Depression is one of the most common conditions in all of psychiatry and is a very common co-existing condition with addiction. Depression may result from any combination of a genetic predisposition, severe personal stressors, certain psychological predispositions such as a negative outlook, and neurochemical depletion from years of drug and alcohol use. Most people start to use substances to pursue the euphoria that is so appealing. Over time, after the substance use has taken a toll, more and more people seek to alleviate depression rather than get “high”. The ability of drugs, especially alcohol, to create a temporary escape from negative emotions leads to a vicious cycle of depression, drug use and escape. This cycle usually causes an individual to spiral down and leave them non-functional and suicidal. The 2 elements necessary for breaking this type of negative cycle are illicit substance abstinence and antidepressant treatment. The substance abstinence is a usual component of addiction treatment but the antidepressant aspect is not always addressed. An evaluation by a psychiatrist is necessary to make the appropriate diagnosis and to then prescribe the appropriate treatment. To be on an antidepressant does not constitute “using” and does not violate any 12-step principles. The use of antidepressants is fully sanctioned by the “Big Book”. The radical 12-step factions that do not support the use of antidepressants should be avoided.