Antidepressant Addiction and Abuse

Antidepressants are some of the most widely prescribed medications in the US. They are generally prescribed by doctors for the treatment of moderate to severe clinical depression. Antidepressants are primarily available as oral tablets and capsules.

Two common forms of antidepressants are:

• Serotonin and norepinephrine reuptake inhibitors (SNRI):
  • SNRIs treat depression through a process that changes the patient’s brain’s chemical balance by interacting with serotonin and norepinephrine in the brain.
• Selective serotonin reuptake inhibitors (SSRI):
  • SSRIs treat depression through a process that changes the patient’s brain’s chemical balance of serotonin.

Doctors also prescribe antidepressants for the treatment of Generalized Anxiety Disorder (GAD), chronic pain conditions, and Obsessive-Compulsive Disorder (OCD).

The most common antidepressants are:

• Fluoxetine (Prozac)
• Venlafaxine (Effexor)
• Citalopram (Celexa)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Escitalopram (Lexapro)

There has been a lot of debate regarding the addictive effects of antidepressants. Although many doctors believe that this drug is not addictive by nature or feature, stopping or reducing the medication for depression can cause withdrawal symptoms, such as nausea, depression, hand tremors, and headaches.

Researchers acknowledge that 50 to 80 percent of people taking antidepressants have suffered withdrawal from quitting or reducing their usage. Part of this is due to the short half-life of these medications.

As antidepressants do not create a euphoric high or rush of dopamine, only a fraction of patients who take antidepressants misuses it. There have been no reports of users engaging in dangerous behaviors, having cravings, and showing incidents of prolonged addictive behaviors from using these medications. Antidepressants do not cause addiction or any euphoric high irrelevant of how the drug is consumed.

Antidepressants may cause adverse effects, but those medications also help patients with depression live a better life. Depression is the number one cause of suicide, and antidepressants play a vital role in lowering suicide rates across the globe.

There are five types of antidepressants currently available. Side effects from these drugs vary depending on the type consumed. Most side effects appear during the first two weeks of consumption.

Many doctors prescribe antidepressants as a safer alternative to benzodiazepines due to its less addictive properties and fewer negative consequences. Although antidepressants do not function in the same way as other addictive substances, long-term consumption of the drug can lead to physical dependence.

“The statistics related to antidepressant abuse show an increasing trend. The most common reason for this misuse is to get a psychostimulant-like effect.”

– Columbia University Department of Psychiatry

Abuse and Misuse of Antidepressants, 2014.

Antidepressants do not cause the typical euphoric effects, nor do they create cravings for the drug. Due to its capability to improve one’s mood, individuals misuse the drug in the hopes that increased dosage may result in a euphoric high. This belief is highly misleading as the mechanism of antidepressants contradicts this presumption.

Antidepressants do not provide immediate effects soon after consumption as it requires time to accumulate in the brain. This drug only starts to actively show signs of its capability after a month of consumption. Due to this reason, most antidepressant abuse is attributed to users increasing their dosage due to its immediate ineffectiveness.

Antidepressant dependence is the state of adaptation that results from taking the drug daily or in excess amounts. An individual with antidepressant dependence can experience withdrawal symptoms when discontinuing the drug use abruptly. However, all users develop a dependence on a drug over a certain period, but not all develop an addiction.

Antidepressant addiction is a chronic, primary, neurobiological disease that is influenced by various psychosocial, genetics, and environmental factors. Some of the behaviors that characterize antidepressant addiction are:

• Compulsive use of the drug.
• Consuming the drug despite being aware of its adverse effects.
• Developing cravings for the drug
• Staying isolated from family and friends.
• Neglecting professional and personal responsibilities.
• Wanting to cut down or quit drug use, but being unable to do so.
• Combining antidepressants with other drugs despite being aware of its dangers

Patients with clinical depression are about 2-3 times more likely to misuse antidepressants. Since antidepressants take long to show results, these individuals may consume more of the medication in an attempt to make it more effective.

