Substance abuse has a bi-directional relationship with depression, and the impact of one on the other is great. People suffering from depression may turn to alcohol, prescription drugs, and/or non-prescription drugs to lift their mood or escape from feelings of guilt or despair. Conversely, people often experience depressive symptoms once the effects of a substance wear off, or as they struggle to cope with how addiction has negatively impacted their life. This myriad of unpleasant thoughts and feelings paired with a dangerous coping mechanism ultimately feeds a very vicious cycle.
According to a study done by St. Louis University, out of a sample of 107,755 patients that were prescribed opioids for ailments such as back pain, headaches, and arthritis, 11.4% developed depression after a month of using the medications — none of whom had received a diagnosis of depression prior to treatment. Researchers believe this result was due to the ways in which opioids essentially rewire the brain’s reward and pleasure systems, as well as changes they cause in hormone levels. Researchers also suggest that opioids are less effective if a person suffers from depression, which can lead a depressed patient to use more to achieve the desired effect.
Another recent trend in opioid abuse is its prevalence in older populations. Older adults are at higher risk of accidental misuse or abuse of these drugs, as they typically have multiple prescriptions for various medical conditions all needing to be managed at once. The number of elderly patients receiving opioid prescriptions increased nine times between 1996 to 2010, and recent estimates suggest that the prevalence of opioid misuse among adults aged 50 years and older is expected to double — from 1.2% to 2.4% — between 2004 and 2020.
In 2017, the U.S. saw 70,237 drug overdose deaths — a significant, age-adjusted increase of 9.6% from 2016 — with a concerning trend in the rising prevalence of opioid abuse. Of those 70,237 deaths, opioids acted as the main driver, claiming responsibility for 47,600 of them.
Nutrition habits play a key role in the onset, severity, and length of a depressive episode. Health professionals often find that patients exhibit similar eating patterns preceding and during the duration of the disease, such as a loss of appetite, skipping meals, and strong cravings for sugary foods.
The still-emerging field of nutritional neuroscience has uncovered multiple nutritional risk factors that directly affect cognition, behavior, and emotions, and that can potentially complicate issues related to depression. Some of these include:
Low complex carbohydrate intake. Serotonin and tryptophan promote feelings of well-being, and the production of both is triggered by foods rich in carbohydrates. However, the type of carbohydrate matters. Low glycemic index (GI) foods — including some fruits, vegetables, and whole grains — are more likely to provide balance when it comes to brain chemistry, mood, and energy level versus high GI foods, like sweets, that provide a rapid spike followed by a rapid crash. These fluctuations and intense “lows” induced by high GI foods can lead to depressive feelings such as sadness and lethargy.
Not consuming enough high-quality protein. A diet rich in high-quality protein — i.e., meats, dairy, and eggs — is one that is rich in essential amino acids. Many of the brain’s neurotransmitters, including those that play a role in depression, are made from amino acids. For example, dopamine is made from tyrosine and serotonin is made from tryptophan. If a person is lacking either of these, the brain will struggle to synthesize the respective neurotransmitters, which may lead to low/depressed moods and heightened aggression in patients.
A lack of folate. The critical role of folate — which can be found in broccoli, spinach, and eggs — in maintaining the health of the brain’s metabolic pathways has been well-documented by researchers, and depressive symptoms have been widely recognized as a common side effect of folate deficiency. Studies show that depressed patients often have blood folate levels that are an average of 25% lower than healthy controls.