Five Stages of Grief: Depression

We are winding down our discussion of addiction and the five stages of grief. Now that we have covered denial, anger, and bargaining, we have only two stages left. Today, we continue our dissection of the five stages with an article on depression. Many are inclined to think of this as the worst of the stages. Depression is the true, unadulterated meat of the grieving process. In fact, we often subconsciously use denial as a means of avoiding this stage. We use anger as a means of substituting our depression with a similarly strong emotion. And we use bargaining as one last Hail Mary pass before we are forced to except the reality of our grief.

Depression is one of the most visceral stages of grief. We become mired in the sadness we are feeling over our loss, and it becomes difficult to feel anything else. Even our capacity for rational thought may become limited, replaced by the power of raw emotion. This is true whether we are in active addiction or addiction recovery. It is true for the codependent, who mourns for the losses incurred by the addict or alcoholic who remains dear to their heart. Fortunately, there are means by which one may cope with depression and facilitate their move into the final stage, acceptance.

Defining Forms of Depression

At various stages throughout history, depression has been attributed to various causes. In some of our earliest years, it was believed to be caused by spirits or demons. This belief has sprung up multiple times throughout the ages. In ancient Greece, Hippocrates developed humoral theory, which attributed depression to an imbalance of bodily fluids. It was the Roman philosopher Cicero who first proposed that depression was the result of psychology, attributing it to such emotions such as grief and fear. Much later, the Persian doctor Rhazes also posed that depression was a psychological condition. In short, it has been known for quite some time that depression can be a clinical condition.

In the early 17^th century, Robert Burton referred to social and psychological causes of depression in his book, Anatomy of Melancholy (the title of which is a reference to humoral theory). This was followed by German psychiatrist Emil Kraepelin in the late 1800s, who wrote about manic depression. While clinical depression may arise from the causes explored by Burton, manic depression is an entirely different disorder. Both of these forms of depression may share comorbidity with addiction. Other clinical disorders may cause depression as well. In fact, Kraepelin’s writings on manic depression served primarily to distinguish the disorder from schizophrenia.

WebMD links depression to a number of other disorders, such as anxiety disorder, eating disorders, bipolar disorder, postpartum depression and seasonal affective disorder. It stands to reason that those who are grappling with such major mental and emotional demons would often see their feelings give way to immense grief and sadness. They also, quite rightly, link depression to substance abuse and addiction. Sometimes the addict may fall into depression as a result of their using, while others who already suffer from depression may use in order to numb the pain of their emotions.

Of course, depression does not always arise as the result of major mental or mood disorders. Sometimes, depression is simply our way of reacting to adverse circumstances. We feel as if life is bearing down on us, and it becomes difficult to feel anything other than sorrow. The Mayo Clinic defines the major symptoms associated with clinical depression, many of which involve physical effects such as fatigue, weight loss, or insomnia. Those who are suffering from non-clinical depression may feel just as woeful as those with clinical disorders, but these physical symptoms will either be less severe or simply non-existent. Those who are not certain whether they are experiencing clinical or non-clinical depression should seek diagnosis from a licensed specialist before their affliction becomes too great for them to manage.

Depression in Active Addiction

The physical signs of depression mentioned above can actually be major signs of addiction. Even if the addict does not feel outwardly depressed, they may begin to lose or gain weight at astounding rates. They may begin to succumb to insomnia or fatigue, experiencing major changes in their usual sleeping habits. They might start to neglect their hygiene, either because they are staying in the house and using all day or because they simply do not have the energy to care about how others see them. These depressive symptoms are all linked to the downward spiral of addiction. Whether they know it or not, the addict is silently grieving the loss of their old self.

When this type of depression and addiction are left untreated, the results can be life-threatening. The addict has already been harming themselves through substance abuse, but they may begin harming themselves through more direct fashions. In some cases, self-harm can become its own addiction, as it becomes the one thing over which the addict has any control. In other cases, the addict may become suicidal. Psychology Today published an article on Robin Williams, who is well-known to have struggled with addiction during his lifetime. Although he had twenty years sober at one point, his struggles had begun anew several years before his tragic suicide. It is unknown whether or not anyone knew that he was depressed, especially to such a fatal extent. Unfortunately, this is often the case. Most addicts will do anything to hide their condition. Hiding their sorrow is simply an extension of that same behavior.

It has already been mentioned that addiction sometimes leads to depression, and vice versa. Interestingly enough, however, studies have failed to deliver any conclusive data regarding which of these cases is more common. Some studies have shown that those who use drugs are more likely to find themselves depressed, whereas it is difficult to conclude from the mere existence of depressive symptoms whether or not the subject will eventually develop an addiction. On the other hand, many studies have shown that a fair number of patients who have sought treatment for addiction to cocaine and alcohol had begun using in order to overcome their strong emotions. In other words, while the correlation of addiction and depressive symptoms is clear, the order of causation is still somewhat elusive.

