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Coexisting Disorders


Depression, along with post traumatic stress disorder, is one of the most commonly undiagnosed clinical conditions.  This is particularly true where there are primary drug problems and clinical staff may see depressive states as being quite a normal consequence of drug dependence.

Any reduction in drug use needs to be carefully monitored in the context of those with depression, particularly if associated with anxiety and used as a primary coping strategy.

The withdrawal syndrome associated with some drugs, particularly amphetamines, and to a lesser extent benzodiazepines and cannabis, can include depressive symptoms.  Withdrawal from any substance or behaviour may leave a depressive void prior to re-establishing new competing behaviours. 

When drug using consequences such as legal charges, family distress, financial problems are combined with poor coping skills and low self image, depression may surface as a key feature.

High suicide and overdose coupled with high rates of depression suggest that all those with coexisting disorders be screened for self-harm and suicidal ideation and/or behaviour.

Depression generally responds well to treatment with an estimated 90% recovery rate.



Incidence and Aetiology



Non-specific treatments
Cognitive-Behavioural Therapy
Drug therapy
Family Involvement
Support groups


Depression may be catetorised in a number of ways:

Reactive or Endogenous
Reactive depression is generally related to an identifiable external event.   Endogenous depression is seen as being generated from within and more likely related to a biochemical disturbance.

Mild and Major depression
Mild depression is sometimes described as such, either because it may lack intensity of more severe presentations, or it appears to be a short-term issue.  However, treatment is requied in both cases as chronic, low grade depression or severe short-term depression can both be debilitating and pose a threat to the client and those around the client.

Bipolar disorder (depressive episode), Major Depression or Dysthymic disorder
Bipolar disorder describes alternating periods of depression and mania. (also called Manic-Depressive disorder).
Major depression refers to reactive or endogenous depression.
Dysthymic disorder refers to a chronic condition where a client has at least 2 years of depressed mood and symptoms such as little pleasure in daily living, retarded social skills and numerous bodily complaints.

Incidence and Aetiology


Clinical depression is said to affect up to 70% of those with a primary diagnosis of substance use problem (other than alcohol) and up to 40% of those with an alcohol-related problem.


Theories about the aetiology of depression include:

- Genetic factors (particularly in regard to Endogenous Depression and Bipolar Affective Disorder)
- Bio-chemical - disturbance in neurotransmitters, particularly a reduction in norepinepherine and serotonin.
- Social stressors such as crisis, migration or separation (which may be compounded by substance use)
- Cognitive view that people have learned to view themselves, the future and current experiences in the negative
- Family systems view relating to a mix of high parental expectations with little approval


Suicidal or self-harming thoughts and/or behaviours
Careless with self (recent accidental overdose)
Low self-image (feeling worthless, ugly)
Loss of hope or future
Existential crisis (loss of life meaning)

Weight loss (or gain)
Reduced activity (or agitated activity)
Sleeplessness (early awake and/or difficult to get to sleep)
Reduced sex drive

Reduced or no contact with others
Desire to escape
Avoid problems

Associated symptoms can include disturbed thought processes including belief in the death of body parts, poor communication, demanding behaviour, self-centredness.

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Non-specific treatments
Program of daily activities, exercise and nutrition program and regular sleep.
Deal with concrete, practical issues.
Care in the use of empathy - may deepen depressive states.

Cognitive-Behavioural Therapy (CBT)
Depression is most commonly treated with a combination of CBT and drug therapy.   CBT aims to correct negative thinking patterns and provide a daily routine which reinforces positive activities, particularly those which include an element of socialisation and self-care.

Psychotherapy which aims to find and manage the root cause of depression (eg early childhood trauma such as sexual abuse) is normally not indicated, particularly during periods of detoxification as this may exacerbate depression and elevate the risk of self-harm or suicide.

Drug therapy
A range of anti-depressant medication may be prescribed.  Clients should be aware that these medications often take several days before their full effect is felt and treatment should be continued for several weeks after symptoms disappear.

The period when mood is first lifting is particularly dangerous, as it is during this time that energy and motivation may be elevated enough to complete a suicide attempt. Some anti-depressants can be lethal if taken in overdose, particularly if mixed with depressant drugs such as alcohol, benzodiazepines or heroin.

Other drug therapy may include Lithium (if bipolar affective disorder) and anti-anxiety medication if accompanied by anxiety or agitation.

The nature of possible interactions with non-prescribed and prescribed substances should be investigated with medical or pharmacy staff and subsequently discussed with the client.

Family Involvement
Family members may require support as clients in their own right.  They may also play a key role as an extension of the therapy team.  Where children are involved, a careful assessment of child safety is required, generally by someone specifically trained in this area such as a child protection worker.

Support groups

Support groups exist for those with depression, drug use problems and for those with both mental illness and substance use problems. Support groups also exist for family and friends of those with mental illness and/or drug use problems.

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 Related Internet Information

 Internet Mental Health

[ Disorders ] [ Mood Disorder Links ]

Contains general overview information & links from Neuroland

The Homeless Handbook (Victoria)

[ Mania ] [ Depression ] [ Grief ] [ Suicidal Behaviour ]
[ Psychiatric Drugs ] [ Glossary of Terms ]

Screening Tools
From WA Drug Abuse Strategy Office

Click here (PDF 8 KB) for the CES Depression Scale 

Click here (PDF 12 KB) for the Assessment of Suicide Risk 

Click here (PDF 8 KB) for the Rosenberg Self Esteem Scale 

Click here (PDF 8 KB) for the Mind Over Mood Anxiety Inventory

Click here (PDF 12 KB) for the Peritraumatic Dissociative Experiences Questionnaire


Other DrugNet Pages in this Subject Heading

Introduction ] Psychiatric and Substance Use Assessment ] Symptoms ] Anxiety Disorders ] [ Depression ] Suicide ] Personality Disorders ] Schizophrenia ] Impact on Parenting ] Disability & Drugs ] Psychiatric Drugs ]

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