Our understanding of mental health is constantly growing, and this means that more and more people are seeking treatment for their concerns.
Antidepressants receive a lot of attention, as they are drugs that are prescribed to relieve particular psychiatric conditions. As with any kind of medication, there are risks involved. With prescription drug addiction being one of the biggest health concerns in the country today, some wonder if you can become addicted to antidepressants.
What Are Antidepressants?
Before we look at antidepressants in the context of addiction, it’s important to understand what precisely we mean when we talk about antidepressants. Medical News Today explains that antidepressants work by correcting chemical imbalances in the brain that cause changes in a patient’s behavior and mood. The changes they bring lead antidepressants to be used for a number of different psychiatric conditions, such as depression, anxiety, panic attacks, obsessive-compulsive disorders and post-traumatic stress disorder.
Antidepressants are also used to treat a number of other medical and mental health conditions, such as:
- Childhood bedwetting
- Chronic pain
That is also behind the reason an uptick in the overall usage of antidepressants. In 1996, 13.3 million Americans took antidepressants; in 2010, the number rose to 23.3 million. Researchers from the University of Pennsylvania, Columbia University Medical Center, and the New York State Psychiatric Institute attribute this to the rise of greater advocacy for mental health treatment, a broadening understanding of mental health disorders, and less stigmatization of concepts of mental health in the public sphere of opinion.
A data brief by the National Center for Health Statistics, and published by the Centers for Disease Control, charted the use of antidepressants by people aged 12 and over in the United States, and found that the number rose from 400 percent from the period of 1988-1994 to the period of 2005-2008. Part of the reason for their popularity is explained by how well they work. The Royal College of Psychiatrists calculated that after three months of treatment, between 50 and 65 percent of people who received antidepressants will experience an improvement in their depression symptoms. This was contrasted with a control population of 25 to 30 percent of people who received a placebo and experienced significant improvement in their depression symptoms.
The Royal College of Psychiatrists further explains that there exist almost 30 different kinds of antidepressants, grouped into five main types:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and noradrenaline reuptake inhibitors (SNRIs)
- Noradrenaline and specific serotonergic antidepressants (NASSAs)
- Monoamine oxidase inhibitors
SSRIs are among the most commonly prescribed antidepressants, according to Mayo Clinic. SSRIs work by selectively preventing the brain from reabsorbing serotonin, a neurotransmitter (chemical) that helps the brain cells send and receive signals. The Journal of Psychiatry & Neuroscience describes how this, in turn, boosts mood and feelings of well-being and happiness.
Can You Become Addicted to Antidepressants?
This tells us a lot about antidepressants, so now we can ask: can you become addicted to them? The answer is not as easy as a simple “yes” or “no.”
Talking about the addictive liability of antidepressants, Medical News Today contrasts them to nicotine, tranquilizers, painkillers, and illegal drugs by pointing out that while those substances require a patient to consume increasing amounts to achieve the same effects, the same cannot be said for antidepressants.
The concept of tolerance is a massive factor in determining whether a substance is addictive (and whether a patient is addicted to a substance). The National Institute on Drug Abuse defines tolerance as the point at which a patient no longer responds to the presence of a drug (or drugs) in their system. In other words, the patient’s body has become so accustomed to the effects of the drug, that they need more and more of the substance just to feel the standard result.
For example, PsychCentral explains that one of the symptoms of alcoholism is an increased tolerance. An alcoholic not only needs to consume more alcohol to get intoxicated, but even regular, moderate amounts of alcohol do not cause any feelings of inebriation. Therefore, their tolerance for alcohol is dangerously high.
With antidepressants, however, the issue of tolerance is different. The Journal of Psychopharmacology explains that the tolerance feature of addiction in antidepressants is “exceptionally rare,” except in cases where patients have a history of substance abuse, or present with other risk factors, such as a family history of drug abuse.
The pharmaceutical composition of most antidepressants makes addiction unlikely, says the Journal, and that for the most part, antidepressants do not have a clinically significant possibility of causing addiction.
Another factor in the differentiation of antidepressants from most of the other mood-altering drugs is that when a patient is weaned off the antidepressant (following a course of treatment and therapy), they will not have the painful and dangerous withdrawal symptoms that occur when a patient tries to get off more addictive substances.
The presence of withdrawal symptoms is another sign of an addiction. If a patient can stop using a substance without feeling any significant effects (either physical or mental), then either the patient’s use of the substance was not addictive, or the substance itself was not addictive by nature. But if the termination of consumption leads to things like muscle aches and pains, sweating, trembling, insomnia, fatigue, irritability and headaches (among other symptoms listed by the National Council on Alcoholism and Drug Dependence), then this would be the sign of an addiction.
Stopping the use of antidepressants, however, rarely causes such effects. PsychCentral reports that only around 20 percent of patients experience what is known as SSRI discontinuation or withdrawal syndrome; of that number, only five percent experience symptoms that can be described as “severe.”
However, some professionals believe that any negative effects that arise from the discontinuation of a course of antidepressants is not the emergence of withdrawal symptoms; instead, it may be a return of the original condition. SANE, a mental health advocacy organization in Australia, said that it is possible to confuse previous feelings of depression and anxiety with those of perceived antidepressant withdrawal symptoms. SANE concludes that antidepressants do not cause issues of addiction or dependence.
Notwithstanding the conventional school of thought on the addictiveness of antidepressants, some health care workers are challenging that notion. Scientists at the Nordic Cochrane Centre at Rigshospitalet in Copenhagen, Denmark, claim that what patients experience trying to wean off antidepressants are full-fledged withdrawal symptoms, which would make antidepressants an addictive substance. The lead author on a meta-analytic study on the two most commonly used antidepressants (SSRIs and benzodiazepines) told Science Nordic that people get “so ill” when they stop taking their medicine that their condition should rightfully be termed an addiction.
Even though the official position of the Danish Health and Medicines Authority is to draw a clear line of distinction between “SSRI discontinuation syndrome” and “withdrawal symptoms,” the researchers from the Nordic Cochrane Centre dismiss that as “pure semantics.” According to the researchers, since patients get “the exact same symptoms” when they stop taking their antidepressants, this necessitates the categorization of SSRI drugs as addictive.
The Danish researchers are not alone in their opinion. Psychology Today relates the story of a 14-year-old girl who started taking an SNRI called Effexor for her migraines. When she gradually scaled back her intake, as she should have, the lack of Effexor in her system caused her to vomit, experience suicidal thoughts, gave her sensations that were like mild electrical shocks, and put her in a constant state of fatigue.
Even as an assistant professor of psychiatry at Harvard University concedes that the girl’s experience is a rare one, a doctor who wrote a book entitled Prozac Backlash called for greater recognition of antidepressant withdrawal symptoms, and the logical conclusion that antidepressants themselves are addictive. While the doctor blamed patients’ doctors for mistaking withdrawal for relapse, the author of the Psychology Today article herself called the phenomenon a side effect that mimics a relapse in depression.
The jury may still be out on the ultimate answer as to whether or not you can become addicted to antidepressants, but what’s clear from the debate is that if you are dealing with issues of depression, anxiety, trauma, panic attacks or obsessive-compulsive disorder, antidepressants are only one side of the treatment equation. As helpful as a prescribed and monitored course of antidepressants will be, actually managing your condition requires a program of therapy and counseling.
That’s why Black Bear Lodge is here for you. You do not have to go through this by yourself. All you have to do is call us today, and our admissions coordinators can help answer your questions about how you can take control of your mental health.