How To Deal With Depression During And After Drug Or Alcohol Detox

So, you've decided to detox from an alcohol or drug dependence — or are helping someone else through the process? While there is no question that breaking free from a dependence will have positive effects on a person's physical and mental wellbeing in the long term, the road there can be a nightmare.

Acute depressive symptoms can be a part of that. Withdrawing from drugs like cocaine and amphetamines, which stimulate the central nervous system, can induce numbness, an inability to experience pleasure, depression, and even suicidal thoughts. Withdrawing from substances that depress the central nervous system — such as alcohol but also opiates, benzodiazepines, barbiturates — tends to come with other symptoms. These can include agitation, anxiety. 

Research that describes how depression may rear its head during withdrawal from just about any substance is out there, for instance:

• Cannabis withdrawal, in heavy or long-term users, can cause irritability, insomnia, feeling nervous, a low appetite, restlessness, physically uncomfortable sensations, and depression. 
• Alcohol withdrawal syndrome can cause irritability, panic, agitation, and diarrhea, but also extremely serious and potentially life-threatening symptoms in extremely heavy drinkers. These include tremors, seizures, and hallucinations. While depression isn't a direct side effect, it can set in as you reevaluate your life. 
• Cocaine and amphetamine withdrawal can cause depressive symptoms for weeks after quitting. 
• Opioid withdrawal can lead to extremely varied symptoms, which can include depression as well as intense pains in the body, severe cravings, and an inability to sleep. 
• Nicotine withdrawal, too, has been associated with depressive symptoms.

How should you handle your detox?

Deciding to break free of your addiction is a brave and bold step, but be careful — depending on what you are addicted to, it can also be physically dangerous. While you're going to be medically fine trying to detox from cigarettes, marijuana, or moderate drinking on your own, even in these cases, you may benefit from support. 

How can you cope with depressive symptoms after saying good bye to an addiction?

Let your healthcare provider know what's going on! They'll be able to tell you if you can expect these depressive symptoms — which often meet the full diagnostic criteria for major depressive disorder, but for shorter amounts of time than are required for a diagnosis — to reasonably subside on their own very soon, or if you'll need additional treatment. 

Some considerations include:

• Have you not previously suffered from depression or another mood disorder? Are depressive symptoms known to be a possible "side effect" of detoxing from your particular substance? Has only a short time passed since you quit? In that case, your doctor probably won't recommend treatment specifically to deal with depressive symptoms — because they're quite likely to subside on their own soon.
• If it's been four weeks or more since you quit, you started experiencing depressive symptoms shortly after, but they're still going on now, you may have a "substance-induced mood disorder". 
• In some cases, people with underlying mood disorders will turn to self-medication with substances. Detox may reveal the underlying mood disorder. 

Talk therapy for depression after overcoming addiction

As a depressed recovering addict, you will benefit from talk therapies that have been proven to help people with both depression and substance abuse problems. You are, as such, most likely to be recommended for cognitive behavioral therapy. This is a therapy that helps you analyze how your thoughts influence your mood and behavior, in order to discard patterns that do not serve you and replacing them with healthier thoughts for a better life. CBT has consistently been shown to help people with substance use disorders as well as those with major depressive disorder. 

Self-help groups can improve your long-term success

Participation in an addiction-recovery program, such as Alcoholics Anonymous or Narcotics Anonymous, has also been shown to boost your long-term success and mood. Your doctor will likely advise you to attend such a program, which can be seen as a "self-help group". Not only can such a group offer accountability, but also a feeling of inclusion and belonging that can boost your feelings of self-worth over time. 

Are antidepressants an option?

Sometimes.

Your doctor will be reluctant to prescribe antidepressants soon after you quit, for several reasons. The first is that depressive symptoms often subside on their own quickly. The other is that people who first start on certain antidepressants, especially SSRIs, can encounter the very same symptoms withdrawal from particular substances can induce. These include agitation, anxiety, nausea, and headaches. 

If, however, you continue to be depressed after the withdrawal period has passed — and especially if you have been diagnosed with major depressive disorder before, or have a family history of mood disorders — antidepressants may be the best option for you. In this case, doctors will prescribe an SSRI antidepressant, a tricyclic, venlafaxine (Effexor), or Bupropion (Wellbutrin). They should avoid Monoamine Oxidase Inhibitors (MAOIs).