Teen Depression and Substance Misuse

The Interrelationship

The word depression has its roots in Latin, originating from a word that means “to press down.” It’s an apt description for a condition that can pull the color out of a day, strip the hope out of the future and allow the person to sink into a deep hole of despair that seems to have no bottom. During adolescence, when hormones run wild and life becomes increasingly strange and challenging, depression is common. The confluence of chemistry and circumstance can take its toll, and teens may feel as though there’s nothing they can do to feel better about their lives.

In desperation, some teens turn to addictive substances, hoping to feel something different, even if only for a moment. These teens are working to solve their own problems, and while that’s something parents might normally commend, when it comes to addiction, a depressed state can increase the risks of catastrophe.

Simple Definitions

All human beings feel down in the dumps from time to time. When things don’t go as planned or a sudden setback strikes, it’s common to feel low, sad or even despondent about the future. When circumstances reverse, however, these blue feelings float away and the pain disappears. For people with depression, on the other hand, the low mood doesn’t fade with time. It might be triggered by an outside factor, but outside factors can’t make it lift. According to the American College of Obstetricians and Gynecologists (ACOG), teens can be diagnosed with major depression if they have the following symptoms nearly every day for at least two weeks:

• Feeling sad, upset or irritable
• Persistent boredom or lack of interest in activities once considered enjoyable
• Significant change in appetite or weight
• Changes in sleep
• Lethargy
• Restlessness and fidgeting, or by contrast, slow and sedated movements
• Feelings of worthlessness
• Inability to concentrate or make decisions
• Thoughts of death

ACOG states that the first two items on this list are most important when it comes to a firm diagnosis, as teens who don’t have either one or both of these symptoms aren’t considered truly depressed. However, any item on this list might cause a parent concern, especially if those symptoms just won’t abate.

Living in a world that’s been zapped of everything enjoyable is a misery, and teens might find that substance abuse can provide them with a momentary feeling of relief. Some teens merely dabble in addictive drugs, just using substances when they’re in the presence of their friends or when they feel as though they’re having a particularly difficult day. Other teens, however, lean on drugs to help them function on a daily basis, and in time, they may feel as though they cannot survive without the drugs they take. Their use may be compulsive, or totally outside of their control, and they may continue substance abuse, even when they know that they should stop this behavior. When a teen crosses the line from dabbling into compulsive use like this, an addiction has set in.

Addictions are private situations, and each person who has an addiction might display different symptoms. There are a few warning signs, however, that remain constant among almost all teens who have addiction issues.

These signs include:

• An increased demand for privacy
• Reduced involvement in family affairs
• New friends, who may talk openly about drugs
• Stealing medications, drugs or money
• Dramatic changes in awareness – asleep one moment and wide awake in the next
• Reduced attention paid to grooming
• Low grades

Why Depression and Addiction Intersect

Depression is remarkably common among teens. In 2007, for example, the National Survey on Drug Use and Health found that 8.2 percent of adolescents experienced at least one episode of depression in the year prior. Some of these teens might never develop an addiction in response to their depression, but many, many others will develop co-occurring addictions as they struggle with depression. The underlying chemistry might be to blame for this phenomenon.

Teens are sometimes depressed due to outside triggers, as mentioned, but the National Institute of Mental Health has confirmed that some teens with depression have low brain chemical levels, and this imbalance could lead them to feel as though life holds no joy. The chemical GABA, which is normally secreted by the brain and utilized by the body in a variety of ways, is lacking in these adolescent brains. Addictive drugs, including marijuana, prescription painkillers and heroin, all work along the same pathways that are augmented in these depressive teens’ brains. They stimulate the production of other feel-good chemicals, including dopamine, which allows the teen to feel a boost of happiness that the teen might find difficult to access without drugs. In a way, the substance abuse is treating the depression, but unfortunately, drugs can make the mental health issue much, much worse.

A brain on drugs is a brain that’s under constant revision. As the drugs enter the body, the brain makes adjustments, ensuring that the effects of drugs won’t overwhelm the brain. Pleasurable chemicals are produced in smaller amounts, and fewer receptors are available to respond to those chemicals. These changes persist even when the drugs are gone. In time, as the addiction wears on, teens may be simply unable to develop normal levels of feel-good chemicals. As a result, their brains are deficient in two major sets of chemicals, both GABA and dopamine. The depression may worsen and deepen as this process moves forward.

While this movement from depression to substance abuse to addiction is common in teens, there are some who follow this process in reverse, taking addictive drugs and then developing depression as the addiction moves forward.

Some drugs, in particular, seem to be linked to a high number of adolescent cases of depression. The National Survey on Drug Use and Health, for example, reports that 10.2 percent of teens who abused inhalants had a case of major depression, compared to only 4 percent of teens who did not abuse inhalants. It’s unclear why specific drugs would be so closely related to depression, but it is clear that the changes some drugs can cause could lead to a higher incidence of depression in some teens.

