The World Health Organization (WHO) estimates that depression is the leading cause of disability worldwide, affecting 350 million people of all ages around the globe.
The National Institute of Mental Health (NIMH) estimates that by the time they turn 18, 3.3 percent of adolescents will have a depressive disorder, and girls are more at risk than boys. Depression is characterized by episodes of sadness that affect everyday life and functioning. Symptoms must be present for at least two weeks to be diagnosed as a depressive disorder.
Anxiety disorders affect nearly 18 percent of the American population, around 40 million people, and they are the most common mental illness in the country, as reported by the Anxiety and Depression Society of America (ADSA). These disorders include generalized anxiety disorder (GAD), panic disorders, post-traumatic stress disorder (PTSD), phobias, social anxiety disorder and obsessive-compulsive disorder. Anxiety disorders affect the way stress is processed.
Anxiety disorders and depression often co-occur together about half the time, according to ADSA. One in 10 adults over the age of 12 in the United States takes antidepressant medications that are used primarily to treat depression and anxiety disorders, making antidepressants the third leading type of prescription drug taken in America, as published by the Centers for Disease Control and Prevention, or CDC.
As with any drug or medication, antidepressants are not without side effects and risk factors. The CDC reports that 14 percent of Americans currently taking antidepressant medications have been taking them for 10 years or longer, and less than one-third of those taking one antidepressant have been seen by a medical professional face to face in the past year. Approximately 80 percent of antidepressant medications are not prescribed by a psychiatrist either, as published by NIMH. Taking medications long-term and without proper supervision, medical treatment, and continuous medical evaluations by trained professionals may potentially lead to drug dependency or addiction.
Addiction vs. Dependence
There are several types of antidepressant medications on the market today, and research varies as to the addiction potential of these pharmaceuticals. Different types of medications work on the brain in varying ways, which may increase the addiction potential in some and not others. Genetic and environmental factors may also play a role in the development of a substance abuse or dependency. Researchers estimate that genetics are a factor between 40 and 60 percent of the time, making some people more prone than others to developing an addiction or substance abuse disorder, as published by the National Institute on Drug Abuse (NIDA).
Medications and drugs alike make chemical changes in the brain, and taking them before the brain is fully developed, like in adolescence, can increase the risk factors for developing a substance abuse problem later on. The use of any prescription drug beyond the scope of its intended or medical use is considered drug abuse. NIDA reports that along with over-the-counter medications, prescription drugs are the most commonly abused substances in America behind alcohol and marijuana. Prescription drugs are generally easy to obtain and falsely perceived as safe since they often come out of a medicine cabinet where they were initially prescribed by a doctor. The 2013 National Survey on Drug Use and Health (NSDUH) reported that half of all prescription drugs used for recreational, or nonmedical purpose, were obtained for free from a relative or friend who got them from a doctor. Using drugs beyond their medical scope increases the risk factors for developing an addiction.
It is important to understand the difference between addiction and dependency. Addiction is considered a disease requiring treatment, while dependence may be a natural physical occurrence when taking medications long-term. Addiction is defined as a chronic and relapsing brain disease wherein the user cannot control compulsive drug use and continues to seek out drugs beyond medical necessity and without regard to negative physical or emotional consequences. Addiction contains both emotional and physical components.
Dependence, on the other hand, is when the brain begins to rely on the chemical changes the drug initiates in the brain, and the body becomes physically dependent on the medication or drug in order to function in what it now perceives as a normal fashion. Dependence can lead to addiction, but not all the time. Someone who is physically dependent on an antidepressant and needs the medication in order to reduce symptoms, for instance, may not seek to increase dosage or engage in any compulsive drug-seeking behavior or abuse.
In order to be officially diagnosed with a substance abuse disorder as defined by the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and published by the American Psychiatric Association you must have at least two of the following symptoms:
- Taking more of the substance than intended or for a longer period of time
- Unsuccessful desire to control substance usage or unsuccessful attempts to stop using the substance
- Substance cravings
- Obsession with the substance
- Substance use interferes with work, school or family obligations
- Cessation of recreation or social events previously enjoyed due to substance use
- Interpersonal relationship damage from substance use and continued use regardless
- Using substance repetitively in physically dangerous situations or circumstances
- Tolerance to substance
- Withdrawal symptoms when substance is removed
- Continued use despite negative physical and emotional consequences
Substance abuse disorders range in severity depending on how many of the criteria are present. When one, two or three symptoms exist, the disorder is considered mild, while the presence of four or five symptoms is considered moderate, and the presence of six or more symptoms is diagnosed as a severe substance use disorder. Severity will also depend on the length of time abusing the substance, method of abuse, and other environmental and genetic predispositions.
The most common types of antidepressant medications prescribed, as indicated by NIMH, are:
- Selective serotonin reuptake inhibitors or SSRIs, such as Prozac, Paxil, Lexapro, Serafem, Celexa, Luvox and Zoloft
- Monoamine oxidase inhibitors or MAOIs, like Manerix, Marplan, Emsam, Parnate and Nardil
- Serotonin and noradrenaline reuptake inhibitors or SRNIs, including Effexor, Cymbalta and Pristiq
- Tricyclics, like Tofranil and Norpramin
- Norepinephrine and dopamine reuptake inhibitors or NDRIs, such as Wellbutrin and Zyban
- Noradrenergic and specific serotonergic antidepressants or NaSSAs, like Remeron
Antidepressants are believed to function by changing the way the brain’s natural messengers, or neurotransmitters, work. Certain neurotransmitters, such as serotonin and dopamine, for example, are partially responsible for mood and positive emotions. Antidepressants often block the reabsorption of these neurotransmitters, thereby changing the chemical balance in the brain and boosting mood. Depressed individuals may have lower levels of some of these natural chemicals, and antidepressant medications can increase their production. Antidepressant medications are proven to improve depressive symptoms between 50 and 65 percent of the time when treating moderate to severe depression after three months of use, as reported by the Royal College of Psychiatrists.
