Antidepressants and Addiction Treatment
Antidepressants can help alleviate the symptoms of depression. Although this is the most obvious reason that physicians prescribe antidepressants, they also prescribe them to treat many other conditions. For example, antidepressants also treat obsessive-compulsive disorder (OCD), migraine headaches, fibromyalgia, panic disorders, chronic pain, insomnia and anxiety. Between 2015 and 2018, 13.2% of Americans 18 years of age and older reported taking antidepressants in the past month.
Symptoms of Depression
Physicians prescribe antidepressants to relieve the following symptoms of depression:
- Suicidal thoughts
- Difficulty thinking and remembering
- Obsession about failures and blaming oneself
- Agitation, restlessness or anxiety
- The inability to move, speak or think quickly
- An increase or a decrease in appetite
- An increase in sleep or a decrease
- Loss of interest in formerly pleasurable experiences
- Frustration and irritability
- Feelings of being hopeless, empty or sad
Antidepressants treat these symptoms by increasing neurotransmitters that promote pleasant feelings. Neurotransmitters are chemicals that exist within the brain.
The Monoamine Hypothesis of Depression
In the 1950s, researchers discovered that people diagnosed with depression were deficient in dopamine, norepinephrine and serotonin. This led the medical community to believe that it could improve these people’s moods by altering the balance between these neurotransmitters in their brains.
The Monoamine Oxidase Inhibitor
The first monoamine oxidase inhibitor was iproniazid. This drug was created as a treatment for tuberculosis, but tuberculosis patients experienced an improvement in sleep, an increase in appetite and euphoria when they ingested the drug. When people diagnosed with depression tried iproniazid, a majority also experienced an improvement in their moods. Imipramine is a tricyclic antidepressant, or TCA. The Food and Drug Administration approved imipramine for the treatment of depression in 1959.
The side effects that these medications caused led them to be undesirable for patients. For example, TCAs cause people to experience drowsiness, dizziness and memory impairments. They also caused potentially serious side effects, such as fatalities from an accidental overdose.
The Selective Serotonin Reuptake Inhibitor
Researchers discovered that serotonin was playing a major role in major depressive disorder. Scientists discovered this fact after they examined the brains of the deceased. They learned that the serotonin levels of these deceased individuals were low. Therefore, Eli Lilly developed a medication that would selectively inhibit the reuptake of serotonin. This would keep more of the serotonin in a person’s brain.
The first SSRI to be approved by the FDA was fluoxetine in 1987. It is more commonly known as Prozac, and it produces fewer side effects than other antidepressants.
How Do the SSRIs Work?
Serotonin Reuptake Inhibitors, or SSRIs, work by increasing the amount of serotonin that exists in the brain. Specifically, they stop the neurons from taking back the serotonin that has been released. With the prevention of the “reuptake” of serotonin, the brain has more serotonin to transmit messages between neurons. The medication is a selective reuptake inhibitor because it only works on serotonin. Examples of SSRIs include Zoloft, Paxil, Prozac, Lexapro and Celexa. These medications are preferable because they are not addictive, and they do not have a stimulant effect.
In general, physicians prescribe patients diagnosed with depression SSRIs first.
How Do Monoamine Oxidase Inhibitors or MAOIs Work?
Monoamine oxidase removes serotonin, norepinephrine and dopamine from the brain, but MAOIs prevent their ability to do this. Because of this, dopamine, serotonin and norepinephrine remain intact so that there is a larger amount of these chemicals in the brain. The medication is not selective, so it affects many other monoamines as well. Therefore, physicians prescribe this medication to treat many other conditions, including Parkinson’s disease.
MAOIs interact with many other drugs, so physicians will only prescribe MAOIs as a last resort. One example of an MAOI is Nardil.
How Do Serotonin-Norepinephrine Reuptake Inhibitors Work?
Serotonin-Norepinephrine Reuptake Inhibitors prevent the reuptake of both norepinephrine and serotonin. However, if a physician prescribes a lower dose of this medication, it will only cause the reuptake of serotonin. To cause the reuptake of norepinephrine and serotonin, the dose must be at a higher level. Examples of SNRIs include Fetzima, Cymbalta, Pristiq and Effexor.
Tricyclic Antidepressants or TCAs
Up until the 1980s, the medical community prescribed TCAs more than any other antidepressant. TCAs work similarly to SNRIs as they prevent the uptake of norepinephrine and serotonin. If a physician prescribed TCAs for a patient diagnosed with depression and they were working well, the physician would continue to keep this client on this medication. New prescriptions may be written in the present day if a client is not responding well to SNRIs or SSRIs. People taking TCAs must be monitored very closely because the danger of overdosing is very real. Examples of TCAs include Silenor, Anafranil, Norpramin, Tofranil and Elavil.
How Do Atypical Antidepressants Work?
Atypical antidepressants don’t work like the previous antidepressants, so they cannot be placed within the more common classifications. Each one works differently from the others, but they still target neurotransmitters that regulate moods. Therefore, they also work on dopamine, norepinephrine and serotonin. They include Trintellix, Viibryd, Desyrel, Serzone, Remeron and Wellbutrin.
Are Antidepressants Effective?
