Are antidepressants addictive?

The 3 most common questions I get regarding antidepressants are 1) are they addictive; 2) how long do they take to work; and 3) do they cause weight gain? (Check out this post to see how long they take to work, and this post to see if they can cause weight gain ).

Antidepressants are not addictive, and there are no plausible mechanisms to suggest that antidepressants could be addictive.

These false notions add to the stigma that surrounds mental illness. This stigma can lead to people being hesitant or afraid to seek help.

Definition of “addictive”

It’s important to first look at what “addiction” means. I’ve often seen this term misused, and I think it’s worth revisiting before going any further.

There are many different definitions for addiction, but the best way I could define it in one sentence is: a compulsive behaviour that is done despite the consequences (social, financial, health) that can be associated with the behaviour.

When addiction is involved with substance use, it’s usually referred to as substance use disorder. I find this term has less stigma attached to it than addict or addiction (words matter); so, substance use disorder is the term I’ll be using for the rest of this post.


What are signs of substance use disorder?

Substance use disorder can generally occur when the substance is able to activate the parts of your brain that “reward” certain behaviours. (These reward centers exist to drive our instinct to eat, sleep, reproduce, etc.) So activating this part of the brain can create a “high”, “buzz”, or sensation of euphoria.

Substances that can be associated with this can include opioids (e.g. morphine, heroin), amphetamines (e.g. “crystal meth”), cocaine, alcohol, nicotine, etc.

Signs of substance use disorder can include combinations of the following:

Losing control

An example would be someone who doesn’t actually want to drink excessive amounts of alcohol, but always ends up drinking way more than anticipated/desired.

Not being able to stop

Such as repeated failures to stop smoking despite wanting to quit.

Substance-seeking behaviour

This can be things like skipping work or family obligations to find more drugs, despite understanding the consequences of doing this. Extreme examples would be resorting to robbery/violence to obtain drugs.

Presence of cravings

Anyone who tries to quit smoking will attest to the strong cravings that can occur when trying to quit. This is a result of your body becoming tolerant/dependent and going into withdrawal when you don’t use the substance in question.


How do antidepressants work?

The first important thing to note is that antidepressants don’t give you a “high”. So they won’t cause any cravings or drug seeking behaviour.

Antidepressants come in different classes that have their own unique mechanism of action. But, overall they will increase the amount/activity of neurotransmitters in the brain. (A neurotransmitter is a type of substance in the brain that allows signals to travel between cells.)


“But, I heard you can go into withdrawal if you stop an antidepressant?”

While there is no “withdrawal”, there is a drug discontinuation syndrome that can occur with some antidepressants. It’s extremely important to note that this discontinuation syndrome is NOT “withdrawal” or like the cravings present in “withdrawal”. Also, it can be avoided/lessened if you taper off the antidepressant.

The exact cause of the discontinuation syndrome is not 100% defined. There are a few hypotheses, one of which is:

Because antidepressants act on neurotransmitters, your brain essentially gets used to this assistance to get to an “equilibrium”. So, if all of a sudden you abruptly remove the medication that helps achieve that equilibrium, there can be a temporary lag before a new equilibrium can be achieved.

A good analogy would be like if you are in a tug of war and both sides are pulling equally. If all of a sudden one side lets go, then the equilibrium is disturbed (and the other team falls on their asses).

The antidepressant discontinuation syndrome usually manifests as flu-like symptoms (headache, tiredness, muscle aches, chills/sweats). Other less common symptoms can include things like jitteriness, tingling/electric-shock sensations, and mild agitation or anxiety. The duration of the discontinuation syndrome is usually a couple of weeks if left untreated.

As I said earlier, this discontinuation syndrome is usually avoidable when properly tapering off the medication. So anyone wanting to stop an antidepressant should make a plan with their physician and/or pharmacist to avoid this syndrome (if applicable).


Conclusion

So, are antidepressants addictive?

No, antidepressants are not addictive.

While there is a potential of a discontinuation syndrome in the case of abruptly stopping some antidepressants, this is not the same as “going into withdrawal”. People do not lose control of their use of antidepressants, nor do they engage in drug seeking behaviour to get more antidepressants.

Let’s refer to the Rxplanation Bullsh*t Meter

We have a reading of 100% pure bovine excrement with this one.

This notion has to stop. In my opinion, it contributes to the fact that many people are afraid to seek help for mental illness.

So, let’s stop spreading this false notion.

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Dan Landry

Daniel (Dan) Landry, founder of Rxplanation.com, is an infectious diseases pharmacist at the Dr-Georges-L.-Dumont University Hospital Centre in Moncton, NB, Canada.

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