Dealing with Depression During Recovery

Stats About Depression in Recovery

First, just how common is depression in recovery? As context, consider the following stats:

• In 2016, nearly 10 million Americans over the age of 18 were treated for substance abuse and co-occurring disorders—with depression being one of the more common of these dual diagnoses—the Substance Abuse and Mental Health Services Administration (SAMHSA) reported.
• In a private survey of clients in substance abuse treatment, roughly 31 percent were reportedly taking antidepressants, 11 percent mood stabilizers, 9 percent anti-anxiety medications, and 8 percent anti-psychotics— all medications for treating various symptoms of depression, depending on the diagnosis. (Learn more about types of depression (a.k.a. “mood disorders”) that co-occur with substance abuse.)
• Men and women with alcoholism have rates of depression three to four times higher than the general population, a “National Comorbidity Study” found in 1997.

Causes of Depression in Recovery

Depression can have various causes in recovery:

• Dual Diagnosis – Given its higher rates of occurrence among people with substance use disorders, an untreated “dual diagnosis” like major depression, bipolar disorder or aother depressive disorder may be the reason for an experience of depression in recovery. There is a strong connection between depression and alcoholism and depression and other addictions, after all. This can be explained by the fact that in a great many cases of addiction, substance abuse develops as an effort to dull or self-medicate the painful and often unbearable symptoms of a depressive disorder.
• Post-Acute Withdrawal Syndrome – Depression can also be a function of “post-acute withdrawal syndrome” (PAWS). PAWS is a common recovery-related phenomenon that typically occurs in the days and weeks after acute withdrawal symptoms have subsided. (Acute withdrawal symptoms tend to coincide with detox and last roughly the first week of recovery.) Depressive symptoms can linger on for months into recovery.
• Addiction-related changes to the brain – Over time, a brain that has been hijacked by drug or alcohol addiction adjusts to the effects of one or more substances by lowering its own natural production of “feel-good” neurotransmitters like GABA, serotonin, and dopamine. These neurotransmitters are what modulate your mood, in essence telling you how you feel: when they are at their optimal levels, they can manifest as a good mood and positive outlook on life; when they’re at low or depleted levels, they can manifest as depression.

  In early recovery, then, when the brain is readjusting to life without drugs or alcohol, depression can occur because of low levels of GABA, serotonin and dopamine. (These take time—typically around 90 days of abstinence from drugs or alcohol, experts say—to build back up to near-normal levels.) A brain that is out of whack and experiencing lower-than-normal levels of GABA, serotonin and dopamine, can generate depressive symptoms that range from mild to severe.

• Grieving the loss of drugs or alcohol – Many people go through a kind of grieving process at the start of recovery. Letting go of drugs or alcohol, however necessary to your health and wellbeing, can entail a sense of loss, after all— and with it, all of the emotions that can go along with grieving any loss. Related to that process, emotions that once lay dormant or were dulled or repressed by drugs and alcohol can arise suddenly or gradually, causing negative changes in mood.

Symptoms of Depression to Watch Out for in Recovery

Classic signs of depression can include the following symptoms— most especially when they all occur together or as a cluster of three to four symptoms:

• A persistently low, sad and/or “empty” mood (as in emotional numbness)
• Consistent negative thoughts
• Anxiety
• Restlessness or irritability
• Difficulties concentrating
• Fatigue
• Changes in appetite (eating significantly less or more)
• Sleep problems (troubles getting to sleep, staying asleep or oversleeping)
• A lack of interest or motivation for hobbies or interests you once enjoyed
• Feelings of guilt or worthlessness

If you or a loved one are experiencing any of the above symptoms over a period of two weeks or more, take this screening for depression from the Anxiety and Depression Association of America (ADAA) and consider consulting a healthcare professional about the results. (The ADAA also provides a directory for finding therapists near you.)

The Dangers of Untreated Depression in Recovery

Any case of clinical depression that goes untreated and is allowed to progress can hurt or kill your recovery. This is especially true during early recovery when cravings tend to be the strongest in response to familiar cues to drink or use drugs:

• Negative emotions like sadness, anger, guilt, helplessness and and/or a sense of worthlessness can drive anyone, regardless of where they are in their recovery, back into the clutches of an old addiction.
• Suicidal thoughts and/or the desire to escape a painful situation can also spur a binge.

In the worse-case scenario, a bout of depression can trigger a drug or alcohol relapse that proves fatal in the form of a deadly overdose or other lethal health effects.

How Dual Diagnosis Treatment Can Help

In short, co-occurring depression and addiction significantly increase the risks of relapse for anyone in recovery. That makes dual diagnosis treatment the recommended course of treatment for those:

• with a personal and/or family history of depression
• with other risk factors for depression
• who want to know whether their substance abuse may be related to clinical depression or merely a case of “the blues”
• who have relapsed before because of depression
• who want to have the right therapies and supports in place in the case that they develop depression while in rehab

A dual diagnosis in the form of depression and drug or alcohol addiction can seem like an impossible foe, but the tools and therapies that dual diagnosis treatment offers can give you more than a fighting chance of recovery.

For related information about dealing with depression in recovery, see the following articles:

• 8 Foods to Reverse Brain Damage from Drugs and Alcohol
• Dual Diagnosis: How Treatment for Co-Occurring Disorders Improves Recovery Outcomes
• Would My Loved One Benefit from Dual Diagnosis Treatment?
• 6 Tips for Helping with Depression After Relapse