Researchers who study antidepressants have found that they are relatively effective. They discovered that the SSRIs and SNRIs were equally effective. In one particular study, approximately 20 to 40 test subjects out of 100 stated that their depressive symptoms improved after six to eight weeks. Another 40 to 60 subjects stated that their symptoms improved in the same time period after ingesting antidepressants. Researchers also found that antidepressants work well on patients diagnosed with chronic depression and may even cause their symptoms to disappear entirely.
Antidepressants do not begin to work immediately. For example, some patients notice differences in their moods after a couple of weeks. Because depressive symptoms may not disappear entirely after a person takes one antidepressant, physicians choose to prescribe a second antidepressant to be taken along with the first. Some people improve significantly when their physicians decide to do this.
Researchers have discovered that there are four medications that provide the best results for the largest number of people. They include the following:
When deciding which antidepressant to prescribe for a patient, physicians must consider the risk of side effects, the person’s medical history and the symptoms the person is exhibiting.
Although antidepressants are not known to be addictive, they are known to cause withdrawal symptoms if the person taking them decides to stop on his or her own. Before you can stop taking an antidepressant, you must consult your physician.
Are There Side Effects for Antidepressants?
Most antidepressants cause people to gain weight except for Wellbutrin. They may also cause people to have a lower libido. In addition, people have complained that they were unable to reach orgasm on SSRIs. Others were unable to remain aroused or become aroused when they took SSRIs.
Atypical antidepressants also cause side effects. A majority of these medications list lightheadedness, dizziness and dry mouth as side effects. Some atypical antidepressants cause insomnia, but others cause drowsiness. In some cases, atypical antidepressants cause constipation while others cause diarrhea. Some may cause a person to experience nausea, but others may cause the person to eat more and gain weight. The most serious side effects include hypertension, birth defects and suicidal thoughts.
One notable side effect of antidepressants is tolerance. Tolerance is what occurs when a person takes medication for a long period of time. Over that period of time, the person’s body becomes accustomed to the dose. As a result, the medication isn’t as effective as it was in the beginning.
Antidepressants and Suicide
Antidepressants do not begin to improve depressive symptoms right away. Therefore, the medical community believes that suicidal thoughts and the desire to attempt suicide remain or may even increase during these first few weeks. Because of this, the medical community warns people that they may continue to have suicidal thoughts during this time. They also need to be monitored closely in these first several weeks. In the event that these people do not begin to show improvement after several weeks have passed, their physicians will switch them to another medication.
A problem may exist in people with undiagnosed bipolar disorder. These people visited their physicians for treatment of depression, and their physicians prescribed SSRIs for them, but some studies have demonstrated that a person’s mood can worsen on SSRIs if the person also has bipolar disorder.
The Likelihood of Serotonin Syndrome
Antidepressants increase the amount of serotonin in a person’s brain so that they can relieve depressive symptoms. A potentially dangerous side effect of this may be serotonin syndrome. Serotonin syndrome is caused by medications that increase the amount of serotonin in the brain.
Symptoms of serotonin syndrome include the following
- Rigid muscles
- Twitching in the muscles
- Dilated pupils
- An increased heart rate
SSRIs and SNRIs are both known to cause serotonin syndrome. This effect has an increased chance of occurring when the person takes other antidepressants, amphetamines, tramadol, lithium, or fentanyl. These symptoms may begin after a physician first places you on antidepressants or increases the dose. If any of these symptoms start, you must notify your physician.
Drug Interactions Between Antidepressants and Other Drugs
Antidepressants can interact with all types of drugs, including over-the-counter drugs and prescription medications. Many other substances also interact with these medications. One example is the atypical antidepressants. Along with other prescription medications and over-the-counter medicines, herbs and supplements can cause dangerous interactions with atypical antidepressants.
When someone combines antidepressants and antipsychotics, these two medications compete with each other for the liver’s enzymes. These enzymes are responsible for metabolizing both of these medications, and when they compete with each other, the levels of each medicine may fluctuate so that there is too much of the drug in your blood.
Antidepressants and alcohol are another lethal combination. The alcohol may cause the depression to worsen, and it may cause the side effects that SSRIs cause to be worse as well.
Can You Take Antidepressants While Pregnant?
In some cases, it is dangerous to take antidepressants while pregnant. Atypical antidepressants and other antidepressants may harm the baby while it is in utero. They may also be injurious if you are breastfeeding. You must consult your physician if you are thinking about becoming pregnant, but you should not stop taking your medication until you have this discussion.
Can You Stop Taking Antidepressants?
Before you stop taking antidepressants entirely, you must plan to taper off gradually, and this may take several weeks. The best way to do this will depend on the type of antidepressant you are taking. For example, atypical antidepressants cause you to experience withdrawal symptoms when you miss your dose. This is known as discontinuation syndrome, and it can be prevented if your physician reduces your dose over a period of several weeks.
What Do You Do If You Overdose?
If you suspect that someone overdosed on antidepressants, you must call Poison Control immediately because the results of an overdose can be very serious. For example, an overdose on SSRIs results in a heart arrhythmia or an irregular heartbeat. In addition to that, TCAs and MAOIs can also lead to death if someone takes too much.
If you or a loved one is addicted to antidepressants, there is hope for you. Granite Recovery Centers can help you get your life back to where you want it to be. You or your loved one will begin in our detox program. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency.
After successfully completing detox, you can move on to the inpatient treatment program. If you are also experiencing a mental health condition, we have a dual diagnosis treatment program for you. Contact us today to learn more.