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Antidepressant Dependence: Psychological & Physiological Aspects

Many people taking antidepressants find them extremely helpful for managing depression, anxiety, and other phobias. A considerable number of people get benefit from antidepressant medication and without them, they wouldn’t be able to hold down a job or maintain a social life. For certain people, antidepressants are a godsend and enhance certain neurotransmitters to alleviate brain functional abnormalities.

For others though, the drug may work initially, but eventually the antidepressant stops working. The person taking the drug assumes they need to stay on it for the rest of their life. At this juncture, either more drugs are thrown into the equation (the person is on a “cocktail”) or they play what I refer to as “antidepressant roulette” – hoping that a new medication will correct their potential “chemical imbalance.”

Antidepressant Dependence: Psychological & Physical

The problem is that even for many who have found no relief from their antidepressant, they become dependent on the medication. While it is controversial as to whether antidepressants are addictive, it is clear to most that have used them that it is possible to become dependent on them for functioning. Discontinuation tends to result in an array of withdrawal symptoms that most people wouldn’t wish on their worst enemy.

In fact, many have gone on to compare the difficulty associated with discontinuing an antidepressant to that of illicit drugs. The definition of dependence is “relying on” or “being controlled by” a substance. Dependence is associated with emotional-motivational symptoms during withdrawal and difficulty quitting the drug due to: reduced capacity to experience pleasure, feelings of anxiety, or feelings of unease.

Psychological Dependence: Brain expects the antidepressant

Anyone that’s taken antidepressants for a prolonged period of time knows that missing just one dose can cause problems such as “brain zaps,” dizziness, and feelings of sickness. This is because the brain has become dependent upon the drug in order to carry out certain functions. After taking the drug for an extended period of time, the brain adapts to accommodate the effects of the antidepressant.

It comes to expect the boost in neurotransmitters like serotonin when you artificially elevate them over time. This is why during withdrawal, your brain becomes even more imbalanced than before you took the drug; your endogenous functioning is likely below baseline. This is why I consider antidepressants to cause a chemical imbalance that may not have been there in the first place (i.e. pre-treatment).

Physical Dependence: Physiology adapts to the antidepressant

Some people are actually able to handle the psychological aspects of withdrawal easier than the physical symptoms. While I would personally consider the psychological effects more severe, many people complain of: body aches, dizziness, headaches, and in some cases itchiness. Some people become so sick that they’d swear they had developed a case of the latest strand of influenza.

The physical symptoms of withdrawal may not be as severe as quitting heroin cold turkey, but they can be persistent and have different severities based on the individual. It is important to realize that there are individuals who simply cannot cope with the array of physical symptoms that emerge when they stop taking an antidepressant. The nervous system and physiological functioning of the individual may have become dependent on the drug for performing certain functions.

When the drug is discontinued, the body is still expecting to receive it – but doesn’t, which leads to difficult symptoms.

Dependence causes people to keep taking antidepressant despite no benefit

Many people stay on antidepressants even when they aren’t getting any benefit. This is what most pharmaceutical companies want – as many people taking their product as possible. There are likely many people taking antidepressants that took them for awhile, didn’t get any benefit, tried to discontinue, and experienced such horrific withdrawals that they decided to keep taking the drug.

With many psychotropic drugs, there are people that have tried to withdraw, but simply can’t cope with the functional deficits, physical, and psychological symptoms upon discontinuation. These symptoms generally can be so severe, that unless you’ve experienced withdrawal on a first-hand basis, reading about it doesn’t do justice.
Trying to discontinue may disrupt work performance, family life, relationships, etc.

After awhile of taking the drug, people are willing to put up with refilling their prescription in order to prevent the dreaded withdrawals and functional deficits that accompany them. The person has become dependent on the antidepressant medication, and will have a difficult time discontinuing, even though they aren’t getting any sort of benefit.

That’s a clear example of dependence, although proponents of antidepressants will skew the definition to fit their paradigm and make the drugs seem “good” and illicit ones seem “bad.”  Researchers concluded that antidepressants were not drugs of dependence in the 1980s, but it was only recently (within the past decade) that doctors and pharmaceutical companies acknowledged withdrawal symptoms.

In the past the withdrawal symptoms were assumed to be non-existent or attributed to a patient’s worsening psychiatric condition – these days we know better.  It is therefore important to update the thinking behind whether a user may experience dependence upon antidepressant therapy.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/10211325

Comparison: Antidepressant Dependence vs. Drug Dependence

According to most professionals, dependence tends to occur when a person: loses control and compulsively uses the drug, develops tolerance, has a strong urge to use the drug, and experiences detrimental effects socially and physically from the drug. While antidepressants may not perfectly embody this criteria, for many they actually can.

  • Loss of control: Sure people taking antidepressants don’t “lose control” and don’t have “compulsive desires” to take the drug. But this is only because taking more of the drug than necessary doesn’t give any greater degree of euphoria or positive affect. Therefore taking more than necessary won’t provide further benefit and is generally unnecessary. Those who do feel good on their antidepressant may often experiment with taking more than their average dose, but another reason to avoid taking more than usual is so that the person has enough to last the entire month.
  • Tolerance: While most medical professionals don’t like to acknowledge it, tolerance often occurs on antidepressants; it is inevitable with any drug. Consistent usage of a drug will create adaptations in physiology and brain chemistry as a result. Tolerance does occur, it’s just more gradual than illicit drugs. An example would be someone who finds their current dose “wears off” and they have to increase it to get the same original antidepressant effect.
  • Strong urge to use: Some people wake up each day with a strong urge to use their antidepressant, especially when it’s making them feel better. They won’t use excessively due to the fact that higher doses may also yield unwanted side effects. They also know that taking their current dose provides benefit for 24 hours, so they don’t need more of the drug to function.
  • Detrimental effect: Drugs that create dependence generally elicit a detrimental effect upon physical or social functioning. An argument could be made that in a subset of antidepressant users, this may be the case. Many people notice significant physical decline in the form of weight gain or other health problems that emerge while medicated. Attempting to discontinue can wreak havoc on a person’s ability to function socially and may provoke a variety of physical symptoms.

Does this mean you should avoid antidepressants?

Not at all. Assuming you’ve tried making practical lifestyle changes and put forth some effort, but haven’t improved, antidepressants could be a good fit. While nearly everyone will develop tolerance and display signs of “dependence,” it doesn’t mean that they’ll be the hardest drug for you to kick. It does mean that you should be aware of the potential withdrawal symptoms before taking your drug, but don’t let the withdrawal symptoms scare you from taking a medication you need either.

Have you experienced dependence on antidepressants?

Although antidepressants may not produce a potent short-term sense of pleasure, many people feel as if they’ve still become dependent on their antidepressant for functioning. If you feel as if you’ve become dependent upon a particular antidepressant, be sure to share the specific drug as well as reasoning as to why you’ve become dependent. Talk about whether the drug is still working (making you feel good), has worn off, and/or whether you are taking it simply as a way to avoid the dreaded withdrawal.

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