Depression, Agitation, and Relapse: Risk Factors in Treatment and Recovery

There are many catalysts that can trigger a substance abuse relapse, but perhaps the most insidious dangers come from certain mental health conditions. By hijacking the brain, they can make all the training and hard work of treatment seem very far away, and the ease and pleasure of getting high or drunk much better by comparison.

Among the various risk factors for relapse in treatment and recovery, depression and agitation rank very high, but they can be countered and overcome.

Depression: An Intensely Negative State of Mind

To understand how depression and agitation (or anxiety or panic disorders) can threaten recovery by way of relapse, it is necessary to look at what such mental health conditions to do the body and mind.

The American Psychiatric Association explains that depression is a very common, very serious medical illness that affects feelings, thoughts, and actions. While everybody feels sad and unhappy from time to time, especially in time of stress and grief, depression is different. In clinical terms, “depression” describes an intensely negative state of mind, a lingering burden of despair and desolation that cannot simply be shaken off or dispelled by being cheered up. Depression is powerful enough to suck all the joy out of life, making the victim lose interest in hobbies or spending time with friends or family. In the words of a writer at Vice, “Depression steals your soul, and then it takes your friends.”

Clinical depression has a number of causes behind it: genetic, psychological, and social, sometimes occurring in isolation and sometimes in combination. These factors may affect how the brain functions, which causes a variety of behavioral and physical symptoms (which, in turn, increase the chance that a person will relapse).

One such symptom is risky and impulsive behavior. A psychologist at Harvard Medical School tells WebMD that even though clinical depression causes fatigue and lethargy, some sufferers resort to drugs or alcohol to try and get out of the cloud that smothers them. The rush and thrill of a brief drug high or alcohol boost provide a small window of relief from the crippling emotional pain of clinical depression.

Mindfulness Therapy

As a mental health disorder, depression “can unearth unbearable feelings,” which simultaneously causes its victims to collapse under its weight and also compels them to try and escape. Some people do this by engaging in self-harm (such as cutting) or risky sexual encounters; others look for drugs and alcohol. Even with counseling and therapy, depression is a long-term condition, warns the Primary Care Companion Journal. Certain reminders of the “unbearable feelings” might trigger the escape response in some people. Part of treatment entails knowing how to control and counter those responses, and one such method might be mindfulness therapy. A meta-analysis study published in the JAMA Psychiatry journal found that mindfulness (a distinct psychological process of focusing the person’s internal and external attention on the present moment) controls depression, and patients in recovery who used a particular form of mindfulness therapy known as Mindfulness-based Cognitive Behavioral Therapy (MCBT) were nearly 25 percent less likely to relapse within five months compared to patients who used only antidepressants. Furthermore, some antidepressants were found to have serious side effects, including suicidal thoughts; mindfulness therapy, on the other hand, had no such issues. The lead author of the study, who is also the professor of clinical psychology at the Oxford Mindfulness Centre at the University of Oxford’s Department of Psychiatry, said that MBCT and antidepressants offered a “significant benefit in terms of reduced rates of relapse,” by giving clients who have a notable history of depression new approaches and skills to stay sober. As a way of empowering clients to take responsibility and invest in their own recovery, MBCT teaches them meditation techniques that they can apply in their daily lives, whenever their depressive feelings become active and the temptation to relapse is noticed.

Mindfulness therapy as part of addiction recovery can be literally lifesaving. According to Psychology Today, people who have depression have a 10 percent lifelong chance of committing suicide, as do people who have a substance use disorder. A person who has both depression and a substance use disorder has a 25 percent chance of suicide risk. For this reason, depression is taken very seriously in substance abuse treatment, and any recovery program should have components for addressing both the addiction problem and the depression, separately and simultaneously.