Depression fatigue stress

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
    Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).



  • Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
  • Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44.4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31. 4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily


  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism



  • In 2020, 20. 7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
  • Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3.4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals


  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program


  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes



  • Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose


  • Medication-Assisted Treatment
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program


  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network



  • In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.


  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.


  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 01/05/2023

Stress and depression: what is the connection and what is the danger? (Part 2)

Irritability, drowsiness, fatigue, panic, tears: you are showing signs of stress turning into depression, the most common mental disorder these days. According to recent studies, 10 to 15% of women and 5 to 12% of men can fall into a severe form of depression during their lifetime. In addition, both stress and antidepressants used in the treatment of mental disorders contribute to accelerated and premature aging of our skin.

Our today's edition of the World of Health column will again be devoted to a problem that we encounter quite often in our lives - stress. This time, we will turn to the advice of psychologists who offer their own solutions to the problem and deal with everyday stress, which can eventually develop into chronic depression.

So, what is stress, how can you deal with it, and, in fact, why do it? To begin with, it is worth recalling that a stressful state is extremely uncomfortable: concentration of attention is disturbed, irritability increases, appetite disappears and there is no proper sleep, and, accordingly, rest. Physicians and psychologists offer various methods of stress relief, including psychological, biochemical, or, simply, drug treatment, physiological and physical, which include massage, exercise, water treatments, and some others. It is rather difficult to give a complete list of means of dealing with stressful conditions in one program, since they often depend on the specifics of the body of each person and the severity of his condition. But it is worth noting that for the treatment of really difficult situations and exclusively for the intended purpose and under the supervision of a doctor, a number of drugs are used. But all doctors and psychologists warn: in no case should you resort to self-medication and the use of tranquilizers and other medicines without a doctor's prescription.

Experts also remind you that, as in the case of all other negative situations, including various diseases, it is better to try to prevent their occurrence than to get rid of them later. In the same way, stressful conditions that can cause depression should also be avoided.

The word depression comes from the Latin name depressio , which means "suppression". This term refers to a state of mental disorder, which is a violation of affect. Affect, in turn, is a short-term and strong positive or negative emotion that occurs in response to the influence of internal or external factors and is accompanied by somatic manifestations. With persistent depression, which lasts more than 4-6 months, it is already considered as a mental illness. Depression in most cases responds well to treatment, but, nevertheless, it is depression that is the most common mental disorder today. True, sometimes people use the word depression not quite on purpose, calling it a bad mood or a state of discontent, which is not clinical depression.

Why is it so important to pay attention to stressful conditions and a possible transition to depression? As we have already said, a huge number of people suffer from this mental disorder in our time. In France alone, there are more than 3 million people with depression, of whom 300,000 have become chronically depressed. According to recent studies, 10 to 15% of women and 5 to 12% of men can fall into a severe form of depression during their lifetime. There are many causes of depression, but stress is one of the main ones.

What explains the connection between stress and depression? According to experts, when a person experiences intense stressful situations on a daily basis, his body almost continuously releases hormones such as adrenaline and cortisol, produced by the medulla and the outer layer, i. e. adrenal cortex. Excessive amounts of these hormones in the body entail negative consequences for the nervous system: an excess of cortisol blocks the growth of new neurons in the brain area that affects mood. Cortisol also interferes with communication between neurons by blocking receptors stimulated by serotonin, which serves as an irritant neurotransmitter, which can lead to depression as a result.

What are the signs that you are experiencing a state of stress that gradually turns into depression? These include a general state of fatigue and a gloomy mood; sudden mood swings and unexpected tears; restlessness, fear, panic, headaches, amnesia, difficulty concentrating, indecision and loss of sense of humor. Doctors have discovered another unpleasant consequence of stress and depression for our body, or rather, for our skin. It turns out that both stress and antidepressants used in the treatment of mental disorders contribute to accelerated and premature aging of our skin. After conducting a study on twin sisters, dermatologists once again confirmed the harmful effects of the sun, alcohol and tobacco on the skin, but also added stress and anti-depression medications, about the harmful dermatological consequences of which scientists previously knew less.

So, while examining the condition of the skin of twin sisters, scientists noticed the difference in the way of life of some of these couples. The study involved 186 pairs of twins, which doctors preferred to the usual possible patients, since the aging of twins is genetically programmed in the same way. And the difference in their appearance gives scientists the key to understanding how they are affected by external factors and the environment. To begin with, the American scientists who conducted the study took photographs of each sister from a pair of twins separately and asked a group of independent experts to determine their age from the photo. Then each of the participants in the experiment was interviewed in order to clarify the details of her lifestyle, nutrition, tobacco use, the presence of depression and the time spent under direct exposure to sunlight ... After that, for each pair of twins, age was determined in relation to lifestyle. The scientists got the results quite original and some of them are completely new. As we have already said, the harmful reaction to the skin of tobacco, alcohol and the sun was confirmed again, but as for stress, it was not previously attributed to the causes of skin aging. So, for example, the stress that many women experience as a result of a divorce from their spouse causes an outwardly divorced sister to look on average 2 years older than her married or widowed relative. The use of antidepressants also has a harmful effect on the skin, but ... here scientists could not determine with accuracy what is more harmful: depression itself or medications for it.

