Still Depressed After Quitting Drinking? What Happens Now

Three months. You counted them.

You got through the first hard week, the wedding where everyone had a drink in hand, the Tuesday nights that you used to have a bottle.

And still wake at five in the morning with something heavy in your chest.

The story is always the same: stop drinking, feel better. So when you are still depressed after quitting drinking, the conclusion seems clear. Depression outlasting the first weeks without alcohol is a clinical signal you may have major depressive disorder.

If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).
Our Fort Worth office is 817-659-7344 for non-urgent questions. We are an outpatient practice, not a crisis service.
SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.

Why are you still depressed after quitting drinking?

Mood usually does change in the first month, so the fact that yours has not is a finding to work with, and it says nothing about how hard you have tried.

Depressive symptoms have been shown to significantly improve after a period of abstinence from alcohol (typically 3 to 4 weeks) https://pmc.ncbi.nlm.nih.gov/articles/PMC6799954/. SAMHSA’s TIP 48 says they “can linger for 3 to 6 months after abstinence.” The direction matters more than the number: improvement usually starts during the first month, and if still present past that window deserves an evaluation.

The authors add that “any diagnosis of depression during active periods of drinking or during acute alcohol withdrawal should be made provisionally.” While you were drinking, the alcohol and the depression were hard to separate. Now they are easier to tell apart.

Is this protracted withdrawal, or insomnia after quitting alcohol?

Two things imitate depression in early abstinence. SAMHSA’s advisory on protracted withdrawal lists, for alcohol, symptoms that outlast the acute phase: “anxiety, hostility, irritability, depression, mood instability, fatigue, insomnia, difficulties concentrating and thinking.”

SAMHSA is careful with the label: no consensus on the term or definition exists, the Diagnostic and Statistical Manual of Mental Disorders has never included a protracted withdrawal diagnosis, and the advisory publishes no timeframes. For alcohol, though, protracted withdrawal “has been well documented,” and anecdotal and case literature suggests symptoms may last two years or longer after the last drink. So the experience is real, and still not something to wait out alone.

NIAAA’s Core Resource on Alcohol reports that alcohol-related sleep changes may recover “only after 30 or more days of abstinence,” and Brower and colleagues, studying 267 patients in 2011, found insomnia “persisted in one-quarter of patients despite abstinence.”

Anhedonia after quitting drinking: why nothing works yet

Anhedonia is the clinical word. The food is fine, the music is fine, the weekend is fine, and none of it lands.

SAMHSA describes the mechanism: repeated substance use leaves the brain responding “less readily to naturally rewarding activities such as listening to music.” A 2014 review of 32 studies by Garfield and colleagues found anhedonia raised across a range of substances and easing with abstinence.

Say the flatness out loud at your next appointment. It is the symptom people most often leave out, because describing it sounds like describing nothing.

Alcohol-induced depression vs. major depression: how the difference gets sorted out

The abstinence that made you feel cheated is what makes diagnosis possible.

McHugh and Weiss write that if depressive symptoms persist after a period of abstinence, “4 weeks is the typical recommendation,” a diagnosis of an independent depressive disorder “can be made with more confidence.” SAMHSA’s TIP 42 uses 30 days. These are confidence thresholds, not switches that flip on day 29, and the same authors note many cases first called substance-induced symptoms were later reclassified as major depression.

An evaluation covers:

• A timeline, which NIAAA’s Core Resource calls “a key tool for differential diagnosis”: whether symptoms were present during earlier stretches without alcohol, which helps “differentiate whether they are alcohol-induced or separate, primary conditions.”
• Screening for bipolar disorder, since an antidepressant given alone can be associated with a switch into mania.
• Direct questions about suicidal thoughts.
• Basic medical screening, because heavy drinking travels with thyroid, liver, and nutritional problems that cause the same fatigue.

What treatment for depression and drinking actually looks like

Treating both sides matters. NIAAA’s Core Resource: “The likelihood of recovery from both conditions is higher if both the AUD and the co-occurring mental health disorder are treated.”

The effects are modest. A 2018 Cochrane review by Agabio and colleagues pooled 33 studies and 2,242 participants. Antidepressants reduced depression severity, but that evidence was low quality and lost significance once high-risk studies were excluded. The better-graded finding was about the drinking: at moderate quality, antidepressants raised the number of people were abstinent during the trials and lowered how much they drank on drinking days.

McHugh and Weiss suggest behavioral activation therapy may have particular promise for the two together. FDA-approved medications for alcohol use disorder also exist; whether this applies to you is a decision for a clinician to make.

