Adjusting to life in recovery can be surprisingly difficult. Before going off to rehab, you looked forward to seeing things turn around on the other side. You envisioned a stable, healthy, productive life awaiting you once you completed the detox and treatment program. So, when you find yourself feeling depressed after rehab it can be disheartening. What gives?
To attempt to explain these residual feeling of being depressed after rehab it is important to note that there are several possible reasons for it. These include:
It helps to have a clear understanding of the workings of the brain’s reward system while in active addiction. The effects of the substance of abuse quite literally overtake the brain’s normal functioning. Because the substance was providing its own source of dopamine on a daily basis, the brain ceased producing its own. When the substance is suddenly withheld, as is the case when getting sober, the brain needs time to recalibrate and start functioning normally again.
During this period, it is common to experience the absence of joy. Daily existence seems flat, lifeless, and dull while the brain regains its normal ability to produce dopamine, the feel-good chemical. This is one of the reasons that, even weeks or months after detox, lingering feelings of depression stubbornly persist. Depression is one of the post acute withdrawal symptoms (PAWS).
Co-Occurring Depression (Dual Diagnosis)
It is quite common for individuals who struggle with a substance use disorder to also have a co-existing mental health disorder. Among the most prevalent co-occurring mental health conditions are depression and anxiety. In some cases, the mental health issue presents first, subsequently followed by the use of drugs or alcohol as a means to self-medicate.
In other instances, the substance problem might spur a mood disorder. This can happen when the individual has experienced ongoing difficulties caused by the ramifications of drug or alcohol addiction. As these negative life consequences mount, depression can result. In recovery, the depression may be a residual effect if it emerged second, or it may be the core disorder that needs to be managed with targeted long-term treatment.
Being depressed after rehab can also be the natural result of having made a significant change in lifestyle. Old friends who were drinking buddies must be shed in recovery, which can result in feelings of loneliness. It takes time to establish new friendships that are supportive of recovery, and to discover new hobbies and activities that do not revolve around substance use.
In the period after rehab, some may find they have to face the consequences of their addiction. The fallout might include financial problems, a job loss, health problems, or damaged relationships. The weight of this fallout can lead initially to feeling depressed after rehab, although in time most issues will be resolved.
Managing Depression in Addiction Recovery
Depression poses a serious risk for relapse in addiction recovery. The symptoms of depression, including persistent sadness and feelings of despair, sleep disturbance, feelings of guilt or shame, and suicide ideation, can become so burdensome that the temptation to relieve them with the substance is a powerful one. For this reason, finding ways to manage or minimize these symptoms is essential in order to protect recovery. The most common methods for treating depression include:
Antidepressants. Antidepressant drug therapy is the primary treatment method for clinical depression. There is a wide range of these drugs available, each of them working in a slightly unique way. Generally, it takes 4-6 weeks before the medication takes effect, and it is common to have to trial a few different drugs before finding one that is effective. It is to be noted that a large number, ranging from 30%-50%, of individuals are unresponsive to antidepressant drug therapy, identified as treatment resistant. Some patients find the side effects of the drugs, which are numerous, to be reason to discontinue the trial.
Psychotherapy. Psychotherapy is another mainstay for treating individuals with depression. Therapy can be useful on a couple of different levels. First, individual psychotherapy can help the individual identify past experiences or present situations that are fueling the depression. The therapist can help the patient work through these issues and find some peace, which can hopefully help alleviate some of the depression. In addition, a form of therapy called cognitive behavioral therapy (CBT) is useful in helping the patient change negative thought patterns.
TMS therapy. For individuals with treatment-resistant depression, an alternative therapy known as transcranial magnetic stimulation (TMS) can offer hope. TMS is a brain stimulation technique that can alter the neuronic activity in the limbic region. It has been shown that some individuals with treatment-resistant depression have slowed brain activity in the left dorsolateral prefrontal cortex, which can be stimulated through the repetitive magnetic pulses. TMS is both safe and effective in the treatment of major depressive disorder.
Support Groups. There are support groups that gather to discuss with each other the challenges or successes they experience regarding their common struggle with depression. These groups can provide a sense of camaraderie, as feeling that they are not alone with their depression battle. This group setting offers an opportunity for social interaction and for gaining mutual peer support.
Lifestyle changes. There are certain lifestyle tweaks that can have significant supportive effects while battling depression. Incorporating these healthy habits into daily life can benefit mental and physical wellness. They include:
- Nutrition. Diet is an important aspect of maintaining brain health and functioning. A healthy, balanced diet can produce positive effects, such as clearer thinking, better concentration, more energy, and a stronger immune system. On the other hand, a diet heavy in salty, fatty processed foods, sugary treats and beverages, and too much caffeine can disrupt cognitive functioning.
- Physical exercise. Exercise can have profound positive effects on mental health. To benefit, it is good to participate in three or four 30 to 60-minute workouts weekly. These might include walking, cycling, swimming, running, hiking, dance cardio, or any sustained aerobic activity.
- Quality sleep. Getting sound sleep on a regular basis is critical for mental health. Studies have determined that we need a minimum of 7 hours of quality sleep each night for optimum wellness. Establishing a regular bedtime, shutting off smartphones and laptops and hour before bed, avoiding caffeinated beverages after mid-day, and avoiding strenuous exercise in the evening can all aid sleep.
Holistic methods. Nurturing the mind-body connection through holistic therapies can also assist with relieving depression symptoms. There are a variety of these mostly Eastern-inspired activities to help reduce stress and increase feelings of calm. These include practicing yoga, using mindfulness techniques, meditation programs, aromatherapy, hypnotherapy, acupuncture, and art therapy.
More About TMS Therapy and Treating Depression After Rehab
TMS therapy was first introduced in the U.S. in 2008, when the FDA cleared it for treatment-resistant major depressive disorder. That decision was based upon a large body of clinical research that demonstrated that TMS therapy could help these individuals with very minimal side effects or risks.
A TMS session is conducted within an office setting, as there is no surgery or general anesthesia involved in the treatment. The patient will be seated comfortably during the treatment sessions, which last about 40 minutes. In most cases, TMS treatment plans are prescribed as 5 sessions per week for 4-6 weeks.
During the treatment session, the individual is fully alert. He or she will feel and hear a light tapping sensation on the scalp where a coil is positioned. The magnetic fields pass through the coil and penetrate the scalp after which they will be converted into electrical currents. These currents target the sluggish brain cells and then stimulate them with the intent to rebalance the brain chemistry in the mood center of the brain.
After a couple of weeks of these TMS sessions the patient will begin to experience a reduction in the depression symptoms. They may find that they are sleeping more soundly, or that they feel more alert during the day. Over the course of treatment, the individual may find their cognitive functioning improving, as well as overall mood. Each person will experience these effects at points that are unique to themselves.
After the session is completed, the patient is free to drive themselves back to home or the workplace with no recovery time necessary. Only minor side effects are reported, such as headache, scalp tenderness, or facial numbness or tingling.
The Importance of Social Interaction in Depression Recovery
Feelings of isolation and loneliness are very prevalent among individuals in the early phase of addiction recovery. It is challenging to completely change one’s lifestyle, friendships, and attitude. This takes time. To prevent the risk of relapse, maintaining social connections is vital. Social interactions may be limited to attending recovery meetings at the beginning, but these are considered protective against relapse. At the meetings, the newly sober can find social support and opportunities to make new sober friendships.
In time, it is helpful to expand social connections by becoming involved in group activities, recreational sports, volunteer work, church ministries, and sober Meet Up groups. Whichever venue one finds to be inviting and edifying, cultivate the social connections to improve mental health and reinforce sobriety.
Anew Era TMS Provides Expert TMS Therapy in California and Texas
Anew Era TMS is a trusted resource for individuals in recovery who may benefit from TMS therapy. The team at Anew Era TMS is dedicated to providing this cutting-edge alternative treatment for those who did not respond to antidepressants. If you are experiencing persistent feelings of depression after trialing several antidepressants unsuccessfully, give Anew Era TMS a call today at