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Are Antidepressants Addictive? It’s Debatable.

Addiction is defined as repeatedly engaging in a particular behavior or using a substance to experience pleasure, regardless of the consequences. Some believe that addiction can be a result of environmental experiences and/or various psychological conditions. When most people think of addiction, they think of gambling, illicit drugs (e.g. cocaine), alcohol, and sex.

One reason people hesitate to try a drug to treat their depression is because they fear they will become addicted to it. Logically one would think that if an antidepressant boosts mood and makes us happier, then it will probably be addictive, right? The truth is that most antidepressants have a very low potential for abuse and addiction compared to other illicit drugs.

Are antidepressants addictive?

Addiction to an antidepressant would be characterized by an inability to stop the antidepressant regardless of consequences. A majority of individuals taking an antidepressant are able to discontinue whenever they want. People do not experience psychological craving for their antidepressant drugs as they would with other illicit substances.

Therefore it can be inferred that antidepressants are not addictive. If they had any sort of addiction potential, they would likely be abused recreationally and be classified as a “controlled substance” by the FDA. Below are several points that support the argument that antidepressants are non-addictive.

  • Ineffective: For many people antidepressant drugs don’t even work to improve their mood. In some cases, the drugs may make a person emotionally numb or feel like a “zombie.” In other cases, the antidepressants cause increased depression and suicidality. Although they are considered clinically effective when compared to a placebo, they do not work for everyone. Recent findings even show some drugs like Paxil may not work as well as initial data suggested.
  • Long-term dosing: Most people stay at the same dose of their antidepressant over a long-term and find it to be effective. Sure tolerance will be inevitable over a long term, but many people stay on the same dose for years with no increase. If the drug were to be addicting, they would be ingesting more of the drug in hopes for a greater antidepressant effect, and would likely establish a higher degree of tolerance over the long term.
  • Low abuse potential: When compared to other classes of drugs, antidepressants have a very low abuse potential. These drugs aren’t typically being sold in the streets or marketed as giving someone a “high.” Although certain antidepressants have occasionally been abused, most people find that the effects aren’t really that great.
  • No universal “high”: With addictive drugs, the effects are usually similar among multiple people who take them. For example, if two people take cocaine, they are likely to have a similar reaction characterized by euphoria, increased stimulation, and excitability. When people take antidepressants, they not only don’t usually feel a “high,” but the effects are more subject to variation based on the individual.
  • No “instant” effect: Compared to other drugs like benzodiazepines and psychostimulants, the effects of antidepressants are not usually instant. Antidepressants can typically take awhile before they have an impact on relieving your depression. In other words, you probably won’t feel better within 20 minutes of taking the drug. Compared to illicit and addicting drugs, antidepressants don’t tend to result in instant euphoria within minutes of ingestion.
  • Slow tolerance development: In the case of addictive drugs, building rapid tolerance is common. Drugs like amphetamines and opioids tend to not only produce immediate euphoric effects, but a person quickly becomes tolerant to these drugs. With consistent usage, a greater dosage of the drug is required to feel the same initial “high.”
  • Pharmacological mechanisms: The mechanisms by which antidepressants work are not considered to cause addiction. Most common antidepressants such as SSRIs inhibit the reuptake of the neurotransmitter serotonin in the brain and gradually boost mood over time. Illicit drugs like amphetamines tend to stimulate the brain and release dopamine, which results in a highly pleasurable experience followed by a crash; this won’t occur with antidepressants.
  • Unwanted side effects: Most people notice unwanted antidepressant side effects as they continue taking their medication. These drugs may work well to improve mood, but things like sexual dysfunction and weight gain can be a huge disappointment. For these reasons, many people quit the drug they’ve been taking and transition to a different one. With more addictive drugs, people are unable to quit regardless of the side effects that they experience. Take cigarettes (nicotine) for example – people know they are linked to cancer, but have an extremely difficult time kicking the habit. Antidepressants are drugs that a person can stop without any sort of craving.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361040/

Can antidepressants be addictive?

Based on other definitions of addiction, antidepressants could be viewed as being addicting in a different way than the more commonly known addictive drugs. By some definitions, an addictive drug can be defined as one that is both “rewarding” and “reinforcing.” Most people that take their antidepressant and get benefit from it, will find it to be both rewarding and reinforcing – encouraging people to continue taking it to feel “happier.” In this regard, one could argue that an antidepressant could become addictive to a certain individual.