Some of the signs of antidepressant misuse are:

• Changes in appetite
• Bloodshot eyes
• Financial difficulties
• Unusualsleeping habits
• Slurred speech
• Diminished appearance

Antidepressants are usually combined with alcohol to enhance the medication‘s effects. However, doctors advise patients to quit alcohol consumption while taking antidepressants, as combining them can result in serious side effects such as:

• Worsened depression or anxiety
• Impaired co–ordination
• Overdose
• Intense sedation
• Dangerously highblood pressure

Patients with depression may sometimes use other medications, such as opiates or marijuana, to self-medicate their depression.

Antidepressants such as Zoloft and Prozac are not dangerous when compared to substances such as narcotic prescription drugs. However, patients should still take the medications, according to their doctor’s prescription. Increasing doses beyond the doctor’s recommendation can lead to serious side effects, such as coma, seizures, and even death.

The other side effects of antidepressants are:

• Lack of emotion
• Insomnia
• Sore throat
• Mental confusion
• Shivers
• Paranoia
• Hallucinations
• Headache
• Sexual dysfunction
• Blurred vision
• Irritability
• Seizures
• Increased appetite
• Weight gain
• Reduced sex drive
• Agitation

Taking any drug in large doses can be fatal, and this applies to antidepressants as well. Consuming antidepressants in excess amounts within a short period can result in a fatal overdose.

A few signs of Antidepressant Overdose are:

• Confusion
• Uncontrollable shaking
• Dizziness
• Irregular heartbeat
• Fainting
• Convulsions
• Impaired co-ordination

Research has discovered that higher doses of prescribed antidepressants increase suicidal rates in teens and young adults (age 18-25.) This led the Food and Drug Administration (FDA) to alter the labeling on antidepressants to warn consumers about its danger.

Below is a list of suicidal behavior and depression that can result from antidepressant abuse:

• Having no plans for the future
• Giving away essential belongings
• Writing wills suddenly
• Having sudden changes in mood
• Increasing alcohol or drug use over time
• Insomnia or oversleeping
• Checking up on insurance plans
• Feeling guilty or worthless
• Losing interest in hobbies
• Talking about life being meaningless or hopeless

Dr. Ronald Dworkin, one of the many critics who believe that doctors in the US unnecessarily prescribe antidepressants, shared his opinion in an interview for CNN:

“Doctors are now medicating unhappiness. Too many people take drugs when they really need to be making changes in their lives.“

– Dr. Ronald Dworkin, CNN, 2007

• 10%: Approximately10 percent of individuals in the US use antidepressants.
• 60%: More than 60 percent of people on antidepressants have used them for over two years.
• 400%:The use of antidepressants has increased by over 400 percent between 2005-2008.

People who have been using antidepressants for more than six weeks will experience symptoms of withdrawal if they quit taking the medications abruptly. Quitting the medication cold turkey sends the user’s brain into a state of imbalance that can be distressing. The accompanying symptoms of withdrawal are usually psychological and physical.

Health practitioners often refer to antidepressant withdrawal as discontinuation syndrome. This is mainly because “withdrawal syndrome” can imply the presence of physical dependence or addiction to antidepressants, although they are regarded as non-addictive.

Discontinuation syndrome explains the same consequences of quitting antidepressants abruptly. However, doctors believe that the term “discontinuation“ greatly undermines the effects of quitting antidepressants.

The abrupt discontinuation of antidepressant consumption can result in rebound depression or symptoms of depression that is much worse than before the use of medications. Rebound depression is a symptom of withdrawal that tends to gradually fade away. However, not everyone who quits antidepressants will encounter rebound depression.

Certain people who stop antidepressant use can slip back into a depressive state that is not characteristic of withdrawal. Individuals who relapse into depression as such are usually put back on antidepressants before trying to quit antidepressant use yet again.

It can be quite difficult to distinguish between the depression caused by withdrawal or relapse. However, doctors should be able to identify and guide patients through this phase.

