Why Does Depression Sometimes Persist in Recovery?

There is a large overlap between addiction and depression. As many as a third of people with depression have a substance use disorder. Many people with depression use substances to relieve their symptoms but the causality goes the other way as well. Substance use can also lead to depression or make pre-existing depression worse by altering brain chemistry, weakening emotional regulation, and making people feel helpless in the face of addiction. Treating the depression associated with addiction is a crucial element of effective addiction treatment. Treating the depression makes maintaining sobriety much easier and once people get sober, they often start feeling much better about themselves and their future. However, some people find they’re still depressed after they get sober. What’s going on here?

If you’ve gotten sober, are in recovery, and still feel depressed, there are two possible explanations. The first is simply that depression is sometimes difficult to treat. Although we are learning more about depression all the time, there’s still a lot we don’t know. Two people with similar depressive symptoms may respond very differently to treatment. For example, some people respond very well to SSRIs, a common antidepressant drug, while others don’t. Studies show that 40 to 60 percent of people report an improvement in depressive symptoms in six to eight weeks. And people respond differently to different medications. It can take some trial and error to find the right combination of therapy and medication to treat depression effectively.

Another reason your depression may persist is post-acute-withdrawal syndrome, or PAWS. This is not an officially recognized condition, but there is a lot of anecdotal evidence it exists. People with PAWS typically report feeling emotionally numb, unmotivated, depressed, or irritable. PAWS is thought to be caused by changes in brain chemistry due to substance use. When the brain has adapted to the presence of a particular substance, it can take a while to adapt to the absence of that substance. Since addictive substances affect the dopamine system, which is responsible for reward-seeking and goal-directed behavior, some people quit drugs or alcohol and suddenly feel numb and unmotivated. Nothing in regular life causes the brain to light up the way drugs and alcohol did, so it’s hard to get excited about anything. The subsequent feeling of depression can be very challenging for people relatively new to recovery.

Fortunately, PAWS typically goes away on its own. It usually lasts less than a year, but may persist for up to 18 months. That can seem like an eternity when you’re living with it, but it helps to keep in mind that the feelings are only temporary. Whether you’re experiencing depression or PAWS, the key is to be patient and keep working on recovery. Things will eventually get better.

At Alta Lama Transformational Services, you will meet knowledgeable, compassionate professionals that understand addiction in all its forms.  Alta Lama uses an integrative and holistic approach to treat addiction and mental health issues. No treatment is one-size-fits-all, where you will have a team of experts prepared to create your customized treatment plan.  We offer care for your mind, body, and spirit, so that you can heal from the inside out and look forward to a lifetime of sobriety and wellness. If you are ready to take the first step in your recovery, please call us at 866-457-3843.