Antidepressant medications refer to a broad group of drugs that are employed for the treatment of numerous disorders. In fact, these medications are among the most frequently prescribed drugs. The data from the Centers for Disease Control and Prevention’s (CDC) National Health and Nutrition Examination survey found that 13.2% of adults aged 18 and over had used these medications in the past 30 days, which approximately equates to over 30 million individuals.
This is to be expected as according to the CDC 4.7% of adults report regular feelings of depression and another 11.2% of adults further reported regular feelings of worry, nervousness, or anxiety. As such the prevalence of both, FDA-approved and off-label use of antidepressant medications for the treatment of disorders such as Major depressive disorder (MDD), Persistent depressive disorder (Dysthymia), Premenstrual dysphoric syndrome (PDS), General anxiety disorder (GAD), Obsessive-compulsive disorder (OCD), and various others is very common. Unfortunately with this common use, frequent antidepressant abuse, misuse, and addiction are also problematic for both users and prescribers alike.
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What Are Antidepressants?
Antidepressants are prescription medications that are designed to alleviate symptoms and signs of depression. In addition to being used for depressive disorder, they are often also prescribed for social anxiety, generalized anxiety, seasonal affective disorder, and dysthymia. Other applications, such as the treatment of pain, are also explored by doctors. How antidepressants work is not fully known. What is known will differ between types of antidepressants. Generally speaking, they increase so-called feel-good chemicals within the body, addressing what is assumed to be a shortage of them within the brain of the person being treated. This is why depression medications for anxiety and other mental health conditions are said to work.
However, since these drugs do not work for everyone, many people question if depression medications work at all. Ultimately, the evidence shows that they do work, with their effectiveness being about double that seen with placebos. However, they are still not effective in nearly half of all people prescribed them. When this is combined with antidepressants side effects, it is difficult to say if they are beneficial in very many cases. Among other effects, there are some antidepressants that cause weight loss or gain. However, not everyone who takes even the best meds will experience this benefit. Indeed, it can be a challenge for many.
Are Antidepressants Controlled Substances?
Antidepressant medications are not considered controlled substances under the United States Drug Enforcement Administration’s (DEA) Controlled Substances Act (CSA). However, all common antidepressants require prescriptions from qualified physicians.
According to the DEA, a controlled substance is one that has a high potential for abuse or dependency. Although antidepressant abuse and addiction can pose a risk for some users, these drugs still do not fall under one of the five schedules of the Controlled Substances Act as the potential for antidepressant addiction and abuse is not as great as that of other scheduled substances.
Types Of Antidepressants
Currently available depression medicines make up a vast and remarkable variety of chemical types. Generally speaking, these drugs enhance serotonergic or noradrenergic transmission through their respective mechanisms of action. For example, the older first generation of drugs such as Tricyclics (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) enhance monoaminergic transmission by inhibiting serotonin and norepinephrine reuptake and by inhibiting monoamine metabolism respectively. The second-generation of new antidepressants, such as Specific Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), which have less toxicity and improved safety profiles when compared to the previous generation, primarily increase monoaminergic transmission by inhibiting neuronal reuptake of serotonin and norepinephrine. Thus, this is an entire class of medications that encompasses many different subclasses. These include:
- Specific Serotonin Reuptake Inhibitors (SSRIs)
- Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
- Tricyclic Antidepressants (TCAs)
- Monoamine Oxidase Inhibitors (MAOIs)
- Atypical Antipsychotics
- Serotonin Antagonist and Reuptake Inhibitors (SARIs)
Below is a table showing which generation each belongs to and some examples of the different antidepressant pills:
| DRUG CLASS | GENERATION | EXAMPLES |
| SSRI | Second | |
| SNRI | Second |
|
| SARI | Second |
|
| TCA | First |
|
| MAOI | First |
|
| ATYPICAL | Mixed |
|
Additionally, there are natural alternatives to depression medications. However, they do not fall into these classes. Even if common depression meds have their benefits, no option is 100 percent safe in all circumstances. Additionally, there is the risk of overdosing on antidepressants if the individual prescribed them is likely to abuse them or is abusing other substances.