Quitting antidepressant use can induce symptoms that are similar to benzodiazepine withdrawal. However, abstinence from antidepressants is comparatively less severe. The more an individual takes antidepressants, the worse the effects and withdrawal are likely to be.

Some of the symptoms of antidepressant withdrawal are:

• Tremors
• Hallucinations
• Lightheadedness
• Confusion
• Headache
• Nausea
• Panic attacks
• Vivid dreams
• Diarrhea
• Anxiety
• Dizziness
• Ataxia

Individuals quitting antidepressant use can also encounter a condition called “brain zap,” an involuntary, shock-like sensation throughout the brain.

Individuals trying to quit antidepressant use, particularly adolescents, can be vulnerable to suicidal thoughts and acts. Thus, it is crucial to speak to a psychiatrist first before attempting to quit antidepressant use.

The withdrawal duration and onset can vary considerably from one person to another. Some individuals may not experience withdrawal symptoms until after a few weeks of the last dose, while some others may experience it sooner.

An individual who has been taking antidepressants for six months can have less severe withdrawal symptoms than someone who has been taking the same medication for two years.

Some antidepressants can cause harmful withdrawal effects. For instance, Paxil and Effexor can generate more intense withdrawal effects as they both contain short half-lives. The sooner the antidepressant leaves the body, the worse the effects of withdrawal shall be.

The approximate half-life of common antidepressants are:

• Paxil – 29 hours
• Celexa – 36 hours
• Lexapro – 30 hours
• Prozac – 5 days
• Effexor – 6 hours
• Zoloft – 24 hours

Antidepressant detox is a process that allows the medications to exit the body. The ultimate goal of medical detox is to help alleviate withdrawal symptoms during detox by the use of other medications. In comparison, tapering-down consists of gradually reducing the medication doses over a period of time rather than advising the patient to quit drug use abruptly.

Medical detox and tapering down programs can help bring the body and mind of the patient to a healthier state. Since withdrawal symptoms can disrupt one’s physical, behavioral, and emotional health, these treatments help patients in finding a balance. Detoxification can also help treat any form of polydrug abuse.

There are no specific principles that govern the tapering-down process. Some people may initially cut their dose by half and then reduce it by quarters. Some may even take as little as a month to taper-down the drug use, while others take several months. Whatever the method may be, treatments must be carried out in a treatment center supervised by a medically trained staff, and a doctor should continuously monitor and change the doses as per the particular needs of the patient.

Inpatient rehabilitation is the ideal choice for individuals with serious depression or drug dependence. They are also well-equipped to treat polydrug abuse and other co-occurring mental disorders.

Inpatient recovery places patients under 24-hour medical supervision. It provides a healthy atmosphere away from the normal pressures of life and also prevents drug-dependent individuals from falling victim to relapses. Inpatient care can range from 28 days to several months.

The first stage of inpatient rehabilitation is medically-assisted detox. However, patients can also successfully detox from antidepressants under their primary practitioner’s supervision in outpatient environments.

Children, teenagers, adolescents, and young adults are particularly vulnerable to antidepressant withdrawal, as they are most likely to experience suicidal thoughts and actions. Thus, the highly-monitored environment in inpatient drug rehabs will greatly help in minimizing catastrophic results.

Cognitive-behavioral therapy (CBT) may further help patients in keeping a distance from antidepressants. CBT teaches individuals with coping tools to manage their depression without the need for medication.

“Studies have shown that cognitive therapy is as efficacious as antidepressant medications at treating depression, and it seems to reduce the risk of relapse even after its discontinuation.”

-Dr. Robert J. DeRubeis et al., Nature Reviews Neuroscience, 2008

Most individuals who successfully get rid of their antidepressant abuse can effectively control their depression without medicines. However, ongoing counseling or treatment is essential to keep the patients grounded.

Effectively managing thoughts and implementing good practices can help individuals control their moods and avoid relapse. Some of the good practices and strategies that help keep depression at bay are: