Some people, especially those in recovery, may worry about developing an addiction to antidepressants. Thankfully, antidepressant addiction doesn’t occur often, but it is a possibility at non-therapeutic doses. This is due to how they can affect and change the brain, leading to a dependence then compulsory use.
Anyone worried about their antidepressant use can bring their concerns to their doctor, who can start a tapering plan or even switch to a different type of antidepressant. Behavioral strategies, like therapy, can help people transition off antidepressants while still managing their symptoms.
What Are Antidepressants?
Antidepressants primarily treat depression1 and other mood disorders, plus conditions like obsessive compulsive disorder (OCD). They work by balancing disruptions in neurotransmitters and boost the reception of serotonin, which can make people feel happier.
Most antidepressants work on serotonin and another neurotransmitter called norepinephrine1. When your brain can receive and process more of these neurotransmitters, symptoms of depression can fade. Depression can go fully into remission due to neuroplasticity1, where your brain changes and adapts to sustain these positive changes.
Common Types of Antidepressants
Antidepressants can have a variety of formulas and interact with different parts and systems within the brain. Your doctor and/or psychiatrist will aim to find the best match for you. A genetic test can help you pinpoint good matches. Sometimes, people cycle through a few antidepressants to find the one that works best.
Interestingly, many antidepressants have off-label uses for conditions besides mood disorders. For example, trazodone can help people fall asleep1. Some other antidepressants help patients with chronic pain.
SSRIs
Selective serotonin reuptake inhibitors (SSRIs) are often the first line of defense against depression2 due to their low side effects and general effectiveness. Most people respond positively to them, and doctors can smoothly pivot to another if one doesn’t seem to have much effect.
Prozac, Zoloft, Lexapro, Paxil, and Celexa are all common SSRI antidepressants. Potential side effects of SSRIs1 include:
- Weight gain.
- Dizziness.
- Nausea, especially for the first couple weeks after starting the medication. In most cases, it goes away.
- Sexual dysfunction.
- Headaches.
SNRIs
Serotonin/norepinephrine reuptake inhibitors (SNRIs) work similarly to SSRIs1, but also block the reuptake of norepinephrine, not just serotonin. Doing this helps various synapses in your brain access more of these neurotransmitters, making you feel better. Norepinephrine triggers the central nervous system’s fight-or-flight response, leading to anxiety and panic disorders if these triggers don’t come when needed. SNRIs can reduce symptoms of both depression and anxiety.
SNRI brand names include Cymbalta, Pristiq, Effexor, and Fetzima. They can cause most of the same side effects as SSRIs, like:
- Nausea that typically goes away after a week or so.
- Headaches.
- Excessive sweating.
- High blood pressure.
MAOIs
Monoamine oxidase inhibitors (MAOIs) are a less-commonly prescribed antidepressant3, often used when an SSRI or SNRI doesn’t work. They’re more likely to have side effects, drug-food interactions, and drug interactions, which is why they’re prescribed with caution.
Common MAOIs include Marplan, Nardinm and Emsam. They can have side effects like:
- Serotonin syndrome (too much serotonin).
- Dizziness.
- Vomiting.
- Constipation.
- High blood pressure and potential death if foods with tyramine are consumed (cheese, alcohol, leftovers, certain fruits, and more).
TCAs
Tricyclic antidepressants (TCAs) also inhibit the reuptake of serotonin and norepinephrine4, which can boost mood and attention. Some versions of TCAs are also used off-label to treat obsessive compulsive disorder (OCD), insomnia, migraines, and chronic pain.
Common TCAs include Elavil, Silenor, and Asendin. Their side effects1 include:
- Dry mouth.
- Difficulty peeing.
- Constipation.
- Seizures.
How Are Antidepressants Misused?
An increase in feel-good neurotransmitters like serotonin can cause a reinforcing effect, though rare in antidepressants since this boost in mood is often subtle and feels natural. Misuse often happens outside prescribed doses5; for example, someone may take double or triple their prescribed dose (sometimes even 10x more) to achieve a ‘high’ similar to other drugs. This sensation only happens with high doses of certain antidepressants5, like bupropion.
Someone taking antidepressants for the sensation of being high may dissolve several pills in water and inject it using a syringe, take multiple pills orally, or crush them into a powder and snort it. To maintain their high dosing, they might request refills sooner than needed, take out prescriptions through multiple doctors, or request higher and higher doses without a demonstrated need.
