Chronic use of opiates and depression are closely linked. Opioid use disorder and depression co-occur in as many as half of all people who abuse opioids. While not indicated for this purpose, opioids for depression are a common form of self-medication. When looking at the relationship between opioids and depression, people may have several questions, including:
- Are the symptoms of depression caused by opioid use?
- Were symptoms of depression present prior to opioid use?
- How do opioid abuse and depression fuel each other?
With more than half of opioid prescriptions being written for people with pre-existing mental health conditions, these questions are more important than ever. Mental health conditions such as depression increase the risk of abusing medications and becoming addicted. However, this group of people is more likely to be prescribed opioid medications than people without mental health conditions.
Article at a glance:
- Opiates and depression are closely linked.
- Depression is a common symptom of opiate withdrawal.
- Opiates are often used to self-medicate.
- Depression and opiate abuse are treatable.
Table of Contents
Do Opiates Make You Depressed?
Depression is common among people who struggle with addiction. Often a person who has experienced mental health symptoms will find relief in drug use. However, many people find that they experience depression, or other mental health disorders, for the first time after developing substance dependence.
One study found that people taking opiates for 90 to 180 days had a 25 percent increase in depression. This change in depression increased by 53 percent if opioids were taken for more than 180 days. Another study found that 10 percent of patients prescribed opioids met the criteria for a depressive disorder after being on medication for one month. While the feelings of hopelessness associated with addiction may certainly be a catalyst for developing depression, this study found an increase in depression in people with no history of depression who were taking medication as prescribed. This study, among others, has caused researchers to examine the cause and effect process of depression from opiates. The question being asked by many researchers is “do opiates cause depression, or does the nature of substance use disorders cause depression?”
Researchers investigating opioid depression symptoms have found that opioids cause changes in the brain’s reward and pleasure centers. Opioid use produces extreme amounts of the brain’s feel-good neurotransmitters to be released which causes the drug use to be remembered as a rewarding experience. Continued surges in the release of these neurotransmitters teach the brain to focus on drug seeking rather than other healthier behaviors. When the drugs are removed from the body, these neurotransmitters become depleted and depression sets in. While this change can be reversed over time, the initial effects of brain changes can be very discouraging for people in early recovery.
Opiate Withdrawal Depression
Opiate withdrawal depression is a common experience and usually begins within the first week of stopping opiate use. However, depression after opiate withdrawal may begin more quickly or slowly for different people. As discussed above, researchers asking the question “does opiate withdrawal cause depression?” have examined how opiate use changes the brain. Especially during early recovery, the brain struggles to naturally produce feel-good neurotransmitters in the absence of drugs, which may lead to intense feelings of depression.
Common Opiates Used to Self-Medicate
Prior to pharmaceutical developments, there was a period in which opiates used for depression was common. Prescriptions for opiates are no longer given to treat depression. Researchers conducting medication trials in recent years have been unable to find any clinically significant basis for using opiates for depression. Despite not being clinically used, opioids are a common form of self-medication for depression.
Oxycodone and Depression
Use of oxycodone and depression frequently co-occur as individuals with depression are both more likely to be prescribed an opiate for pain and more likely to experience chronic pain. As a result, co-occurring oxycodone use disorder and depression is a relatively normal occurrence. When a person stops taking oxycodone their brain struggles to recreate the level of feel-good neurotransmitters caused by the oxycodone. As a result, a person is more likely to experience depression. This is even more likely for a person with pre-existing depression.
Vicodin and Depression
Depression caused by the use of Vicodin is fairly common. Chronic pain can cause depression just as depression can cause chronic pain. No matter the original cause, Vicodin is commonly prescribed to patients seeking pain management. Vicodin may then alter brain chemistry to create a temporary, non-sustainable euphoria followed by a depressive state.
Codeine and Depression
Codeine, commonly prescribed for pain and severe cough, is often described as less dangerous than other opiates. However, codeine can still be addictive. In recent years codeine syrup has become more frequently abused. Depression is a common result of long-term codeine use. When codeine use becomes chronic, periods without codeine are marked by depression. This relationship between codeine and depression does not only occur for people with a history or predisposition to depression — it may also occur in people with no history of depressive symptoms.
