Antidepressants Abuse and Addiction Treatment Options
Antidepressant use is common in the United States, with prescription rates rising annually. These high rates threaten the well-being of millions, particularly those overusing or misusing their prescription. By 2018, over 13% of the American adult population had taken antidepressants in the past 30 days, and when the pandemic hit, depression rates in the U.S. tripled. This spike in depression led to increased consumption of antidepressants worldwide.
The majority of individuals prescribed antidepressants do not abuse them. However, select classes of antidepressants carry a high risk of abuse potential, making those with a history of substance abuse vulnerable. When you start to sift through the available research, you see how complex this topic is — especially since there are so many different antidepressants taken under various circumstances.
This guide focuses on the link between antidepressants and addiction, covering everything from symptoms to the next steps when needing professional help. Please check out the mental health services by Zinnia Health to discover more about your path to a better future.
Are Antidepressants Addictive?
Antidepressants are not generally viewed as addictive substances. Unlike many sleeping pills and sedatives, some research suggests that antidepressants don’t typically cause physical dependence or addiction. However, many patients experience withdrawal symptoms when trying to discontinue use, which is discussed in detail below.
The available research supports the idea that antidepressants are often dependence-forming, but there is a lack of research concerning antidepressants and addiction. When considering an addiction to alcohol or opiates, cravings and relapse are often features of dependence. However, antidepressants generally don’t create cravings once patients have stopped using them and withdrawal symptoms have ceased.
For decades, the question of whether antidepressants are addictive has been debated. Many clinicians agree the risk is low or non-existent, while others have challenged this. The debate has become increasingly complex, especially when patients are diagnosed with mental health disorders or abuse of other substances, such as alcohol.
One of the criteria for addiction is the need to increase the dose to achieve the desired effect. With antidepressants, cravings typically don’t play a role. However, there are instances when patients need to increase their dose because a selective serotonin reuptake inhibitor (SSRI) has stopped working. This phenomenon is called “Prozac poop-out,” which may require a higher dosage or the addition of another antidepressant. This need to increase the dose doesn’t mean they’re addicted to their medication — but complications can quickly arise when substances are mixed.
Individuals who live with mood disorders and are prescribed antidepressants often exhibit signs of substance use disorder. In these cases, they may face an increased risk of abusing their medication. Based on the National Epidemiologic Survey on Alcohol and Related Conditions, over 40% of people with lifetime major depressive disorder also had alcohol use disorder, and over 17% had a drug use disorder.
Potential for Abuse Depends on the Antidepressants Prescribed
One key review focused on case reports and clinical data found 21 cases of antidepressant addiction. Of these cases, 16 involved tranylcypromine or amineptine. These drugs’ potentially addictive effects may be linked to their dopaminergic (pleasure-related) and stimulant properties. The study concluded that discontinuation and withdrawal symptoms have long been recognized when taking antidepressants. However, features of addiction, such as tolerance and compulsive use, are rare. Tranylcypromine and amineptine should be avoided in those with a history of substance misuse.
Antidepressants are tricky because there are so many variations. These medications branch across five main classes and have unique properties. For example, some help reduce anxiety symptoms, some are stimulating, and others are sedative.
For example, case reports show that when patients abuse bupropion, a drug used to treat depression, users can experience cocaine-like, euphoric effects or feelings of being “high” — a slippery slope for those vulnerable to drug abuse. Understanding this drug’s pharmacology offers greater insight into why it’s misused.
The route of administration is also a significant factor. Although some reports mentioned patients taking bupropion orally to get high, most take this drug intranasally. Snorting any prescribed drug is a red flag for addiction, as the main objective is to get high.
As you review each class of antidepressants, each presents its effects and potential for abuse. For example, serotonin and norepinephrine reuptake inhibitors (SNRIs), which include duloxetine, venlafaxine, and desvenlafaxine, can create an “amphetamine-like high.” A wide range of effects have been reported when taking high doses of SNRIs and when overdoses are fatal, a combination of an SNRI and other drugs or alcohol are often to blame. These deadly occurrences showcase the heightened risk of antidepressant misuse among those with a history of illicit drug abuse.
What Are the Symptoms of Antidepressant Addiction?
The symptoms of antidepressant addiction can be a highly personal experience based on one’s individual mental health and history of substance use. If you want to learn more about the connection between mental health and addiction, read this research article.
In 2014, a comprehensive search was conducted on PubMed, Medline, and PsycINFO using search terms relevant to addiction and antidepressants. The researchers found growing literature on the misuse and abuse of antidepressants. In most cases, antidepressant abuse occurred in individuals with co-morbid (simultaneous) substance use and mood disorders. The greatest motivation to abuse such medications was to experience a psychostimulant-like effect.
Side effects of antidepressants vary, even when taken at doses prescribed to patients. However, when antidepressants are abused, negative consequences can be severe, including confusion, seizures, and psychotic-like symptoms. Again, these symptoms become much more complex and dangerous when substances are mixed. For example, taking bupropion with alcohol or stimulants can increase one’s risk of having a seizure.
One case study found that when a 49-year-old man with no history of psychotic illness snorted 1,200 mg of bupropion daily, he experienced auditory hallucinations. These hallucinations ended when he discontinued use. At high doses, this drug can also lead to heart damage.
Withdrawal Symptoms That Develop From Antidepressant Use
To better understand the effects of antidepressant addiction, it’s important to compare the difference between addiction and dependence.