We are an outpatient psychiatry practice. Dr. Ghelber treats addiction as part of general adult psychiatric care and is a certified provider of buprenorphine treatment for opioid use disorder. We do not offer detox, residential rehab, partial hospitalization, intensive outpatient programs, or 24/7 substance use services. If that is the care you need, the SAMHSA helpline above exists for it.

If standard treatment does not work

Sometimes depression is its own condition, gets treated properly, and still does not go away. This may be  treatment-resistant depression. Although resistant to treatment, there are treatment options

Deep TMS delivers magnetic pulses through a cushioned helmet. The BrainsWay system is FDA-cleared, under 510(k) K122288 from January 2013, for depressive episodes in adults with major depressive disorder who did not improve enough on antidepressant treatment in the current episode. BrainsWay is also cleared for smoking cessation, but not for alcohol use disorder.

IV ketamine is another option. Its use for depression is off-label and considered investigational by the FDA. Ketamine is also a Schedule III controlled substance under 21 CFR 1308.13, with recognized potential for misuse, which is why substance use history is assessed before an infusion series Ketamine is not a treatment for addiction; that is not an established use and not offered here.

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If you have started drinking again

In a 1998 study in Archives of General Psychiatry, Greenfield and colleagues followed 101 adults hospitalized for alcohol dependence; major depression at admission was associated with a shorter time to a first drink, hazard ratio 2.03. That was an inpatient sample, not everybody. SAMHSA notes that people affected by anhedonia and other protracted withdrawal symptoms may return to substance use to relieve them, when resisting is hardest. None of that predicts your future, and none of it means treating depression prevents a return to drinking. It is a reason to have it looked at now.

NIAAA notes that suicidality is a concern for many people who drink heavily, whether or not they have alcohol use disorder, and drinking again while already depressed puts both in the same room. If your thoughts turn toward not wanting to be here, call or text 988, or call us at 817-659-7344. That is not a call you have to earn by getting worse first.

If you are drinking, do not stop abruptly on your own. SAMHSA’s detoxification guidance says seizures, delirium tremens, and dysregulation of temperature, pulse, and blood pressure “can lead to fatal consequences” in severe alcohol dependence. The FDA’s 2020 boxed warning for the benzodiazepine class says stopping them abruptly “can result in withdrawal reactions, including seizures, which can be life-threatening.” Some people need medically supervised withdrawal; the American Society of Addiction Medicine’s 2020 guideline covers both ambulatory and inpatient care. Talk with a clinician first, and go to an emergency room if shaking, confusion, or a seizure develops.

Frequently asked questions

How long does depression last after you quit drinking?
Nobody can promise a time. NIAAA’s journal says depressive symptoms typically improve significantly after roughly 3 to 4 weeks of abstinence; SAMHSA’s TIP 48 says they can linger 3 to 6 months, and SAMHSA’s protracted withdrawal advisory describes symptoms clearing for the first month or two and then returning. If your mood has not moved, get it evaluated.

Is this a treatment center for alcohol use disorder?
No. We are an outpatient adult psychiatry practice. Dr. Ghelber treats addiction as part of general psychiatric care and is a certified provider of buprenorphine treatment for opioid use disorder. We do not provide detox, residential rehab, partial hospitalization, intensive outpatient care, or 24/7 substance use services. Call SAMHSA at 1-800-662-HELP (4357) for those.

Would TMS or a ketamine infusion help me stay off alcohol?
We do not offer either for that purpose, although they may help. BrainsWay Deep TMS is FDA-cleared for major depressive disorder in adults, and its only substance-related clearance is for smoking cessation. IV ketamine for depression is off-label and considered investigational by the FDA.

Why is quitting alcohol on your own considered risky?
SAMHSA’s detoxification guidance describes seizures, delirium tremens, and dangerous swings in temperature, pulse, and blood pressure in severe alcohol dependence as outcomes that can be fatal, and the FDA says benzodiazepine withdrawal can be life-threatening. Talk with a clinician before you stop, and go to an emergency room if shaking, confusion, or seizures develops.

The bottom line

Mood usually improves in the first weeks after the drinking stops. Depression still fully present three months later deserves attention, not a conclusion about your character. Some of it may be protracted withdrawal or unresolved sleep; some may be a depressive disorder of its own, You did the hard part. To succeed you may need a next appointment..

Talk with us

If you are in Fort Worth or the surrounding North Texas area and what you have read here sounds familiar, we would be glad to talk it through with you. The Institute for Advanced Psychiatry is an outpatient practice at 6800 Harris Parkway, Suite 100, treating adults 18 and older. You can request an appointment or call 817-659-7344.

