Depression is an illness – a medical disorder with very specific signs and symptoms.


Many patients receiving treatment for chemical dependency also require treatment for depression – it is very common as a co-existing disorder in dual diagnosis.Depression is a brain disorder that often results from chronic strain or stress. Anxiety, chemical dependency, and other disorders sometimes co-exist with depression creating the need for dual diagnosis treatment

When several symptoms of depression co-occur with chemical dependency for longer than two weeks and interfere with ordinary functioning, professional dual diagnosis treatment is needed for depression and chemical dependency.

Symptoms of Depression

Sometimes depression is not recognized because patients don’t feel depressed. The onset of the first episode of major depression may not be obvious if it is gradual or mild. The symptoms of major depression characteristically represent a significant change from how a person functioned before the illness. The symptoms of depression include:

  • Profoundly sad or irritable mood.
  • Pronounced changes in sleep, appetite, and energy.
  • Difficulty thinking, concentrating, and remembering.
  • Physical slowing or agitation.
  • Lack of interest in or pleasure from activities that were once enjoyed.
  • Feelings of guilt, worthlessness, hopelessness, and emptiness.
  • Recurrent thoughts of death or suicide.
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

Facts about Depression


Major depression is a serious medical illness affecting 9.9 million American adults, or approximately 5 percent of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Major depression is the leading cause of disability in the U.S. and many other developed countries.Nearly twice as many women (6.7 million) as men (3.2 million) suffer from major depressive disorder. Major depression can occur at any age including childhood, the teenage years and adulthood. All ethnic, racial and socioeconomic groups suffer from depression. More than half of those who experience a first episode of depression will have at least one other episode in their lives. Some individuals may have several episodes in the course of a year. If untreated, episodes commonly last anywhere from six months to a year. Left untreated, depression can lead to suicide.

Major depression is also known as clinical depression or unipolar depression. Other depressive disorders include dysthymia (chronic less severe depression) and bipolar disorder (manic depression). People who have bipolar disorder experience both depression and mania. Mania involves abnormally and persistently elevated mood or irritability, elevated self-esteem, and excessive energy, thoughts, and talking.

Causes of Major Depression

There is no single cause of major depression. Psychological, biological, and environmental factors may all contribute to its development. Whatever the specific causes of depression, scientific research has firmly established that major depression is a biological brain disorder.Norepinephrine, serotonin, and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Scientists believe that if there is a chemical imbalance in these neurotransmitters, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers.Scientists have also found evidence of a genetic predisposition to major depression. There is an increased risk for developing depression when there is a family history of the illness. Not everyone with a genetic predisposition develops depression, but some people probably have a biological make-up that leaves them particularly vulnerable to developing depression. Life events, such as the death of a loved one, a major loss or change, chronic stress, and drug and alcohol abuse may trigger episodes of depression. Some illnesses and some medications may also trigger depressive episodes. It is also important to note that many depressive episodes occur spontaneously and are not triggered by a life crisis, physical illness, drug and alcohol abuse, or other risks.

Treatment of Depression and Chemical Dependency

Transitions Recovery employs a holistic approach to help each individual with dual diagnosis depression and chemical dependency. The treatment of depression is not limited to medication. There are a number of ways to treat depression, including individual therapy, group therapy, family therapy, cognitive therapy, and medications if indicated. Patients are assessed as to their individual needs, and appropriate recommendations are made. In most cases, a combination of therapeutic interventions effectively relieves the symptoms.Although major depression can be a devastating illness, it is highly treatable. Between 80 and 90 percent of those suffering from serious depression can be effectively treated and return to their normal daily activities and feelings. Many types of treatment are available, and the type chosen depends on the individual and the severity and patterns of his or her illness. There are three basic types of treatment for depression: medications, psychotherapy, and group therapy. They may be used singly or together during dual diagnosis treatment.


The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine can be corrected with antidepressants. Four groups of antidepressant medications are most often prescribed for depression.

Tricyclic antidepressants (TCAs)

Still widely used for severe depression. TCAs elevate mood and activate behavior, but it often takes three to four weeks for an individual to respond. These medications include amitriptyline (Amititril, Elavil), desipramine (Norpramine), doxepine (Sinequan), imipramine (Antipress, Imavate, Tofranil), nortriptyline (Aventyl, Pamelor), and protriptyline (Vivactyl).

Monoamine oxidase inhibitors (MAOIs)

Often effective in individuals who do not respond to other medications or who have atypical depressions with marked anxiety, excessive sleeping, irritability, hypochondria, or phobic characteristics. These medications include phenelzine (Nardil) and tranylcypromine sulfate (Parnate).

Selective serotonin reuptake inhibitors (SSRIs)

These act specifically on the neurotransmitter serotonin. In general, SSRIs cause fewer side effects than TCAs and MAOIs. These medications include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Useful as first-line treatments in people taking an antidepressant for the first time and for people who have not responded to other medications. In general, SNRIs cause fewer side effects than TCAs and MAOIs. These medications include Venlafaxine (Effexor).

Bupropion (Wellbutrin)

This newer antidepressant medication classified as a dopamine reuptake blocking compound. It acts on the neurotransmitters dopamine and norepinephrine. In general, bupropion causes fewer side effects than TCAs and MAOIs.

Consumers and their families must be cautious during the early stages of treatment when energy levels and the ability to take action return before mood improves. At this time – when decisions are easier to make, but depression is still severe – the risk of suicide may temporarily increase.


There are several types of psychotherapy that have been shown to be effective for depression, including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that mild to moderate depression can often be treated successfully with either of these therapies. However, severe depression appears more likely to respond to a combination of psychotherapy and medication.

Cognitive-behavioral therapy (CBT)

Helps to change the negative thinking and behavior associated with depression while teaching how to unlearn the behavioral patterns that contribute to the illness.

Interpersonal therapy (IPT)

Focuses on improving disturbed personal relationships that may worsen depression.

Dual Diagnosis – Depression and Chemical Dependency

Our comprehensive approach to depression and drug and alcohol addiction treatment begins immediately with medical, psychiatric and psychological evaluations. Each patient benefits from a dual diagnosis treatment program that is tailored to their specific needs for depression and chemical dependency.Our highly regarded staff is trained and experienced in recognizing and treating depression and chemical dependency. Our psychiatrist assesses patients who may be struggling with psychiatric or emotional disorders or who may already be on psychotropic medication.Our psychiatrist can prescribe appropriate non-addictive psychotropic medication to ease the affects of these disorders, giving the patient an opportunity to successfully participate in the dual diagnosis treatment process. The psychiatrist will provide periodic medication reviews to make sure that prescribed medications and therapies are having the desired effects.

To determine if you or a loved one may require dual diagnosis for treatment of depression and chemical dependency, call 800-626-1980 now to talk to us.

This web copy was reviewed by Transitions Recovery Program’s Director – Marian Bach, LMHC, CAP