Antidepressants: Addiction, Abuse, Effects and Treatment

What Are Antidepressants?

Antidepressants are prescription medications that are used to treat a range of mood disorders and chronic pain conditions, including major depressive disorder, generalized anxiety disorder, bipolar disorder, post-traumatic stress disorder (PTSD), panic disorder, and obsessive-compulsive disorder (OCD). In some cases, antidepressants are also prescribed as part of addiction treatment, when mental health is a concern. They work by acting on neurotransmitters — the chemical messengers that deliver information between neurons, or brain cells.

Depending on the type of antidepressant, these prescription medications either increase the release or block the reabsorption of the neurotransmitters norepinephrine, serotonin, dopamine, or in some cases, a mixture of the above.

Available by prescription through a physician, antidepressants are one of the most frequently prescribed types of prescription drugs. The Centers for Disease Control and Prevention (CDC) reports that between 2015–2018, 13.2% of Americans aged 18 and over reported taking antidepressant medication in the past 30 days – a 3.2% increase from the previous decade. Within the same study, the CDC found a substantial increase in antidepressant use primarily amongst women.

How Do Antidepressant Medications Work?

Antidepressants can be effective in treating depression and other mood disorders, however, results vary based on the individual patient and the type of antidepressants being used. With that being said, a 2016 case study published in The Lancet Medical Journal, found that the twenty-one most commonly prescribed antidepressant medications were more effective than placebo for adults with major depressive disorder.

While antidepressants do not cure mental health conditions such as major depressive disorder or generalized anxiety disorder, they can be a helpful tool when combined with psychotherapy as part of a full treatment plan.

Types Of Antidepressants

When prescribing an antidepressant medication, physicians will take into account a variety of different factors, including individual symptoms, possible side effects, interactions with other medication, pregnancy or breastfeeding, cost and healthcare coverage, and whether a particular medication has worked for a close relative.

There are six antidepressant medications that work in slightly different ways and have different side effects.

Side Effects of Antidepressants

Antidepressants are a key part of treating depression, anxiety, and other mental conditions, however, like any prescription medication, they can cause some side effects. Some of these side effects are believed to be a direct result of the antidepressant medication’s effect on the brain and tend to be similar amongst drugs in the same class. Common examples of antidepressant side effects include dry mouth, dizziness, headaches, restlessness, and issues with sexual dysfunction. While these conditions are frequently perceived as side effects of antidepressants, some of them can be caused by depression itself.

Whether or not someone has side effects and the nature of the symptoms depends on the antidepressant medication, the dose, and how long they’ve been taking the medication. Some side effects can be more acute when a person first starts taking an antidepressant medication.

While much less common, other side effects include possible heart issues, seizures, liver damage, and suicidal thoughts or behaviors.

Although there are risks and side effects associated with taking antidepressants, they help many people live more fulfilling and functional lives.

Antidepressants and Addiction Treatment

Substance use disorders are overrepresented among individuals with mental illnesses such as depression and anxiety. In fact, an estimated 32% of individuals with major depressive disorder also have substance use disorders.

Introduced by the World Health Organization in the mid-1990s, the term dual diagnosis refers to the co-occurrence of a substance use disorder with mental illness, which is also known as co-occurring disorders. Data suggest that individuals with co-occurring substance abuse and mental health conditions are more likely to have a positive outcome if they receive treatment for both conditions simultaneously, which typically involves a combination of antidepressants and therapy.

While antidepressant abuse is possible, a 2019 study found that SSRIs are effective in treating co-occurring mental health and substance abuse disorders, especially when addiction treatment options pair antidepressant drugs with psychotherapy.

In addition to helping treat co-occurring mental health conditions, antidepressant medications are used in addiction treatment to help ease withdrawal symptoms including body pain and insomnia, and provide mood elevation during the drug and alcohol detox process.

Are Antidepressants Addictive?

Medical professionals generally do not consider Antidepressants to be addictive in the traditional sense. However, antidepressants can cause physical dependence, as evidenced by the withdrawal symptoms that occur when someone suddenly reduces their dose or stops using antidepressants altogether.

Unlike prescription painkillers or illicit drugs such as heroin or cocaine, antidepressants don’t have the euphoric effects or “high” that other drugs have. As a result, a person will not experience acute cravings for antidepressants when they are without them.

With that being said, if someone has used the same antidepressant over a long period of time, it is possible to develop a passive tolerance to the point where the medication stops working. This may require them to increase their dosage or change their medication to better address their mental health needs. The Mayo Clinic refers to this phenomena as the “poop out effect” or antidepressant tolerance, which is also known as tachyphylaxis.

If an antidepressant stops working, it could mean that the body has adjusted to changes in neurotransmitter levels and is now opposing shifts that antidepressants cause, making the medication less effective. However, other factors can also influence the effectiveness of a particular antidepressant, including worsening depression, new medications, or other medical conditions such as hypothyroidism, which can contribute to depression.

