When an addict goes into rehab, their goal may seem simple: to stay clean and sober. Learning to live clean and sober is complicated. The devil is in the details: how to manage daily stress, how to deal with painful feelings like boredom and loneliness without self-medicating, how to cope with sober social situations. You’ve been through detox and rehab already. You’re gathering tools for sober living from recovery groups like AA. But what if you happen to suffer clinical depression and anxiety, and your doctor writes a script for meds? Wait, those are pills. Can you safely use prescription anti-depressants and anti-anxiety drugs as part of your dual recovery? Are there any alternatives?
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Roughly 40% of Americans with at least one episode of mental illness are also addicted to drugs and/or alcohol, according to the National Alliance on Mental Illness. Often, these dual-diagnosis patients were using drugs to change their mood from chronically depressed or anxious to cheerful and socially-engaged. (Ask any addict how that works out in the long term.) The subsequent drug abuse that developed made it difficult to spot their underlying mental illness.
In treating dual diagnosis patients, many clinicians feel they are limited to prescribing only those medications that don’t have a high potential for physiological addiction. Most doctors, as well as some recovery groups, say the addict must avoid all substances -- even anti-depressants -- because they alter one’s mood.
However, some of the most effective prescription drugs for depression, such as Effexor, Prozac, and Zoloft, are safe for addicts because their mood-altering effects happen over several weeks’ time, and are not physiologically addictive. (Lab rats don’t press a lever to get repeat doses of Prozac as they do for cocaine.) According to the American Academy of Family Physicians, anti-depressants carry no risk of relapse when used as directed by a physician. Recovering addicts struggling with depression are best served by participating in a self-help group in addition to pharmaceuticals.
Anti-anxiety medications, such as benzodiazepines, can be dangerous for recovering addicts because they are both mood-altering and highly addictive. Yet in some cases, anti-anxiety prescription may be appropriate in treating severe anxiety during early recovery. Be aware that most 12-step groups will consider you neither clean nor sober while using anti-anxiety meds. However, medically speaking, to use a prescription anti-anxiety medication is a decision best made by you and your physician.
If prescriptions are contraindicated during your recovery, below are eight natural alternatives used by rehab centers and individuals during all stages of addiction recovery. Each of these is freely available in the United States without a prescription. But as with prescriptions, the effects of some herbal supplements could lead to a relapse; please ask your physician for guidance before trying any of these supplements.
Supplements for Depression
- St. John’s Wort (Hypericum): St. John’s Wort is the most popular herb used in treatment of mild to moderate depression in addicts. Its active components hypericin and hyperforin inhibit monoamine oxidase and reuptake of serotonin and norepinephrine as prescription anti-depressants do. For this reason, St. John’s Wort should never be taken along with prescription SSRI anti-depressants because it can lead to a dangerous condition called serotonin syndrome. St. John’s Wort has been thought to trigger mania or psychosis in some patients with underlying bipolar or schizophrenia.
- SAMe (S-adenosyl methionine): Our bodies naturally make this molecule via a reaction of the amino acid methionine with adenosine triphosphate. The SAMe in dietary supplements is produced in labs using yeast cell cultures. SAMe supplements, available in Europe by prescription and in North America over the counter, have been studied since the 1950‘s for their ability to relieve depression symptoms. A June, 2011 analysis of clinical evidence conducted by a Canadian integrative medicine center found that SAMe reduced depressive scores in 4 out of 5 small randomized controlled trials. However, according to the Mayo Clinic, SAMe has triggered anxiety and mania episodes in some people, including those with bipolar disorder.
- Omega-3 Fatty Acids: This essential fatty acid is found only in food sources such as fish, nuts and some plants. People often take concentrated omega-3 supplements to treat depression and cognitive symptoms such as slowed thinking. According to University of California, Los Angeles researcher Dr. Fernando Gómez-Pinilla, "Dietary deficiency of omega-3 fatty acids in humans has been associated with increased risk of several mental disorders, including attention-deficit disorder, dyslexia, dementia, depression, bipolar disorder and schizophrenia." Because omega-3‘s effects on mood are subtle and occur over time, similar to anti-depressants, omega-3 doesn’t appear to raise the risk of relapse for addicts.
- 5-HTP (5-hydroxytryptophan): A naturally-occurring metabolic intermediate, 5-HTP is a precursor of serotonin, the neurotransmitter that most affects mood. Serotonin is also known as 5-HT; vitamin B6 helps enzymes convert 5-HTP to 5-HT, therefore supplementation with B6 combined with 5-HTP may be especially useful in treating depression. Our diets contain little 5-HTP, but this amino acid can be extracted from the plant Griffonia simplicifolia, source of most 5-HTP in supplements. There seems to be little risk of using 5-HTP alone as a natural mood elevator, but as with St. John’s Wort, never use it while taking SSRI’s.
Supplements for Anxiety
- Kava kava: A preliminary study done in 2001 claimed that the active ingredients in kava kava, called kavapyrones, can ease drug cravings through binding to brain regions associated with cravings. But kava kava definitely changes mood shortly after ingestion,: users report a very relaxed feeling, sometimes accompanied by “pins and needles,” numb or creeping sensation in the skin. Many people who take kava experience a temporary but strong euphoria. Also, note that kava kava can cause liver inflammation and damage if used in excess, or when there is pre-existing liver disease. For these reasons, kava is probably unsafe for recovering addicts.
- L-Theanine: Traditionally sourced from green tea, L-theanine is an amino acid derivative that naturally increases GABA (gamma-aminobutyric acid) and dopamine levels. Higher GABA levels are associated with feelings of calm, increased ability to think, and improved mood. Dopamine levels are associated with wanting pleasurable things like food, sex, and drugs. The dopamine pathways of recovering addicts become altered during periods of drug abuse, because many drugs promote extremely high levels of dopamine over periods of time, leading to the system’s inability to regulate itself naturally. The calming effects of L-theanine are very mild compared to benzodiazepines or other prescription downers.
Fundamental Lifestyle Changes to Heal Depression and Anxiety
- Exercise: Moderate exercise is proven to reduce depression symptoms, from cognitive problems to lethargy and apathy. A regular exercise routine should be a critical part of the recovering person’s self-care toolkit. It may sound like old-fashioned advice to recommend a daily walk in fresh air and sunshine, but it benefits a person on so many levels. Exercise is the safest, cheapest, and most effective alternative treatment for depression there is, and very unlikely to trigger a relapse (although we know of several addicts in recovery who seem to become dependent on exercise to maintain a good mood; personally, if you had to pick your poison, choosing moderate exercise isn’t likely to cause serious life consequences.)
- Correcting Nutritional Deficiencies: Another tool in the addict’s self-care toolkit is maintaining an excellent diet. Ideally, the addict should be assessed and treated for vitamin and mineral deficiencies, which are frequent in long-term addiction but which, such as anemia, could also have existed prior to the substance abuse. When the body has proper fuel, all aspects of the person are much better able to cope with stress, anxiety, all the demands of sober living. Tom Leland, M.D. is quoted as saying at a medical panel discussion at the National Methamphetamine Drug Conference that "it takes three months for the dopamine depletion to recover. Amino acid nutrients, such as QUIT vitamins with neurotransmitter replacements, are sometimes helpful."
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