Understanding the Link Between Cocaine Use and Depression

Key takeaways

• Cocaine use can produce an excess of dopamine in the brain, potentially leading to lasting problems such as depression and other mental health conditions.
• The drug may also indirectly promote depression by causing anhedonia (reduced ability to feel pleasure), sleep disturbances, and by worsening underlying contributors to depression.
• If you’re experiencing depressive symptoms while using cocaine, seek help from a mental health professional who can create a treatment plan tailored to your situation.

In the immediate term, cocaine can heighten alertness, boost energy, and create a sense of euphoria. However, repeated cocaine consumption can alter brain function in ways that may trigger or exacerbate depression.

Studies indicate that roughly half of people with substance use disorders also have a co-occurring mental health condition. This includes individuals with cocaine use disorder. The most frequently seen co-occurring problems are depression and anxiety.

So, does cocaine cause depression — or does depression increase the likelihood someone will use cocaine?

The truth is complex and differs across individuals, depending on factors like medical history, patterns of cocaine use, and other personal variables.

Below is a closer look at what researchers know — and don’t yet know — about the relationship between cocaine and depression.

How cocaine affects your brain

Before exploring the connection between cocaine and depression in more depth, it helps to understand how cocaine acts on the brain.

Cocaine’s stimulant effect comes from its interaction with the mesolimbic dopamine pathway — commonly called the brain’s reward circuit. This system is triggered when dopamine, a neurotransmitter linked with pleasure and reward, is released.

Everyday enjoyable activities — such as eating tasty food or engaging in sex — prompt dopamine release.

Once dopamine is released, it occupies gaps between neurons. Normally, nearby cells reclaim some of that dopamine for reuse in a process called reuptake, which helps keep dopamine levels balanced.

Cocaine interferes with that reuptake mechanism. The result is an accumulation of dopamine, producing intense euphoria and heightened awareness.

Does cocaine cause depression?

When the effects of cocaine fade, that surplus dopamine dissipates as well. This drop contributes to the “comedown” or acute withdrawal many people feel in the hours or days following use.

During this acute withdrawal period, you may notice depression-like signs, including:

• low mood
• fatigue
• reduced motivation
• lowered sex drive

These symptoms often improve within a few days as your brain restores its dopamine and other neurotransmitter balance.

But with repeated, long-term cocaine use, the brain adapts to frequent dopamine surges by making less dopamine and reducing dopamine receptor numbers — receptors needed to produce dopamine’s effects.

This reduction in dopamine function can contribute to persistent complications, including depression and other mental health issues.

Such neural changes also promote tolerance to cocaine, meaning larger or more frequent doses are needed to achieve the original effect. That pattern can lead to cocaine use disorder.

Learn more about dopamine and its role in substance use disorders.

Other links between cocaine and depression

Cocaine may also promote depression through several indirect pathways.

Anhedonia

Anhedonia is a diminished capacity to experience pleasure or a loss of interest in normally rewarding activities. It’s common among people with depression and those going through withdrawal from cocaine, alcohol, opioids, or amphetamines.

Researchers are still investigating why some cocaine users develop anhedonia while others do not.

A 2018 study found that anhedonia among people with cocaine use disorder was linked to particular genes involved in inflammatory processes.

Sleep difficulties

Poor sleep increases the risk of developing depression.

Cocaine can interrupt sleep by:

• making it harder to fall asleep
• lowering sleep quality
• shortening the total duration of sleep

If cocaine is used only sporadically, these sleep disruptions usually subside within days.

However, with continued use, sleep problems can become more persistent. After stopping cocaine, sleep disturbances may continue through the withdrawal period, which can last from a week to several months.

Sleep disruption related to cocaine use may partly contribute to depression or worsen existing depressive symptoms.

Underlying causes of depression

For many years, experts thought depression was a risk factor for substance use and for developing a substance use disorder.

Yet a 2017 review of animal studies suggests the relationship is not straightforward.

The authors point out that multiple factors can lead to depression. For some people, genetics play a major role. For others, depression may stem from a stressful upbringing or other environmental influences — often a mix of genetic and environmental causes.

These root causes may clarify the association between depression and cocaine use.

For example, the reviewers noted that rodents showing depression-like behaviors were actually less likely to self-administer cocaine and, when they did, consumed less than controls.

Conversely, rodents that experienced early-life stress — a potential contributor to depression — were more inclined to self-administer cocaine.

These findings imply the connection between depression and cocaine may be tied more to the underlying drivers of depression than to depression itself.

Still, while these animal studies offer insight, additional human research is needed.

Other health impacts

Beyond contributing to depression or depression-like symptoms, cocaine use can cause a variety of other harmful health effects.

In the short term, cocaine can raise heart rate, blood pressure, and body temperature. These changes can heighten the risk of heart attack or stroke, particularly in people with preexisting heart disease.

Possible long-term effects of chronic cocaine use include:

• nasal damage such as nosebleeds and loss of smell (with snorting)
• lung injury (if smoked)
• intestinal tissue infection
• cardiovascular problems, including arrhythmias or coronary artery disease
• reduced fertility
• symptoms of psychosis
• paranoia

Recognizing an emergency

While fatal overdoses from cocaine alone are less common, fentanyl and other synthetic opioids are increasingly contaminating cocaine supplies.

Call 911 or your local emergency number right away if someone shows signs of an opioid-related overdose, including:

• trouble breathing
• noisy breathing
• loss of consciousness
• constricted (pinned) pupils
• pale, clammy, or unusually ashen skin

If you plan to use cocaine, consider carrying naloxone, a medication that can reverse an opioid overdose if the cocaine is contaminated.

Learn more about how to respond to a possible overdose.

Treating depression and cocaine use disorder

If you’re experiencing depressive symptoms and worry that cocaine might be a factor, there are several paths to support.

If you feel comfortable, discuss the issue with your primary care provider. They can refer you to mental health professionals or a treatment team experienced in managing both depression and cocaine use disorder.

You can also search for a qualified mental health professional on your own. Many therapist directories let you filter for clinicians who specialize in co-occurring substance use and mental health conditions.

For confidential, free guidance, consider contacting:

• SAMHSA’s National Helpline at 800-662-4357 or use their treatment locator
• Support Group Project
• Narcotics Anonymous
• SMART Recovery

Treatment varies depending on individual needs but often involves a combination of psychotherapy and medication.

For related information about substance effects and mood, see resources like how long does cocaine high last and approaches for mood management such as tea for depression.

The bottom line

Long-term cocaine use can raise the likelihood of developing depression or depression-like symptoms.

If you have depressive symptoms and use cocaine, consider working with a mental health professional to build a treatment plan that fits your needs.