Mental health and opioid addiction are problems that affect our loved ones, communities, and the population at large. Here in Hennepin County, harmful effects from opioid use continue to rise, especially among disadvantaged groups.
While opioid addiction has many causes, its connection with mental health conditions like depression can’t be overlooked. Understanding how to recognize depression in those around us, especially if they may seem high-functioning, can be a crucial way to offer support before addiction takes control.
High-functioning depression and Opioid Addiction
High-functioning depression isn’t a medical diagnosis, but it’s a term that helps describe how some people with clinical depression may operate. For many individuals with major depressive disorder or clinical depression, they have difficulty completing daily tasks and keeping up with demands. People with high-functioning depression, however, can outwardly appear to live their lives without trouble, while internally, they’re suffering.
We are accustomed to the outward symptoms of clinical depression that are easy to spot: lethargy, an inability to get out of bed, avoidance of social situations, loss of appetite, and changes in weight. All of these symptoms look like depression. For those with high-functioning depression, some or all of these symptoms may not be visible.
High-functioning depression can cause the same internal feelings in individuals while they’re completing other daily tasks. These symptoms include: loss of joy or interest in activities; feelings of worthlessness or isolation; difficulty sleeping; changes in eating habits; feeling sad or hopeless; difficulty concentrating; and negative self-thoughts.
Genetics and life circumstances play into an individual’s risk for developing depression, but the “high-functioning” part often depends on someone’s support system and personality. Some people are able to hide their symptoms well, masking their internal turmoil as a response to cultural expectations or learned habits. Others may actually have more trouble functioning than it appears; while we see a normal daily life, they’re actually outwardly struggling in areas we cannot see.
Research shows that there is a large degree of overlap among people who suffer from depression and use opioids. In one study published in the National Library of Medicine in 2021, 17% of depressed individuals used opioids, in contrast with only 5% of those without depression. Understanding how these two conditions relate is critical for treatment.
There is a bi-directional relationship between opioid use and depression; no matter where the cycle started, those with depression are more likely to use opioids, and opioid use can lead to higher rates of depression. For people who begin opioid use as a result of chronic pain or surgery, the constant need to increase the dose for the same perceived effects can cause depression — it feels like a never-ending battle that doesn’t have a reasonable solution.
Many people who have high-functioning depression want to maintain a sense of normalcy. They don’t see their mental health condition as a barrier to success, and they certainly don’t want to advertise it to others. In an effort to keep their symptoms manageable, many people with high-functioning depression turn to medication.
Opioids are a common way to self-medicate against the symptoms of depression. By mimicking our body’s natural production of opioids like endorphins, these drugs can stimulate some of the pleasure centers that are often underperforming in people with depression. Those with high-functioning depression are often highly aware of how opioids improve their mood and ability to get through the day.
As an observer, the only way to know someone has high-functioning depression might be through ongoing conversations and close observation of their mood and habits. They also may be reluctant to open up and be honest about their challenges, especially if they pride themselves on handling things independently.
Support from loved ones is often one of the most essential parts of recovery. That’s why it’s crucial that you don’t ignore the signs of high-functioning depression or opioid addiction if you see them, even if that means being persistent in your efforts to offer care.
Rather than taking opioids out of habit (as some people do when they’ve used the drugs for post-surgery relief, for example), those with high-functioning depression often consider their use very purposeful and measured. Unfortunately, they fail to see when drug use crosses a threshold into addiction before it’s too late.
Our bodies adapt to opioid use and require progressively higher doses to feel the same effects. The process of slowly ramping up opioid use means that it becomes harder and harder to stop using the drugs; the effects of withdrawal become increasingly painful. Early intervention from friends and family can be one of the best ways to help a loved one end their opioid use with minimal consequences.
If you see symptoms of high-functioning depression in your loved one, understand that they may not see their condition as problematic and may feel comfortable with their chosen opioid solution. Your concern should not come from a place of judgment but rather from one of concern, love, and education.
The best thing you can provide a loved one suffering from high-functioning depression is your support. Show them you’re on their team without judgment. A concrete way to express this solidarity is by finding resources for education and treatment in your area. Here in Hennepin County, there are a variety of resources online and in-person for opioid addiction.
Having high-functioning depression does not mean opioid use is unavoidable. The more we understand the connection and reach out to support loved ones who are suffering, the less likely it is that opioids will control their life.
