Medications Used for Depression and Their Addiction Risks
As their name suggests, antidepressants are used to treat people who have depression. Many people who undergo a drug or alcohol addiction treatment program may be prescribed antidepressants to combat anxiety and depression that may occur during withdrawal, states MedlinePlus, a division of U.S. National Library of Medicine. In other instances, antidepressants may be used during ongoing addiction treatment to address co-occurring mental health issues or to stabilize mood on a more long-term basis.
Categories of Antidepressants
More than eight different categories of antidepressants exist. The most common group of antidepressants are SSRIs, or selective serotonin reuptake inhibitors. These work by treating serotonin imbalance in the brain. They decrease serotonin reuptake, which leaves more serotonin in the brain. Examples of SSRIs include:
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Paroxetine (Paxil, Brisdelle, Pexeva)
- Escitalopram (Lexapro)
- Fluvoxamine (Luvox)
- Fluoxetine (Sarafem, Prozac)
Serotonin and norepinephrine reuptake inhibitors affect both serotonin and norepinephrine levels in the brain in order to reduce the symptoms of depression. They lessen the amount of serotonin and norepinephrine absorbed by the brain, which improves mood and helps to ease chronic pain. Some examples of SNRIs are:
- Levomilnacipran (Fetzima)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Khedezla, Pristiq)
- Venlafaxine (Effexor XR)
Tricyclic antidepressants, also known as TCAs, are a classification of the antidepressants that are used when other more common depression medications aren’t effective. Some examples of tricyclic antidepressants include:
- Clomipramine (Anafranil)
- Desipramine (Norpramin)
- Nortriptyline (Pamelor)
- Imipramine (Tofranil)
- Trimipramine (Surmontil)
Tetracyclic antidepressants are related to tricyclic antidepressants. Tetracyclic antidepressants have four cyclic rings that inhibit the reuptake of noradrenaline and serotonin. These drugs are used to treat both depression and anxiety by balancing neurotransmitters. Examples of tetracyclic drugs include:
- Maprotiline (Ludiomil)
- Mirtazapine (Remeron)
Dopamine reuptake inhibitors (DRIs) prevent the reuptake of dopamine. Additionally, they usually prevent the reuptake of norepinephrine. Neurotransmitters dopamine and norepinephrine affect mood, and drugs in this classification treat both depression and seasonal affective disorder (SAD). They are also used to treat obesity, narcolepsy, and attention deficit hyperactivity disorder (ADHD). These drugs can sometimes help a person quit smoking. Bupropion (Wellbutrin) is an example of a DRI.
As a 5-HT1A receptor antagonist, vilazodone (Viibyrd) balances serotonin and other neurotransmitter levels to treat depression. Vilazodone is rarely used as an initial treatment for depression. Generally, it’s used when other medications haven’t worked or when other medications have caused harmful side effects.
The 5-HT2 receptor antagonists change chemicals in the brain in order to treat depression. Nefazodone is an example of this type of drug. Trazodone is another medication that works on the 5-HT2 receptor with a mechanism of action similar to nefazodone. Vortioxetine (Brintellix) is a 5-HT3 receptor antagonist that alters brain chemical activity to treat depression.
The first types of antidepressant to be developed were monoamine oxidase inhibitors. They are not used as much today because of the dangerous side effects and drug interactions related to their use. MAOIs change the chemistry of the brain to treat depression by preventing the removal of the neurotransmitters serotonin, norepinephrine, and dopamine. They also have the potential to raise blood pressure to dangerously high levels. Some examples of MAOIs are:
- Tranylcypromine (Parnate)
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
Do Antidepressant Medications Cure Depression?
Antidepressants don’t cure depression, as noted by Psychology Today. Per Mayo Clinic, they merely relieve the symptoms of the condition, and once the person stops taking the medication, symptoms reappear. They can, however, be quite effective at relieving symptoms.
A study noted by the National Institute of Mental Health stated that out of 4,000 patients treated with an antidepressant, 41 percent of patients who were switched to a placebo relapsed, whereas only 18 percent who stayed on the antidepressant relapsed.
While antidepressants can be key to managing depression, they should be used in conjunction with therapy.
How Many People Take Antidepressants?
The use of antidepressants has increased over the years. As noted by The New York Times, one in 10 people was prescribed an antidepressant in 2013. Women in their 40s and 50s account for a good portion of this group. In fact, one in four women in this age group is on an antidepressant. The Centers for Disease Control and Prevention reports that 14 percent of Americans who are on antidepressants have been taking them for 10 years or longer.
Are Antidepressants Addictive?
Traditionally, antidepressants aren’t thought of as addictive substances; however, some degree of physical dependence can develop. As with any substance, antidepressants can lead to psychological dependence, particularly if they are abused.
An antidepressant can make a person feel as though they can’t be happy without taking the drug. Because each antidepressant works differently on the brain, some are more addictive than others.
What Symptoms Are Associated with Antidepressant Addiction?
Because antidepressants change the chemistry of the brain, each one causes different symptoms of withdrawal. Some have more intense symptoms of withdrawal than others. The withdrawal stems from the brain feeling as though it needs the antidepressant in order to function normally. Additionally, the person may feel as though they can’t live normally without taking an antidepressant. They will then become irritable until they obtain more of the drug.
In many cases, the person isn’t truly psychologically addicted to the antidepressant. Sometimes, discontinuation symptoms occur when a person stops taking an antidepressant; this simply means that levels of neurotransmitters are changing, and it doesn’t mean the person is addicted to the substance. Although the discontinuation symptoms may be uncomfortable, they’re usually not serious. They may include agitation or depression. As a result, doctors may prescribe a tapered approach when getting off an antidepressant. With this approach, the person will slowly lower their dosage over a set period of time until they are not taking it altogether.
How Can a Person Lessen the Risk of Becoming Addicted to Antidepressants?
All antidepressants should only be taken exactly as prescribed. There’s an increased risk of addiction when a person misuses a prescription, which is a common practice. The National Institute on Drug Abuse states that an estimated 52 million people have used prescription drugs for nonmedical purposes at least one time throughout their lives. A person should never take more than prescribed or take an antidepressant more oftentimes than recommended. In addition, a person should never take an antidepressant if it wasn’t prescribed to them.
It’s also considered abuse if a person alters the form in which the medication is intended to be taken. For example, crushing antidepressants and snorting the resulting substance is abuse of the drug. These substances should also not be mixed with other substances of abuse, such as alcohol, opioids, or stimulants.
As mentioned, before a person discontinues an antidepressant, they should consult their primary care physician. The doctor will be able to decrease the dosage at a rate that’s comfortable for the person. The taper is done slowly to prevent or reduce discontinuation symptoms. Generally, the person will be prescribed a lower dosage and kept at that amount for a designated time. Then, the dosage is decreased again until the person no longer needs to take any of the drug.