Alcohol use disorder (AUD) and depressive disorders are among the most prevalent psychiatric disorders and co-occur more often than expected by chance [1].
According to The National Institute on Alcohol and Alcohol Abuse (NIAAA), recovery from AUD is a long-term change process that may be characterized by occasional returns to heavy drinking. Especially in the bumpy first year, patients will benefit from ongoing support to help maintain the changes they are making. One of the common symptoms in recovery is experiencing depression. Read on to learn more about depression in recovery and how to cope.
What Does Recovery from Alcoholism Look Like?
The NIAAA has developed a definition of recovery as follows [2]:
“Recovery is a dynamic process with two clinical goals:
- Remission from AUD symptoms as listed in the DSM-5 (Diagnostic and Statistical Manual 5 of the American Psychiatric Society), with the exception of craving.
- Cessation from heavy drinking, defined for women as no more than 3 drinks on a single day and no more than 7 drinks per week, and for men as no more than 4 standard drinks on a single day and no more than 14 drinks per week.”
There is hope for recovery, grounded in science. The majority of people with AUD can reduce their drinking and alcohol-related problems over time, with studies showing a reliable pattern of improvement that counters views of AUD as an inevitably worsening disorder.
The NIAAA outlines what the change process for recovery looks like, summarized here [2]:
- Many with less severe disorder recover without treatment. Those who do seek treatment have more severe AUD and related mental health disorders such as depression or trauma
- Although abstinence is often the goal in recovery, many people choose a goal of cutting back rather than quitting drinking
- Success often happens after just a few serious attempts. (2 to 5)
- Relapses to heavy drinking are common (1-2 short periods or a few longer periods in the first year)
- Negative emotional states (such as depression), cravings and sleep issues can persist after people quit or reduce drinking. Changes in brain neurocircuits underlie these problems. Initiating and maintaining abstinence can help reduce craving and negative mood over time. This in turn can help prevent relapses.
- Improvements can be steady or bumpy. At first happiness and self-esteem may dip, but this gradually decreases beginning 6-12 months into recovery
What Causes Depression During and After Recovery?
Let’s start with a brief explanation of the impact of alcohol on the brain. Regular alcohol intake affects numerous neurotransmitters in the brain. Some, like glutamate, stimulate signal-receiving neurons, while others do not. like GABA, inhibits the neurons.
Alcohol enhances GABA’s effect, suppressing the activity of neurons. With chronic alcohol exposure, GABA receptors become less responsive. More alcohol is needed to achieve the same level of suppression. This is called tolerance.
When you stop alcohol intake, since the GABA receptors are less responsive, an imbalanced state of excitatory transmission is created in the brain. In addition, the number of glutamate excitatory neurotransmitters remains elevated. Both of these mechanisms contribute to the hyperexcitability of the neurons that is typical of alcohol withdrawal. This causes the symptoms to appear. [3].
Lethargy is a natural response to the effects of withdrawal from AUD and the level of energy, effort and time someone puts into becoming sober.
Letting go of alcohol means that any underlying issues such as anxiety or depression may emerge. The co-occurrence of both AUD and depression has greater severity and worse potential outcomes than either disorder alone, including a heightened risk of suicidal behavior [1].
Signs of Depression
A low mood after a night of drinking can feel pretty bad. But if you already have depression, you might feel even worse, since alcohol can increase the intensity of your emotions.
Alcohol-induced depressive disorder refers to a depressive-like syndrome with depressed mood and loss of interest or pleasure in activities. It occurs only during and shortly after alcohol intoxication and withdrawal and passes after 3-4 weeks of abstinence from alcohol. It is associated with significant distress and impairment. Longer-lasting depression may be experienced for a year or more, depending on its severity.
Both AUD and depression during recovery have a number of shared symptoms, including:
Psychological:
- Disrupted mood
- Feeling low
- Feeling numb
- Feeling irritable
- Feeling worried
- Loss of libido
- Low self esteem
Cognitive:
- Feeling worthless
- Difficulty concentrating
- Lack of interest in activities or hobbies
Physical:
- Fatigue
- Lack of energy
- Agitation
- Insomnia
- Loss of appetite
Depression, Recovery, and Relapse
Alcohol itself is a depressant. And there is a high level of depression among those with AUD who seek treatment. Interestingly, women are more likely to experience depression before AUD, while men are more likely to develop AUD after depression. Although alcohol-induced depressive disorder is defined by remission of the depression after stopping alcohol, the disorder has been associated with risk for onset of later major depressive disorder.
So in recovery there is a period of 3-4 weeks during which initial depression is most likely. As recovery continues there is a possibility that issues may emerge that lead to depression. For some this may be longer-term. For most others, antidepressant medications combined with therapy can be of significant help.
When there are relapses, which do occur for most people, depressed feelings may re-emerge, especially if the person feels they have failed. But recovery is a journey and may involve several relapses especially in the first year after stopping alcohol. In this case, adjusting medication dose or re-starting a period of medications can be helpful.
How to Cope with Depression During Recovery
Giving up alcohol may feel like the loss of one of the central relationships in someone’s life. As a result, losing alcohol can bring forth a wave of sadness, despite the support systems they may have. The addicted person may feel lost or directionless in both their life and relationships. They may feel hopeless and lost. They may cycle through guilt and shame.
For some, this may evolve into depression which may last several weeks and then subside. For others, protracted depression may develop—a depression which may have been masked by alcohol misuse.
Typical ways of coping include:
- Mindfulness meditation for stress reduction
- Exercise
- Balanced diet
- Antidepressant medication if required
- Therapy
- Use your support network
- Practice self-care
- Develop a daily routine
- Journaling
- Get outside
- Start a new hobby
How to Cope With Depression After Recovery
Every person’s experience with recovery is unique. Following recovery many of the above activities can continue to help you stay balanced. Assess your antidepressant or other medication with your doctor. Continue therapy if you have begun. Start therapy if you haven’t yet.
Safely Recover from Addiction and Depression in Utah
Treatment is available in Utah. Are you or a loved one looking for a compassionate space to heal from depression, other mental health issues or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.
Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.
Sources
[1] McHugh RK, Weiss RD. Alcohol Use Disorder and Depressive Disorders. Alcohol Res. 2019 Jan 1;40(1):arcr.v40.1.01
[2] National Institute on Alcohol and Alcohol Abuse. 2022. Support Recovery: It’s a Marathon, Not a Sprint.
[3] Saitz R. 1998. Introduction to alcohol withdrawal. Alcohol Health Res World. 1998;22(1):5-12
