Sober Synthesis

What is the Prevalence of Co-Occurring Depression and Substance Use Disorders (SUDs)?

• Nearly ⅓ of people with major depressive disorder also have a substance use disorder
• Major depressive disorder is the most common co-occurring psychiatric disorder among people with Alcohol Use Disorder (AUD).
• Depression, even for those that did not have a history of depressive episodes, is a common symptom of Post Acute Withdrawal Syndrome (PAWS)
• Fifty-60% of people recover from depression after 6 months of abstinence, especially when a participant in a treatment program and/or a self help group

What are the Different Subtypes Types of Depressive Disorders?

• Substance Induced and/or Medically Induced Depression
• Situational Depression
• Seasonal Affective (winter months when sunlight is more limited) Depression (SAD)
• Persistent Depressive Disorder (formerly named Dysthymic Disorder)
• Major Depression
• Bipolar Depression

What Is Post-Acute Withdrawal Syndrome (PAWS)?

• The cause of PAWS is neurobiological. Dependence on drugs or alcohol leads to neural pathway changes, particularly in the reward network (dopamine). 
  • To reset the reward network balance in early recovery, people can experience significant dopamine downregulation.
• The re-adjustment of these central nervous system changes can lead to cognitive, mood and physical changes that persist beyond acute withdrawal. 

• Common symptoms include:
  • anhedonia (the inability to feel pleasure)
  • anxiety
  • cravings
  • depression
  • difficulty focusing or thinking
  • difficulty with memory
  • executive dysfunction (organization, decision-making)
  • fatigue
  • increased sensitivity to stress
  • inexplicable chronic pain
  • impaired coordination
  • insomnia and other sleep problems
  • irritability
  • low libido

• Duration can last up to 2 years and symptoms often come and go.

PAWS (uth.edu)

What Evidence-Based Self-Help Activities Can Decrease Depressive Symptoms?

Important Note: Activities that take more effort, are best started as soon as possible after awaking to maximize optimal body/brain chemistry. 

• Exposure to sunlight or a blue (UVB) light substitute, especially within 2 hours after awakening and as much as possible throughout the day. Note: clouds do not block UVB light and windows do block UVB light.
  • This sunlight sets circadian rhythm for restorative sleep and boosts serotonin levels.
• Exercise
  • Increases the norepinephrine in the body
  • Has a positive effect on the tryptophan-serotonin pathway 
  • Optimal exercise dose: 150-180 minutes exercise per week
  • When depression significantly impacts ability to exercise, any physical activity (making a bed, washing dishes) can activate these responses. In addition, there is evidence that focused visualization of exercise can stimulate the same brain activity until one can physically exercise. 
• Nutrition
  • Evidence points to excessive inflammation as a precursor or exacerbator of depression.
    • People who are depressed have more of an appetite for carbohydrates because they are trying to get more tryptophan which is eventually converted into serotonin. However, carbohydrates increase inflammation.
  • Essential fatty acids (Omega 3s) decrease inflammation and have been demonstrated to relieve some symptoms of major depression 
    • Tuna, salmon, anchovies, and sardines have high levels of omega 3s.
    • Critical threshold level for supplements: 1,000 mg EPA Omega 3 (not DHA).
  • Some studies suggest that a ketogenic diet may have a positive impact on depression by enhancing GABA (mood balancer) and the phosphocreatine system (energy).
    • Creatinine(monohydrate) supplements (dose 1g – 5g) may improve mood and other symptoms of major depression. 
• Laughing
  • Daily exposure to people, animals, places, and things that can induce laughter. Note: Real time experiences, versus recorded experiences, are more influential for mood enhancement.
• Play activities 
  • Releases endogenous opioids and promotes experimenting with new activities/roles. 
• Deliberate healthy exposure to cold 
  • Can enhance mood regulation, mental clarity and cognitive function, stress resilience, reduced anxiety, and enhanced sleep.
• Journaling and/or mindfulness exercises to observe unhelpful thinking and enhance creative thinking. 
• Social and/or animal connection. Again, real time experiences are the most influential for mood enhancement.
• Minimizing social media and/or electronic scrolling, especially early in the morning. 

 Proposed questions for thought/sharing

1. If you have experienced or are experiencing depression, what activities have helped decrease your depression to support your recovery/wellness?
2. If you are experiencing depression, what activities are you planning to start to help decrease your depression?

Disclaimer

This summary is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed.