Youths With Depression Face Higher Odds of Prescription Drug Misuse

Youths with depression had about twice the odds of misusing prescription psychotherapeutic drugs and about 4 times the odds of prescription drug use disorder compared with peers without depression, according to a cross-sectional study published in JAMA Network Open.¹

Study Used 2 Years of National Survey Data

Researchers from Boston Children's Hospital analyzed the 2023 and 2024 National Survey on Drug Use and Health (NSDUH). The sample included 22,906 adolescents aged 12 to 17 years and 27,723 young adults aged 18 to 25 years.

Depression was defined as a past-year major depressive episode (MDE) based on DSM-5 symptom criteria reported by respondents. A past-year MDE was reported by 16.3% of respondents, an estimated 9.8 million individuals nationally. Prevalence was higher among females than males (22.0% vs 10.7%) and among non-Hispanic White respondents (18.4%) than among non-Hispanic Black (11.4%) and Hispanic (14.9%) respondents.

Prescription psychotherapeutic drug misuse was reported by 6.6% of youths with a past-year MDE, and 6.0% met criteria for use disorder. Rates were 3.2% and 1.5%, respectively, among youths without an MDE.

After adjustment for sex, race and ethnicity, and insurance status, youths with a past-year MDE had higher odds of misuse (OR, 2.09; 95% CI, 1.75-2.50) and use disorder (OR, 4.02; 95% CI, 3.37-4.80). The drug classes examined were opioid analgesics, tranquilizers, stimulants, and sedatives.

Emotional Distress Cited More Often for Opioid and Tranquilizer Misuse

Among youths who misused each drug class, those with depression were more likely to cite helping with feelings and emotions as their main reason for misusing opioid analgesics (10.2% vs 3.7%; P = .01) and tranquilizers (29.8% vs 13.2%; P = .003).

Among youths who misused opioid analgesics, those with depression were less likely to cite pain relief as the main reason (44.5% vs 62.3%; P = .001), although it remained the most common reason in both groups. However, they were more likely to cite feeling good or getting high for opioids (18.0% vs 10.6%; P = .02) and stimulants (14.2% vs 7.9%; P = .04). Among youths who misused sedatives, 55.4% of those with depression cited sleep as the main reason vs 28.3% of those without (P = .04), but the estimates were imprecise and the CIs wide.

The authors said the findings suggest “unmet mental health needs may contribute to a meaningful share of misuse,” though they noted that higher rates of misusing opioids and stimulants to feel good or get high show recreational motives remain important among youths with depression.

Treatment Gaps May Leave Youths Self-Medicating

The authors tied the findings to limited access to mental health care. According to SAMHSA's 2024 NSDUH, about 40% of the 3.8 million adolescents aged 12 to 17 with a past-year MDE did not receive mental health treatment.² Earlier research covering 2011 to 2019 found that the proportion of adolescents treated for both depression and a substance use disorder fluctuated between 4.5% and 11.6%.³

The authors said their results support the need for earlier identification of depression in youths, integration of substance use screening into mental health care and mental health screening into substance use care, and expanded access to developmentally appropriate treatment before self-medication progresses to persistent substance use disorders.¹ They described this as in line with American Academy of Pediatrics recommendations.

Limitations Include Self-Report and Cross-Sectional Design

The study has several limitations. Survey responses may be affected by reporting bias, particularly for stigmatized topics. Slight variation in question formatting between survey years may have affected response rates, which were about 45% to 48% among youths. The cross-sectional design prevents causal conclusions, and the authors noted the association is likely bidirectional. Respondents selected only a "main reason" for misuse, which may oversimplify motivations, and motivation options differed by drug. The NSDUH also excludes people experiencing homelessness who are not in shelters, and the analysis focused on depression rather than other mental health conditions.

References

1. Toce MS, Porter JJ, Lim JK, Bourgeois FT. Substance misuse prevalence and risk factors in adolescents and young adults with depression. JAMA Netw Open. 2026;9(10):e2639343. doi:10.1001/jamanetworkopen.2026.39343
2. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results From the 2024 National Survey on Drug Use and Health. HHS publication PEP25-07-007, NSDUH series H-60. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Accessed October 27, 2026. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases
3. Lu W, Muñoz-Laboy M, Sohler N, Goodwin RD. Trends and disparities in treatment for co-occurring major depression and substance use disorders among US adolescents from 2011 to 2019. JAMA Netw Open. 2021;4(10):e2130280. doi:10.1001/jamanetworkopen.2021.30280