- What are Antidepressants?
- Types of Antidepressants
- How are Antidepressants Abused?
- Are Antidepressants Addictive?
- Statistics and Facts About Antidepressant Abuse
- History of Antidepressants
- Physical and Neurological Effects of Antidepressants
- Antidepressant Combinations
- Negative Health Consequences
- Signs and Symptoms of Antidepressant Abuse
- Antidepressant Withdrawal Symptoms
- Treatment for Antidepressant Addiction
- Key Sources
- Medical Disclaimer
Antidepressants are a type of medication used to treat clinical depression, anxiety disorders, and certain pain conditions. People who suffer from depression and anxiety may find relief from these medications as they increase the amount of feel-good hormones in the brain. However, while antidepressants are largely intended for short-term use, many Americans take these drugs for much longer, leading to the potential for dependency and addiction.
According to the Anxiety and Depression Association of America (AADA), an estimated 14.8 million Americans suffer from clinical depression. Therefore, drugs like antidepressants are in high demand, especially as these medications are designed to boost a person’s mood and energy. In 2018 alone, some 70.9 million prescriptions for antidepressants were written, compared with only 36 million in 2008.
Because antidepressants alter a person’s brain chemistry, they can create dependency and withdrawal effects if a person stops taking them. Antidepressants can also become psychologically addicting if someone needs them to feel normal in their day-to-day life. This means that while antidepressants are not as physically addictive as other medications, they still pose a risk for abuse.
However, treatment is available for individuals who become addicted to antidepressants. Before going into the types of treatment that are available for this addiction, this article will provide an outline of what antidepressants are and what the long-term effects may be.
What are Antidepressants?
Antidepressants are a class of prescription medications that are used to treat mood disorders and other related conditions. Primarily used for moderate to severe depression, these medications work by altering the availability of certain neurotransmitters in the brain — particularly serotonin and norepinephrine. Together, these two chemicals influence mood, appetite, sleep, energy, and attentiveness.
Aside from depression, antidepressants are also used to treat anxiety disorder, obsessive-compulsive disorder (OCD), bipolar disorder, as well as chronic pain conditions like fibromyalgia. While there is some controversy over the effectiveness of antidepressants, these medications are widely prescribed. They are also often prescribed to patients as a safer alternative to benzodiazepines.
Types of Antidepressants
The most common types of antidepressant medications are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). However, there are a few other types that are also in use, as outlined below.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are one of the most prescribed medications for depression because they have fewer side effects than some of the other types. SSRIs work by blocking the reuptake of serotonin, effectively making more of this neurotransmitter available in the brain. The intended result of this increased availability of serotonin is an improved and more stable mood.
Examples of SSRIs include:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
SNRIs are similar to SSRIs; however, they work by increasing both serotonin and norepinephrine levels in the brain. While serotonin largely affects mood, norepinephrine affects energy and cognition. Therefore, SNRIs are useful for other conditions like anxiety disorders, attention deficit hyperactivity disorder (ADHD), fibromyalgia, neuropathic pain, and menopausal symptoms.
Examples of SNRIs include:
- Effexor (venlafaxine)
- Pristiq (desvenlafaxine)
- Cymbalta (duloxetine)
- Fetzima (levomilnacipran)
Tricyclic Antidepressants (TCAs)
Prior to the arrival of SSRIs, TCAs were the most prescribed antidepressants. Like SNRIs, TCAs also increase the availability of norepinephrine and serotonin in the brain. Named after the three rings that make up their chemical composition, tricyclics also treat depression, anxiety, and chronic pain conditions. However, the use of these drugs has decreased as they can produce a number of side effects. Therefore, they are typically reserved for people who have not responded well to SSRIs/SNRIs.
Examples of TCAs include:
- Elavil (amitriptyline)
- Tofranil (imipramine)
- Norpramin (desipramine)
- Pamelor (nortriptyline)
- Anafranil (clomipramine)
- Silenor (doxepin)
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs are another medication that is only prescribed if a patient hasn’t responded to other antidepressants. These drugs work by inhibiting monoamine oxidase, an enzyme that is responsible for removing norepinephrine, serotonin, and dopamine from the brain. MAOIs thus work by increasing the amount of these neurotransmitters in the brain. Their overall function on monoamines and the central nervous system also makes them a valuable treatment for conditions like Parkinson’s disease. However, MAOIs are not as widely prescribed because they are known to cause dangerously high blood pressure when combined with some foods or medication.