  • Boosted mood: Not only can antidepressants boost mood, but in some cases they can trigger hypomania. Usually when this occurs, a person will experience euphoria, increased energy, talkativeness – similar to an amphetamine high. Some would argue that the euphoria as a result of antidepressant usage can be considered an artificially induced “high” that people could “crave” in the future.
  • Change brain activity: Using antidepressants is known to alter brain activity and connectivity.  In fact studies have shown that one does of an SSRI changes brain connectivity within hours of initial administration.  Over the long term, it is thought that significant changes take place in the brain, possibly leading to dependence on the drug for functioning.
  • Cravings: People who take antidepressants don’t typically “crave” the next dose of their drug, but they may look forward to it if it’s helping. Unlike illicit drugs, people aren’t generally seeking out antidepressants as a result of a “craving” or instinctual urge they cannot resist. In some rare cases, a person may find an antidepressant medication to produce consistent euphoria – leading them to crave the drug should they run out.
  • Dependence: Becoming dependent on a drug often is simultaneous with addiction. As a person takes enough of the drug over a long-term, they become both physically and psychologically dependent on it for functioning. In the case of antidepressants, dependence is established over the long-term as a result of physiological adaptations. The dependence from an antidepressant is gradual, but over time, people become dependent on the drug for psychological functioning. This is why many people believe antidepressants cause a chemical imbalance over the long term, which can take awhile to recover from after discontinuing treatment.
  • Tolerance: Like all drugs, a person can become tolerant to antidepressants. Years ago it was thought that tolerance isn’t established while taking antidepressants. The truth is that they make changes in your brain and alter homeostatic physiology over time. Compared to illicit addicting drugs, a person generally doesn’t develop as quick of a tolerance to antidepressants as they would other substances. It can take over a year to develop tolerance to the same dose of certain medications. With that said, tolerance still occurs which can lead a person to increasing the dose to feel the same effect.
  • Withdrawal: Many have drawn parallels to the withdrawal symptoms from antidepressants and illicit drugs. Although the two cannot be directly compared, some would argue that coming off of certain antidepressants can be just as severe. Most people experience both debilitating physical and psychological withdrawal symptoms upon discontinuing antidepressants. In many cases symptoms such as dizziness, anxiety, increased depression, etc. are just as debilitating as other drugs. Anyone who’s been through a potent withdrawal from these drugs can attest to this fact.
  1. Source: http://www.ncbi.nlm.nih.gov/pubmed/14615695
  2. Source: http://www.ncbi.nlm.nih.gov/pubmed/25187753

Mainstream Verdict: Antidepressants are NOT addictive

Above are some valid points that support the idea that antidepressants could be addictive like other illicit drugs. However, the mainstream view of addiction tends to involve a drug that produces a “high” that people will seek out regardless of consequences. The mainstream view of addiction also involves experiencing a strong craving that an addict cannot resist.

In regards to antidepressants, (most) people are not getting a “high,” rather are simply taking them to feel less depressed or slightly better in terms of mood. Older antidepressants like Amineptine (a tricyclic antidepressant) that were found to be addictive were quickly pulled from markets. Some have suggested that antidepressants like Wellbutrin or those influencing the neurotransmitter dopamine could be addicting.

Dopamine is a neurotransmitter that influences addiction and increasing it, results in pleasurable feelings. Medications on the market like Wellbutrin have such negligible effects on dopamine that experiencing euphoria is less common. The FDA and researchers generally make sure that there is a low potential for addiction with antidepressants before they are approved.

Personal thoughts: Antidepressants are not usually addictive

I think that antidepressants can be addictive in certain individuals, but these individuals are likely few and far between. Those that really get a potent mood boost or experience “euphoria” (i.e. hypomania) may look forward to taking their medication each day and crave it. However, even in these cases where a person may crave their antidepressant, the euphoria is unlikely to be sustained.

A majority of people do not take their antidepressant medication to feel “pleasure” or get any reward, they do it because it helps them function and reduce the emotional pain that they’re dealing with. You will not find people engaging in risky behavior in order to get more of their antidepressant and when people quit taking their antidepressant, they generally do not experience withdrawal “cravings” like they would with a truly addictive substance.

Having taken an array of antidepressants, my personal experience was that these drugs weren’t addicting. Part of the reason is that once a drug stops working and/or makes a person feel worse, they naturally won’t want to take it anymore. While taking the drugs, they can be addicting in the sense that you want to keep taking it to feel good (assuming they work). But when the drug effect wears off you probably won’t “crave” to go back on it at any point in the future.

And while the argument could be made that every drug is addictive to a certain extent, the degree to which antidepressants are addictive is considered marginal compared to a substance like heroin, cocaine, or even nicotine. Do you think antidepressants are addictive drugs? Some people can certainly form a good case suggesting that they are, but the mainstream consensus is that if it’s a prescription, it’s probably not. Feel free to share your thoughts in the comments section below.

Suggested: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139704/

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