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In the short term, cocaine can increase your alertness and energy, as well as cause a feeling of euphoria. But frequent cocaine use can cause changes in the way your brain functions that may contribute to — or worsen — depression.

Research suggests that about half of all people who live with substance use disorders have a co-occurring mental health condition. This includes people with cocaine use disorder (previously called cocaine addiction). The most common co-occurring conditions include depression and anxiety.

So, does cocaine use cause depression? Or does depression make someone more likely to use cocaine?

The answers to both questions are complicated and vary from person to person based on things like medical history, level of cocaine use, and other factors.

Here’s a closer look at what experts do and don’t know about the connection between cocaine and depression.

Before diving deeper into the link between cocaine use and depression, it’s important to understand how cocaine affects your brain.

Cocaine produces its stimulating effects by interacting with the mesolimbic dopamine system — aka your brain’s “reward system.” This reward pathway is activated by the release of dopamine, a neurotransmitter that’s linked to feelings of happiness and pleasure, among others.

Certain pleasurable activities — like eating good food or having sex — trigger the release of dopamine.

When dopamine is released in your brain, it nestles into spaces between neurons. Usually, nearby cells will absorb some of this dopamine for later reuse. This process is known as reuptake. It helps to regulate the amount of available dopamine in your brain.

Cocaine blocks this reuptake process from happening. As a result, excess dopamine builds up, causing intense feelings of euphoria and alertness.

As the effects of cocaine wear off, so does all that extra dopamine. This contributes to the “comedown” or acute withdrawal that many people experience in the hours or days after using cocaine.

During this acute withdrawal phase, you might experience depression-like symptoms, including:

  • low mood
  • fatigue
  • lack of motivation
  • reduced sex drive

These symptoms typically resolve within a few days as your brain replenishes its supply of dopamine and other neurotransmitters.

But with repeated long-term cocaine use, your brain starts to adapt to this frequent dopamine surplus by producing less dopamine and reducing the number of dopamine receptors, which are needed in order to activate dopamine’s effects.

This decrease in dopamine can lead to long-term complications, including depression and other mental health concerns.

These changes can also contribute to your body developing a tolerance to cocaine, meaning you’ll need to use more of it in order to feel the same effects you initially did. This can lead to the development of cocaine use disorder.

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

Cocaine use may contribute to depression in a few less direct ways, too.


Anhedonia refers to a decreased ability to feel pleasure or a loss of pleasure in non-drug rewards. It’s common in people with depression as well as those going through withdrawal from cocaine, alcohol, opioids, or amphetamines.

Researchers are still trying to learn why some people who use cocaine develop anhedonia but others do not.

In a 2018 study, researchers found that anhedonia in people living with cocaine use disorder was associated with certain genes that play a role in developing inflammation.

Sleep difficulties

Having issues sleeping can increase your chances of developing depression.

Cocaine use can disrupt your sleep by:

  • making it harder to fall asleep
  • decreasing the quality of your sleep
  • decreasing the amount of time you stay asleep

If you only use cocaine occasionally, these effects will typically resolve within a few days.

But with ongoing use, these effects can have more of a lasting impact. If you stop using cocaine, you may continue having sleep disturbances throughout the withdrawal period, which can last anywhere from a week to several months.

It’s possible that sleep issues related to cocaine use could partially contribute to depression or worsen preexisting depression symptoms.

Underlying causes of depression

Historically, many experts considered depression to be a risk factor for both substance use and the development of a substance use disorder.

However, a 2017 research review of several animal studies suggests this connection isn’t quite so clear-cut.

One reason the authors note is that there are many factors that can contribute to developing depression. For some people, depression may have a strong genetic component. For others, depression might be rooted in a stressful childhood or other environmental factors — or a combination of genetic and environmental factors.

These underlying causes may provide more specific insight into the link between depression and cocaine.

For example, the authors noted that rodents displaying depression-like symptoms actually appeared less likely to self-administer cocaine. Those who did typically consumed less cocaine than the control group.

But rodents who experienced early-life stress, a potential contributor to depression, were more likely to self-administer cocaine.

These results suggest the links between depression and cocaine might be more closely related to the underlying causes of depression, rather than the depression itself.

Still, while this research gives us insights, further research will need to be done in humans.

In addition to contributing to depression or depression-like symptoms, using cocaine can cause a range of other potentially harmful health effects.

In the short-term, cocaine can increase your heart rate, blood pressure, and body temperature. These effects can increase your risk of having a heart attack or stroke, especially if you have a preexisting heart condition.

Potential long-term effects of chronic cocaine use include:

Recognizing an emergency

While overdoses involving cocaine alone aren’t common, contaminants including synthetic opioids like fentanyl, are increasingly showing up in cocaine.

Make sure you and those around you know to call 911 or your local emergency number right away if someone experiences any of the following signs of an opioid-induced overdose:

  • trouble breathing
  • noisy breathing
  • loss of consciousness
  • pinned pupils
  • pale, clammy skin, or skin that looks ashen or washed out

If you plan on using cocaine, you may also want to consider carrying naloxone, a medication that can reverse an opioid overdose if someone ingests contaminated cocaine.

Learn more about how to handle a potential overdose.

Was this helpful?

If you’re having symptoms of depression and are concerned cocaine use could be a contributing factor, you have several options for support.

If you feel comfortable doing so, consider bringing up the issue with your primary healthcare professional. They can refer you to a mental health professional or care team trained to address both depression and cocaine use disorder.

Alternatively, you can search for a mental health professional on your own. Many therapist databases allow you to search for professionals who specialize in addressing co-occurring mental health concerns and substance use.

Or you can reach out to the following services for confidential, free guidance:

Treatment can take many forms depending on your symptoms and needs, but it could include a combination of therapy and medication.

Cocaine use, especially when done long-term, may increase your chances of developing depression or depression-like symptoms.

If you’re having symptoms of depression and use cocaine, consider working with a mental health professional to develop a treatment plan designed to meet your needs.