Morphine and Depression
Morphine can reinforce drug use after even one single dose, like other opiates. The morphine-depression link is like that of other opioids and depression. Morphine and depression frequently co-occur due to the changes in brain chemistry caused by morphine use. Morphine is frequently used in medical settings. Patients without a prior history of depression have exhibited symptoms of depression after stopping the medical use of morphine.
Hydrocodone and Depression
Hydrocodone is another commonly abused opiate prescription that results in negative changes in brain chemistry. Depression is a common experience for people who have stopped using hydrocodone. Use of hydrocodone and depression co-occur for the same reasons as with other opiates.
Fentanyl and Depression
Fentanyl is an extremely strong opioid that is linked to increases in the rate of accidental overdoses in the United States. The equivalent of approximately six grains of salt is a lethal dose of fentanyl and one hundred times more potent than morphine. Currently, fentanyl is abused on its own or added to other opioids such as heroin. As the pleasurable effects of fentanyl increase, so do the risks of brain chemistry changes leading to depression. Fentanyl use and depression frequently co-occur due to the potency of fentanyl. People who use the drug in its pure form or mixed with other drugs are highly likely to experience fentanyl depression when discontinuing use.
Opiates and Depression Treatment
Effective treatment is available for people who struggle with both opiate use and depression. Whether a person uses opiates for depression self-medication or develops depression following opioid use, recovery is possible. When a person is both stopping opiates with depression treatment beginning a structured treatment plan is likely to give the best outcomes. Whether a person seeks inpatient or outpatient treatment, a successful treatment plan will include:
- Peer support
- Individual counseling
- Medical support during detoxification
- Family education and counseling
- Step-down and transitional services
- Follow-up and on-going support
Whether depression or opioid use comes first, treating depression and co-occurring substance use disorder requires a skilled professional. If you or a loved one struggles with addiction and a co-occurring mental health condition, like depression, help is available at professional centers across the country. The Recovery Village offers comprehensive treatment for substance use and co-occurring disorders. For more information about our care options, reach out to a representative today.
Carlsson, K. H., Monzel, W., & Jurna, I. “Depression by morphine and the non-opioid analgesic agents, metamizol (dipyrone), lysine acetylsalicylate, and paracetamol, of activity in rat thalamus neurones evoked by electrical stimulation of nociceptive afferents.” National Center for Biotechnology Information, Published March 1988. Retrieved December 5, 2018.
Caruso, C. “Most Opioid Prescriptions Are for People with Depression, Other Mood Disorders.” Scientific American, Publish June 26, 2017. Retrieved December 5, 2018.
Frecska, E., Perenyi, A., & Arato, M. “Blunted prolactin response to fentanyl in depression. Normalizing effect of partial sleep deprivation.” National Center for Biotechnology Information, Published May 30, 2003. Retrieved December 5, 2018.
Frecska, E. “Prolactin response to fentanyl in depression.” Biological Psychiatry, Published 1989. Retrieved December 5, 2018.
Scherrer, J. F., Salas, J., Bucholz, K. K., Schneider, F. D., Burroughs, T., Copeland, L. A., Lustman, P. J. “New depression diagnosis following prescription of codeine, hydrocodone or oxycodone.” National Center for Biotechnology Information, Published May 2016. Retrieved December 5, 2018.
Scherrer, J. F., Svrakic, D. M., Freedland, K. E., Chrusciel, T., Balasubramanian, S., Bucholz, K. K., Lawler, E. V., Lustman, P. J. “Prescription opioid analgesics increase the risk of depression.” National Center for Biotechnology Information, Published 2013. Retrieved December 5, 2018.
Kosten, T. R., & George, T. P. “The neurobiology of opioid dependence: implications for treatment.” National Center for Biotechnology Information, Published 2002. Retrieved December 5, 2018.
McIntosh, C., & Ritson, B. “Treating depression complicated by substance abuse.” Cambridge University Press, Published 2001. Retrieved December 5, 2018.
Motaghinejad, M., Fatima, S., Banifazl, S., Bangash, M. Y., & Karimian, M. “Study of the effects of controlled morphine administration for treatment of anxiety, depression and cognition impairment in morphine-addicted rats.” Advanced Biomedical Research, Published 2016. Retrieved December 5, 2018.
National Institute on Drug Abuse. “Overdose Death Rates.” Retrieved February 8, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a 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 provider.