By Patti Richards

She wakes thinking today might be different. As her sleepy mind works to catch up to her body, she stretches. No pain — so far so good. But when her feet hit the floor, she feels it. The first twinge of the day. “Knees again,” she thinks, and wonders how long it will take to feel the full force of the flare. She reaches for meds and a glass of water on the bedside table. “Must get ahead of the pain, or today is lost,” and down goes the pill she hoped to leave behind just this once. Sigh. Maybe the other prescription waiting downstairs will help lift her mood. It didn’t yesterday, but who knows, today may be different.

For people who live with chronic pain, the cycle of trying to stay ahead of the pain while managing daily tasks can be overwhelming. The frustration and anxiety associated with daily pain management increases the risk of depression. When antidepressants are added to pain medications, the results can be devastating. Both medications are highly habit forming, so the risk for addiction is greatly increased. This may help explain at least part of the current opioid epidemic in the US.

Neural network graphicOpioids work by changing the way the body responds to pain. But opioid medications also produce feelings of euphoria in the user. When taken with antidepressants that help balance neurotransmitters associated with mood and emotion, these feelings grow dramatically. When the brain’s response to pain is changed by synthetic substances, the naturally occurring neurotransmitters can no longer do their job. For example, over time the brain responds to surges in dopamine from opioids by reducing its own dopamine receptors.1 This causes the brain to depend on the drug’s chemicals to produce those feelings. Certain antidepressants inhibit the reuptake of dopamine, which results in more dopamine in the cells than would normally be there.2 With those two drugs combined, the increase of dopamine can result in permanent changes to the brain, even after the drug is stopped.

Pain or Depression?

More than 2 million people used prescription drugs for nonprescription reasons in the United States in 2014.3 And more than half of opioid prescriptions written are for people with anxiety, depression and other mood disorders.4 People with undiagnosed depression can mistake their symptoms for chronic pain, and those with chronic pain can develop depression from the use of opioid medications. Better patient monitoring has cut down on the incidence of “doctor shopping” for new prescriptions. But running out of medicine when drug dependence develops finds many turning to heroin, which is cheaper and easier to get.

Recognizing the difference between pain and depression is an important part of developing the right treatment plan for either condition. Widespread, unexplained aches and pains that no medication can seem to reduce are often the first signs of depression, while joint pain or stiffness, nerve pain, unexplained rashes or insomnia can be signs of autoimmune diseases or other conditions.5 In either case, using opioid pain medications for too long or without an appropriate diagnosis can make depression worse and lead to addiction.

Symptoms of Depression

Depression develops in opioid users because the drugs cause changes in hormone levels and in the brain’s pleasure and reward system. Researchers have also found that opioids don’t work as well in people suffering from depression, which can lead to using more of the drug to find relief from pain.6 Until you have an accurate diagnosis, which often involves much trial and error along the way, opioid pain relievers may do more harm than good. If you suffer from chronic pain and suspect depression might be the culprit, look for the following signs:

  • Lack of interest in activities
  • Depressed mood or irritability
  • Changes in appetite
  • Changes in sleep habits
  • Feelings of guilt and despair
  • Lack of energy
  • Inability to concentrate
  • Suicidal thoughts6

If you or a loved one has any of these symptoms, it’s time to get help.

Signs of Opioid Addiction

Struggling with chronic pain can be challenging. Knowing what medicine to take and when to take it without fear of addiction and adverse side effects make things even more difficult. If you deal with chronic pain and use opioids on a regular basis, look for the following signs of opioid dependence:

  • Taking opioids in larger amounts or for longer periods of time than prescribed by a doctor
  • Trying to stop using opioids on your own unsuccessfully
  • Becoming preoccupied with getting and using the drug, and spending a great deal of time recovering after use
  • Experiencing cravings or withdrawals when the drug is stopped
  • Problems at work, school, home or relationships because of the drugs
  • Needing more of the drug to achieve the same level of experience
  • Engaging in dangerous or illegal behaviors while under the influence of the drug6

Finding Help for Depression and Opioid Addiction

If you or a loved one has symptoms of depression, experiences chronic pain for no reason or struggles with opioid abuse, we are here for you. Call our toll-free helpline 24 hours a day to speak to an admissions coordinator about the best treatment options for your situation. You are not alone.


1 Sherman, Carl. “Impacts of Drugs on Neurotransmission.”National Institute on Drug Abuse, March 9, 2017.

2How Different Antidepressants Work.” WebMD, Accessed January 30, 2018.

3What is the scope of prescription drug misuse?National Institute on Drug Abuse, January 2018.

4 Bukaty, Robert F. “51 percent of opioid prescriptions go to people with depression and anxiety.” STAT, June 26, 2017.

5 Hall-Flavin, Daniel K. “Pain and depression: Is there a link?” Mayo Clinic, March 11, 2016.

6 Smith, Kathleen. “Depression and Opioid Abuse.”, July 10, 2017.