Mood disorders are classified as bipolar or depressive, and they commonly occur together with substance use disorders. The combination causes adverse clinical effects. The co-occurrence of substance abuse disorders and mood disorders can be attributed to three factors (Nunes & Rounsaville, 2006). First, the pathological effects of one disorder can increase the risk of developing the other. Many Individuals with substance abuse disorders claim that they use them to combat their moods. People with these mood disorders may also try to self-medicate themselves. For instance, a depressed individual may start using cocaine because it energizes them. Secondly, there is an overlap in the neurological pathways. The neurotransmitter circuits are affected by both addictive substance use and the mood disorders. The overlapping suggests that brain changes resulting from one disorder can affect the other. Lastly, both disorders have genetic risk factors. Some variants of genes can increase the risk of both illnesses. The genes can increase vulnerability to mood disorders which may make an individual self-medicate (Nunes & Rounsaville, 2006).
The mood disorders are caused by the following.
Stress mainly caused by personal disasters or tragedies has been associated with the onset of depressive disorders. The disorder is common during certain life stages that involve significant transitions such as menopause, giving birth and bereavement, which are associated with hormone imbalances. Also, they are more common in disabled people, women, and older adults. Other events including starting a new job, divorce or retirement also increases the risk (Daley & Douaihy, 2006).
Depression tends to occur more in people who are emotional, sensitive, high-tempered and highly anxious. Individuals who are perfectionists set high standards for themselves and the vulnerability increases. If one is not is not independent, when they are let down they are likely to be depressed compared to those who are optimistic in life.
Neurotransmitters such as serotonin, dopamine, and noradrenaline regulate a persons mood. When their signaling is disrupted or depleted, one gets depressed.
Physical Illness and Certain Medications.
Physical illness causes depression by lowering the mood and this is experienced when one is in pain or discomfort. Conditions such as heart diseases, stroke, cancer, AIDs and Parkinsons disease can also contribute to depression. Drugs like isotretinoin for treating acne, interferon-alpha, an antiviral drug and corticosteroids increases the risk of depression (Daley & Douaihy, 2006).
Individuals who have immediate families with bipolar disorder and depression are at higher risk. Studies suggest that many genes act together with other factors to cause mood disorder.
Abuse of substances like alcohol, cigarettes, and illegal drugs can start at younger ages. Some risk factors increase the chances of substance abuse. This includes family history that affects the early development of a child such as lack of parental attachment, parents drug abuse and addiction, chaotic environment and bad parenting skills. Other individual factors include, male gender, ADHD, history of mood disorders and antisocial personality disorder (Daley & Douaihy, 2006). Young adults are more vulnerable because of peer pressure. They are influenced to try out on alcohol and cigarettes with the aim of mimicking their behaviors. Some believe in certain myths that using drugs can aid to alleviate boredom, stress, and depression. When family or friends pressure them to perform beyond their capabilities in academics or sports, they may get the impression that drugs will help them. Also, when their elders engage in drug abuse, they may start to use the same or different drugs.
Mood stabilizers, either lithium or valproate, in combination with an antipsychotic, for example, olanzapine or risperidone are used in the treatment of manic episodes in bipolar disorders. Carbamazepine or oxcarbazepine can also be used. For depressive disorders, lithium or lamotrigine are the first line treatment. If the patient is extremely sick, you administer lithium and an antidepressant simultaneously. Electroconvulsive therapy (ECT) can be used if the patient has suicidal thoughts or is majorly depressed. Also, cognitive behavioral therapy (CBT) helps the patient uncover negative beliefs and unhealthy patterns such as negativity or exaggeration of circumstances (AlGommer & Moselhy, 2005).
Treatment of substance abuse disorders comprises of counseling, intensive outpatient treatment, medications, recovery support services and peer supports. Medication Assisted Treatment (MAT) is combined with behavioral therapies and counseling. Acamprosate, Naltrexone, and disulfiram are used in treating alcohol use disorder. Nicotine replacement medications, bupropion, assist in tobacco use disorders. For opioid use disorder, buprenorphine, methadone and naltrexone aids in its treatment (Daley & Douaihy, 2006).
Gender and Cultural Influences
There is an equal ratio of men and women who have melancholic depression while non-melancholic depression is more likely in women. This can be attributed to hormonal factors, unsatisfactory marriages and stress internalization among women. Men are more apt to engage in substance drug use. Cultural factors such as poverty exposure play a significant role in the development of depression. Factors related to race and ethnicity such as country origin increase the risk of exposure to stressors such as poverty, violence and stressful environments. Culture builds an individuals expectation regarding effects of drug abuse (AlGommer & Moselhy, 2005). This can be protective, for example, the use of alcohol among the ancient Aztecs was restricted for ceremonial purposes. Excessive substance use occurs during social transitions among cultural groups who are least exposed to the drug.
AlGommer, O. & Moselhy, H. (2005). Seasonal affective disorder and substance use disorder. Journal Of Substance Use, 10(5), 327-329. http://dx.doi.org/10.1080/14659890412331318958
Daley, D. & Douaihy, A. (2006). Addiction and mood disorders (1st ed.). Oxford: Oxford University Press.
Nunes, E. & Rounsaville, B. (2006). Comorbidity of substance use with depression and other mental disorders: fromDiagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) to DSM-V. Addiction, 101, 89-96. http://dx.doi.org/10.1111/j.1360-0443.2006.01585.x
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