Most prescribing physicians are moving away from tricyclics and MOAIs due to the side effects and diet restrictions that they may incur and leaning more toward SSRIs. Since depression often co-occurs with other disorders, including anxiety disorders, additional medications such as benzodiazepine anti-anxiety medications, like Valium and Xanax, may also be prescribed in tandem with antidepressant medications. This can increase the potential side effects and risk factors if mismanaged or not properly supervised.
The side effects of antidepressant medications will vary depending on your personal experiences, genetic makeup, and type of medication required. Generally speaking, antidepressants are not thought to be as effective on mild forms of depression, but rather are reserved for more moderate to severe manifestations. General health concerns or risk factors may include:
- Weight gain
- Dry mouth
- Nausea and/or vomiting
- Irregular heart rate
- Sleepiness or drowsiness
- Indigestion
- Confusion
- Tremors
- Sexual dysfunction
- Trouble urinating
- Heightened blood pressure
- Potential for increased suicidal thoughts or tendencies
Tricyclic antidepressants may cause an unsafe drop in blood pressure when you stand up. Side effects are increased with the introduction of other drugs or alcohol. If you, or someone you know, are experiencing suicidal thoughts, seek immediate professional help. Be sure to discuss these potential health concerns with your doctor, and keep in mind that you may experience more or fewer of these side effects than others.
Are SSRIs Addictive?
There is much debate on the topic of antidepressant pharmaceuticals, specifically SSRI medications, and their addictive potential. It is well-known that substance abuse changes the chemical makeup of the brain and interferes with the natural production of several of its neurotransmitters, which are responsible for pleasure and mood much in the same way that prescription medications do. Chronic illicit drug and alcohol abuse may lead to a physical and psychological dependence on these substances in order to maintain feelings of balance and normalcy. This dependence may turn into an addiction when the need for substance abuse takes over and excessive amounts of time are dedicated to obtaining the substance, using it, and recovering from its effects. SSRI medications are often mistakenly referred to as “happy pills,” although they do not seem to produce the same sense of euphoria or artificial happiness that other medications, including benzodiazepines, do. SSRIs seek to regain a natural balance in the brain instead of merely increasing pleasant feelings; therefore, it is estimated that no high is established by taking them illicitly.
In order to be classified with an addiction, a tolerance to the drug must be established, leading to drug-seeking behavior, which doesn’t seem to occur with SSRIs. While addiction seems less likely, dependency can occur when taking SSRIs long-term as can withdrawal symptoms. This is often mistaken for true addiction. Some researchers argue that the presence of withdrawal and physical dependency does indeed make SSRIs addictive, while others disagree.
Symptoms of SSRI withdrawal include insomnia, nausea, alteration of touch sensation, and feelings of electrical shocks in the brain. When these symptoms are present, it is referred to as SSRI discontinuation syndrome, and it is not officially a side effect of addiction. A Danish study published in Science Nordic argues that as many as 37 out of the 42 withdrawal symptoms for the known addictive benzodiazepine medications that were largely discontinued as antidepressant medications with the rise of SSRIs are identical to those experienced during SSRI discontinuation syndrome.
Whether or not antidepressant and SSRI medications are considered officially addictive, if you are suffering from depression and/or long-term usage of these medications, you may benefit from specialized treatment for substance abuse and mental health disorders. You should not quit taking these medications without assistance from a doctor or other medical professional.
Dual Diagnosis
Depression varies widely from person to person. It is defined by the Mayo Clinic as a mood disorder affecting how you think, behave, and feel, and it is indicated by loss of interest and persistent sadness. The treatment of depression often requires both medications and behavioral or Cognitive Behavioral Therapy (CBT) in order to be most successful. CBT teaches coping mechanisms and helps individuals to modify negative thought and behavior patterns into more positive outlooks and self-images. Healthy lifestyle changes, including a balanced and nutritious diet as well as exercise or recreational opportunities, are helpful during recovery as well as they increase natural endorphins and pleasant feelings.
Depression often co-occurs with other mental health disorders and substance abuse as those suffering may turn to illicit substances or alcohol in order to numb the pain or in an attempt at self-medication. Similarly, the abuse of substances may lead to depression or depressive thoughts. It is often unclear which comes first, but ADAA estimates that depression and substance abuse disorders co-occur at least 20 percent of the time.
When two disorders are present in the same person at the same time, it is considered a dual diagnosis, or co-occurring disorders, and specialized treatment is the best option for a lasting recovery. Evidence-based treatment models combine the expertise of clinicians with scientific research and individual personalities in order to determine the best course of action. Dual diagnosis treatment is the most successful when teams of medical professionals work together to provide integrated and simultaneous treatment of both disorders. Both depression and substance abuse disorders are then treated as primary disorders.
Whether you, or your loved one, struggle with depression, substance abuse, or both, FRN treatment centers provide comprehensive and compassionate care plans designed to fit each individual’s unique set of circumstances. Family, group and individual therapies and counseling sessions are often combined with medications and peer support or self-help groups. Contact us today to determine the best path toward a lasting and healthy recovery.
Further Reading About Antidepressant Addiction
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton