PAWS or Depression? Long-Term Withdrawal Symptoms vs a Mood Disorder

Weeks or months after stopping, many people still struggle with poor sleep, low mood, irritability, anxiety and trouble concentrating. This is often called post-acute withdrawal syndrome, or PAWS. It can also be depression, and telling them apart matters.

What PAWS looks like

PAWS is not a formal diagnosis, but it describes a common experience: symptoms that come and go in waves, often triggered by stress, and gradually ease over months as the brain heals.

When it may be depression

• Low mood or loss of interest most of the day, nearly every day, for two weeks or more
• Symptoms that are steady or worsening rather than easing
• Feelings of worthlessness or thoughts of death or suicide
• Depression that began before substance use or runs in the family

How we sort it out

Your provider asks about the pattern and timing, uses screening questionnaires such as the PHQ-9, and checks for medical causes such as thyroid problems. Depression and PAWS can overlap, and both are treatable.

Why it matters

Untreated depression is one of the strongest triggers for return to use. Treating it, with counseling and medication when appropriate, protects recovery.

If you are having thoughts of harming yourself, call or text 988 or call 911.

Help at Hope Addiction Medicine

Our team combines medication with counseling and behavioral therapies, in person at our West Ashley office in Charleston and by telehealth when appropriate. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment or call our office.

This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber. If someone may be overdosing, call 911 and give naloxone if you have it.