We might note a similar relationship between addiction and depression’s twin siblings, shame and guilt. Psych Central writes about depression’s link to shame, whether one is ashamed because of something they have done or simply something they perceive themselves to be. Those who struggle with self-worth may actually convince themselves that they are bad people. They will then abuse substances to alleviate themselves of these feelings, after which they will do or say things to others that corroborate their negative self-image. This self-fulfilling prophecy will lead to a vicious cycle of shame, substance abuse, and behaviors that only serve to cause more shame.

In our article on anger, we explored the manner in which envy, blame and resentment can lead to rage. There is a similar relationship between guilt, shame and depression. It does not matter whether our shame came before our addiction or the other way around. It all leads to the same place in the end. But those who seek an end to their depression will often enter recovery, and this can make all of the intensity and suffering worthwhile.

Depression in Addiction Recovery

The guilt and shame so deeply linked to depression does not immediately go away when the addict enters recovery. How could it? The Fix, a website dedicated to speaking about addiction and recovery, notes that many people see view addiction “as a moral failing, linked to both a weak character and criminal activity, which should be addressed with swift and final punishment by our legal system.” We’ve actually mentioned these negative personality myths before, and how damaging they can be to the addicts who are all too aware of the stigma that has been attached to those with their disease. This can be even worse for those who enter rehab while there are major legal issues awaiting them when they leave their treatment facility.

During early recovery, the addict will find themselves on something of an emotional roller coaster. As their body goes through the detoxification process, they will be feeling worse than they have felt in some time. Once it is over, they will begin to feel an immense joy, almost like a natural high. After this subsides, they may fall into depression for a time. As they adjust to their newfound sobriety, they will continue to fluctuate in mood for quite some time. During the downer periods of these fluctuations, they may sometimes wish to use again. Psychology Today writes that the addict will often feel shame over this, believing that their desire to use marks them as a failure. This effect can be especially potent if the addict is re-entering recovery following a relapse.

The trouble with this shame and depression is that it complicates the recovery process. On the surface, it may seem as if addiction and depression are two separate entities which simply inhabit the same body simultaneously. But in reality, they are more like interlocking pieces of a greater puzzle. If they are kept separate, these puzzle pieces will form a picture that is fragmented and unclear. Instead, we must view them as a single entity. If the addict is to stand any chance at making a long and lasting recovery, their addiction and their depression must be dealt with at the same time.

One issue remains that must be discussed in terms of depression and recovery. This is the issue of post-acute withdrawal syndrome, or PAWS. This is not unlike the fluctuation discussed earlier, but its intensity is on a much greater level. Those who suffer from PAWS will experience depression, insomnia, panic attacks, drug cravings, and decreased functionality of cognition. They will suffer from terrible mood swings, and their disturbed mental state will often give way to suicide ideation. On more than one occasion, this has crossed the line from ideation to actual attempts at committing suicide. In the worst instances, these attempts have been successful. Those who suffer from PAWS are generally heavy users, people who have wrought havoc on their neural pathways through extended periods of substance abuse. Their brain no longer derives a sense of pleasure from natural dopamine release, and yet they crave it constantly. There is a high risk of relapse in such cases, as the addict will feel the need to seek immediate gratification in order to release them from the hellish prison of their cravings and depression.

We were not lying earlier when we said that depression is often the first step toward acceptance. In many cases, depression is a sign that the addict has acknowledged the depth of their problem. But we cannot move toward acceptance until we become willing to seek a healthy means of ending our sorrow. And to do that, we must live to bear the emotional burden that our addiction has laid upon us. No matter how much it may feel like it, this stage of the addict’s grieving process is not insurmountable. But for those whose cases are worse than others, professional help might be needed in order to guide them through the pain.

Depression and Codependency

Codependent relationships are notoriously one-sided. The addict might not mean to take as much as they do. But whether they mean to or not, the codependent friend or family member will keep on giving. WebMD notes that codependents have a tendency to sacrifice for others when they are not receiving much themselves. It does not take a stretch of the imagination to see how this type of behavior can lead to gradually worsening depression. Any human being is liable to become woeful when their needs are not being met, even if they are sacrificing those needs by their own volition.

Codependency for Dummies actually breaks down the common feelings of guilt, shame and depression that are commonly felt by those who live in states of codependency. Since codependents have a tendency to take on the problems of others, they are prone to fall deeper into guilt and depression every time the addicts in their lives do something wrong. Over time, their self-worth is eviscerated, and they find it harder and harder to value themselves. This is not necessarily a constant thing. There are many times at which the codependent feels superior in their ability to look out for those they love. But this only sets them up for another hard fall later on.

