Are Antidepressants Addictive?

Generally, antidepressants are not considered addictive, and they don’t cause users to have cravings (according to WebMD).

These non-addictive antidepressant medications are classified as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Both work by inhibiting certain receptors in the brain that relieve major depression.

However, some medications treat depression and don’t fall into the antidepressant category. These medications are in the benzodiazepine class, and are primarily administered to people with sleep, anxiety, or mood disorders.

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While SSRIs and SNRIs are considered to be safer than benzodiazepines, they can produce withdrawal or discontinuation symptoms after users stop taking them. They are also able to produce a number of concerning health complications. When antidepressants are ingested with alcohol and other drugs, they can be fatal.

Keep reading to find out more about the reasons why antidepressants can be harmful when misused and the options for professional treatment.

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Depression and Antidepressants

About 322 million people around the world have been diagnosed with depression, which is a severe mood disorder. Depression is described as persistent sadness exemplified by an overall loss of interest in activities they previously found pleasurable.

What Constitutes Depression?

The principal authority for psychiatric diagnoses is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

It states that a person must experience five or more symptoms during the same two-week period, and at least one of the symptoms should be a depressed mood or a loss of interest or pleasure. More specifically, the following criteria are needed to diagnose someone as having depression:

  1. Depressed mood, most of the day and nearly every day.
  2. Markedly diminished interest or pleasure almost all activities most of the day, nearly every day.
  3. Significant weight loss (when not intentionally dieting), weight gain, or decrease or increase in appetite, nearly every day.
  4. Slower or reduced thought patterns and a reduction of physical movement (which is observable by others, not merely subjective feelings of restlessness or slowness).
  5. Fatigue or loss of energy, nearly every day.
  6. Feelings of worthlessness or excessive or inappropriate guilt, nearly every day.
  7. Diminished ability to think, concentrate, or make decisions, nearly every day.
  8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, a suicide attempt, or a specific plan to commit suicide.

For a diagnosis of depression, these symptoms must cause someone clinically significant distress or impair them in their social life, career, or other areas of their life. In additin, the symptoms must not be a result of substance abuse or another medical condition.

The Role of Antidepressants

Antidepressant medications don’t cure depression, but they are prescribed to treat the symptoms that come with depression. While there are several classes of antidepressant medications, SSRIs and SNRIs are most commonly prescribed.

SSRIS (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

SSRIs (Selective Serotonin Reuptake Inhibitors) are prescribed to treat symptoms of depression that are moderate or severe. They work by increasing levels of serotonin, the neurotransmitter that modulates memory, learning, reward, and cognition in the brain. SSRIs block the reabsorption of serotonin in the brain, which makes the chemical more readily available.

The Food and Drug Administration (FDA) approved the following SSRIs to treat depression:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
  • Paroxetine (Paxil and Pexeva)
  • Citalopram (Celexa)
  • Vilazodone (Viibryd)

SNRIS (SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS)

SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors) also treat depression, as well as  anxiety disorders and chronic pain. SNRIs work by blocking the reabsorption of serotonin and norepinephrine in the brain. In effect, SNRIs impact brain chemistry and communication in  neural circuits, which regulates the mood and provides relief from depression (according to the Mayo Clinic).

The following SNRIs have been approved to treat depression:

  • Desvenlafaxine (Pristiq and Khedezla)
  • Levomilnacipran (Fetzima)
  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor XR)

Other, less commonly prescribed SNRIs include tricyclic and monoamine oxidase inhibitors (MAOIs).

Tricyclic antidepressants include amitriptyline, doxepin, imipramine (Tofranil), nortriptyline (Pamelor), and desipramine (Norpramin). They are less frequently prescribed than other antidepressants because they cause more side effects.

MAOIs are typically prescribed after other antidepressants have proven to be ineffective. These medications can have serious side effects, and they include tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan).

