Last Updated on May 12, 2021 by Ben Lesser
Antidepressants are not as addictive as substances like alcohol and heroin.
Antidepressants abusers do not experience the cravings that other drugs cause, nor do they share the euphoria, addictive behaviours, or adverse effects that many other drugs do.
Antidepressants can also cause physical dependence in some people. People who suffer from depression are also more likely to misuse other substances.
Antidepressant addiction can develop in people who never needed the drugs, to begin with. Some people are misdiagnosed with depression and given antidepressants as a result. According to one study, nearly two-thirds of patients with depression were misdiagnosed and given unnecessary antidepressants.
The World Health Organization (WHO) estimates that depression is the leading cause of disability worldwide, affecting 350 million people of all ages around the globe.
The National Institute of Mental Health (NIMH) estimates that by the time they turn 18, 3.3 per cent of adolescents will have a depressive disorder, and girls are more at risk than boys. Depression is characterized by episodes of sadness that affect everyday life and functioning. Symptoms must be present for at least two weeks to be diagnosed as a depressive disorder.
Anxiety disorders affect nearly 18 per cent of the American population, around 40 million people. They are the most common mental illness in the country, as reported by the Anxiety and Depression Society of America (ADSA). These disorders include generalized anxiety disorder (GAD), panic disorders, post-traumatic stress disorder (PTSD), phobias, social anxiety disorder and obsessive-compulsive disorder. Anxiety disorders affect the way stress is processed.
Anxiety disorders and depression often co-occur together about half the time, according to ADSA. One in 10 adults over the age of 12 in the United States takes antidepressant medications used primarily to treat depression and anxiety disorders, making antidepressants the third leading type of prescription drug taken in America, as published by the Centers for Disease Control and Prevention, or CDC.
As with any drug or medication, antidepressants are not without side effects and risk factors. The CDC reports that 14 per cent of Americans currently taking antidepressant medications have been taking them for ten years or longer, and less than one-third of those taking one antidepressant have been seen by a medical professional face to face in the past year. Approximately 80 per cent of antidepressant medications are not prescribed by a psychiatrist, as published by NIMH. Taking medications long-term and without proper supervision, medical treatment, and continuous medical evaluations by trained professionals may lead to drug dependency or addiction.
What Are Antidepressants?
Antidepressants work by rebalancing neurotransmitters in the brain, which helps relieve depression and anxiety. Antidepressants are often given to people with certain mental illnesses or depression to manage their symptoms. Antidepressants come in several ways, each of which acts differently.
Many antidepressants, for example, operate by increasing serotonin, a natural chemical in the body that helps to stabilize mood. It aids in the elimination of unpleasant symptoms such as excessive depression, anxiety, and signs of obsessive-compulsive disorder.During the years 2011–2014, 12.7% of people aged 12 and up, 8.6% of men, and 16.5 per cent of women took antidepressant medicine in the previous month.
Long-term planning Antidepressants are widely used, but many people are unsure of how long they may need to take them. Doctors usually recommend this form of medication for at least a year to ensure that the patient receives the drug’s full benefit. Another explanation is that depression will last anywhere from four to eight months, so you’ll need ample time for the treatment to work and the body to return to normal after the depression has passed. After a year on the drug, the patient must decide whether they no longer need the medication or whether they believe in maintaining it for a few more months will benefit their situation.
Dependence vs Addiction
Antidepressant dependency is a state of adaptation caused by frequently taking a drug, in which sudden discontinuation of use or rapid dose reduction may result in a specific withdrawal syndrome.
Antidepressant Addiction is a primary, chronic, a neurobiological condition whose development and expression are influenced by genetic, psychosocial, and environmental influences. At least one or more of the following habits are present: impaired control over substance use, compulsive use, continued use despite harm, and craving. Addiction to drugs is a treatable condition that can be treated through a multidisciplinary approach, but relapse is typical.
There are several different forms of antidepressant drugs on the market today, and research on addiction’s potential varies. Various drugs impact the brain in various ways, increasing the risk of addiction in some people but not others. Environmental and genetic factors may influence substance abuse or dependence. According to the National Institute on Drug Abuse(NIDA), individuals’ biology is more vulnerable to addiction or drug abuse than others by a factor of 40 to 60% of the time.
Medications and drugs alike make chemical changes in the brain. Taking them before the brain is fully developed, like in adolescence, can increase the risk factors for developing a substance abuse problem later on. The use of any prescription drug beyond the scope of its intended or medical help is considered drug abuse. NIDA reports that prescription drugs are the most commonly abused substances in America, behind alcohol and marijuana, along with over-the-counter medications. Prescription drugs are generally easy to obtain and falsely perceived as safe since they often come out of a medicine cabinet where they were initially prescribed by a doctor. The 2013 National Survey on Drug Use and Health (NSDUH) reported that half of all prescription drugs used for recreational or nonmedical purpose were obtained for free from a relative or friend who got them from a doctor. Using drugs beyond their medical scope increases the risk factors for developing an addiction.
