Antidepressant Addiction and Abuse

Although antidepressants aren’t addictive in the traditional sense, they do cause severe dependence on users over time.

Antidepressant - Addiction | Table of Contents

What Are Antidepressants?

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)

Are Antidepressants Addictive?

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.

FAQ

Do antidepressants work?

The effectiveness of antidepressants may vary from patient to patient. Doctors first recommend an antidepressant that they consider to be effective, but If it doesn’t work as expected, they will switch to a different antidepressant until they find one that works for that patient.

Do antidepressants actually make you happy?

Antidepressants do not make you feel euphoric. However, they help you manage your emotional responses and react more realistically.

Types of Antidepressants & Their Side Effects

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.

Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)

SSRIs and SNRIs are the most commonly prescribed antidepressants. While SSRIs block the absorption of serotonin in the brain, SNRIs raise the levels of serotonin and norepinephrine that play a key role in stabilizing mood.

The side effects caused by these drugs are quite similar to one another.

  • Low blood sugar
  • Constipation or diarrhea
  • Rashes
  • Trouble sleeping
  • Headaches
  • Dizziness
  • Sedation
  • Weight loss
  • Dry mouth
  • Sweating
Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) get their name from the three rings in the drug’s chemical structure. TCAs are used for the treatment of depression, fibromyalgia, certain types of anxiety, and chronic pain. This drug increases the levels of serotonin and norepinephrine in the brain. Side effects may include:

  • Seizures
  • Insomnia
  • Irregular heartbeat
  • Rash/hives
  • Hypertension
  • Constipation
  • Urinary retention
  • Weight loss
  • Increased pressure on the eye
  • Sexual dysfunction
  • Hypertension
  • nausea
  • Vomiting
  • anxiety
Monoamine Oxidase Inhibitors (MAOIs)

This type of antidepressant was commonly prescribed before the introduction of SSRIs and SNRIs. This medication is only prescribed by doctors when SSRIs are ineffective. MAOIs restrains an enzyme in the brain that helps break down serotonin. Side effects of this medication may include:

  • Inflammation
  • nausea
  • Sexual dysfunction
  • diarrhea
  • Drowsiness
  • Constipation
  • Blurry vision
  • Weight lossorweight gain
  • Seizures
  • Headaches and dizziness
  • Hypertension
  • Irregular heartbeat
Noradrenergic and Specific Serotonergic Antidepressants (NASSAs)

This medication increases the concentration of neurotransmitters in the brain. The side effects of this drug may include:

  • Dry mouth
  • Dizziness
  • Fainting
  • Weight gain
  • Constipation
  • Blurry vision
  • White blood cell reduction

Antidepressant Abuse & Addiction

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 Addiction Vs. Dependence

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

Signs of Antidepressant Abuse

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

Common Drug Combinations

Antidepressants are usually combined with alcohol to enhance the medications 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 coordination
  • Overdose
  • Intense sedation
  • Dangerously highblood pressure

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

The Dangers of Antidepressants

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

Antidepressant Addiction Statistics

  • 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.

What is Antidepressant Withdrawal?

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.

Withdrawal or Relapse Depression?

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.

Withdrawal Symptoms

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.

Withdrawal Duration

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 Withdrawal Timeline

Days 1-3

Depending on the antidepressant, most patients experience the initial manifestations of a withdrawal syndrome in the first three days after the last dose.

Days 4-5

Withdrawal symptoms during this period are more severe. Users can experience dizziness, diarrhea, shakiness, and fever. People who have been taking high doses of antidepressants for a longer period may experience the most severe effects.

Weeks 1-3

Withdrawal symptoms usually remain for three weeks. During this period, withdrawal symptoms also tend to diminish in impact. Most people who quit antidepressant use will stop getting withdrawal symptoms after three weeks.

Weeks 4+

There are various factors that influence the duration of antidepressant withdrawal. Some patients can have symptoms that can last a few months.

Treatment for Antidepressant Withdrawal – Medical Detox and Tapering-Down Program

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.

Treatment Centers

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 Rehab

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.

Relapse Prevention Techniques and Ongoing Treatment

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.

Tips to Prevent a Relapse Depression

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:

Maintain healthy relationships

Obtaining solid support from friends and family is vital during tough times. Thus, take commendable attempts to be with people who wish the best for you. The people you interact with must also be optimistic thinkers.

Get a pet

Pets are a great source of companionship that can rescue people from isolation. Caring for a pet often gives a sense of purpose and need.

Exercise

Many people agree that meditation stimulates brain functions and holds depression at bay. Activities such as running, swimming, cycling, weightlifting, and walking are a few perfect exercises to promote good thinking. Many studies have shown that walking for 20-40 minutes, three days a week can alleviate certain depressive symptoms. More specifically, exercising activates neurotransmitters, like endorphins and serotonin, that can ward off depression.

Eat healthily

Food has a powerful impact on how you feel. Try to eat healthily, as an unhealthy diet can reduce energy and contribute to a depressed state.

Get enough sleep

Unhealthy sleeping patterns can quickly lead to a relapse depression. Heading to bed at the same time every night and aiming for 8 hours of sleep a night can significantly reduce depression.

Use relaxation and stress management techniques

Stress and frustrations are a few of the powerful causes of depression. Thus, implementing relaxation techniques, such as yoga and meditation, can help relieve potential triggers.

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