Addiction & Depression

I continue to be baffled when I hear of people being started on anti-depressants while they are still in a detox or shortly after being released from one without having had a previous history of depression. If you need to be detoxed from your drug of choice (yes, alcohol is also a drug) then your central nervous system has taken a major ‘hit.’

Post detox, there is going to be some degree of depression; from feeling a little out of ‘sorts,’ to, ‘man, I slept 12 hours and I still feel exhausted,’ or, ‘man, I was up and down every hour last night!’

This is part of the price for travel.

What we need to watch for is whether this is a case of substance induced mood disorder, or, true major depressive disorder. Substance induced mood disorder will usually clear over a period of time. How long it takes depends on variables such as: what type of drugs, how much, for how long, medical issues that may also be going on, etc.

What was the person’s history like when they were drug and alcohol free for an extended period of time? Did they have bouts of depression over a lengthy period of sobriety? If so, were there life events that could have brought on depression such as: end of a relationship, death of a loved one, losing a job, etc.

As I say to my patients, “Do I drink/drug because I am depressed, or, depressed because I drink/drug?”

The answer is “Yes.”

Both issues need to be addressed concurrently. Prescribing a psycho-active drug and not requiring a person to be in some type of treatment or therapy to help determine the causation to me is just another example of our societies often held belief, “give me a pill, fix me now!”

I remember reading years ago a recommendation that was put forth by a collaborative effort between MGH and McLean’s Hospital that if a person was not a good historian as to their past mood status, or, did not have a history of extended periods of sobriety from which to report, then being followed by a qualified therapist on a weekly basis for a period of between two weeks to two months, they should be able to ascertain if medication intervention is warranted.

So what would I recommend before the start of anti-depressants? Well for starters, how about a complete physical exam with blood work to establish a beginning baseline; not the knee tap, cough, cough, quick look-see that more often than not takes place when one is entering a detox.

Next, a nutrition consult. In one of the programs that I currently work in I inform the patients that I can arrange such a consult. Very few ever take me up on my offer. I recommend to them that they stay away for the alcohol/addict diet; nicotine, caffeine, flour, sugar and sometimes Crisco (deep fried food).

Then on the agenda is exercise. I suggest they start out by walking maybe two or three days a week for twenty minutes to half an hour. One just has to ‘Google’ exercise and mental/physical health to see the benefits that can be derived. Exercise is a natural mood elevator. Caution should observed in not doing too much, too soon however.

By the way, if a person wants a safe, family orientated place to work out but money is an issue, YMCA’s will never turn anyone away for an inability to pay. They will have a person fill out financial aid forms and adjust the membership fees accordingly. Many halfway houses here in the Boston area have agreements with local YMCA’s for their house members. Makes sense, no? (I must admit I am a little biased here. I have been a member of the “Y” since the age of six, lol)

To me the most insidious form of depression is dysthymia. The U.S. National Library of Medicine defines it as: “a chronic type of depression in which a person's moods are regularly low. However, symptoms are not as severe as with major depression.”

In my private practice if I have a client that has several months clean and he or she begins to talk about being bored and/or tired I see red flags flying all over the place.

You feel bored?
Yea, there’s nothing to do. At least when I used I didn’t feel anything.
Did you ever have a time in your life that you had ‘stuff’ to do?
Well yea, but I was a kid.
What type of stuff?
You know, go hiking, fishing, maybe hit the movies.
Why don’t you try to do some of those things now?
I would but I’m always so wicked tired.

Are you bored and tired, or possibly in a dysthymic state of depression. Research states that more women than men suffer from depression. From my clinical observations of the past twenty years I don’t believe this to be true.

What I do believe is that more women than men ‘report’ depression. This might explain why more men than women are successful in their first suicide attempts. Although ‘successful’ is not really a great term to use. (http://www.sciencedaily.com/releases/1998/11/981112075159.htm)

Men are more apt to report addiction issues before other mental health issues; women the inverse is true.

On a final note, I always suggest to my patients that they do not allow their primary care physicians to prescribe them psycho-active medications. They simply do not have the expertise to do so. If you knew how much time (or how little time as the case is) they had in medical school on addiction and mental health, I doubt you would really want them prescribing for you. Unless of course, you are looking for a doctor “feel good.”

As an example, you go to your primary care physician stating you feel depressed. He or she may think, well, xyz medication is fairly innocuous; I’ll just put them on a low dose, that’s all. Did they ask you how long you have felt depressed, or, have you recently been going through life changes such as: death of a loved one, loss of a job, or, the big question, ‘have you been feeling suicidal?’ Did they highly suggest that you see a therapist in addition to the medication? Probably not.