It is essential to understand the difference between addiction and dependency. Addiction is considered a disease requiring treatment, while dependence may be a natural physical occurrence when taking medications long-term. Addiction is defined as a chronic and relapsing brain disease wherein the user cannot control compulsive drug use and continues to seek out drugs beyond medical necessity and without regard to adverse physical or emotional consequences. Addiction contains both emotional and physical components.
Whenever the brain starts relying on chemical transformations caused by drugs, dependence occurs. This causes the brain and the body to become physically reliant on the medication or treatment to function normally. Addiction may occur as a result of dependency, but not always. For example, a person who is physically addicted to antidepressants and requires it to relieve symptoms will not attempt to increase the dose or participate in any compulsive drug-seeking behaviour or violence.
Indications of Addiction
To be officially diagnosed with a substance abuse disorder as defined by the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and published by the American Psychiatric Association, you must have at least two of the following symptoms:
- Taking more of the substance than intended or for a more extended period
- Unsuccessful desire to control substance usage or unsuccessful attempts to stop using the substance
- Substance cravings
- Obsession with the substance
- Substance use interferes with work, school or family obligations
- Cessation of recreation or social events previously enjoyed due to substance use
- Interpersonal relationship damage from substance use and continued use regardless
- Using substance repetitively in physically dangerous situations or circumstances
- Tolerance to substance
- Withdrawal symptoms when a sensor is removed
- Continued use despite harmful physical and emotional consequences
Substance abuse disorders range in severity, depending on how many of the criteria are present. When one, two or three symptoms exist, the condition is considered mild. In contrast, the presence of four or five symptoms is deemed moderate, and the presence of six or more symptoms is diagnosed as a severe substance use disorder. The severity will also depend on the length of time abusing the substance, abuse method, and other environmental and genetic predispositions.
The most common types of antidepressant medications prescribed, as indicated by NIMH, are:
- Selective serotonin reuptake inhibitors or SSRIs, such as Prozac, Paxil, Lexapro, Serafem, Celexa, Luvox and Zoloft
- Monoamine oxidase inhibitors or MAOIs, like Manerix, Marplan, Emsam, Parnate and Nardil
- Serotonin and noradrenaline reuptake inhibitors or SRNIs, including Effexor, Cymbalta and Pristiq
- Tricyclics, like Tofranil and Norpramin
- Norepinephrine and dopamine reuptake inhibitors or NDRIs, such as Wellbutrin and Zyban
- Noradrenergic and specific serotonergic antidepressants or NaSSAs, like Remeron
Antidepressants are believed to function by changing how the brain’s natural messengers, or neurotransmitters, work. Certain neurotransmitters, such as serotonin and dopamine, are partially responsible for mood and positive emotions. Antidepressants often block these neurotransmitters’ reabsorption, thereby changing the chemical balance in the brain and boosting mood. Depressed individuals may have lower levels of some of these natural chemicals, and antidepressant medications can increase their production. Antidepressant medications are proven to improve depressive symptoms between 50 and 65 per cent of the time when treating moderate to severe depression after three months of use, as reported by the Royal College of Psychiatrists.
Most prescribing physicians are moving away from tricyclics and MOAIs due to the side effects and diet restrictions that they may incur and leaning more toward SSRIs. Since depression often co-occurs with other disorders, including anxiety disorders, additional medications such as benzodiazepine anti-anxiety medications, like Valium and Xanax, may also be prescribed in tandem antidepressant medications. This can increase the potential side effects and risk factors if mismanaged or not adequately supervised.
The side effects of antidepressant medications will vary depending on your personal experiences, genetic makeup, and type of medication required. Generally speaking, antidepressants are not thought to be as effective on mild forms of depression but are reserved for more moderate to severe manifestations. General health concerns or risk factors may include:
- Weight gain
- Dry mouth
- Nausea and vomiting
- Irregular heart rate
- Sleepiness or drowsiness
- Sexual dysfunction
- Trouble urinating
- Heightened blood pressure
- Potential for increased suicidal thoughts or tendencies
Tricyclic antidepressants may cause an unsafe drop in blood pressure when you stand up. Side effects are increased with the introduction of other drugs or alcohol. If you, or someone you know, are experiencing suicidal thoughts, seek immediate professional help. Be sure to discuss these potential health concerns with your doctor, and keep in mind that you may experience more or fewer of these side effects than others.
Is it Possible to Become Addicted to SSRIs?
