Antidepressants & Addiction

What Are Antidepressants?

The antidepressant medication class is large and includes drugs that can treat depression and a variety of other conditions.[2] 

Antidepressants work by increasing the levels of chemicals like serotonin and noradrenaline within the brain. This alteration can improve mood, although researchers aren’t sure why.[2] Antidepressants can also disrupt pain signals, easing discomfort from chronic conditions. 

Most doctors combine antidepressants with therapy. Since these medications don’t address the root cause of mental illness, people often need more help to feel better. 

“GPs should not prescribe antidepressants routinely for mild depressive/anxiety symptoms. Patients starting antidepressants should be advised that they are to be taken for a limited period only and that there is a risk of withdrawal problems on stopping them.”[3]

Key Facts About Antidepressants

How Antidepressants Work

Antidepressants are typically delivered in oral form. People take tablets once or several times per day, as directed by their doctors. 

Each dose moves through the digestive system, crossing the blood/brain barrier. Once there, they trigger brain cells to release key neurotransmitters like serotonin and noradrenaline. The alteration can ease key depression symptoms, block pain signals, and increase relaxation.[2] 

Medical Uses for Antidepressants: Why Are They Prescribed? 

Most medications in the antidepressant class were designed with conditions like persistent depressive disorder in mind. But doctors can use these same therapies to address other illnesses too. 

Your doctor might prescribe antidepressants to treat one of the following issues:[2,5]

• Depression 
• Insomnia 
• Obsessive-compulsive disorder (OCD) 
• Generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD)

Different Types of Antidepressants 

Multiple types of antidepressants exist. While they all serve the same basic function, they work in slightly different ways. 

Monoamine Oxidase Inhibitors (MAOIs) 

MAOIs were the first antidepressants. Doctors were introduced to these medications in the 1950s, and they prescribed them widely. Now, doctors use them rarely. Side effects like dizziness and insomnia make them unpleasant choices for many people.[6]

Your doctor might use MAOIs to treat issues like panic disorder, social phobia, and depression that don’t resolve with other medications. 

Selective Serotonin Reuptake Inhibitors (SSRIs) 

SSRIs are used as front-line treatment for depression and other mental health issues. They’re considered safe, effective, and tolerable for most patients.[7]

SSRIs come in multiple forms, including tablets, capsules, and liquids. Most people take their dose once daily. Side effects like sedation or brain fog are relatively rare for most people using these therapies.

Selective Noradrenaline Reuptake Inhibitors (SNRIs)

SNRIs were designed to replace SSRIs.[2] But they haven’t lived up to the high hopes researchers had about them. Even so, your doctor might choose this type of medication to help ease depression. 

If you’ve used SSRIs without relief, an SNRI medication might be a better choice. 

Noradrenaline & Specific Serotonergic Antidepressants (NASSAs)

These medications work by increasing noradrenaline within your brain. If you’ve used SSRIs for depression without relief, this therapy could be a good choice. 

Unlike SSRIs, these medications don’t come with sexual side effects. But they can cause more drowsiness than other drugs. 

Tricyclic Antidepressants (TCAs)

TCAs are older than other medications in this class. They come with more side effects, including some so unpleasant that people quit their drugs. 

If you’ve used other antidepressants without relief, your doctor might try TCAs. But they’re rarely the first therapy your doctor reaches for. 

Serotonin Antagonists & Reuptake Inhibitors (SARIs)

SARIs are antidepressants, but they’re rarely used alone. Doctors tend to add a SARI to an existing antidepressant to help their patients get a good night’s sleep. These medications are very sedating and can make people feel sluggish and slow during the daytime. 

Atypical Antidepressants 

Some newer depression therapies have unique chemical functions and modes of action. They’re so new that they don’t have their own chemical categories. Instead, doctors just call them atypical. 

If you’ve exhausted all other treatment options, they could be a good next step. 

Commonly Prescribed Antidepressants 

There are dozens of different antidepressants for doctors to choose from. These are a few of the most popular options:[2,6] 

Brand Name	Generic Name	Commonly Prescribed For
Zoloft	Sertraline	Major depressive disorder, post-traumatic stress disorder, panic disorder
Prozac	Fluoxetine	Major depressive disorder, bulimia nervosa, obsessive-compulsive disorder
Celexa	Citalopram	Depression, including major depressive disorder
Lexapro	Escitalopram	Major depressive disorder, generalized anxiety disorder
Effexor	Venlafaxine	Depression, anxiety, panic attacks, social anxiety disorder
Paxil	Paroxetine	Major depressive disorder, obsessive-compulsive disorder, anxiety disorders
Oleptro	Trazodone	Major depressive disorder
Wellbutrin	Bupropion	Major depressive disorder, seasonal affective disorder, smoking cessation
Cymbalta	Duloxetine	Major depressive disorder, generalized anxiety disorder

Addiction Potential: Are Antidepressants Addictive?

Experts say antidepressants are not addictive. People who take them for long periods may develop withdrawal symptoms, but physical dependence is not the same as addiction.[8]

Addiction vs. Dependence 

It’s easy to confuse addiction and physical dependence. But these two conditions aren’t the same. 

Physical dependence occurs when your body adjusts to the presence of drugs. In time, your cells need the medication to function. Without it, you feel discomfort and (sometimes) drug cravings. 

