Wednesday January 25th 2017

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Dealing with depression after getting sober

By Shanthi Mogali, M.D.

The psychology of addiction include two large tent poles of behavior:

Cope
and
Comfort.”

When you are in the process of active addiction, consumption of drugs and alcohol allows you to avoid aspects of reality with which you’re not comfortable. This avoidance behavior is a way to cope, and the everyday ritual of substance abuse can quickly become a comfortable yet devastating routine.

When a person with substance abuse enters treatment and begins to live a life of sobriety, losing your routine and attempting to face reality can be a serious source of anxiety ­– even driving you into depression. So, what are some ways that you can cope with depression in addiction recovery?

Review more here. Then, we invite you to ask your questions about depression treatment at the end. In fact, we try to respond to all legitimate questions personally and promptly!

Depression can surprise you!

Although many individuals in recovery learn new coping skills for anxiety during their treatment, they may find themselves surprised by feelings of depression. Some may be familiar with depressive thoughts and feelings, but for many people who have suffered from substance abuse, the symptoms of depression can be new and overwhelming. Sometimes one may even feel guilty about being depressed or “missing” their substance of choice after having successfully entered a life of sobriety. Still others might feel ashamed of their depression.

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It is important to know that one should not feel ashamed about depression. Depression is very common in the United States. According to the National Institute of Mental Health, 6.7 percent of all U.S. adults (15.7 million people) had at least one major depressive episode in 2014. Further, as educational programs and forums about substance abuse and dependence are making way into public settings, physicians are seeing an increase in people presenting for treatment.

In fact, many providers are noticing that with treatment of many substance abuse disorders, there is often an underlying moderate to severe depressive disorder that requires attention. When an individual suffers from both a substance use disorder as well as a depressive disorder (or other mental health disorder, e.g. bipolar disorder, anxiety disorder), it is called a Dual Diagnosis. Most facilities are now acknowledging the connection between mental health and substance abuse and are investing more treatment and focus in addressing dual diagnosis.

Recognizing depression: What does it look like?

People who are recently out of treatment should be aware of the symptoms of depression and take note of changes in their daily activities as they enter the first several months into a sober lifestyle. There are several well-documented signs of depression. To be characterized as a major depressive episode, the depressed mood must last for at least two weeks accompanied by at least four of the following symptoms.

Common signs of depression include:

1. Sleep: The earliest signs of any mood disorder often present as sleep irregularities. Often times, people suffering from depression experience a significant loss in quality of sleep but may have either an increase or decrease in the amount of sleep.

2. Interests: Often there is a gradual decrease in the level of enjoyment one experiences by doing the activities they once loved. It is often difficult to initiate these activities as well.

3. Energy: Energy levels can decrease dramatically when one starts to feel depressed. Doing everyday chores or grooming can seem exhausting.

4. Concentration/attention: Many who suffer from depression will immediately notice their mind wandering. They have difficulty paying attention to even the simplest of things, like watching their favorite TV show from beginning to end. It is common to see problems at work such as: inability to participate in meetings, unable to answer emails in a timely fashion, or shifting tasks.

5. Appetite: Appetite changes in depression can vary from person to person. Some people see a dramatic decrease in appetite and food intake. The desire to eat can diminish and result in significant weight loss. On the contrary, some people experience an increase in appetite, especially with carbohydrate craving. As a result, some may experience weight gain.

6. Hopelessness or worthlessness: Negative thoughts are a common sign of depression. Often feelings of hopelessness, worthlessness and guilt are related to an event or situation (i.e financial problems, relationship difficulties, substance use), but sometimes they are very self-focused/intrinsic with no external explanation. For example, someone who is clinically depressed can:

  • feel hopeless that depression will not improve
  • feel guilty that depression is affecting family members, or
  • feel worthless that depression has overcome their life

Having people rate their sense of worth and sense of hope is very important as a treatment provider, as it is useful to help assess the risk of suicide.

7. Anxiety: Many people experience anxiety. Some may have an anxiety disorder without a mood component. However, many times depression and anxiety co-exist. Depression can result in one experiencing significant symptoms of anxiety. It is extremely important to assess someone for depressive symptoms when evaluating their anxiety to ensure adequate treatment for both depression and anxiety disorders.

8. Thoughts of death: Sometimes life feels so difficult that people start fantasizing about what it would be like to not exist or to “go to sleep and never wake up.” It is important that if these thoughts start to occur that an evaluation for depression is recommended. Thoughts of death may seem benign, but it is not uncommon that these thoughts start to become more intense. When this occurs, the risk of suicide increases significantly, and it is essential that one seeks intensive professional help.

Potential for relapse during depression

The potential for relapse in those suffering from dual diagnosis is very high. Some people will self-medicate to treat their depression by resuming consumption of alcohol as well as using illicit substances. Initially substances may make them feel as though symptoms of depression are improving, however in the long run it only worsens. It is key for a person at risk of relapse to seek help for not only the impulse to drink or use drugs but also for the underlying depression.

Self-worth and accomplishment must come from within

Often times when a person enters recovery and embraces a sober lifestyle, they receive an abundance of support and positive reinforcement from family, friends, mentors, and colleagues. For some, this external validation can come to define who they are, or their sense of self-worth. But once they settle down into the doldrums of regular life and all the compliments die down, depression can set in, along with a feeling of emptiness.

To avoid depression, self-worth must come from within.

Internal validation, or self-validation, means accepting one’s own experience, thoughts, and feelings. It doesn’t mean one’s thoughts or feelings are always right. Sometimes simply acknowledging and either accepting or reframing one’s own thoughts and feelings can be of utmost importance to deal with a tough situation. Self-validation can help people in recovery manage their feelings and be truthful with themselves. Honesty with oneself is a key component of sobriety.

Treating Depression

If you or someone you love is having suicidal thoughts, emergency medical treatment is advised.

Others with less acute depression can seek out individual or group therapy, and if prescribed by a psychiatrist, take anti-depressants. Mild to moderate depression can be addressed through physical activity, particularly aerobic or muscular strength training, according to recent studies. Those with mild to moderate depression should also check in with their support networks. Replacing negative thoughts with positive ones as well as mindfulness can be helpful in relieving people of depression.

Finally, a person suffering from depression should not expect a quick solution. Improvement will be gradual. It is important to develop a working relationship with a therapist or psychiatrist following sobriety and be open to treatment options available.

About the Author: Dr. Shanthi Mogali, Director of Psychiatry at Mountainside, is certified in addiction psychiatry as well as general psychiatry and neurology. She is also affiliated with the Columbia University/New York State Psychiatric Institute Division of Substance Abuse. She provides psychotherapy to enhance motivation and prevent relapse in individuals struggling with alcohol, marijuana, cocaine, and opioid abuse. She is a Suboxone provider and also experienced in administering Vivitrol injections for opioid and alcohol dependence. She is actively involved in research with areas of interest in opioid dependence and complicated grief.

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About Mountainside Recovery

Mountainside is nationally recognized for the effectiveness of its drug and alcohol addiction treatment programs. Our Integrative Care Model provides a comprehensive set of treatment and care offerings coordinated by a multidisciplinary team of experienced addiction treatment professionals. We are lauded for our ability to partner with each client and the client’s family and healthcare professionals in developing and executing individualized treatment plans that promote long-term sobriety.

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