There is a lot of discussions on pharmaceuticals of Pharmaceutical properties, especially SSRI drugs, as well as their addictive qualities. Substance abuse is well known for altering the brain’s chemical makeup and interferes with the normal development of many neurotransmitters that are responsible for pleasure and mood in the same manner that prescription drugs do. Chronic illicit drug and alcohol abuse may lead to physical and psychological dependence on these substances to maintain feelings of balance and normalcy. This dependence may turn into an addiction when the need for substance abuse takes over and excessive amounts of time are dedicated to obtaining the substance, using it, and recovering from its effects. SSRI medications are often mistakenly referred to as “happy pills.” However, they do not seem to produce the same sense of euphoria or artificial happiness that other medicines, including benzodiazepines, do. SSRIs seek to regain a natural balance in the brain instead of merely increasing pleasant feelings; therefore, it is estimated that no high is established by taking them illicitly.
Antidepressants are not commonly thought to be addictive in doctors’ conventional sense. Antidepressants may induce physical dependency, as shown by the withdrawal symptoms that may occur when antidepressants are stopped or reduced. When people stop taking antidepressants unexpectedly, they sometimes experience withdrawal symptoms such as nausea, tremors, and depression.
However, few people give up their everyday commitments to find antidepressants because the incentive is insufficient; antidepressants do not provide a euphoric rush of dopamine. For antidepressants, there are no cravings, no risky habits, and no examples of long-term Addiction.
People try to misuse antidepressants by snorting them, particularly Wellbutrin, but this does not lead to Addiction. When no other options are available, it’s usually done to give the patient a placebo effect when they’re craving their actual drug of choice.
To be classified with an addiction, a tolerance to the drug must be established, leading to drug-seeking behaviour, which doesn’t seem to occur with SSRIs. While obsession seems less likely, dependency can happen when taking SSRIs long-term, as can withdrawal symptoms. This is often mistaken for true addiction. Some researchers argue that the presence of withdrawal and physical dependency does indeed make SSRIs addictive, while others disagree.
SSRI withdrawal symptoms include insomnia, nausea, alteration of touch sensation, and feelings of electrical shocks in the brain. When these symptoms are present, it is referred to as SSRI discontinuation syndrome, and it is not officially a side effect of addiction. A Danish study published in Science Nordic argues that as many as 37 out of the 42 withdrawal symptoms for the known addictive benzodiazepine medications that were discontinued mainly as antidepressant medications with the rise of SSRIs are identical to those experienced during SSRI discontinuation syndrome.
Whether or not an antidepressant and SSRI medications are considered officially addictive, if you are suffering from depression and long-term usage of these medications, you may benefit from specialized treatment for substance abuse and mental health disorders. It would be best to quit taking these medications without assistance from a doctor or other medical professional.
Antidepressants help many people live happier, more active lives, despite the dangers associated with their use. Patients who have been prescribed antidepressants should never avoid taking them without first consulting their doctor.
Depression varies widely from person to person. It is defined by the Mayo Clinic as a mood disorder affecting how you think, behave, and feel, and it is indicated by loss of interest and persistent sadness. The treatment of depression often requires both medications and behavioural or Cognitive Behavioral Therapy (CBT) to be the most successful. CBT teaches coping mechanisms and helps individuals modify negative thought and behaviour patterns into more positive outlooks and self-images. Healthy lifestyle changes, including a balanced and nutritious diet and exercise or recreational opportunities, are helpful during recovery and increase natural endorphins and pleasant feelings.
Depression often co-occurs with other mental health disorders and substance abuse. Those suffering may turn to illicit substances or alcohol to numb the pain or attempt self-medication. Similarly, the abuse of substances may lead to depression or depressive thoughts. It is often unclear which comes first, but ADAA estimates that depression and substance abuse disorders co-occur at least 20 per cent of the time.
When two disorders are present in the same person simultaneously, it is considered a dual diagnosis or co-occurring disorders, and specialized treatment is the best option for a lasting recovery. Evidence-based treatment models combine clinicians’ expertise with scientific research and individual personalities to determine the best course of action. Dual diagnosis treatment is the most successful when medical professionals work together to provide integrated and simultaneous treatment of both disorders. Both depression and substance abuse disorders are then treated as primary disorders.
Whether you, your loved one, struggle with depression, substance abuse, or both, FRN treatment centres provide comprehensive and compassionate care plans designed to fit each individual’s unique set of circumstances. Family, group and individual therapies and counselling sessions are often combined with medications and peer support or self-help groups. Contact us today to determine the best path toward lasting and healthy recovery.
Ben Lesser is one of the most sought-after experts in health, fitness and medicine. His articles impress with unique research work as well as field-tested skills. We are honored to have Ben writing exclusively for Dualdiagnosis.org.