Physical dependence is often part of addiction, but people hooked on a substance have other symptoms. They have a desperate need to take the substance and can’t stop, even if they want to do so. 

A person with an addiction needs to address physical dependence. Detox programs (typically the first part of the recovery process) can help. But they also need help overcoming the habits and thought patterns that sustain drug use. That second element separates the treatment of addiction and dependence. 

Side Effects: How Antidepressants Affect the Body Over Time 

Like all prescription medications, antidepressants can cause side effects. But it’s difficult to predict what your discomfort might look like. 

Each antidepressant works a little differently. The symptoms you experience are dependent on the drugs you take. 

In general, antidepressant side effects can be split into short-term and long-term versions. 

Short-Term Effects 

Most antidepressants cause sleepiness and sedation, especially during the first few days you take them. You could also feel constipated, and you could develop indigestion and stomach aches. Despite these digestive troubles, you could notice that you’re gaining weight, especially around your midsection.[3] 

Long-Term Effects

The hazards you could face from taking antidepressants for long periods include physical dependence. You’ll need larger doses to do the work small doses once handled. You may feel sick between your doses. And you may crave your drugs when it’s time for another pill.[1]

Some people develop serotonin syndrome after long periods of antidepressant use. As the chemical builds up in the brain, you can experience a high body temperature, an irregular heartbeat, and seizures. This is a medical emergency.[6]

Short-Term Effects	Long-Term Effects
Sedation	Serotonin syndrome
Agitation or restlessness	Tolerance
Digestive difficulties	Sickness between doses
Sexual dysfunction	Withdrawal symptoms when you quit

Sources: [3,8]

Signs & Symptoms of Abuse: What to Look Out For 

Most people prescribed antidepressants don’t misuse them.[9] But people with a history of substance abuse issues can add these medications to their drug routines. These are common signs to watch for:[8,9]

Physical

Antidepressants are typically sedating drugs. People taking large doses may seem sluggish and slow. They may forget what they said or did while they were high. And in some cases, antidepressants cause severe and uncomfortable constipation that’s hard to hide. 

Mental 

It’s hard to sustain a drug habit. People with addictions may seem anxious, especially when they’re not sure where their next dose is coming from. They may also experience depression, especially when they try to quit antidepressants and other drugs. 

Behavioral 

Some people with addictions become secretive, as they’re trying to hide their addictions from the people they love. You may also notice that they spend more time with people on drugs, and they may leave the house at odd hours to meet their dealers. 

Physical	Mental	Behavioral
Sedation	Confusion	Withdrawing from others
Lack of coordination	Anxiety	Spending time with drug dealers
Constipation	Depression	Poor performance at work or school
Withdrawal symptoms	Memory loss	Secretive behaviors

Sources: [8,9]

Antidepressant Overdose Potential 

Antidepressants are powerful medications. Most will cause serious side effects when taken in large quantities. 

An antidepressant overdose can cause the following symptoms:

• Heart rhythm issues such as tachycardia
• Hypotension (low blood pressure)
• Drowsiness
• Coma
• Rigid muscles
• Mental confusion
• Seizures
• Blurred vision
• Fever
• Muscle twitches
• Depressed breathing

Antidepressant Withdrawal Symptoms 

After long-term antidepressant use, you will develop discomfort when you quit suddenly. While every medication is different, most antidepressants cause withdrawal.

Common symptoms associated with antidepressant withdrawal include the following:

• Fever
• Headache
• Nausea
• Panic attacks
• Tremors
• Hallucinations
• Lightheadedness
• Confusion
• Anxiety
• Dizziness
• Vivid dreams
• Diarrhea
• Ataxia (impaired balance or coordination)

Treatment of Antidepressant Abuse 

If you’re using antidepressants as prescribed by your doctor, you’re not abusing them. But if you’re adding these drugs to other substances, or you’re buying them from street dealers, you may benefit from a treatment program. 

Addiction therapy should be personalized. The approaches that work best for one person may be wrong for you. But most teams use the elements described below when building programs for their patients.

Tapering Off Antidepressants 

Since quitting some antidepressants suddenly causes seizures, doctors typically recommend a taper.[10] Your doses will get smaller on a personalized schedule. In time, you’ll use no drugs at all. 

Your taper may move quickly if you’ve used small doses for a short period. But if you’ve used a lot of antidepressants for a long time, you may need to move slowly to avoid withdrawal symptoms. Your doctor can set a schedule best for you. 

Medical Detox 

Since many people abuse antidepressants along with other drugs, a medical detox program may be helpful. Here, treatment teams will use medications to help you quit using drugs like heroin, cocaine, alcohol, and other illicit substances. When you finish this program, you’ll be sober. 

Rehabilitation 

While tapers and detox programs can help you get sober, rehabilitation can help you stay that way. You may start in an inpatient rehab program, where you move into the facility and away from temptation. As you get better, you may use outpatient rehab and practice your skills while you live at home.

Behavioral Therapy 

No pill or shot can help you change your habits and thought patterns. Behavioral therapy can. 

Your doctor might use cognitive behavioral therapy to help you change the way you react to common drug triggers.[11] And you might benefit from motivational interviewing to help strengthen your resolve to stay sober. 

Aftercare

When your formal treatment program is complete, you might benefit from attending support group meetings. Connect with others in recovery and learn from your peers. You might also connect with your therapist in outpatient meetings and strengthen your relapse prevention skills.