Hence, it is also important to be aware of the dangerous interactions between these antidepressants and alcohol.
Antidepressant Uses
Antidepressant uses go far beyond the expected treatment of depression. Their use is seen in everything from pain management to the management of symptoms of premenstrual dysphoria. Exactly how a given depression medication will be prescribed will often be determined by its specific class and its adverse effect profile.
There are many examples of TCAs being prescribed for pain, but few for treating menopause. As such, patients and their doctors must carefully consider medication and its application before deciding on one.
| Anxiety | Anxiety disorders, whether generalized, specific, social, or others, are the most common mental health disorders today. These disorders are associated with a group of complex cognitive, affective, physiological, and behavioral symptoms that are often quite burdensome and stressful to individuals experiencing them. Pharmacotherapy with firstline drugs such as SSRIs and SNRIs as well as atypical and tricyclic antidepressants in combination with psychology therapy, such as Cognitive Behavioral Therapy, form the backbone in the management of chronic anxiety disorders. |
| Depression | The effectiveness of these drugs for depression was key in their development. All depression medications currently in use have at least been statistically demonstrated to be at least somewhat effective in addressing depressive disorders. However, much variability exists in the therapeutic response and tolerability of different depression meds among patients. Thus, which medications are best will depend on the patient and the regimen of their treatment. For example, It is possible for certain medications to be effective at first but then patients may discover that the long-term use of depression meds results in diminished effectiveness. Ultimately, the experience is highly individual. |
| Sleep | The use of antidepressants for sleep problems is widespread, but unfortunately, none of these medications are licensed for insomnia or have adequate evidence for their efficacy. Nonetheless, certain depression meds with sedative properties such as Doxepin, Mirtazapine, and Trazodone continue to be used for their sleep-promoting effects. |
| Use For Headaches And Migraines | Pharmacologic prophylaxis with some of these medications can be used for the prevention of chronic migraines and tension-type headaches that respond poorly to more conventional therapies. The goal of those used for headaches and migraines treatment is to prevent them from occurring, not treat the pain. Tricyclic medicines show the most promise in treating this kind of pain. However, these medications are associated with more severe side effects than newer generation depression meds. As such, their use should only occur with significant caution. |
| Bipolar Disorder | The use of antidepressants for Bipolar disorder is often controversial. It is believed that older, first-generation depression medications may trigger rapid switching of moods between depression and mania which can pose a risk to the user’s health. However, similar induction of rapid cycling does not appear to be well associated with new antidepressants such as SSRIs. Thus the careful and closely monitored use of certain SSRIs for bipolar disorder, often in conjunction with other drugs such as mood stabilizers, can sometimes be seen. Nonetheless, there still remain concerns regarding taking depression medications for Bipolar disorder. |
| Use For Pain Treatment | Doctors often turn to these medications for chronic pain. Research tends to support this use more than many other, more common applications of these medications. However, it is first-generation depression meds that are most effective. This can be problematic given their numerous side effects. While these drugs can help people get out of crippling nerve pain, the new side effects they take on could end up being debilitating. |
Another consideration when opting for the use of these drugs is which medication is best for the patients given their age and their sex. For example, teens and children are especially at risk of experiencing increased suicidal thoughts and actions after starting therapy. That’s why depression medicine use is highly discouraged in young children, with patients ideally being at least 12 years old before beginning treatment. Side effects and effectiveness of drugs can also vary between the sexes. Studies have found that male and female bodies respond differently to the presence of depression medications. Hence, the prescription of depression medications must be precisely tailored to the needs of the patient.