Examples of MAOIs include:
- Nardil (phenelzine)
- Parnate (tranylcypromine)
Noradrenaline and Specific Serotoninergic Antidepressants (NaSSAs)
A lesser-known class of antidepressants is NaSSAs. These drugs work by increasing the concentration of serotonin and noradrenaline in the brain while blocking some serotonin receptors. Therefore, they are known to both increase concentrations of neurotransmitters while also enhancing their transmission. NaSSAs are also known to have fewer side effects because of the way they block certain serotonin receptors.
Examples of NaSSAs include:
- Aptazapine (CGS-7525A)
- Esmirtazapine (ORG-50,081)
- Mianserin (Bolvidon, Norval, Tolvon)
- Mirtazapine (Norset, Remeron, Avanza, Zispin)
- Setiptiline/teciptiline (Tecipul)
How are Antidepressants Abused?
Antidepressants are sometimes prescribed over benzodiazepines because they are seen to pose less risk for abuse. However, misuse of these medications still occurs in a couple of ways.
The first is that some individuals try to achieve psychostimulant effects by taking large doses. The mistaken assumption is that because antidepressants influence mood, high doses will create euphoria. However, antidepressants work gradually over time and will not induce a “high” by taking large amounts.
Another more common way that antidepressants are abused is in the amount and length of time they’re taken. Some individuals take more than prescribed because they feel they aren’t working effectively (or they stop working altogether). Even more common is the fact that many people take antidepressants for years when in fact, these drugs are designed to be used for 6 to 9 months. According to some estimates, 50% to 60% of people take antidepressants for longer than two years.
Are Antidepressants Addictive?
The topic of antidepressant abuse leads to the question of whether these medications are addictive. In short, these drugs are considered less addictive compared with other medications like benzodiazepines.
However, addiction can occur with antidepressants, especially if they are taken for a long time. As the brain becomes accustomed to the way these drugs alter the brain’s neurochemistry, a person can develop tolerance and withdrawal symptoms such as rebound depression, fatigue, dizziness, and suicidal thoughts if they stop taking them.
Antidepressants can also become psychologically addictive. People who become dependent on the effects may need these substances to feel some semblance of “normal” in their daily life. Also, withdrawal symptoms such as anxiety and rebound depression can cause a person to continue to take antidepressants for an indefinite period.
Statistics and Facts About Antidepressant Abuse
Below are some general statistics surrounding antidepressant abuse in the US:
- The World Health Organization (WHO) estimates that depression affects around 350 million people worldwide.
- According to the Centers for Disease Control (CDC), between 2015–2018, 13.2% of adults used antidepressants in the past 30 days.
- Women are twice as likely to use antidepressants as men. The CDC reports that use among women is around 17.7%, while use among men is around 8.4%.
- Between 2005 and 2008, the rate of antidepressant use increased by almost 400%.
- According to a 2018 analysis of federal data by The New York Times, nearly 25 million people have been on antidepressants for at least two years.
- An analysis by the National Center for Health Statistics indicates that roughly 31 million people in the US aged 12 and above took antidepressant medication in the past month.
History of Antidepressants
Antidepressants originated in the 1950s when scientists began to explore the idea that changing the biochemistry of the brain could alter a person’s mood.
The first two antidepressants to come into the fore were iproniazid — a monoamine oxidase inhibitor (MAOI) originally developed for tuberculosis — and imipramine, a tricyclic. Both medications showed success in managing depression, which subsequently led to the development of other medications within these drug classes. The only downside to these medications is that they were also accompanied by uncomfortable side effects such as weight gain, fatigue, and overdose deaths.
In the 1980s and 90s, serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine inhibitors (SNRIs) entered the picture and dramatically changed the landscape of antidepressant medications. These groundbreaking drugs had fewer side effects and demonstrated greater clinical success, which meant that they began to replace MAOI and tricyclic classes of antidepressants. The first SSRI to enter the market was Prozac (fluoxetine) in 1987, with sales soon reaching the $1 billion mark.
Today, antidepressant use is widespread in the US. According to the CDC, approximately 1 in 10 people aged 12 and above are taking these medications.
Physical and Neurological Effects of Antidepressants
Antidepressants affect the brain chemicals responsible for mood, energy, and cognition. This results in an array of physical and neurological effects as the drug is taken over time. Some of the most common are:
- Increased energy
- Improved appetite
- Better quality sleep
- Improved mood
- Reduced anxieties and fears
Depending on the type, antidepressants can also produce uncomfortable side effects. These include:
- Lack of emotion
- Mental confusion
- Sore throat
- Sexual dysfunction
- Blurred vision
- Reduced sex drive
- Dry mouth
- Skin reactions/hives
- Low blood sugar
- Racing heartbeat
- Increased appetite
- Weight gain
Another harmful side effect of antidepressant use is a condition known as “serotonin syndrome”. This occurs when there is more serotonin than the body can handle, and it usually occurs at high doses and/or if the person has been taking the drug for a long time.
Serotonin syndrome is most often associated with SSRIs and SNRIs and can occur when these drugs are taken alone, or if they are combined with other serotonergic agents such as St. John’s Wort, and other drugs like amphetamines, fentanyl, lithium, and tramadol.
Serotonin syndrome is a potentially life-threatening condition and can produce symptoms such as:
- Muscle tremors
- Racing heartbeat
- Increased sweating
- Muscle rigidity
If someone is experiencing serotonin syndrome, it’s important to seek medication treatment right away. A doctor can also advise on safe dosages of your medication, especially if you’re taking it with other serotonergic substances.
While antidepressants can’t make a person high, some people do abuse these drugs by combining them with other substances—either by chance or to minimize side effects. While this can be toxic, some of the most frequent combinations include:
Alcohol is one of the most common substances that is combined with antidepressants. Individuals who are taking these medications may consume alcohol to ease side effects, or they may not realize the dangers of mixing the two. The problem with alcohol and antidepressants is that they can augment some of the side effects, such as dizziness, drowsiness, and coordination. It can also lead to an array of dangerous consequences. These include:
- Worsened depression or anxiety
- Intense sedation
- Dangerously high blood pressure
- Impaired coordination
Another combination to avoid is stimulants (e.g., amphetamines, cocaine, Adderall) and antidepressants. While it may seem harmless, stimulants prompt the brain to release serotonin. Therefore, since both antidepressants and stimulants increase the availability of serotonin in the brain, it can lead to “serotonin syndrome.” Individuals who take these substances together should be aware of the potential symptoms of serotonin syndrome and seek medical help immediately.
Like alcohol, cannabis can increase the sedative effects of antidepressants. While this may be appealing or desirable for some people, it can lead to abuse. Also, there is a risk that an individual may take too much of either or both substances, leading to over-sedation and loss of consciousness. Also, cannabis tends to worsen or enhance anxiety, which is dangerous for those with panic disorders or anxiety issues. Cannabis also produces similar side effects to antidepressants, such as dizziness and nausea, so combining the two may worsen these symptoms.
Negative Health Consequences
When taken in high doses and for long periods, antidepressants can lead to health consequences such as:
- Weight gain
- Dry mouth
- Irregular heart rate
- Sleepiness or drowsiness
- Sexual dysfunction
- Difficulty urinating
- Heightened blood pressure
- Increased suicidal thoughts or tendencies
It’s also important to be aware of the signs and symptoms of an antidepressant overdose which include:
- Impaired coordination
- Uncontrollable shaking
- Irregular heartbeat
Signs and Symptoms of Antidepressant Abuse
People who are addicted to antidepressants can exhibit the following signs of abuse.
Physical Signs of Abuse
- Bloodshot eyes
- Diminished appearance
- Changes in appetite
- Slurred speech
Behavioral Signs of Abuse
Antidepressant addiction can also lead to behavioral signs. Some of these are similar to other prescription drug addictions and can include:
- Sudden mood swings or behavioral changes
- Taking antidepressants without a prescription
- Running out of prescriptions early
- Faking symptoms to get a prescription
- “Doctor shopping” to acquire multiple prescriptions at once
- Hiding or lying about antidepressant use
- Isolating from family and friends
- Loss of interest in activities or hobbies
- Acting suspiciously
- Engaging in “poly-substance use” (abusing multiple substances at once)
- Ongoing or new debts, job losses, or financial problems
- Relationship issues
Antidepressant Withdrawal Symptoms
Chronic antidepressant abuse can create tolerance and withdrawal symptoms. Some of the most common symptoms include:
- Insomnia or vivid dreams
- Flu-like symptoms, such as achy muscles and chills
- Electric shock sensations
- Rebound depression
Treatment for Antidepressant Addiction
If you are addicted to antidepressants, help is available. Below are some common forms of substance abuse treatment that can also be effective for drugs like antidepressants. These therapies are often most effective when combined with other treatments and are accessible through a doctor or rehab facility. You may also want to enroll in inpatient or outpatient options, depending on your needs.
Stopping On Your Own
While antidepressant withdrawal is less intense compared with other drugs like opioids, stopping on your own is not recommended. The major concern with antidepressants is rebound anxiety and depression, which can put a person at risk for relapses and suicidal ideation. Medical detox centers are the best way to safely wean yourself off these medications, as doctors and clinical staff can keep you safe and comfortable. They can also provide other medications to help minimize the withdrawal effects.
Dual diagnosis programs are designed to treat co-occurring addiction and mental health conditions. These programs can be highly beneficial if you struggle with issues such as anxiety or clinical depression. Rehab facilities that provide dual diagnosis are often led by psychiatrists or other mental health experts who are qualified to diagnose and treat underlying mental health disorders. Enrolling in a dual diagnosis program allows you to address your conditions while safely detoxing from antidepressants.
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) is the gold standard treatment for many addictions and mental health conditions. This type of therapy helps individuals identify and re-frame negative thinking patterns while also fostering a stronger sense of self-worth. CBT also provides a framework for dealing with stress, addiction triggers, cravings, and how to deal with situations that encourage drug use.
The Matrix Model
The Matrix Model is an evidence-based approach that consists of a mixture of behavioral therapy, counseling, 12-Step support, family education, and more. Individuals who receive this type of treatment learn about addiction and relapse while developing a stronger sense of self-esteem and self-worth. This therapy involves a close working relationship between the patient and the therapist and has shown to be effective for many types of addictions.
Motivational interventions such as motivational interviewing (MI) consist of counseling techniques for addiction. Based largely on a reward system, these techniques help individuals deal with cravings and remain abstinent by teaching them it is possible to achieve sobriety using self-control. Motivational interventions also usually involve the use of rewards or incentives.
Support groups are another fundamental and effective way to treat addictions and substance abuse. Well-known groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and 12-Step programs can provide support, guidance, and encouragement, especially as individuals transition into a life free of substances. Additionally, these groups are known for helping people to reduce the risk of relapses.
Depending on your situation, your doctor may prescribe other antidepressants as part of the detox process. For example, they may substitute a longer-acting antidepressant for a shorter-acting one.
During the detox process, doctors may also provide supplements to assist with the withdrawal symptoms. Some of the top supplements that are recommended for antidepressant withdrawal are:
- Activated Charcoal: helps eliminate residual toxins in the body.
- Melatonin: helps with regulating sleep cycles.
- Glutathione: reduces inflammation.
- Fish Oil or Krill Oil: reduces symptoms like brain zaps, anxiety, and aggression.
- Magnesium: helps calm and de-stress the body.
- Vitamin B Complex: helps with energy and aids in the production of serotonin.
- 5-HTP or L-Tryptophan: helps the body produce serotonin.
- John’s Wort: naturally helps with rebound depression.
Wellness and Holistic Activities
As part of therapy and rehab, wellness and holistic therapies can also be highly beneficial. This includes activities such as yoga, massage therapy, music and art therapy, fitness, and social outings. These activities and therapies are great for encouraging calmness, emotional expression, and teaching skills about health and nutrition.
If you or a loved one are struggling with antidepressant abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Winerman, L. (2017). By the numbers: Antidepressant use on the rise. American Psychological Association. https://www.apa.org/monitor/2017/11/numbers.
Carey, B., and Gebeloff, R. (2018). Many People Taking Antidepressants Discover They Cannot Quit. The New York Times. https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html.
Hall-Flavin, D. (2019). Antidepressant Withdrawal: Is There Such a Thing? Mayclinic.org. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressant-withdrawal/faq-20058133.
Harvard Medical Publishing Staff. (2019). What are the real risks of antidepressants? Health.Harvard.edu. https://www.health.harvard.edu/mind-and-mood/what-are-the-real-risks-of-antidepressants.
Lesser, B. (2021). Addiction to Antidepressants. Dualdiagnosis.org. https://dualdiagnosis.org/prescription-drug-treatment/antidepressant-addiction.
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