Contributor: Krista Smith is an author and lead facilitator at Gulf Breeze Recovery in Gulf Breeze, Florida.
Addiction and depression are often intrinsically linked together, one typically occurring in response to the other or even simultaneously. Yet there is often a stigma associated with taking prescription medications while recovering from an addiction to alcohol or drugs. The general public tends to look down on those who use medications such as anti-depressants or anti-anxiety medications, even when prescribed by their doctor and used in the appropriate manner because there’s a sense that being “sober” should equal being free from any mind-altering drug, including those that could possibly save a person’s life.
Antidepressants are Different
Antidepressants have little in common with addictive drugs like opioids or benzodiazepines, which tend to work quickly and produce a sense of “euphoria” for the user for a short time, after which the user is left craving more. At some point, more and more of the drug is needed to produce the same level of high and a vicious cycle is created. Antidepressants such as SSRIs or SNRIs work very differently on the brain and take weeks or even months to note a difference.
The basic premise of these is that they temporarily block the absorption of neurotransmitters to allow the nerve cells better communication pathways, which can in turn help regulate a person’s mood. There is no immediate benefit to these medications or any feeling of euphoria, just a bit of a bridge to help nerves in the brain communicate more efficiently. For many people who have successfully completed a recovery program and still struggle with depression, an antidepressant medication may be a good choice for maintaining mental health and avoiding relapse.
Keep in mind, often people are misdiagnosed with depression during the throes of a full blown addiction problem as diagnosticians aren’t always able to get a “clean” diagnosis without a natural baseline free of substances, particularly if the patient isn’t completely honest about their drug or alcohol use.
Some Depression is Natural
Depression or depressive thinking can also be a natural by-product of addiction because often people are overwhelmed with guilt, shame, fear or even grief about the actions they take to maintain or hide their addiction. And after recovery, when a person is no longer using they can feel depressed because they are no longer numbing the sensations of life with substances and have to find a “new normal” for their mental health, which is exacerbated by the fact that brain chemistry and hormones are affected by drug and alcohol use often for many months after getting sober.
Physicians know that brain chemistry and neurological functioning may take some time to recover to full capacity, particularly after lengthy drug or alcohol use, and advise patients to, well, be patient. “In my experience,” says psychiatrist Dr. John Hayes(t), “from a clinical standpoint, people are typically going to see 80% of their improvement in mood stability and sleep disturbance, autonomic nervous system instability, appetite and cravings within the first two months, and then over the next year the remaining 20% of improvement will occur. Individual variation of how quickly a person returns to their full health potential has a lot to do with a person’s genetics, the environment they live in, their nutrition, the breadth of their recovery efforts, and how well they are taking care of themselves spiritually as well as physically.”
Everyone is Different
But occasionally doctors have found cases of depression and anxiety so prevalent after recovery, they automatically assume most people fresh out of a rehab program will need antidepressants. “My general practitioner prescribed me (an SSRI) as soon as I got home from rehab”, says a recent guest of Gulf Breeze Recovery, a non 12 step rehab in Gulf Breeze, Florida. “I didn’t feel depressed, I didn’t feel sad, in fact, I felt good for the first time in years. I took them because my doctor prescribed them, but taking them made me feel groggy and “muted”, so I told him I wanted off. I was surprised that a physician would automatically give someone a prescription when they hadn’t reported any symptoms. I’ve done just fine without it.” Other patients report that antidepressants provided the crutch they needed while their brain and body physically recovered from their addiction. “I completed recovery a year and a half ago,” says another guest from Gulf Breeze Recovery, “I was physically feeling great and excited about getting back to my life, but I still felt something was off. I was tired but couldn’t sleep, excited but couldn’t get motivated. My doctor prescribed me a low dose antidepressant and after a few weeks, I noticed a difference. It helped me get over the hump after rehab and I worked with my counselor to improve my diet, exercise more, sleep regularly, and just overall be more healthy. I’ve since stopped using it, but I think it helped enormously.”
“The classes at Gulf Breeze Recovery use a non-traditional approach to depression: understanding that everyone thinks depressing thoughts from time to time, and learning to not let any thinking, depressive or otherwise, define who you are as a person,” says Reed Smith, one of the founders. “This can be a huge relief for someone who just needs to realize they can be healthy in order to live a healthy life.”
How do you know if antidepressants after recovery are right for you? Like most things, there’s no “one size fits all” answer. Experts all agree that diet and exercise play a major role in our mental health(1), especially after addiction(2) and that there is no substitute for living a healthy lifestyle and getting restorative sleep. If eating a healthy diet, getting proper exercise and good sleep habits aren’t quite enough to produce a healthy body and mind, medications such as SSRIs could be considered for a short term and the benefits and risks should be carefully weighed with your general practitioner. Be open and honest with your physician, both about your history with drugs or alcohol as well as any feelings of depression or anxiety, and together you should be able to work out a plan that feels right for you.
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About the author:
Krista Smith is an author and lead facilitator at Gulf Breeze Recovery in Gulf Breeze, Florida. Krista helped develop and refine the Total Health Recovery program in use there and is currently working on her master’s in Psychology.
- Craft, L., & Perna, F. (n.d.). The Benefits of Exercise for the Clinically Depressed. Retrieved September 8, 2015.
- Smith, M., & Lynch, W. (n.d.). Exercise as a Potential Treatment for Drug Abuse: Evidence from Preclinical Studies. Retrieved September 8, 2015.
- John C. Hayes, MD is a psychiatrist who has worked in the Addictive Disease field for many years and teaches classes on the psychological component of recovery at Gulf Breeze Recovery in Gulf Breeze, Florida.
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions and co-occurring disorders. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals. We at Addiction Hope understand that addictions result from a combination of environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on September 18, 2015. Published on AddictionHope.com