The last class of SNRIs is atypical antidepressants, which  includes mirtazapine (Remeron), bupropion (Wellbutrin, Aplenzin, and Forfivo XL), trazodone, vortioxetine (Trintellix), and vilazodone (Viibryd).

The Dangers of Using Antidepressants

Although traditional antidepressants aren’t considered addictive, the FDA requires them to carry a black-box warning because their use can increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults under 25 (particularly in the first few weeks after one starts taking an antidepressant, or after the dosage has changed).

There is also a debate about whether SSRIs and SNRIs can become addictive. While they are formulated not to, they have side effects and withdrawal symptoms that make them dangerous when misused.

The Side Effects of Antidepressants

The uncomfortable and painful side effects associated with SSRI medications include:

  • Dry mouth
  • Difficulty falling or staying asleep
  • Restlessness
  • Dizziness
  • Drowsiness
  • Nausea
  • Diarrhea
  • Headache
  • Nervousness or agitation
  • Blurred vision
  • Reduced sexual desire
  • Erectile dysfunction
  • Headaches
  • Blurred vision

The use of SNRIs can produce the following side effects:

  • Dry mouth
  • Dizziness
  • Nausea
  • Headaches
  • Excessive sweating

Other possible side effects may include:

  • Tiredness
  • Constipation
  • Difficulty falling or staying asleep
  • Loss of appetite
  • Reduced sexual desire or difficulty having an orgasm
  • Erectile dysfunction

Overdosing on Antidepressants

As with any substance, the misuse of antidepressants can lead to an overdose, especially if they are abused with other substances. When both medications are taken alone, SSRI and SNRI overdoses rarely lead to death. However, while a typical dose of SSRI may range between 20 to 80 milligrams, a 520-mg dose of fluoxetine has proven to be fatal (according to Healthline).

A typical dose of an SNRI such as venlafaxine ranges from 75 to 225 mg a day, but a 2,000-mg dose has resulted in death.

Again according to Healthline, these are the common symptoms of overdose associated with antidepressants:

  • Dry mouth
  • Drowsiness
  • Dilated pupils
  • Confusion
  • Nausea and vomiting
  • Headache
  • High blood pressure
  • Fever
  • Blurred vision

Severe overdose symptoms include:

  • Low blood pressure (hypotension)
  • Rapid heart rate (tachycardia)
  • Seizures
  • Tremors
  • Hallucinations
  • Coma
  • Cardiac arrest
  • Respiratory depression
  • Death

Serotonin Syndrome

Overdosing on antidepressants can put users at risk for developing serotonin syndrome, which is caused by an excessive accumulation of serotonins in the body. An overproduction of serotonin can produce mild symptoms (such as shivering and diarrhea) or severe symptoms (such as seizures and fevers). Serotonin syndrome can also be life-threatening.

Serotonin syndrome typically occurs within several hours of taking a new drug or increasing the dose of a drug (according to the Mayo Clinic).

These are the signs and symptoms of serotonin syndrome:

  • Headache
  • Confusion
  • Shivering
  • Goosebumps
  • Loss of muscle coordination
  • Muscle twitching
  • Agitation or restlessness
  • Rapid heart rate
  • High blood pressure
  • Dilated pupils
  • Muscle rigidity
  • Excessive perspiration
  • Diarrhea

The life-threatening effects of severe serotonin syndrome are seizures, irregular heartbeat, high fever, and unconsciousness.

The Dangers of Polysubstance Abuse

The dangers of using antidepressants become magnified when people take them with alcohol or other drugs, including the risk of toxicity and death (according to Healthline).

The Effects of Benzodiazepine

If any class of antidepressants has the potential for becoming addictive, it’s benzodiazepines (or benzos). The longer a user takes any of them, the more likely they are to develop a dependence that can evolve into an addiction.

