Louis DeSanto, 32, started drinking his freshman year of high school, right around the same time his parents got divorced. “I didn’t like being alone and I liked being in another state of mind,” says DeSanto, who was soon hosting boozy parties for his friends every weekend. “It made me feel normal and a part of something.”
Fast-forward a few years after college graduation, and DeSanto’s condition had dramatically worsened. He was driving intoxicated to and from the office most days. “My routine was a sad one. I’d come home, drink until I passed out on the couch, and if I was lucky, I’d wake up in time for work,” he says. “I had passing thoughts that I didn’t like myself. As soon as I had those thoughts, I would think, ‘I’m too sober for this,’ and I would drown those thoughts.”
DeSanto — who has been in recovery for six years and is now living in Philadelphia, married with two kids — shares his mental health struggles through the nonprofit Minding Your Mind, which organizes presentations designed to reduce stigma and encourage help-seeking behavior. “If I can reach one person, it’s worth it,” he says.
Many Forms of Danger
Chances are, there are plenty of people who resonate with DeSanto’s story of depression tangled up with hazardous behavior. It’s not just substance abuse. People with depression, even those who aren’t suicidal, often put themselves at risk, says clinical psychologist Jill Weber, PhD, who practices in the Washington, D.C., area.
“Many people I work with say, ‘I don’t have a plan to die, but if it ended right now, that would be OK,’” she says. “‘Who cares if I drive in a reckless manner, or walk alone in a dangerous neighborhood at night?’”
She notes that depression can make it harder to regulate anger, so those patients are more likely to get into an altercation. DeSanto recalls wrestling and punching his way through drunken arguments that made no sense. The night before he finally checked into a treatment center, he’d been throwing objects, kicking doors, and screaming.
There are countless under-the-radar behaviors that Weber has seen that can become more serious over time — things like not drinking enough water or not seeing a doctor about a nagging symptom. “Depressed people can also struggle with feeling not hungry or overeating,” Weber adds.
For Dayna Altman, a 32-year-old mental health advocate in Boston, her eating disorder — which manifested in calorie counting and overexercising — became a way of expressing how she was feeling.
“The depression felt so overwhelming that I didn’t have the words. So I showed it in my behaviors. I felt that was how people would know how much pain I was in,” says Altman, who has since founded Bake It Till You Make It, which celebrates the healing power of food.
It Goes Both Ways
Did her depression cause the eating disorder? Altman, who also lives with obsessive compulsive disorder, doesn’t think so. “These things run in my family, and then they got intertwined,” she says.
Co-occurring mental health conditions are common, explains Petros Levounis, MD, past president of the American Psychiatric Association and chair of the psychiatry department at Rutgers New Jersey Medical School. He specializes in addiction and has seen that when people struggle with both depression and addiction, there is a tendency to pin the blame solely on one or the other. The reality, he says, is that depression can lead to addiction, addiction can lead to depression, and sometimes, there is no relationship between the two conditions at all.
“By no means is there only one culprit making people miserable. We have to think about genes and the environmental factors that come into play,” Levounis says. Certain pathways in the brain seem to be responsible for substance abuse as well as other risky behavioral addictions, such as those related to internet use, gambling, and sex. “Once addiction has taken hold, it’s like a brain switch,” he says.
But regardless of how this process occurs, a dual diagnosis can be particularly dangerous. Opioid overdose is the top risk that comes to mind for Kenneth R. Conner, PsyD, MPH, professor of emergency medicine and psychiatry at the University of Rochester Medical Center. Although deaths are on the decline, overdose remains the leading cause of death for Americans aged 18-44.
“An estimated 13% of people who overdose and die have a depressive disorder,” Conner says. “That’s probably a major underestimate because it has to be a known depressive disorder. Depression can be a private, quiet experience.”
Finding the Right Treatment
There is good news for people struggling with depression: “When somebody comes forward, it tends to be treatable with therapy and medication,” Conner says.
But in cases with multiple diagnoses — such as depression plus a substance use disorder — it may take some extra digging to find the right providers.
“It’s not unusual for there to be an unfortunate game of hot potato with a mental health care clinic not wanting to handle substance abuse, or a substance abuse clinic that can’t treat mental health,” Conner says.
Treatment is most successful when all aspects happen concurrently, Levounis notes. One approach he suggests when risky behavior is involved is motivational interviewing. The goal is to encourage patients to identify ways they can make things better.
“Find the tiniest discrepancy between where the patient is and where they’d like to be,” Levounis says. “All of us have something to change in our lives.”
He also recommends promoting healthy lifestyle habits, such as engaging in physical activity, eating nutritious meals, getting enough sleep, strengthening social connections, and developing a mind-body practice. “Patients seem to be attracted to this approach and success rates have been impressive,” Levounis says.
Recovery is not a speedy process, Altman says. She likens it to a bread baking demonstration she developed for the mental health outreach nonprofit organization Active Minds: “The first step is dissolving a yeast packet into water,” she says, which symbolizes how she felt before seeking help in college. “When I talk about therapy, I add in the sugar and flour. Kneading the dough is the work I put in with these programs.”
Although Altman has come a long way, she acknowledges that her journey continues. “I have three therapists right now. When I’m sharing my story, there’s no final point,” she says.
If you or anyone you know is experiencing a crisis, you can call or text 988 anytime to get support and learn about available resources.