Sadly, some people misuse antidepressants with the intent of taking their lives. In 2011 nearly every emergency room visit for a drug-induced suicide attempt came from prescribed medications; 20% of those overdoses involved antidepressants5, the highest percentage after prescribed opioids.
Can You Become Addicted to Antidepressants?
It’s very unlikely. One study answers this question6 with, “antidepressants do not have a clinically significant liability to cause addiction.” This is because most antidepressants don’t cause pleasurable or rewarding effects6, as addictive drugs like cocaine or alcohol do. And compulsive use of antidepressants, as seen in substance use disorders, is “exceptionally rare.”6
Antidepressants can cause withdrawal symptoms7, which raises an argument for their addictive potential since people may need to keep taking the substance to avoid withdrawals, similar to opioids and other addictive substances. Tapering plans can prevent uncomfortable withdrawals.
Factors Contributing to Antidepressant Misuse
Those who misuse antidepressants often have a history of substance use disorders5 or other comorbid conditions. And, as expected, people who misuse antidepressants typically have a mental health condition like depression. Since symptoms of depression can include suicidality8, these patients can be more likely to misuse their prescribed antidepressants in an overdose.
Signs of Antidepressant Addiction
If you’re worried a loved one struggles with an antidepressant addiction, you can watch for signs and start an open-minded conversation. If you’re worried about your antidepressant use, you can bring your concerns to your doctor and look for signs of addiction in your own life.
Some key signs of an antidepressant addiction include:
- Taking more than their prescribed dose. For example, you may notice they take three pills when the prescription bottle only says to take one.
- An inability to stop taking the pills, even if negative health, work, or relationship consequences arise.
- Spending excessive time and money to procure antidepressants.
Treatment Options for Addiction
If you’re struggling with an antidepressant addiction or any drug or alcohol addiction, you have resources available for recovery. Treatment options broadly fall into 2 categories: inpatient and outpatient care.
Inpatient Care
Inpatient treatment includes treatment in a hospital (often for acute withdrawal needs or overdoses) or attending a residential rehab. At rehab, you’ll live with peers and receive treatment from clinical staff, who monitor your health and emotional needs around the clock.
Each day often follows a structure, with time for therapy (group therapy, 1:1 sessions with your therapist, and family therapy), fun activities, peer meetings, and downtime. Rehabs last 28+ days, aiming to treat both mental and physical needs for comprehensive healing. You’ll also learn relapse prevention strategies and get connected with outpatient levels of care, if desired, to continue your healing journey.
Outpatient Care
In short, outpatient care is the treatment you attend without living at a treatment facility. You return home after treatment and have more flexibility to work, attend school, and meet family needs. Outpatient care could include
- Day treatment, where you undergo therapeutic treatment and practice practical recovery skills for 5-7 days a week. Sessions often last 5-7 hours daily, making day treatment the most intensive version of outpatient care.
- In intensive outpatient programs (IOPs), you attend treatment 3-4 days weekly for about 3 hours a day. These also offer therapy, peer support, and an encouraging and supportive recovery environment but with a less intensive schedule.
- General outpatient can include 1-2 weekly group therapy sessions, lasting an hour or so each.
- Regular 1:1 therapy sessions with a therapist. You may see them once a week, once every two weeks, or at the cadence best fit to your recovery needs.
Help from Your Doctors
As medication prescribers, your primary care physician (PHP) and/or psychiatrist can also help you. They can ensure that, going forward, all antidepressant prescriptions are carefully considered and that you have a clear plan for how to take them without risking addiction.
For example, your doctor may only prescribe a week’s worth and set up regular appointments to check in and monitor your use. Or you can work out a plan with loved ones, like a spouse or parent, to keep your medications locked in a safe. This can also be a preventative measure for people struggling with suicidal thoughts or with a history of suicidal ideation and attempts.
At your appointment, you can ask questions like,
- “What is the addictive potential of this medication?”
- “Are there other medications with less addictive potential that I could try first?”
- “What signs should I look out for that mean this medication isn’t a good fit?”
- “What can I do if I start to feel like I’m relying on it too much?”
Find Treatment for Drug Misuse
Recovery exists for all types of addictions, including antidepressant addiction. Treatment can help you navigate the underlying causes of addiction and address emotional struggles with healthy coping strategies and new behaviors.
You can use Recovery.com to find prescription drug treatment centers and see their insurance information, reviews, photos, and more.