I recently noticed that a blogger posted his
theory on the addictive properties of antidepressants. He pointed out that
people get "psychologically addicted" and that using the term
"addiction" for physical addiction seemed too restrictive. His supporting evidence is a newspaper article about how Glaxo Smith Kline
dropped its claim on a patient information pamphlet for paroxetine saying that
the drug was "not addictive". David
Healy is quoted as saying "If there is withdrawal, then there is physical
dependence. There will be some people who will never be able to halt this
drug, there will be some for whom halting will not be awfully difficult and
some for whom it is a real issue". The article goes on to say that although
SSRIs are not like opiates they are "more comparable to the
benzodiazepines such as diazepam, which is now prescribed only with great
caution because of withdrawal problems".
Working in the addiction field this entire line of thinking
is rhetorical. There is significant psychiatric comorbidity in people with
addictions with anywhere from 40-75% having co-occurring disorders. Most of
those co-occurring disorders are anxiety disorders and depression and they are well
known triggers for relapse as well as initiating drug and alcohol use in the
first place. Contrary to public denial, addictive disorders have huge
liabilities in terms of morbidity and they are often lethal illnesses. My goal is to reduce the risk of relapse by
treating the co-occurring disorder while the person is being treated for
addiction. SSRI medications are one of the mainstays of treating anxiety and
depression these days. They are effective medications. I would not be
prescribing them if they caused "psychological addiction". Furthermore,
many treatment programs for addiction teach the concept of cross addiction and
nobody studying that concept would want to take an SSRI if it caused any kind
of addiction.
A better starting point would be to look at more
comprehensive definition
of what an addiction is. That starting point would be the October 2011
definition issued by the American Society of Addiction Medicine. Paragraph 2 of the short definition will
suffice and reading those four lines should make it very clear that the use of
antidepressant medications does not lead to addiction. The real hallmark of
addictions is uncontrolled use and there is no evidence that modern antidepressants
are used in an uncontrolled manner. Additional
evidence is that antidepressants have absolutely no street value and therefore
are in the majority of 34 million chemical compounds listed in Chem Abstracts
of which only about 322 are addicting.
If your doctor has recommended that you take an
antidepressant medication certainly be aware of the fact that there may be
discontinuation symptoms. Discontinuation symptoms are not an addiction. Needing to take an antidepressant for a
chronic mood or anxiety disorder is not an addiction. Contrary to Dr. Healy's opinion there are a number of nonpsychiatric medications can be discontinued and cause severe discontinuation symptoms. The term "physical dependence" suggests an addiction or the inappropriate use of a potentially addicting drug where in fact that is not the case with antidepressants. Comparing antidepressants to other clearly addictive
compounds like benzodiazepines or opioids is not an accurate comparison across
any dimension. I agree that any person considering an antidepressant drug needs to be aware of the fact that mild to
moderate symptoms can respond to psychotherapy as well as medication. ANY medication can lead to rare but very serious
complications. Any person considering treatment with medications needs to be working with a physician who is skilled in the use of these medications and who can address any potential side effects. My personal experience in
treating people who have severe anxiety and depression is that they reach a
point that anyone with a severe chronic illness reaches in making a decision
about medication. That point generally involves asking themselves: "What
else am I going to do?".
As physicians we can never minimize the importance of that
question.
As a former SSRI user I can say that they were most definitely addictive physically for me. It took 12 weeks for the symptoms to subside. The only reason they are touted as non addictive is so drug sales increase. Its a for profit business.
ReplyDeleteJust wondering if the blogger here has a conflict of interest. Because in the real world, people get hooked on these perfidious drugs and suffer horrible effects that can't be attributed to the underlying depression (e.g. convulsions) when they cease taking them. And because big pharma - like Eli Lilly - has a track record of lobbying for "withdrawal symptoms" to be reframed as "discontinuation syndrome".
ReplyDeleteI not only have no Pharma conflict of interest, but I also don't have the conflict of interest that may be more common these days and that is making unrealistic claims about medications, psychiatry, etc. for one's own personal gain.
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