If you are in crisis or thinking about harming yourself, please do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or go to your nearest emergency room.

SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.

Sources

1. McHugh RK, Weiss RD. “Alcohol Use Disorder and Depressive Disorders.” Alcohol Research: Current Reviews (journal of the National Institute on Alcohol Abuse and Alcoholism) 2019;40(1):arcr.v40.1.01. https://pmc.ncbi.nlm.nih.gov/articles/PMC6799954/
2. National Institute on Alcohol Abuse and Alcoholism. “Mental Health Issues: Alcohol Use Disorder and Common Co-occurring Conditions.” Core Resource on Alcohol, 2025 update. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/mental-health-issues-alcohol-use-disorder-and-common-co-occurring-conditions
3. Substance Abuse and Mental Health Services Administration. “Protracted Withdrawal.” Substance Abuse Treatment Advisory 2010;9(1). https://library.samhsa.gov/sites/default/files/sma10-4554.pdf
4. Substance Abuse and Mental Health Services Administration. “Substance Use Disorder Treatment for People With Co-Occurring Disorders.” TIP 42, updated 2020. https://www.ncbi.nlm.nih.gov/books/NBK571013/
5. Substance Abuse and Mental Health Services Administration. “Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery.” TIP 48, 2008. https://www.ncbi.nlm.nih.gov/books/n/tip48/p1_ch1/
6. Substance Abuse and Mental Health Services Administration. “Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances.” TIP 45, 2006. https://www.ncbi.nlm.nih.gov/books/NBK64116/
7. Lindsay DL, Freedman K, Jarvis M, et al. “Executive Summary of the American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management.” Journal of Addiction Medicine 2020;14(5):376-392. https://pubmed.ncbi.nlm.nih.gov/32909985/
8. U.S. Food and Drug Administration. “FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class.” Drug Safety Communication, 2020-09-23. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
9. U.S. Food and Drug Administration, Center for Devices and Radiological Health. “510(k) Premarket Notification K122288, Brainsway Deep TMS System.” Decision date 2013-01-07. Indications for Use verified against the 510(k) summary at https://www.accessdata.fda.gov/cdrh_docs/pdf12/K122288.pdf. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K122288
10. U.S. Food and Drug Administration, Center for Devices and Radiological Health. “510(k) Premarket Notification K200957, BrainsWay Deep TMS System (smoking cessation).” Decision date 2020-08-21. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K200957
11. U.S. Drug Enforcement Administration. “Schedules of Controlled Substances: Schedule III.” 21 CFR 1308.13. https://www.ecfr.gov/current/title-21/chapter-II/subchapter-A/part-1308/section-1308.13
12. Agabio R, Trogu E, Pani PP. “Antidepressants for the treatment of people with co-occurring depression and alcohol dependence.” Cochrane Database of Systematic Reviews 2018;4(4):CD008581. https://pubmed.ncbi.nlm.nih.gov/29688573/
13. Greenfield SF, Weiss RD, Muenz LR, et al. “The effect of depression on return to drinking: a prospective study.” Archives of General Psychiatry 1998;55(3):259-265. https://pubmed.ncbi.nlm.nih.gov/9510220/
14. Brower KJ, Krentzman A, Robinson EAR. “Persistent insomnia, abstinence, and moderate drinking in alcohol-dependent individuals.” The American Journal on Addictions 2011;20(5):435-440. https://pubmed.ncbi.nlm.nih.gov/21838842/
15. Garfield JBB, Lubman DI, Yucel M. “Anhedonia in substance use disorders: a systematic review of its nature, course and clinical correlates.” Australian and New Zealand Journal of Psychiatry 2014;48(1):36-51. https://pubmed.ncbi.nlm.nih.gov/24270310/
16. Institute for Advanced Psychiatry. “Diana Ghelber, MD.” Accessed 2026-09-03. https://www.psychiatryfortworth.com/providers/diana-ghelber-md/
17. Institute for Advanced Psychiatry. “Ketamine Infusion Therapy.” Accessed 2026-09-03. https://www.psychiatryfortworth.com/services/ketamine-infusion-therapy/

Medical disclaimer

This article is for general education and is not medical advice, a diagnosis, or a treatment recommendation for any individual. Reading it does not create a physician-patient relationship. Treatment decisions, including whether any medication or procedure is appropriate for you, should be made with a qualified clinician who knows your history. Do not start, stop, or change a psychiatric medication without talking to your prescriber. If you are experiencing a medical or mental health emergency, call 911 or 988.