Understanding Opiate Withdrawal Depression

 

The magnitude of the US opiate epidemic is overwhelming. According to the Center for Disease Control (CDC), in 2016, approximately 63,600 people died from opiate overdoses—a figure that equates to 115 Americans daily—with the number of opiate-related deaths currently five times higher than it was in 1999. Many experts blame the epidemic on the deceptive marketing practices of major pharmaceutical companies in the late 1990s which capitalized on our nation’s unprecedented mental health disorders, chronic stress, and physical pain. 

Although many people initially abuse opiates to escape from the debilitating effects of depression, such abuse frequently triggers more depression and creates a vicious circle known as a “bi-directional relationship.” Once hooked into this circle, users require more opiates in higher doses in order to sustain the same fleeting benefits. Any time a user experiences a lapse in between uses, or total cessation, whatever euphoria they temporarily experienced is crushed beneath the black cloud of depression that inevitably accompanies rebound effects. This leads to a crippling pattern that is both difficult to break and impossible to effectively treat without professional intervention.     

NATIONAL AND GLOBAL STATISTICS

The US opiate crisis has spiraled out-of-control to the point where strict government regulations and the threat of severe legal penalties for trafficking or undocumented possession are not a sufficient deterrent. In fact, a growing black market continues to thrive using the dark web and other illicit means to sell and mass distribute the euphoria-inducing drugs. To put the magnitude of America’s opiate epidemic into clearer perspective, consider the following statistics gleaned from the National Institute on Drug Abuse (NIDA):

• In 2013, opiate painkillers were prescribed over 200 million times, resulting in widespread diversion and abuse.
• Currently, a record 26 – 36 million people abuse opiates globally.
• Over two million adults in the US suffer from opiate-related substance abuse problems.
• Approximately half a million US adults are addicted to heroin.
• In 2010, opiate abuse resulted in approximately 17,000 deaths in the US.
• According to the American Society of Addiction Medicine (ASAM) approximately 75 percent of all people suffering from opiate addiction end up addicted to heroin.

MECHANISM OF ACTION

Opiates are chemically engineered to work by binding to opiate receptors located in the brain and throughout the central nervous system (CNS). Over time, this binding process blocks signals that indicate the presence of pain, releasing a surge of dopamine and other “feel good” neurotransmitters such as serotonin. Once physical tolerance has been established—an accelerated process in many users, especially polysubstance abusers or those suffering from chronic pain—increasing dosage and frequency of use are required to maintain the same temporary benefits.

Unfortunately, in addition to the euphoric, pain-relieving qualities opiates for which opiates are prized, they exhibit many destructive effects. Opiates are known for causing multiple physical and especially psychological problems, particularly with long-term use. In addition to their depressant effect on the respiratory system—impairing breathing and dangerously slowing the heart rate—opiates cause rebound depression, the result of a chemical backlash. The brain and CNS, used to artificially elevated levels of neurotransmitters, experiences a painful crash once opiates begin to exit the system. This crash is triggered by impaired brain chemistry stemming from the depletion of dopamine, serotonin, and other vital neurochemicals.  Due to the serious and lasting psychological consequences of opiate addiction, the majority of users require professional, medically managed detox and behavioral health treatment. 

WITHDRAWAL AND TREATMENT

In many users, opiates become addictive even when taken exactly as prescribed under the care of a licensed physician. In cases where diversion, inordinately high doses, or unauthorized means of ingestion are involved, they may become addictive very quickly. Once someone is addicted, mild withdrawal symptoms may appear in as little as four to six hours following dosage, although moderate symptoms generally take 12 to 24 hours to surface. While the most severe, distressing symptoms typically peak within three to five days, diminishing symptoms may linger for approximately two weeks to one month. During this period, medically managed detox is of critical importance as the user is most psychologically fragile, physically agitated, and prone to depression.

The primary goal of medically managed opiate detox is to prevent the dangerous and potentially deadly onslaught of symptoms known as precipitated withdrawal.  Once a user has safely transitioned beyond the acute withdrawal stage under professional medical care, they face the longer-term effects associated with opiate addiction. Post-acute withdrawal syndrome (PAWS), a cluster of primarily mood-based symptoms, may affect users for months, and even years, depending upon the extent of their addiction and individual variables such as:

• Biochemistry
• Age
• Gender
• Height
• Weight
• Lifestyle choices
• Overall health
• Polysubstance abuse
• Co-occurring mental health disorders

Opiate addiction and the resulting psychological effects—particularly depression—are all highly treatable and favorable treatment outcomes may be obtained through the following detox and treatment options:

• Hospitalization—clients may require short-term hospitalization in order to monitor vital signs, administer necessary IV fluids, and recover from the debilitating effects of a recent overdose.
• Inpatient Treatment—clients may elect to enroll in a residential treatment program featuring round-the-clock medical monitoring and clinical supervision. This short-term option, which generally lasts between 30 and 90 days, is considered extremely effective in providing opiate addiction treatment and premium behavioral healthcare.
• Outpatient Treatment—clients may elect to enroll in a non-residential program that offers greater flexibility based upon their personal or professional schedules. While less intensive in nature when compared to inpatient treatment, outpatient facilities offer many of the same medical and clinical benefits.
• Medication-Assisted Treatment (MAT)—at all levels of treatment (with the exception of hospitalization) clients are prescribed a combination of evidence-based medications and appropriate psychotherapy aimed at identifying and resolving the underlying causes of opiate addiction and related depression.