Antidepressant Withdrawal Symptoms

While addiction is rare, if a person takes antidepressants for an extended period of time, their body can become physically dependent on them. As a result, individuals may experience withdrawal symptoms when they cease taking antidepressants. According to a study published in the British Journal of Psychiatry, patients whose SSRIs were abruptly replaced with a placebo experienced a host of withdrawal symptoms including dizziness, fatigue, insomnia, headaches, and flu-like symptoms, as well as irritability, aggression, anxiety, panic attacks, and noticeable mood changes. Depending on the kind of antidepressant used, a 2018 study published in The Primary Care Companion for CNS Disorders also found that some patients experienced intermittent “brain zaps,” a sensation that patients describe as a jolt of electricity in the brain.

According to the National Alliance on Mental Illness (NAMI), up to 80% of people who abruptly discontinue antidepressant use experience some withdrawal symptoms or discontinuation syndrome, a term used to describe a range of symptoms that may occur when patients discontinue taking SSRIs or SNRIs.

How to Detox From Antidepressants

To avoid or lessen antidepressant withdrawal symptoms, the American Psychological Association recommends that people do not stop taking antidepressants abruptly. Instead, people should gradually reduce their dose of antidepressant medications by tapering off their antidepressant use over several weeks.

When considering tapering off antidepressants, it’s important to do so under the guidance and supervision of a doctor. Antidepressant withdrawal symptoms have been linked to specific drug’s elimination half-life, a measure of how long it takes for half of the drug to be metabolized and eliminated from the body. Depending on the type of antidepressant, some may require a different tapering-off period than others. For example, SSRIs like Paxil (paroxetine), which has a half-life of about 24 hours, should be tapered down over a more extended period of time as compared to other prescription drugs like Prozac (fluoxetine), which has a longer half-life of up to four days.

Antidepressant Abuse

Although the majority of people use antidepressants as prescribed to treat mental health conditions such as anxiety and depression, antidepressant abuse and misuse are still possible.

Antidepressants accumulate slowly in the brain, therefore it can take up to a month to feel the effects of antidepressants. During this time, some people will misuse antidepressants by taking higher than recommended doses thinking it will expedite or enhance the effects of their prescription medication.

Mixing Antidepressants with Drugs and Alcohol

It’s not uncommon for people to combine antidepressant medication with other drugs and alcohol to amplify feelings of sedation. Those who also struggle with a substance use disorder may combine antidepressants with other substances such as marijuana or opioids to self-medicate, leading to dangerous, potentially life-threatening outcomes, including overdose.

While doctors recommend avoiding alcohol when taking antidepressants, it’s one of the most commonly combined substances. Alcohol is a nervous system depressant. Combining alcohol with antidepressant medication can worsen symptoms of depression while causing excessive drowsiness and dizziness. Consuming alcohol while taking antidepressants can result in serious physical and mental health issues, including:

• High blood pressure
• Intense sedation
• Increased depression and anxiety
• Impaired coordination

For the same reasons, those taking antidepressants should abstain from using cannabis and illicit substances such as cocaine, heroin, ketamine, and amphetamines.

Antidepressant Overdose

Similar to other prescription medications, it’s possible to overdose on antidepressant drugs if you take them in high doses. The risk of overdose increases if antidepressant medications are mixed with alcohol or other substances. In severe cases, these antidepressant overdoses can be fatal.

A review published in the Emergency Medicine Journal found that TCA overdoses are the most common form of antidepressant overdose. They also tend to be the most severe. In fact, a 2017 report from the American Association of Poison Control Centers (AAPCC) found tricyclic antidepressants are among the top 25 medications linked with the highest number of deaths from overdose. Other classes of antidepressant medications such as SSRIs and SNRIs were not featured on that list.

A person experiencing an antidepressant overdose will have mild to severe symptoms, depending on the type of antidepressant taken, the quantity, and whether they have been mixed with drugs or alcohol.

Common antidepressant overdose symptoms include the following:

• Blurred vision
• Body tremors or shaky limbs
• Confusion
• Dilated pupils
• Drowsiness
• Fever
• Headache
• High blood pressure
• Nausea
• Vomiting

Severe symptoms of an antidepressant overdose include:

• Cardiac arrest
• Coma
• Hallucinations
• Low blood pressure
• Rapid heartbeat
• Shaking
• Seizures

Depending on the factors outlined above, these symptoms may be fatal. If a suspected antidepressant overdose has occurred, it’s important that the person seek emergency medical attention immediately.

Detox and Rehabilitation for Antidepressant Abuse

As outlined above, stopping antidepressants abruptly can lead to a host of different withdrawal symptoms. Even if you’re not abusing antidepressants, it’s still important to seek medical attention. A physician can create a taper-off schedule for antidepressant use that helps mitigate unwanted withdrawal symptoms.

While antidepressant abuse isn’t very common it does still occur, and it can lead to very dangerous outcomes. If you or a loved one are unable to stop misusing antidepressants or have experienced an antidepressant overdose, you may need treatment.

For individuals who require a more intensive treatment plan, an inpatient addiction treatment program that specializes in treating both antidepressant abuse and co-occurring mental health conditions can be very beneficial.

While seeking treatment for antidepressant abuse or dependence may seem daunting, help is widely available. Regardless of the addiction treatment program you embark upon, an accredited rehab center can provide the supportive environment necessary to create a positive foundation for long-term recovery.

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