Major depressive disorder

Depressive episodes rates are elevated in individuals with co-morbid substance use disorders.

These symptoms include:

• The presence of depressed mood person feels down, flat, depressed (and often irritable) most of the day and every day for at least 2 weeks or and loss of interest of pleasurable activities for at least 2 weeks associated with at least three of the following symptoms:
  • Significant appetite or weight loss or gain
  • Insomnia or hypersomnia
  • Psychomotor retardation or agitation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive guilt
  • Impaired thinking or concentration: indecisiveness
  • Suicidal thoughts/thoughts of death.
  The mood disturbance is associated with a range of biological including:
  • A change in sleep and appetite (either increased or decreased)
  • Impaired concentration and memory
  • Impaired energy levels and motivation
  • Impaired libido
• Psychomotor agitation or retardation may be present in more severe cases. Depressed mood may be associated with depressive thought content, including thoughts of helplessness (there is nothing anyone can do to improve the situation), and life is no longer worth living and thoughts of suicide. 
• There may be thoughts of hopelessness (there is no way out and no future ahead) and excessive guilt.
• More severe forms of major depression result in significant impairment in functioning, so that the patient struggles to manage the everyday tasks they need to complete.
• Suicidal thoughts may occur with severe major depression and may result in suicide plans, with suicide attempts with heavy drinking, opioid dependence, amphetamine withdrawal. The depression usually resolves with treatment of the substance use disorder.
• Significant depressive symptoms are common with heavy drinking, opioid dependence, amphetamine and cannabis withdrawal. This depression requires treatment in its own right.

General indicators that depression is not substance related are: