For those suffering from severe mood disorders, antidepressant drugs can be life-saving treatment. However, like many other prescription medications, antidepressants have the potential for abuse and addiction.
What are antidepressants and what do they do?
Antidepressants are a class of drugs that affect neurotransmitters in the brain like dopamine and serotonin, which are essential in regulating mood. By acting on these neurological systems, antidepressant drugs can restore chemical balance in the brain and alleviate symptoms like depressed mood and suicidal ideation. Their function also makes them effective at treating many other mental health disorders including anxiety and personality disorders.
Though antidepressants have important medical uses, their mood-elevating effects can lead to abuse and dependence. Even antidepressants that are used as prescribed can become addictive and problematic over time. Prolonged antidepressant use can also have unintended physical and psychological effects
Antidepressants are categorized according to the neurotransmitters in the brain they affect as well as how they achieve their functions. The following are the most commonly used antidepressants.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are the most commonly prescribed antidepressants because they have fewer side effects than many other antidepressants. As their name suggests, they function by inhibiting the reuptake of serotonin in the brain. This neurotransmitter is associated with happiness and positive mood. By preventing reuptake, it increases the availability of serotonin in the brain, elevating mood and alleviating feelings of depression. Some well-known examples of SSRIs include:
- Prozac
- Zoloft
- Lexapro
- Paxil
- Celexa
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SRNIs work by inhibiting reuptake of both serotonin and norepinephrine. Norepinephrine is a neurotransmitter that increases alertness, arousal, and attention. Since norepinephrine is a key component of the body’s fight-or-flight stress response, SNRIs are also commonly used to treat anxiety and attention disorders. Some examples of SNRIs include:
- Cymbalta
- Effexor
- Pristiq
- Fetzima
- Khedezla
Serotonin antagonist and reuptake inhibitors (SARIs)
SARIs function primarily on serotonin neurotransmitters, but their function varies slightly from that of SSRIs and SNRIs. In addition to blocking serotonin reuptake, they also prevent the function of the serotonin transporter protein, which increases the amount of serotonin available in the brain. In addition to depression, SARIs can be effective in treating anxiety and insomnia. SARIs include:
- Axiomin
- Normarex
- Psigodal
- Serzone
- Nefadar
Monoamine oxidase inhibitors (MAOIs)
MAOIs work by preventing the monoamine oxidase enzyme from breaking down neurotransmitters like serotonin, dopamine, and epinephrine. By preventing its function, these neurotransmitters become more freely available in the brain. However, MAOIs have severe side effects caused by the excessive accumulation of serotonin. Some examples of MAOIs include:
- Nardil
- Emsam
- Marplan Parnate
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Rather than affecting serotonin, NDRIs work on norepinephrine and dopamine. They prevent the reuptake of these neurotransmitters and increase their availability in the brain. Dopamine is an important neurotransmitter that is part of the brain’s reward system and makes you feel good. NDRIs also carry fewer risks of side effects. Examples of NDRIs include:
- Wellbutrin
- Zyban Aplenzin
Tricyclics
Tricyclic antidepressants work by preventing the reuptake of serotonin and epinephrine. However, they are associated with side effects such as high blood pressure and cardiac problems. As such, their use is limited to medication-resistant depression. Some examples of tricyclic antidepressants are:
- Tofranil
- Elavil
- Pamelor
Tetracyclics
Tetracyclic antidepressants can be effective in treating severe depression, but like tricyclics, their use is uncommon due to the severe side effects associated with their use. These are some examples of tetracyclics:
- Mazanor
- Remeron
- Ludiomil
- Asendin
Are antidepressant drugs addictive?
Antidepressant drugs don’t contain chemical components that make them highly addictive by nature. However, their positive effects on mood can lead to tolerance and dependence. Tolerance occurs when the same dose no longer has the same effectiveness. Typically, this requires adjusting to a higher dosage. When this occurs repeatedly, a person becomes physically dependent on antidepressants. Discontinued use can lead to severe withdrawal symptoms and rebound depression.
In addition to these risks, some specific antidepressants have more severe side effects and higher potential for overdose and dependence. This is especially likely when the drugs are taken at higher doses than prescribed. When used in conjunction with other drugs or substances, the risk of antidepressant overdose also increases. All of these uses may be problematic or detrimental over time, requiring professional addiction treatment to overcome.
In addition to its primary effect, antidepressant drugs carry the risk of short-term side effects. These vary according to the class of antidepressant being used and may improve over time with continued use.
Common side effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Anxiety or agitation
- Dizziness
- Loss of appetite
- Insomnia
- Indigestion
- Headaches
- Diarrhea
- Constipation
- Impaired sex drive
Potential side effects of tricyclic and tetracyclic antidepressants
- Blurred vision
- Constipation
- Drowsiness
- Dizziness
- Tachycardia
- Dry mouth
- Excessive sweating
- Confusion
- Urinary retention
Due to its wide-ranging effects on the brain, prolonged use of antidepressants can lead users to experience a variety of long-term effects. These include:
- Sexual dysfunction including inability to orgasm or erectile dysfunction in men
- Weight gain
- Suicidal ideation
- Blunted or numbed emotion
- Increased risk of cardiovascular disease
- Tolerance
- Dependence
Antidepressant withdrawal
Withdrawal occurs when antidepressant drug use is suddenly discontinued or drastically cut down. When the body has become accustomed to the chemical changes brought on by antidepressants, stopping their use can lead to unpleasant or distressing withdrawal symptoms that come on within one or two days. These are referred to as antidepressant discontinuation syndrome and can last several weeks.
Withdrawal symptoms include:
- Anxiety
- Rebound depression
- Headaches
- Irritability
- Flu-like symptoms
- Nausea
- Dizziness
- Sensations of electric shock
How to safely quit using antidepressants
Since antidepressants are typically prescribed to treat severe mood disorders, discontinuing their use should be done carefully and with the guidance of a doctor or psychiatrist. The safest way to stop using antidepressants is to reduce dosage gradually over a long period of time. This allows the body to better adapt without the drug and decreases the likelihood and severity of withdrawal symptoms. If necessary, medication assisted treatment can help alleviate withdrawal symptoms.
Treatment for antidepressant use and addiction
Addiction treatment may be required when a person has become physically dependent on antidepressants or is misusing them. Treatment may include medical detox which helps reduce the side effects brought on by withdrawal, making it easier for individuals to eliminate the drug before progressing to therapeutic treatment.
Individual and group therapy, provided as part of inpatient or outpatient addiction treatment, can help individuals resolve underlying issues related to antidepressant use including the mood disorders for which it was prescribed. Therapy can provide helpful insights as well as relapse prevention and other skills that can help them combat depression without the need for medication.
Antidepressants FAQ
How long should I take antidepressants?
Antidepressants can be an essential tool to manage mood disorders and other mental illnesses, but long-term use can lead to adverse effects including increased risk of cardiovascular disease. You should always consult your doctor or psychiatrist to determine how long you should take antidepressants according to the severity and duration of your depressive episode.
Can I drink alcohol while I’m on antidepressants?
Since antidepressants can interact with alcohol, which is a nervous system depressant, it is best to avoid drinking while on antidepressants. Alcohol may also worsen bouts of depression over time, counteracting the effects of antidepressants.
What other treatments are effective for depression?
Antidepressants are not the only way to treat depression. In fact, for mild depression, even lifestyle changes like regular exercise can improve depression. For moderate or severe depression, psychotherapies are effective at treating the root causes of depression and helping develop healthier ways of coping with life stresses and trauma that may underlie mood disorders.
Are there any natural remedies for depression?
While natural remedies can help alleviate symptoms of depression, they may not be sufficient as standalone treatments. Some natural remedies that have shown promise in managing depression include exercise, mindfulness meditation, omega-3 fatty acids, St. John’s Wort, and S-adenosylmethionine (SAMe). However, it is crucial to consult with a healthcare professional before incorporating any natural remedies into your treatment plan, as they may interact with other medications or have adverse effects.
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