But, as doctors and psychologists urge us to, even if you are stressed or the doctor has diagnosed you as depressed: don't panic! These are all things that can be fixed! In addition, experts remind us that stress can also be positive, giving us energy and the necessary resilience in various difficult situations. The main thing is to always remain attentive to yourself, and if necessary, do not hesitate to go to a specialist, but even better - try, if possible, to remain in good health!

Symptoms of stress and depression, remedies for depression and stress - CMP "Alliance"

Depression is a mental condition characterized by depressed mood, pessimism, lack of enjoyment in life and hobbies, difficulty remembering and concentrating.

According to the World Health Organization, more than 300 million people in the world suffer from the disorder. One of the main causes of the disorder is stress: negative events in life (separation, loss of a job or valuable property, death of a loved one), long-term conflicts with relatives, colleagues, acquaintances. Women of any age are especially susceptible to such reactions.


Our body can take a lot. But if the negative impact of the environment exceeds its capabilities in strength or lasts too long, the body cannot withstand, the reserves are depleted - the person becomes ill. Rest won't help here anymore, treatment is needed.

Stress is usually understood as a non-specific protective reaction of the body, which is caused by the influence of physical (pain, cold, infection) or psychological factors (personal experiences, changes in the usual way of life). With prolonged exposure, the stress reaction loses its protective properties and begins to have a damaging effect on the body.

Due to a strong negative event (the so-called psychotrauma) or chronic stress, psychogenic depression develops. It becomes difficult for a person to work and concentrate, he quickly gets tired, the world around him becomes gray, dull, joyless. Both career and personal life suffer - stress only increases. Therefore, it is important not only to diagnose in time, but also to know how to overcome stress and depression so as not to start the disease and not lead to hospitalization.

Manifestations of depression and stress

The main manifestations of stress are anxiety and restlessness. A person is constantly worried, often without an adequate reason, "for nothing". Quick fatigue, sleep disturbance (restless sleep, early waking up before the alarm clock, drowsiness during the day), irritability joins. Not uncommon is the occurrence of panic attacks, which are characterized by sudden bouts of anxiety and fear.

An accurate diagnosis can only be made by an experienced psychotherapist. It is important to determine the type of depression, because each option has its own treatment regimen.

The main symptoms of depression are the so-called depressive triad, which includes:

  • depressed mood, depression, depression;
  • mental retardation - lethargy, passivity, reticence, lack of emotions, loss of appetite, lack of initiative; thoughts around the same worries, often unreasonable guilt, pessimism;
  • motor retardation - severe weakness, a feeling of impotence, a person tends to take one position and may not move for days - for example, lying in bed, staring at the ceiling. Some people, on the contrary, do not find a place for themselves - they anxiously walk around the room, wring their hands, cry.

One of the symptoms that significantly reduces the quality of life of a patient with depression is sleep disturbance. It is characterized by the inability to fall asleep for a long time and a short, superficial sleep that does not bring a feeling of rest. Insomnia, stress, depression are manifestations of mental illness, malfunctions in the nervous system. Sleep disturbance should alert you and become a reason to contact a specialist.


Sleep disturbance - insomnia, early awakening - these are often the first symptoms of incipient depression. It’s better to get treated right away, because further on it becomes more and more difficult to work, you don’t want to leave the house, thoughts of suicide come.

The symptoms of stress and depression are often blurred. A person can deny or not notice for a long time that stress takes more and more strength from him. Depression and fatigue, irritability and concentration difficulties are perceived as the norm, a person does not even remember that it was different before. Rest and a change of scenery, a diet rich in vitamins will help only together with the main treatment - psychotherapy and drug support.

Treatment of depression and stress

Unfortunately, there are no laboratory or instrumental methods for diagnosing stress and depression. The only option is to contact an experienced psychotherapist or psychiatrist. This is the only way to be sure of the effectiveness and safety of the treatment.

You can find a good doctor on the Internet based on information about his education - not only primary specialization is important, but also additional courses: a doctor must periodically improve his qualifications and be aware of modern standards of diagnosis and treatment. Another criterion is patient reviews.

Psychotherapy is the most common non-drug treatment for mental depression and stress.

Depending on the severity of the disorder, treatment begins either with non-drug methods (psychotherapy) or with their combination with drugs.

Some types of psychotherapy that are used for depression and stress: