Are antidepressants addictive? The sensible use of antidepressants

20. October 2019

If you’ve been following our blog for a while, you’ve probably noticed that for many of the mental health disorders presented, medication is one of the building blocks of successful therapy.

For this reason, in this article we would like to take a closer look at the topic of psychotropic drugs and antidepressants in particular, and address worries and prejudices associated with taking psychotropic drugs. In addition, we give you an overview of common agents and provide you with useful tips on the proper use of psychotropic drugs.

What psychotropic drugs are there anyway?

Psychotropic drugs is an umbrella term for medications taken in connection with mental illness. This brief overview shows you subgroups of psychotropic drugs that, although named for the primary disorder in which they are used, are often used across diseases.

Antidepressants

Use in moderate to severe depression, anxiety disorders, and obsessive-compulsive disorders (e.g., Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Norepinephrine Reuptake Inhibitors (SNRIs)).

Anxiolytics

Antianxiety medications (e.g., benzodiazepines (short-term only), but also antidepressants).

Sedatives

For severe agitation and panic attacks (e.g., benzodiazepines). Caution: dependence potential.

Antipsychotics

For psychosis and schizophrenia, but also as an adjunctive medication for major depression (e.g., clozapine, risperidone, aripiprazole).

Mood stabilizer

For bipolar disorders and schizophrenia, but also as an additional medication for severe depression also called phase prophylactics (e.g. lithium).

Anti-dementia drugs

For dementia (e.g., memantine).

Because depression and anxiety disorders are among the most common mental health conditions, antidepressants are prescribed significantly more often than the other drugs. As a result, they are more subject to public debate and have to contend with prejudice surrounding their mode of action, perceived addictive potential, and side effects. This article will therefore focus on the topic of antidepressants in the remainder of this paper.

Antidepressants taken a closer look

There are a variety of antidepressants: among others, citalopram, venlafaxine, fluoxetine, or mirtazapine are prescribed for moderate to severe depression. These are different drugs with different modes of action (see below: How do antidepressants work?). In the best case, the prescription is made after a comprehensive diagnosis by a psychiatric specialist. However, general practitioners can also prescribe antidepressants. Physicians base their choice of medication and dosage on medical guidelines for the treatment of mental illnesses such as depression.

Important: Accurate diagnosis is essential for mental illnesses, because there are depressive disorder patterns in which antidepressants are not automatically indicated (e.g. bipolar disorders).

When to prescribe antidepressant medication – the judicious use

Antidepressants are prescribed for moderate to severe depression, anxiety disorders, and compulsive disorders, and help restore chemical balance in the brain. They are also used for chronic pain or insomnia. Antidepressants are designed to improve patients’ well-being. Depending on the active ingredient, they can increase drive, reduce tension, and brighten mood. It is not guaranteed that all patients will respond equally well to an antidepressant. Depending on metabolism, different medications and dosages may need to be tried from time to time.

How do antidepressants work?

In depression, the ratio of neurotransmitters in the brain is out of balance, particularly the neurotransmitters serotonin and norepinephrine, among others, which can affect drive and mood (Schandry, 2011). Almost all antidepressants act on the serotonin and norepinephrine systems. This is also what the abbreviations SSRI or SSNRI (English abbreviation for Selective Serotonin (and Norepinephrine) Reuptake Inhibitors), which are often mentioned in connection with antidepressants, stand for.

Antidepressants are not a miracle drug

Unfortunately, we have to take away the hope that a medication can solve all symptoms like a magic pill. Antidepressants alone are often not enough for the successful and sustainable treatment of depression. Rather, they create a foundation on which other therapy components, such as psychotherapy and sports, can be applied. In addition, there are also patients who do not respond to certain drug groups. In such cases, it can take a long time to find the right medication.

What are the side effects of antidepressants?

The saying “No effect without side effects” unfortunately also applies to antidepressants. For example, nausea, digestion, or restlessness may occur, especially in the first few weeks after starting to take them. Physicians must educate their patients about possible side effects and closely monitor patients during the first few weeks to ensure that medications are not hastily discontinued due to accompanying symptoms. Fortunately, the side effects of the first few weeks often pass on their own. Known long-term side effects of some, but not all, medications are weight gain and sexual dysfunction.

Important: We humans differ greatly from each other in our metabolism. Therefore, the side effects are always individual and may or may not occur.

The effect of antidepressants does not occur immediately

It is very important to note a special property of antidepressants: They do not take effect immediately, but time-delayed, because the drugs trigger complex neurobiological processes. This delay is one reason why many sufferers discontinue the medication far too early out of their disappointment at the lack of an effect and do not even give the medication a chance to take effect.

Prejudices about antidepressants

In the case of physical illnesses, we often don’t even ask closely when the doctor prescribes us a medication. We take it in the hope of improvement and also accept side effects more or less willingly. In the case of psychotropic drugs, the concerns are often greater, because it is our mental well-being that is at stake here.

Unfortunately, over the years and through many lurid articles, TV shows or Internet forums, these concerns have become scientifically unprovable myths, as a result of which doctors often encounter mistrust when prescribing psychotropic drugs.

Education about antidepressants
The task then is to counter these prejudices and fears with education. Informed patients who know about the effects and side effects of the medication are more satisfied, feel valued and take the medication more regularly as prescribed.

Let’s take a look at the most common prejudices about antidepressants and examine them more closely:

“Antidepressants are addictive.”

Here is where confusion can arise between the sedatives and antidepressants mentioned above. Sedatives (especially benzodiazepines) can produce dependence, but antidepressants cannot. Dependence or addiction is defined in such a way that addicts need constant increases in dosage. They feel a strong internal urge to consume the addictive drug and have difficulty controlling their consumption. This is not the case with antidepressants.

The myth also comes from the fact that antidepressants cannot be stopped from one day to the next. Suddenly stopping the medication can upset the circulation and the psyche and lead to symptoms similar to initial side effects. However, this alone is not a criterion to speak of dependence.

“Antidepressants change the personality.”

As you have already read, antidepressants work in the brain. This leads to the fear that they can change the personality and hide the real essence of the person. This is not the case: antidepressants do affect components of the psyche (drive and mood), but this effect is not so extreme as to completely change the original character of patients. Rather, it is often the case that the parts of the personality buried by the depression can reemerge, as the symptoms of the depression subside as a result of the antidepressants.

Tips for the correct use of antidepressants

If you yourself or a loved one are affected by depression and the doctor has prescribed a medication after extensive consultation, then we would like to help you benefit from the medication in the best possible way with these tips.

Eventually have the level of the drug checked in the blood: After you have taken the antidepressant for a few weeks, it should be visible in the blood count. If it has no effect or side effects occur even at low doses, a determination of the drug concentration in the blood may be useful. Ask your treating physician for a blood test.
Never discontinue abruptly: Do not discontinue the medication without consulting your doctor. You may experience discontinuation symptoms (see above) or relapse into a depressive episode.
Regular checks with the doctor: With the specialist or family doctor, you should discuss at regular intervals whether the antidepressant still shows the desired effect and is still indicated.

Be reminded to take: Like all medications, antidepressants should be taken regularly. If you are prone to forgetting to take them, set an alarm on your smartphone or ask family members to remind you to take them.

Read the package insert (with care): As a patient, it is desirable to be aware of the medications you are taking. But beware: the package insert really lists all the symptoms that have ever occurred while taking the medication. Therefore, it also lists very low probabilities of occurrence and symptoms that may not be related to the medication. The listing does not mean that these side effects will necessarily occur in everyone! In case of doubt or concern, you should always consult the attending physician.

Caution when taking other medications: The simultaneous use of antidepressants with other medications should always be in consultation with the doctor. For example, the degradation processes of the drugs via the kidney or liver play a role. Interactions may occur here.

Antidepressants as an opportunity

In conclusion, antidepressants are a chance in the treatment of depression. They are not a guarantee of improvement or cure, but they can initiate necessary processes. For many patients, they help them, in combination with psychotherapy, to participate actively and joyfully in life again. If you approach it well-informed and together with your doctor, antidepressant therapy can be a step toward mental health.

References

(1) Schandry, R. (2011). “Biological psychology. 3rd, completely revised ed.” Meinheim, Basel: Beltz Verlag

(2) https://www.leitlinien.de/nvl/html/depression/empfehlungen

Categories: Therapy

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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