Why do I feel like crap in recovery?

There’s this promised idea that recovery makes you feel better.. “You’ll be happier”, “you’ll have better relationships”, “you’ll have more energy”... and instead you feel.. depressed, tired, lethargic, on edge, just not yourself... Is all this hard work worth it to feel this bad?!? Maybe a voice inside wonders if you would feel better in your addiction/eating disorder.. 

You’re not making it up! And it’s not your fault. Here’s some neurochemistry on why you feel down and off-balance when letting go of an addiction/eating disorder behaviors... and how your brain will eventually change!

The Dopamine Loop

Dopamine is a neurotransmitter associated with activities like eating and sex- things that keep the human species alive-it makes you feel good so you do them. This is designed to have a good feedback loop! Food makes you feel good so you will eat it and stay alive!

This cycle is taken over by drugs like heroin. This explains why some drug addicts give up or even abstain from food because they are so focused on getting drugs. The drugs replace the feedback loop that drives you to eat and reproduce so that you can feel good again.

However, it is not just drugs that can co-opt this circuit. Intense experiences such as life or death thrills, crimes, and orgasms can activate this loop. The same part of our brain that lights up the first time you take a hit of cocaine or get your first win at gambling... is the same part of our brain that lights up when someone likes your post on social media! 

Texting and cell phones affecting this loop. You know that desperate need to check your email even though you know the only thing you’ve gotten in the last 30 seconds is an advertisement ...and still you’re hitting the button.. yep, that’s the addictive, dopamine feedback loop. At some point, your email made you feel good.. your brain remembers that and it’s trying to reproduce the same effect.

So how does this play out in eating disorders..?

Exercise

Interestingly enough, exercise can also co-opt this cycle. Meaning that exercise can give you a high that makes you feel really good. And in some cases, exercise can make you feel so good that you may avoid food and sex and other life sustaining activities to feel good.

Anorexia

Anorexia and the role of this loop is less understood. It’s complicated. Research has shown that both struggling anorexics and anorexics who have been recovered for a little while do not receive the same amount of pleasure from food.

Research has not determined which happens first. Does it happen before a person develops an eating disorder and is part of what leads to the eating disorder? Or is it one of the brain changes that happens as a result of the eating disorder? Not sure. Research may never figure this out; it would require a large cohort of people to have multiple brain scans over the course of their lives. But it does mean that, in the brains of people with anorexia, when you eat food.. you have less pleasure. This means that food isn’t as motivating. Researchers believe that this may mean that other facets of anorexia became more motivating like the feeling of control. Research has found that in brains of anorexics, dopamine is more prone to go to an area of the anorexic brain that is associated with worrying and long-term consequences. This part of the brain is associated with learning behaviors. So this biochemically this explains why for some people, eating a piece of cake is highly enjoyable in the moment (dopamine gives an almost immediate biochemical pleasurable payoff!) and in the moment they experience little thought about the connection to weight gain in the future (because the dopamine is not going to the worry center). But for the person with anorexia, the same piece of cake gives little pleasure (because their dopamine is  activating the area of the brain that thinks about the long-term consequences). So thoughts in the anorexic brain about the cake are less pleasurable and more fearful (I.e. “I can’t eat that because...”). As a result, researchers hypothesize the anorexic brain may get more reward out of abstaining than eating. (Note this is only momentary benefit. In the long-run, being underweight leads to decrease in brain mass, difficulty concentrating, lower social cognition, etc, etc!)

The big question is does this change after recovery? Not sure. I have not found research that indicates if this biochemistry changes after recovery. Though some people think that having more positive associations with food will help the brain link the idea of food to a more pleasurable experience. 

Binging

When you frequently overeat, this area desensitizes to dopamine meaning that you require more and more food to get that good feeling. But frequent binging can also complicate this cycle. Eventually binging can increase dopamine and block serotonin which puts a reign on dopamine production meaning it's harder to feel good.

The Cycle

So you may begin to hit a point where some of these things don't feel as good as they did...:-( but you can’t stop doing them.. Why?

1- Our bodies have many systems so it’s not just the dopamine loop. Some of these activities are also affecting other systems like your central nervous system which has it's own feedback loop.

2-Your brain has changed and adapted to the additional flood of dopamine in your system. (Both of these following analogies are oversimplification of complex body systems, but it may be helpful to think about it like this...)

Imagine that your brain originally had an established equilibrium. It produced some level of dopamine. This system wasn’t perfect (and it may be why you needed a boost of ED/addictions). At some point, your brain figured out that every time you use a drug, binge, or exercise, it’s as if you press a button releasing a shot of dopamine to the brain. Think of it as “pressing a dopamine button”. Over time you need more and more dopamine...  you hit the button more and more and more..

Your brain used to produce dopamine to survive but now it gets used to the idea that you’ll get these big surges of dopamine linked to the behaviors so it changes it’s usual output. In order to keep balance, your brain is dependent on these behaviors to produce dopamine. 

When you stop the behaviors, you stop pressing the dopamine button...and that means you feel awful.. you may feel tired, depressed, down, not yourself, off for no reason. Sometimes it doesn’t matter what you do.. you can’t feel good... & you crave feeling good again..

Think about it like a small town…

You could also think about this as analogous to a small isolated town/island. At one point, imagine this small isolated town/island was entirely self-sufficient. The community produced the food and products everyone needed to survive. The balance was not perfect... sometimes things felt pretty hard economically but there was an equilibrium.  

