Antidepressants & Addiction

Antidepressants have the potential to be addictive, and it’s clear that many can cause physical dependence. They also can be toxic if you take too much, which is especially a problem because a rare side effect of these medications is suicidal thoughts. 

If you start to experience troubling thoughts while on antidepressants, talk to a doctor right away.

What Are Antidepressants?

Antidepressants are a broad category of medication primarily used to treat depression, but they can also help treat a variety of other conditions (discussed more below). 

We don’t completely understand why antidepressants work to treat depression, although it’s believed a key part of how they work has to do with the way they increase neurotransmitters in the brain, several of which are linked to mood and emotion.

An individual may take antidepressants long term or as a temporary measure. In either case, antidepressants usually work best when combined with psychotherapy, where a person talks with a mental health professional about their problems and works to change the way they think and their general lifestyle to find ways to deal with certain issues in healthier ways.

Key Facts About Antidepressants

Here are some key facts about antidepressants:

• In 2018, an estimated 7.2% of American adults had at least one major depressive episode.
• From 2015 to 2018, 13.2% of American adults reported using antidepressants within the last 30 days when surveyed.
• Among Americans, women tend to use antidepressants more than men. The highest use group according to one survey was women ages 60 and over, with over 24.3 percent of this group using these drugs.
• Antidepressant use seems to increase with higher levels of education among men, but use rates do not differ significantly by education level among women.

Different Types of Antidepressants

These are different types of antidepressants:

Selective Serotonin Reuptake Inhibitors (SSRIs)

This is the most widely prescribed type of antidepressant. It works by reducing the reuptake of serotonin in the brain, an important neurotransmitter that helps with a variety of functions, including mood. 

SSRIs come with the potential for side effects, with a commonly cited symptom being sexual issues, such as problems getting erections or orgasming. However, they are usually considered safe and effective when used as prescribed.

Selective Noradrenaline Reuptake Inhibitors (SNRIs)

Originally designed to replace SSRIs, selective noradrenaline reuptake inhibitors (SNRIs) haven’t lived up to that purpose, instead working as an additional antidepressant option that can help some people more than SSRIs. For other people, they don’t work as well. 

SNRIs have a valid purpose in the treatment of depression, especially if SSRIs have been ineffective for a person.

Noradrenaline and Specific Serotonergic Antidepressants (NASSAs)

This class of antidepressants is often used for people who cannot take SSRIs, producing a similar effect to SSRIs. NASSAs are not associated with sexual dysfunction, a symptom SSRIs can sometimes cause, but they do cause more drowsiness when first being used. 

Tricyclic Antidepressants (TCAs)

TCAs are an older type of antidepressant and aren’t usually a first-line treatment due to more dangers associated with their use that aren’t as present with more modern antidepressants. They are generally only used if other types of antidepressants have been ineffective, and a person has especially severe depression.

Serotonin Antagonists and Reuptake Inhibitors (SARIs)

Similar to TCAs, SARIs aren’t a first-choice antidepressant. They are sometimes used if other antidepressants prove ineffective or produce significant side effects that make them difficult for a patient to keep using. 

Why Are Antidepressants Used?

In addition to treating depression, antidepressants are also sometimes used to help treat the following conditions:

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

Depression often co-occurs with other mental health conditions, so many people may end up taking antidepressants in addition to other medications that are meant to target other mental health problems for which they may have sought help.

Some antidepressants may have specific uses outside of the above. For example, TCAs can sometimes help treat bipolar disorder, and there is some evidence that they may be helpful in treating chronic nerve pain.

Can Antidepressants Be Addictive?

While many medical experts compare drugs like SSRIs favorably in terms of addiction and abuse potential compared to benzodiazepines, a type of anti-anxiety medication often associated with addiction, there’s some evidence this comparison isn’t as supported by facts as some believe.

