects are just as significant. In episodes of heroin withdrawal, depression is common, which reflects the way heroin affects the brain.

Heroin doesn’t just hijack the brain’s pain response system but it also alters levels of dopamine and serotonin, which are brain chemicals responsible for regulating mood and feelings of pleasure. When these chemicals flood the brain, people feel good. This surge can only last so long before serotonin, dopamine and other neurochemicals are depleted, leaving people in worse moods than before.

Heroin withdrawal can also cause depression by affecting how people perceive and think about their lives. Research shows that the stigma and isolation of addiction contribute to feelings of despair in people who use heroin. The cycle of craving can be demoralizing, making life feel bleak. As people start to see themselves and the world differently, they can lose touch with positive memories and abandon plans for their future.

The pain and chaos of running out of heroin, severe withdrawal symptoms and having to find more heroin to counteract them can provoke hopeless thoughts. It can seem like there is no way out of the cycle of addiction other than death or a miracle. These thoughts can reinforce the heroin-induced neurochemical changes that maintain depression.

Fortunately, these depressive thoughts are not realistic. The cycle of addiction and depression is painful, but it is not hopeless. Whether people had depressive symptoms before they started using heroin or started experiencing them afterward, the right treatment can help them recover from both depression and addiction.

Feelings of depression or anxiety can lead to suicidal thinking. If you or a loved one is experiencing suicidal thoughts or tendencies, call the National Suicide Prevention Hotline at 1-800-273-8255.

Dual Diagnosis Treatment for Depression and Heroin Addiction

Addiction treatment focuses on how substance abuse affects people, regardless of other psychological factors that may influence their behavior. For example, people may spend time in treatment groups exploring the ways that addiction impacted their careers and relationships. For many people, this laser focus on the impact of substance use is effective. However, people with co-occurring mental health disorders do best when they receive treatment that addresses additional psychological factors.

For people with clinical depression, early recovery can be a difficult time. They may feel more confused and hopeless. Without heroin or other substances that relieve emotional pain, depressive symptoms can become worse. People may be tempted to resume using heroin and drop out of treatment altogether.

Programs with an integrated approach aim to prevent these outcomes by offering interconnected services that address both mental health and substance use disorders. The right interventions can help people abstain from using drugs and alcohol while assisting them to cope with psychological symptoms. People in an integrated program may attend group therapy for substance use disorders while engaging in individual therapy for a mental health condition and taking antidepressants or other psychiatric medications.

Dual diagnosis treatment acknowledges that factors other than substance abuse can cause or prolong depression. By providing treatment that targets underlying mental health problems, integrated programs help people heal in ways they might not have even realized were possible. Research supports this approach, showing that reducing depression improves substance abuse treatment outcomes for people who were using heroin and that substance abuse treatment lowers rates of depression.

If you think that you may have major depressive disorder, you can read more about how the disorder is diagnosed and treated. If you struggle with heroin abuse and depression and need treatment, contact The Recovery Village today. A representative can talk to you about different integrated treatment options that can meet your needs.

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Editor – Camille Renzoni
Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more
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Medically Reviewed By – Stephanie Hairston, MSW
Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more
Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.