The depression that results from codependency is a major facet of addiction as a family disease. It is one of the most evident effects that the addict’s use has on those around them. In some cases, it may lead the codependent to tread their own path of sorrow and substance abuse. In these cases, the codependent will generally try to hide their own addiction from the subject of their grief. The result is two people battling the same disease, each trying their hardest to hide their condition from the other. Needless to say, this will only exacerbate their depressive symptoms and cause them to feel even more guilt and shame.

Much like with anger, the codependent will often react to the addict’s depression by responding in kind. This has been studied in cases of marital codependency. One spouse’s depression will influence a similar emotional experience in the other. Not only does this create a lot of turmoil for each person in the relationship, but it puts a fair amount of stress on the marriage itself. Every time one depressed spouse goes out of their way to seek reassurance from the other, they are actually pushing their spouse away. This can be true for either the addict or the codependent. If this behavior persists for two long, the foundation of their marriage may be torn asunder.

The codependent’s depression is quite understandable, given the unfortunate nature of their circumstances. They are watching someone they love slowly kill themselves, while usually taking responsibility for their loved one’s plight. In addition, they are exposed to the addict’s depression on a regular basis. They are grieving the loss of their relationship with a loved one, while wondering if they should be preparing themselves for the loss of the addict’s life. It is enough to drive anyone to a dark frame of mind.

Living and Coping with Depression

One of the first keys to living and coping with depression is to realize that it is not a sign of weakness. The mere fact that someone is depressed does not mean that they are less of a person. Much like addiction, many people feel that there is a stigma attached to depression. They feel that people will not understand how they feel, and so they bottle these feelings up inside. This is incredibly unhealthy behavior, serving no other purpose than to ensure that our emotions are not dealt with in a healthy way. In many ways, this behavior is where depression and denial intersect.

The tendency to deny depression can be much stronger in men than women. Since women are more likely to admit their feelings to others, they are more likely to seek help for their depressive symptoms. The importance of such help, however, is prevalent in all those who suffer from such debilitating emotions. While the Centers for Disease Control and Prevention have indicated that men are nearly four times more likely to commit suicide than women, it has also been shown that around eighty percent of those who report depressive symptoms have recovered through counseling and other forms of treatment. Depression can be a death sentence, but it doesn’t have to be.

In cases of clinical depression, medication might sometimes be appropriate. WebMD has compiled a comprehensive list of useful drugs that can be used to counter symptoms of depression. For help selecting a medication that is best for you, it is always vital to seek the advice of a qualified professional such as a physician or psychiatrist. Also note that there are medications that can help numb substance cravings. For instance, we offer Vivitrol treatment here at Amethyst that can help to kill the cravings of alcoholics and opiate addicts. Medication, of course, is not necessarily the answer in and of itself. In some cases, clinical depression is intensified by situations that would cause anyone to fall into a pit of despair. In these cases, there is no substitute for therapy. This is why no one should jump to medication as an immediate solution. Take time to consider the source of your depression before seeking help to decide upon the best course of action.

During milder periods of depression, there are a few simple things you can do to help yourself. Of course, those who deal with depression on a regular basis have probably Googled several lists that repeat the same information. Lifehack has one of the better ones, which offers some common advice such as mindfulness and positive thinking. For more information on how to practice mindfulness, look at our guides to walking meditation and sitting meditation. Many also recommend good nutrition, a subject we have briefly covered in the past. A few other good ideas recommended by Lifehack include exercise, journaling and listening to upbeat music, as well as getting some sun (even if just in the form of a sunlamp). They also recommend distracting yourself by keeping busy, but be forewarned that this might actually not be the best advice. It might work for some people, but others will simply slip into a state of denial and move backward in their progress toward acceptance.

As we have in the other articles in this series, we should take a moment to acknowledge the existence of numerous supports groups such as Al-Anon, Nar-Anon and Co-Anon, each of which exists primarily to help the families and friends of addicts and alcoholics help each other cope with their loved one’s disease. Camaraderie is an important part of human living, especially for those who are living with depression. Those who are deeply depressed may often feel as if they are not understood by others. Through the lens of depression, everyone else seems happy and well-adjusted. But we all have our demons, and communicating with those who understand us can help us learn how to cope with them. We also have our own channels of support in the form of our Amethyst Recovery Moms’ Corner and parent alumni program, for the parents of addicted children who have come through our treatment center. Codependents grappling with depression should seriously think about researching support groups in their local area so that they may meet with others who share their compassion and concerns.

Whether you are currently in active addiction, recovering from addiction, or simply wanting the best for an addict to whom you are close, you will likely come face to face with depression at one point or another. Do not be alarmed. While depression is sometimes the sign of a deeper mental disturbance, its function in the grieving process verges on the positive. For when we succumb to depression, we are acknowledging that there is an issue to be dealt with. And in that moment, we are unwittingly preparing ourselves for the final stage in the process of grieving our addiction.