When benzos are recreationally abused, they can produce adverse effects, such as:

  • Depression
  • Tremors
  • Dysphoria or the feeling of being separated from reality
  • Loss of appetite
  • Muscle twitching
  • Memory impairment
  • Motor impairment
  • Nausea
  • Muscle pains
  • Dizziness
  • The apparent movement of still objects
  • Lightheadedness
  • Sensitivity to touch, sound, and light
  • Numbness or pins-and-needles sensation
  • Hallucinations
  • Sensitivity to Smell

Signs of Addiction

When someone is addicted to a substance, they typically exhibit compulsive, drug-seeking behavior, so obtaining the substance becomes their primary motivation.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists 11 criteria for drug addiction, which help clinicians diagnose this condition. If someone shows at least two of these symptoms over a 12-month period, they may have an addiction disorder. SSRIs and SNRIs may not be as dangerous or addictive as benzos such as Valium and Xanax, but they can still compel users to display the signs of addiction listed below:

  • Taking more of the drug than intended, for a longer period of time than intended.
  • A persistent desire to stop taking drugs or repeated unsuccessful attempts to quit taking them.
  • A lot of time spent trying to get drugs, abuse them, and/or recover from their effects.
  • Intense cravings or urges for specific drugs.
  • Failing to go to work or school and/or meet obligations to friends and family members because of drug abuse.
  • Ongoing drug abuse despite related physical, mental, emotional, or social problems.
  • Giving up hobbies or activities to abuse drugs.
  • Continuing to abuse drugs in inappropriate situations, such as using them before work, driving while intoxicated, or misusing them around children.
  • Developing a physical tolerance (meaning the body needs more of the drug to experience the original level of intoxication).
  • Experiencing symptoms of withdrawal when trying to quit using the drug.

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Discontinuation Symptoms and Timelines

Discontinuation syndrome can present itself when antidepressant use is reduced, interrupted, or wholly discontinued. This form of withdrawal can produce a range of symptoms, including nausea, insomnia, anxiety, sensory changes, and poor balance. Discontinuation syndrome can occur within three days, and it can last up to several months.

It should be noted that the discontinuation symptoms are not the same for every SSRI medication. Drugs with a shorter half-life produce a more common discontinuation reaction. Of all the antidepressants, fluvoxamine (Luvox) has the shortest half-life, so it has the highest severity of discontinuation symptoms.

In the case of serotonin and norepinephrine reuptake inhibitors, venlafaxine (Effexor) has the shortest half-life, so it produces the fastest discontinuation symptoms.

Professional Treatment Options

Generally, antidepressant medications aren’t addictive, and overdosing isn’t fatal. However, they can produce a number of troubling and toxic effects that can endanger your health, and these effects are greater with benzos.

When any of the aforementioned substances are used with alcohol or other drugs, the risk of severe health complications and death increases.

If you fall into any of those usage categories, professional addiction treatment can help you get sober. Even more importantly, it can spare you the damaging health complications that accompany misuse and abuse.

In addition, dual-diagnosis treatment can treat a co-occurring mental health issue (such as depression) while you’re receiving substance abuse treatment.

In a professional program, you will meet with clinical staff to determine the appropriate recovery plan. For cases of severe addiction and polysubstance abuse, you should undergo medical detoxification, which safely and comfortably removes these substances from your body.

Residential treatment involves staying at a facility and receiving comprehensive care and therapy. It’s the best treatment for benzodiazepine addiction and polysubstance abuse. In residential treatment, you’ll receive access to a range of evidence-backed therapies. To maximize the effectiveness of any residential program, a minimum of a 90-day stay is recommended (according to the National Institute on Drug Abuse).

If your misuse solely involves antidepressants, an outpatient program is the most appropriate option. In outpatient, you can attend therapy and counseling sessions on a part-time basis while living at home or pursuing another arrangement (such as sober living).

In either case, you’ll receive counseling designed to help you discover the root of your addiction. You’ll also be given education and life skills to help you sustain your sobriety. Once your treatment has completed, the clinical staff will connect you to aftercare and alumni programs that provide a supportive and encouraging community for your recovery.

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