OVERCOMING OPIATE-RELATED DEPRESSION

Treating opiate withdrawal depression is not possible without following a multidimensional, holistic approach. The following six factors represent post-treatment essentials:  

• Exercise—daily exercise is a natural, inexpensive way to feel great while maintaining peak mental and physical condition. The multi-tiered benefits associated with a regular exercise program include releasing endorphins, regulating a healthy flow of neurochemicals to the brain and CNS, stabilizing mood, reducing cravings, balancing key nutrient levels, and most importantly, eliminating depression. Regular exercise has also been scientifically proven to improve sleep, significantly curb anxiety, reduce stress, and enhance self-esteem. Many clients recovering from opiate addiction are anxiety-ridden and chronically overstressed—a combination of factors that leads to depression (or exacerbates existing depression). Engaging a vigorous exercise routine for just 30 minutes daily is a surefire way to feel fantastic while helping the body and mind recover from opiate abuse.
• Diet—although many Food and Drug Administration (FDA) approved medications are excellent for helping to reduce depression—they are not enough. Actually re-building the body and mind following opiate addiction requires healthy, nutrient-rich foods and beverages. Especially for clients in early recovery—when the body and mind are more fragile and easily disrupted—dietary toxins of any kind should be limited or avoided. Dietary toxins include sugar, alcohol, fried or processed foods, caffeine, energy drinks, and many other artificial beverages that feature chemicals as the primary ingredients—all of which exacerbate depression. Clients should consume a natural, toxin-free diet that follows FDA food group and daily caloric intake recommendations, never skipping meals or substituting processed foods for nutritious, home cooked meals.
• Developing a Spiritual Practice—empirical evidence strongly supports the 12-step notion that spirituality is a critical aspect of recovery. Addiction is a chronic, relapsing disease that hijacks free will and over-rides the very foundation of spirituality—one’s ability to consciously choose. Once addicted, clients inevitably become isolated and self-destructive, trapped in their own depressing feed-back loop. Breaking free from this dysfunctional cycle requires belief in a higher power and actively working a spiritual program designed to increase faith while challenging false idols and eliminating unhealthy escape mechanisms.
• Socializing—it has been said that the opposite of addiction is connection. Without a healthy sense of social camaraderie and connection, people suffer from the toxic effects of self-imposed isolation. For clients recovering from opiate addiction and subsequent depression, it is especially important that a concentrated effort be made to make new connections, develop a strong community of sober support, and enjoy hobbies and recreational activities that involve others. Remember, a productive, active life is a healthy life!
• Continuing Therapy—as a general rule, long-term opiate addiction requires long-term treatment. Clients who have successfully completed inpatient or outpatient therapy must be prepared to continue attending individual and/or group therapy until they gradually overcome the depressing effects of PAWS and return to optimal mental functioning. For some clients, this process can take months or years, but in every case is well worth the effort.
• Maintenance Medication—depending upon their original presenting issues and mental health condition, clients may need to continue on maintenance doses of medication. Antidepressants (SSRIs), SNRIs, benzodiazepines, anxiolytics, tricyclics, beta-blockers, and antipsychotics are all examples of medications that may be prescribed—solo or in tandem—to help stabilize clients and treat opiate withdrawal depression.

Opiate addiction is not a disease affecting only those with known substance use disorders (SUDs), a family history of abuse, or genetic susceptibility. Anyone, at any time, regardless of race, age, gender, socioeconomic status, or religion can find themselves addicted to opiates. If you or someone you love are addicted to opiates and in need of treatment, call a substance abuse professional today.  Never be ashamed of the fact that you have a problem and need help, rather, be empowered by your courage in facing the truth and taking action.

Also remember, in the event of an overdose seek immediate medical attention by calling 911 or visiting your nearest hospital emergency room (ER). An opiate overdose is considered a serious, potentially life-threatening situation.

For more about opiate addiction and recovery, check out these related articles:

• “Preventing an Opiate Overdose with Naloxone”
• “How Long Does it Take for Opiates to Leave Your System”
• “Methadone Detox and Treatment”
• “Experimentation Vs Addiction: How to Tell the Difference “

Sources:

• Addiction Science and Clinical Practice. The Neurobiology of Opioid Dependence: Implications for Treatment. July, 2002.
• National Institute on Drug Abuse (NIDA). Opioid Overdose Crises. March, 2018
• The Journal of Pain. Comparison of the Risks of Opioid Abuse or Dependence Tepentadol and Oxycodone: Results From a Cohort Study. Oct, 2013
• National Center for Injury Prevention and Control. Opioid Overdose Epidemic in the United States. September, 2017.
• AAP News and Gateway Journal: Pediatrics. Prescription Opioids in Adolescence and Future Opioid Misuse. Nov, 2015.