Antidepressant Addiction And Abuse Overview
Information about the prevalence of antidepressant abuse and addiction is unfortunately unavailable as this group of drugs is not included in epidemiological studies that evaluate the misuse of prescription medications. However, if one were to estimate the rates of misuse and abuse from the rates of psychotherapeutic drug misuse, which in 2020 was as high as 5.8% in individuals aged 12 and older, then the number would indeed be concerning.
Additionally, it is often quite difficult to determine what qualifies as antidepressant abuse or antidepressant addiction as different sources of literature define each term uniquely, which makes determining the prevalence even more difficult. Generally speaking, these terms can be defined as either use without a prescription, in greater amounts, more often, or longer than a prescribing physician intended.
Despite the lack of information, there are certain reports of cases of antidepressant addiction and abuse. One study from the Columbia University Department of Psychiatry which assessed antidepressant abuse and misuse found that among the most frequently misused drugs of this group were Monoamine Oxidase Inhibitors and Bupropion. However, this is not to say groups such as Specific Serotonin Reuptake Inhibitors (SSRIs), Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclics (TCAs), and Atypical Antipsychotics do not have a potential for misuse.
Are Antidepressants Addictive?
Users often have the question of are antidepressants addictive? In general, depression meds are not thought to be addictive as they are considered to have low liability for abuse. But that is not to say that antidepressant addiction does not exist. As the body comes to depend on antidepressant pills, it will stop producing chemicals in the same way, which means that tolerance and withdrawal phenomenon may occur. This is particularly common for individuals who have concurrent substance use and mood disorders. Additionally, someone can feel mentally addicted to them if they find that their use brings them comfort, even if they are abusing the medication. Addictive depression meds can be just as problematic as any other drug of abuse. As such, stopping antidepressants safely is important. No one should consider stopping cold turkey. Additionally, it should be under close medical supervision, preferably in a drug rehab facility.
Antidepressant Addiction Signs And Symptoms
It can be very difficult to detect antidepressant addiction signs and symptoms, as those struggling will often try to conceal this fact. However, there can be certain physical as well as psychological and behavioral clues that may point to this issue.
Physical Symptoms and Signs of Antidepressant Addiction May Include:
- Weight loss
- Pupillary dilation
- Psychomotor agitation
- Sweating
- Elevated blood pressure
- Increased or decreased heart rate
- Nausea
- Vomiting
- Chest pain
- Abnormal heart rhythms
- Seizures
- Muscle weakness
- Tremors
Psychological and Behavioral Symptoms and Signs of Antidepressant Addiction and Abuse May Include:
- Euphoria
- Elevated mood
- Excessive socialization
- Anger
- Impaired judgment
- Missing appointments
- Frequent requests for refills
- Frequent requests for increased doses
Additionally, attempts should be made to determine if any of the symptoms and signs of either risky use or misuse of generalized substance use disorder are present in these individuals. Some of these can include for example neglect of obligations, excessive drug seeking, use in hazardous situations and development of either tolerance or withdrawal.
Who Is More At Risk Of Antidepressant Addiction
Although it is not clearly defined what specific demographic would be more prone to abuse and subsequent addiction to any medication from this group, due to relative lack of epidemiological studies, there are certain predisposing risks which may lead a person to misuse prescription antidepressants.
These Risk Factors Include:
- Previous personal or family histories of substance abuse
- Current or past incidences of psychiatric disorders such as depression or anxiety
- Being exposed to an environment in which substance abuse is tolerated
- Dealing with marital discord, unemployment, abuse, or neglect
Getting Help With Antidepressants Abuse And Misuse
Anyone who wants to stop the use of antidepressants, whether due to abuse, addiction, or just not wanting to rely on them, should seek help. When either abuse or misuse is identified, it is very important to identify the motives behind inappropriate use. The motives are highly important as they determine the modality of treatment. The exact modality of therapy will ultimately be decided between a patient and their physician but it can include further pharmacotherapy with alternative medications, psychoeducation, and counseling, or even drug addiction rehab centers where users can safely detox and find further appropriate substance abuse treatment.
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