Making a Bad Situation Worse

A deepening depression could lead some teens to make terrible decisions. Teens might choose to steal in order to pay for their drugs, for example, and their depression may make them more careless than they would normally be. These teens might get caught, as a result, and they might enter the criminal justice system.

Teens who don’t get caught might spend time with other teens taking drugs or abusing alcohol, and they might:

• Obtain a sexually transmitted disease
• Get into physical altercations
• Become pregnant or father a child
• Drive, or ride with an impaired driver, and get injured in the process

These situations could all place intense mental pressure on a teen, once again making the depression much worse. The chemical changes caused by the ongoing addiction can also deepen a depression and make it harder for the teen to think clearly and find joy. The two conditions seem to knit together and strengthen one another, and the teen may find it difficult, if not impossible, either to stop using drugs or to see the depression lift.

Teens who don’t feel as though a reasonable end is in sight might choose to end their lives. For these teens, death seems preferable to a life that will always include pain and suffering. Teens who abuse drugs may be well aware that the substances they abuse could be used as important weapons in a suicide attempt, and in time, the allure of suicide may begin to grow. Teens may plan ahead for their suicide, and parents might be able to spot the signs and step in before their teens take this terrible step.

Suicide warning signs include:

• longing for death
• Saying goodbye to family members and friends
• Giving possessions away
• Seeming suddenly happy, when sadness has lingered for a long time prior

Getting a Loved One Into Treatment

According to the Substance Abuse and Mental Health Services Administration, about 27.6 percent of older adolescents who enroll in addiction treatment programs also have a mental illness. Since this issue is so very common, therapists are adept at helping teens with these types of co-occurring problems. Teens can’t be helped, however, if they never enter into treatment programs. This is where families play a vital role.

Teens rely on their parents for emotional support and guidance. They don’t have the life experiences that their parents have, and they may simply not know that depression and substance abuse can be treated. These teens might feel as though their lives are hopeless, and that they are helpless, and as a result, they might never ask for help. Parents might need to take charge of the situation, telling their teens about how treatment works and why it’s so important. Parents might also need to find a treatment program for their children, and then transport their children to the chosen facility. It can seem forceful or even harsh to place a child in treatment, but parents who do so may be providing their children with a ray of hope they can lean on, and with hope, they might find the strength to get better.

Treatment Options

Depressed teens with addictions are often treated in so-called “dual diagnosis programs” in which both the addiction and the depression are treated at the same time, by the same therapist. These programs can provide teens with real tools they can use to amend their lives, and the lessons teens can learn in therapy might help to infuse their adult lives and keep them from falling into the same bad habits as they age.

Teens might be provided with cognitive behavioral therapy, in which they’re asked to work closely with their therapists and develop a specific set of tools they can use when symptoms of depression appear or when the urge to use drugs begins to grow. The therapy is difficult, and teens are often asked to do homework assignments between sessions, so they’re always thinking about the problem and what they’ll need to do to improve, but this therapy can have a dramatic impact on a teen’s health. According to a study funded by the National Institute on Mental Health, this type of therapy was an effective treatment for depression, even when it’s the only treatment provided.

Some teens with severe symptoms of depression need medications in order to heal, and there are many different types of medications that can alter brain chemistry and allow teens to feel their symptoms begin to ease. Some teens who are recovering from addictions to opiate drugs like heroin or prescription painkillers also benefit from medications, as the drugs they take can change brain chemistry to such a degree that clear thought seems difficult, if not impossible. Replacement medications could allow these teens to feel calmer, and this might allow them to participate in therapy on a more focused basis.

Not all teens who enter treatment need to take medications, and not all programs that treat teens offer medications.
In general, it’s a personal decision that the teen’s therapist is best qualified to make. Parents can add input, and the teen should also be allowed to discuss the issue, but the therapist is likely to hold the expert opinion that needs to be followed in order for the teen to recover.

Alternative therapies might also play a role in treatment of these issues. Teens might benefit from spending time outdoors, for example, and therapeutic hiking trips can allow them to experience the push-pull of their muscles and escape the defeating thoughts that circle about in their minds. Learning how to meditate might also be helpful for depressed teens, as meditation might allow them to learn how to experience their emotions without feeling the need to amend their feelings with drugs.

Finding the right program for your teen can seem intimidating, but your family doctor may be able to provide you with vital help. If you have a son with addiction and depression issues, we are able to help. At Muir Wood, we specialize in helping teens who have addictions, and our counselors are adept at dealing with the emotional triggers that lie beneath these adolescent addictions. To find out more about the help we can provide, please call us or download our admissions packet.