What’s also known is that many antidepressants can cause physical dependence, which results in withdrawal if you suddenly stop taking them (discussed more later). The most significant withdrawal symptoms are generally associated with medications that affect serotonin systems, such as SSRIs.

Addiction vs. Dependence

One issue that complicates the discussion about whether a given antidepressant may be addictive is that addiction and physical dependence are not identical. Physical dependence on a medication occurs when the body adjusts to your use of a drug over time, essentially treating the presence of that drug as “normal.” Discomfort and potentially drug cravings occur in its absence until the body can adjust. 

Physical dependence is often a part of addiction, but it is not all that encompasses addiction. Addiction is characterized by a strong sense of needing to take a drug and having difficulty stopping even if you logically want to stop and can see its use damaging your quality of life and health. 

A person addicted to a medication needs to overcome physical dependence, which is usually an early step in the recovery process, but they will also need to overcome the psychological need, or psychological dependence, driving them to want to take more of a medication.

Can You Overdose on Antidepressants?

Antidepressants have the potential to be dangerous if you take too much, which is a notable issue because they can also cause suicidal thoughts in rare cases, especially in younger users. Antidepressants are commonly used in cases of self-poisoning, an issue prescribers need to consider when deciding which medication to prescribe to a patient. 

Withdrawal

Antidepressant withdrawal, which again only signals physical dependence and does not necessarily mean a person is addicted to antidepressants, can vary in severity and symptoms depending on the medication a person was taking, how much they were taking, and how suddenly they stop taking it. 

These withdrawal symptoms aren’t usually dangerous, but they can be distressing. 

Antidepressants generally work by affecting neurotransmitters in the brain. Sudden changes to the current level of neurotransmitters in the brain can result in mood swings, anxiety, and irritability. While not the only way a person might experience these sudden changes, suddenly stopping one’s medication can cause this to occur. The body needs to slowly adjust to the new level of neurotransmitters present for a person to start to normalize.

Antidepressant withdrawal can look like depression. This can be challenging if you have been using the medication to treat depression and want to see if you still need it. One way to tell these phenomena apart is that discontinuation symptoms emerge quickly, whereas a relapse into depression usually occurs later and more gradually.

Treatment Options for Antidepressant Abuse

If you feel you can’t stop taking antidepressants but also see them damaging your quality of life, you should seek treatment from an addiction professional. Importantly, not all use of antidepressants signals addiction. If you have a legitimate prescription and are using your medication as prescribed to treat a chronic mental health problem, there may be a reason your doctor thinks you should take your medication long term.

The standard approach to addiction treatment often involves the following:

• Behavioral counseling
• Undergoing medication cessation or withdrawal under medical supervision (often via a tapered approach)
• Evaluation and treatment for related mental health issues, including depression and anxiety
• Long-term follow-up care, including further, consistent behavioral counseling, to help prevent relapse

In some cases, medication may be used as part of your treatment process, although this will depend on the nature of your addiction and what, if any, evidence-based options are available that may help as part of the process.

References

Overview – Antidepressants. (November 2021). UK NHS.

Antidepressant Use Among Adults: United States, 2015-2018. (September 2020). NHS.

Uses – Antidepressants. (November 2021). UK NHS.

Scientist: Antidepressants Cause Addiction. (May 2013). ScienceNordic.

Side Effects – Antidepressants. (November 2021). UK NHS.

Toxicity of Antidepressants: Rates of Suicide Relative to Prescribing and Non-Fatal Overdose. (May 2010). British Journal of Psychiatry.

Going off Antidepressants. (May 2022). Harvard Health Publishing.

Treatment Approaches for Drug Addiction. (January 2019). National Institute on Drug Abuse.

Abuse and Misuse of Antidepressants. (August 2014). Substance Abuse and Rehabilitation.

Antidepressant Use and Risk of Self-Harm Among People Aged 40 Years or Older: A Population-Based Cohort and Self-Controlled Case Series Study. (August 2022). The Lancet.