Although psychological dependence is possible, “dependence” commonly refers to physical dependence, resulting in a range of withdrawal symptoms following discontinued use. Changes in behavior, which are the result of changes in the brain, can be signs of physical addiction. For example, an addict often prioritizes their substance use above all else, creating detrimental consequences within their personal and professional life.
Based on this understanding, dependence can occur without addiction. However, addiction is often not far behind once dependence develops, especially among those with a higher predisposition to substance abuse.
If you or a loved one have become dependent on antidepressants and are showing signs of addiction, you may wish to stop using your drug of choice. When you try to stop, however, you’ll likely experience withdrawal symptoms. Research shows that antidepressant discontinuation symptoms develop for all classes of antidepressants. For example, when dependent on SSRIs, common withdrawal symptoms include nausea, dizziness, lethargy, and headaches. To avoid these symptoms, many will continue to take antidepressants, even if they are no longer needed for the condition they were initially prescribed for.
The first instance of antidepressant discontinuation (withdrawal) symptoms was reported in 1959 concerning imipramine. Since then, many studies have documented instances of antidepressant withdrawal. In 2019, a large review was conducted. The researchers examined data from 271 case reports, 40 controlled trials, and 38 longitudinal (observation over time) studies. It was found that the most common withdrawal symptoms associated with antidepressants were mild, including mood changes, dizziness, headaches, and poor sleep. Serious, prolonged issues are rare but depend on the type of antidepressant. Monoamine oxidase inhibitors (MAOIs), for example, have increased risk.
Antidepressant Withdrawal Is Likely Underreported
Withdrawal symptoms related to antidepressants are likely underreported. Approximately one-third of patients taking antidepressants discontinue use within one month without consulting their doctor; by three months, this number increases to 50%.
A Danish study found that the most frequent calls to a national medical hotline involved antidepressant withdrawal phenomena. These findings illustrate the importance of patient support, especially when the individual experiences challenging symptoms. For example, antidepressant withdrawal can lead to dozens of symptoms, ranging from cognitive to sensory and cardiac to gastrointestinal. Even delirium can develop when patients withdraw from certain antidepressants, like tranylcypromine.
The Duration of Use Could Be Relevant
How long it takes to become addicted to antidepressants and experience withdrawal symptoms isn’t black and white — there are a lot of gray areas. However, it’s clear that long-term antidepressant treatment increases patients’ risk of adverse effects. Data collected from 180 patients found that 73.5% experienced withdrawal symptoms, and 43% reported a link to addiction. These individuals had been taking antidepressants for three or more years. It’s also not uncommon for patients to experiment with different medications — as many as 35 prescriptions over five years.
Antidepressants work by altering levels of neurotransmitters, including serotonin and dopamine. Following continued use, neurons adapt to the altered levels of neurotransmitters. The symptoms can be uncomfortable when these levels change quickly, which happens when you abruptly stop taking your prescription. Many aren’t prepared for discontinuation symptoms, and patients often continue taking antidepressants because of safety concerns linked to withdrawal rather than a perceived need for the medication.
In the study mentioned above, one patient is reported to have said, “I was never informed by doctors of long-term side effects or addiction/development of tolerance and went through extremely severe withdrawal symptoms attempting to get off (suicidal level depression). Only by persisting through terrible suffering did I wean myself off.”
The study also found that a common belief among patients is that therapy or counseling is important as an alternative to or in combination with antidepressant medication.
The Link Between Antidepressants and Alcohol Abuse
Co-occurring disorders are common among individuals with depression and anxiety disorders, including alcohol use disorder. Although antidepressants can help individuals in treatment, as they reduce the severity of depressive symptoms, dangers are involved. Again, bupropion is an antidepressant that can create adverse effects when combined with alcohol, including a lower seizure threshold. The key is finding the right antidepressant, which can be challenging.
One of the greatest concerns is that if a patient continues to drink heavily, symptoms of depression may worsen. Prescribed antidepressants may not work as well as they should; in some cases, the combination will threaten one’s health. For example, combining alcohol and an MAOI can cause a dramatic spike in blood pressure. In vulnerable individuals, a stroke could result. Liver toxicity is also a significant area of concern.
If you’re struggling with depression and alcohol misuse and are trying to mask it all with antidepressants, you must seek a professional healthcare provider or recovery center for help. There are plenty of evidence-based treatment options that will help you overcome symptoms of depression and substance use disorder. Although antidepressants may be part of your comprehensive treatment plan, therapy can help you address the underlying cause of your mental health disorder. Take advantage of available support systems to live a healthier, more fulfilling life.
Zinnia Health Can Help
If you have been taking antidepressants for an extended period, are struggling with mental illness, or are abusing additional substances, it’s imperative to seek help.
When stopping antidepressants, you should discuss your goals with a medical professional because depression can return if you quit too soon. You’ll want to make a plan that often involves tapering doses. Since so many antidepressants exist and dose reduction scheduling differs for each class, it’s not recommended that you complete this process alone.
When working with a professional team, they can help you build a treatment plan that addresses your unique needs. For example, fewer than 20% of people on antidepressants undergo psychotherapy, even though this approach can significantly reduce the likelihood that a patient will relapse. This is where Zinnia Health shines.
At Zinnia Health facilities nationwide, individuals can access treatment programs tailored to their unique needs. Whether you’re suffering from childhood trauma or are battling the outcome of a genetic predisposition, Zinnia Health offers treatment options that work. You can regain control of your health and life — Zinnia Health will be your guiding light.