Then one day, quite by accident this small community discovered a small mine that they had a rare resource that people outside of their town desperately desired. This completely changed their town. People flocked to their town to help mine it and process it. Those people spent money on things that had not been produced before so the town started producing different products.  Rather than producing all of the basic things they needed, they started ordering things from neighboring towns and even countries. The economy completely changed. It also wasn’t perfect, but the town found an economic equilibrium.

And then, one day, the mine dried up. There was no more precious resource. And the town’s economy was sent into turmoil. Factories shut down. People moved out. There was suddenly a lot less money. The economy was in shambles. People panicked! Older people in town said, “it’s ok, we can make everything we need like we did before”. But actually that was hard...  planting fields had been turned into industrial parking lots. The younger generations didn’t even know how to make the things they needed.

A few people in the town were desperate to return to how the town had felt when they had the resource. They scoured the countryside looking for another mine. They felt like the mine would give them security and some stability. Eventually, they found a small mine. It reopened and production started again. But somehow this time it wasn’t the same. The economy didn’t go back to where it had been before. There was so much fear in the town that all would be lost. The community needed to know there were a lot of mines to feel safe.

Then, that mine dried up. And the economy fell to pieces again. A wise townsperson said, “we must rebuild the economy to what it will look like today. We can not go to the way before the mine or the way life was during the mine. We must find our economic balance now.” The next few years were hard. People returned to some of their old practices, they also found some new ones. It was a time of doubt and uncertainty. Of trying new things and failing. Of feeling like the town was just getting by and very off balance.

Today, the town has reached a new economic equilibrium. It is not the one it had before. It is not the one it had during the height of the mine. It is a new balance. 

When you stop using behaviors, you quit pressing the “dopamine button”, it is like closing the mine. Suddenly your body loses the happy spurt of dopamine that had become dependent on. This is tumultuous to your system, your brain chemistry feels completely off balance. You feel depressed, off, not yourself...Your system needs time to find a new chemical balance. 

But this time of feeling off-balance can feel horribly low, and some parts of you know that if you just pushed the button, you’d feel a bit better... even if you know you’ll regret it later.. Some parts of you may feel like the townspeople who desperately scoured the countryside for a new mine. Those parts remember feeling happier in your ED/addiction. They would do anything to go back there. They say.. “just one more time pressing the button...”

But when you do “press the dopamine button”, it is like reopening another mine, it creates more chaos in your system. And that tells your body once again.. don't worry I'll keep doing "X" (ie drugs, binging) to make more dopamine! 

Why is it so hard to quit?!?

This is why it’s hard to quit. Our bodies are looking for balance. Our drive for substances or behaviors is the part of our brain that remembers that at one point those were the things that temporality took us out of this dark hole. The cycle of using a behavior....and quitting again... and feeling depressed... so depressed that you want to use again... is partly driven by this neurochemistry. That desperate drive of our brain to make us feel good.

So how do we break this cycle?

1- Wait out the cycle and hope it can get better. 

So unfortunately, one of the best things is to wait out the miserable feeling. Eventually, your brain will readapt to the lack of dopamine and adjust your brain chemistry. You will start feeling ok again without having to do those things! But sitting in that space can be brutal.. you feel depressed, you feel off, & you don’t feel like yourself. Unfortunately, this may take a while; it is not a pleasant process. And it may feel confusing, this feeling may be most prominent at a point where you’ve made a lot of progress. It may at come at a time where you think that life should be falling into place.. you have coping skills, you have worked so hard, and yet you feel so..... down, so off:-(. You may think... "I am doing recovery, why do I feel so depressed?" It may also be confusing to friends and family to see you feeling this way... and their comments can feel hurtful. Restoring equilibrium is not an overnight process but it is worth it. You will not feel this way forever. Believe and keep going!

2- Identify replacement sources of dopamine that do not involve cross-addiction.

This is tricky. And this is why many people pick up a new addiction during recovery. For instance, it is easy to become dependent on excessive exercise while getting off drugs. You’ll need help from people outside your head (like a treatment team) to navigate what possible alternatives might be and what is a reasonable amount.

3- Oxytocin

The neurotransmitter produced by breast feeding is called oxytocin. It's the transmitter that helps you bond to a child during breastfeeding or to a partner during sex. It similarly can make you feel amazing.. It can also take the place of dopamine in the neurotransmitter balance! (So similar to drugs, exercise, binging, etc... taking care of your baby makes you feel good!) Some people describe that their baby makes them feel high similar to their experiences with drugs. Addicted women who are pregnant are likely to decrease their use of substances, partially because the baby provides motivation and partially because of oxytocin-the chemical balances your brain and makes it easier to quit using substances. You may find that having a child, having a pet, being pregnant, or breastfeeding helps you in recovery. On a biochemical level this is true! Take advantage of it! As a cautionary side note, a study of addicts who had ceased using substances significantly during pregnancy returned to "normal" use by the time the child was 18 months-2 years. The brain chemistry balance shifts and parenting can get even more stressful which makes you prone to return to behaviors. So enjoy the temporary boost but expect a decline. And use that time to prepare yourself with coping skills for when your brain begins to shift again!

If you relate to this blog post, I want you to know that horrible feeling of blahness is not uncommon and not your fault. It is scary. It is confusing. It can feel like it will never end. AND it may even be a sign that you are getting better. This time is difficult:-(. Find support. Get help from providers  and practice self-care as your body and mind finds balance. You are amazing for fighting this long through a dark tunnel! Take care of yourself and keep moving forward!

Christi Sherman