Digital Dharma

The Middle Path, One Day At A Time


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Antidepressants and PAWS

In reviewing today’s search terms, I found four listings that read “Do all antidepressants cause PAWS?”  I’ve previously gotten comments on the PAWS article indicating that there is confusion about this issue, and I’d like to lay it to rest here, if possible.

PAWS is caused by changes in our brains as they become addicted to alcohol or other drugs.  When the drug is withdrawn, there is a period of dysfunction while the brain repairs itself.  It begins two to three weeks after cessation of the drug(s), and continues for several months or, in extreme conditions, for up to two years.

Antidepressants (ADs) neither cause nor prolong Post Acute Withdrawal Syndrome (PAWS).  Antidepressant medications act on different portions of the brain.  They will not trigger addiction, cause relapse or otherwise negatively affect recovery.  In fact, many recovering people benefit greatly from using antidepressants.   Depression is common in early recovery, and ADs can literally make the difference between successful recovery and relapse.

There are people in the rooms of AA, NA and some of the other 12-step groups who, with only the best of intentions, advise newcomers to stay off all drugs.  With due respect, they may know a lot about how they themselves recovered, but they are not mental health or addiction professionals.  If you are feeling as though life isn’t worth the trouble, or having feelings of self-harm, see a physician about getting on an antidepressant medication.

The life you save may be your own.

Note: Although they are not addictive and do not cause PAWS, ADs should not be stopped, once begun, without the supervision of a physician.  There is no withdrawal per se, but there can be a rebound effect leading to deep depression if they are not tapered off rather than quitting “cold turkey.”


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A Comment From the PAWS Article

Dan was kind enough to comment on the Post Acute Withdrawal Syndrome article I wrote some time ago.  You can read the article here. I so liked the way he expressed himself on the issue of store-front detox docs, that I asked if I could use his comment:

Dan, on May 18th, 2009 at 18:32 Said:

I succumbed to the Madison-Avenue hyperbole spewed by a storefront Suboxone-peddling physician. This doc assured me that my years of opiate abuse/dependency would dissipate in a mere two weeks with this wonder drug. Granted, while on Suboxone I felt wonderfully well; afterwards, however, my spirits crumbled as I began to feel worse than I had during the peak of cold-turkey withdrawal. Of course, he dutifully advised me that I was experiencing PAWS – and for an additional $800 in cash I could enjoy another two to four weeks of Subox. I gallantly and charmingly declined.

My relapse was all but inevitable. Eights months later (after a literal drive-by intervention) I entered a medical detox facility and then was assigned to an intensive outpatient program three times per week, three hours per day for 24 sessions – attached thereafter to a one-year aftercare program. This process has been life-changing for me. And right now we are “working” on the skills and strategies to understand and soberly cope with PAWS. Who woulda thunk? The group’s facilitator is an LADC who focuses a huge amount of therapy time on helping her clients understand PAWS and its propensity for leading to relapse. Not only does she make us dig deeply to uncover our original motives for “using,” she guides us and prompts us to do the work necessary to cope during recovery.

There is hope out there. To all who now suffer, understand the pain – instead of trying to cover it. In so doing, you improve greatly the chances that your tomorrows will be improvements upon your “today.” Indeed, this, too, shall pass.

My Most Positive Thoughts to All –

Dan