Depression commonly goes hand-in-hand with substance use, but how is it connected with withdrawal?
While the decision to quit drinking or using drugs is quite possibly the best decision someone with addiction can make, that doesn’t mean it’s easy. Your life will improve radically. However, you have to first navigate the hurdle of withdrawal. The severity of that withdrawal, and whether you might struggle with depression, really depends on the type of addiction you (or your loved one) were suffering with.
The process of withdrawal
Anyone who has used substances—whether alcohol or drugs—for a prolonged period may go through the process of withdrawal. Why? Over time the body develops a tolerance to the substance, meaning you need more and more to get the same effects. Certain substances, like opioids and benzodiazepines, can cause the body to become physically dependent on them to feel functional. When this occurs, stopping the substance may cause withdrawal. Withdrawal means that the body is adjusting to no longer having that substance in your system.
The process of withdrawal really depends on the type of substance, how long it has been taken, and in what doses. For example, opioid withdrawal usually begins 8-24 hours after the last dose and can last for 4-10 days.
Typically, one can expect a range of withdrawal symptoms (these also depend on the type of substance) for a period of up to two weeks. Benzodiazepine withdrawal can start within 1-4 days and last several weeks or months. In some cases, it can result in post-acute withdrawal syndrome (PAWS), which I’ll discuss more below. It is worth noting that there are medications available that can help alleviate withdrawal symptoms.
Withdrawal symptoms
Broadly speaking, withdrawal symptoms include:
- Depression
- Anxiety
- Restlessness
- Difficulty sleeping
- Nausea
- Diarrhea
- Sweating
- Body aches
- Yawning
- Mood swings
- Low energy and fatigue
- Irritability
As mentioned earlier, the type and severity of withdrawal symptoms depend on the type and amount of substance taken.
Post-acute withdrawal syndrome (PAWS)
In some instances, people in withdrawal may experience symptoms for a prolonged period of time, i.e. beyond the typical two-week window. This extended process of withdrawal is called PAWS. Post-acute withdrawal often happens in episodes of a few days and can recur periodically. These episodes can persist for up to a year.
Symptoms of PAWS include:
- Depression
- Anxiety
- Mood swings
- Low energy/fatigue
- Chronic pain
While PAWS can happen with any substance withdrawal, it most commonly occurs with these substances: alcohol, antipsychotics and antidepressants, benzodiazepines, marijuana, stimulants like cocaine, and opioids.
Facts about depression
Continued drug use can affect the chemical messaging in the brain associated with motivation and reward. As the brain adjusts to the absence of substances, people may experience symptoms of depression, such as sadness, feelings of hopelessness, lethargy, feeling low or a sense of doom, and lack of energy.
It is important to remember that if you feel like you can’t cope and the depression is prolonged (i.e. longer than the withdrawal period), then you should consult your medical provider.
How to navigate depression in withdrawal
It’s important to go into recovery with an awareness of the potential side effects, including depression, so you can plan for them. If you’ve been taking substances for a prolonged period and worry you may experience withdrawal, it’s critical that you check in with your medical provider and/or an addiction expert that can guide you through the process. You can talk to them about the possible use of medication-assisted treatment that can alleviate withdrawal symptoms.
While it may seem that depression is overwhelming or too painful to navigate, please remember that there are resources to help you through the process. Once you reach the other side, you will feel relief to live a life in recovery.
Need more help?
You may find the following resources helpful to help navigate withdrawal:
SAMHSA National Helpline (website): 1-800-662-HELP (4357) — TTY: 1-800-487-4889
SAMHSA Treatment Locator for Behavioral Health Treatment Services (website)
SAMHSA Disaster Distress Helpline (website): 1-800-985-5990 — Call or text.
