Before I started taking psych meds, one of the major concerns I had was addiction.
I didn’t want to be an addict of any sort as I’m quite familiar with the horrors of addiction, having addicts in the family. I’ve also read my fair share of substance abuse information. Will I get addicted to antidepressants?
And I knew people often took antidepressants for long periods of time, sometimes forever.
So weren’t these people addicted to antidepressants?
What is Addiction?
The term “Addiction” is not used in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The DSM-IV-TR has a class of disorders known as Substance Related Disorders. The two substance related disorders are:
- Substance Abuse
- Substance Dependence
No addiction.
It’s not that addiction as a concept isn’t used in psychology or psychiatry; it’s just that it’s not a diagnosis. It’s more a common turn-of-phrase than anything else. (As fellow HealthyPlace blogger Kendra Sebelius points out, the next version of the DSM may include a definition for addiction.)
Substance Abuse – Are you abusing antidepressants?
Because substance abuse is a diagnosis, its symptoms are specifically defined. Here is the substance abuse definition:
- A pattern of substance use leading to significant impairment in functioning.
- One of the following must be present within a 12 month period: (1) recurrent use resulting in a failure to fulfill major obligations at work, school, or home; (2) recurrent use in situations which are physically hazardous (e.g., driving while intoxicated); (3) legal problems resulting from recurrent use; or (4) continued use despite significant social or interpersonal problems caused by the substance use.
- The symptoms do not meet the criteria for substance dependence as abuse is a part of this disorder.
Substance Dependence – Are you dependent on antidepressants?
Again, because this is a diagnosis, substance dependence symptoms are also well-defined. Substance dependence is defined as the following symptoms:
- Substance use history which includes the following: (1) substance abuse; (2) continuation of use despite related problems; (3) increase in tolerance (more of the drug is needed to achieve the same effect); and (4) withdrawal symptoms.
Can You Abuse Antidepressants or Have an Antidepressant Abuse Disorder?
Well, not if you ask me. The pattern of antidepressant use would have to, in some way, significantly harm you and your life over the course of a year. And in spite of this harm, you would have to continue to take it.
Substance abusers can most easily be thought of as the guy that knocks over Granny to get her pension check , then is arrested and he keeps doing drugs, regardless.
No one knocks over Granny for fluoxetine (Prozac). Seriously.
Can You Be Dependent on Antidepressants or Have an Antidepressant Dependence Disorder?
This one doesn’t seem terribly likely either seeing as if you can’t have an antidepressant abuse disorder you can’t have an antidepressant dependence disorder either. You might achieve tolerance or withdrawal, but it’s hard to meet the other factors of substance dependence.
Withdrawal itself, or tolerance itself, does not meet the criteria for a substance disorder.
(More on other types of psych meds and their likelihood for dependence and abuse next time.)
Psych Med Addiction – Antidepressants
So because of the way substance dependence is currently defined, it includes both physical and psychological components of dependence. In my opinion, this is pretty much addiction. But, as I try to be accurate here, I won’t call it addiction, I will call it dependence.
Medication Dependence (Addiction) – Mood Stabilizers
So basically, taking a drug you need, even if you need higher doses and get withdrawal symptoms upon cessation, this is not dependence, abuse or addiction. It is simply drug use. Antidepressants are psych meds you use. This is similar to any disease.
Epileptics use anticonvulsants. They go through withdrawal if they suddenly stop taking them. But they are in no way addicted to their anticonvulsants.
So no, we’re not addicted, dependent or abusing psych meds. The people who say we are mostly say so out of ignorance or in an attempt to inflame and shame people.
I am a bipolar 1, who experiences switching with even the teensiest amount of an antidepressant. I definitely have an unhealthy abusive relationship with antidepressants. They act like speed for me. It takes less than a half an hour for me to shift into hypomania and then it is up up up like a balloon. Then once you are high, why not get higher? And as any manic feels a lack of control over impulses, I don’t stop even when my life falls apart. I either go right off the deep end or I flush them in an attempt to save myself from myself.
But you know what no one thinks?
No one thinks people would abuse anti depressants. So every few months when I get real depressed, I find myself sulking into some new clinic with my tail between my legs looking for salvation. I take them. I flip. I light the world on fire.
Antidepressants are a wildly addictive and dangerous form of self regulation for me personally
Tanya
Another informative, well structured article pointing out some important points in our attitudes and words when dealing with psych med and the people that take and rely on them.
I agree with all of your points. I don’t see my years of taking antidepressants an addiction and I know my wife doesn’t see years of taking Clozaril plus plus plus other in her daily cocktail an addiction. They are a necessity that allow us to function in a level plane so we can enjoy all life has to offer.
In this mental health field it doesn’t seem to matter what anyone writes about, there is always someone ready to start criticising. I understand and accept, that sadly this is not an exact science. Everyone and every diagnosis presents differently and requires a different approach. After all we are all individuals so it makes sense that our issues will be individual as well.
Medication doesn’t work exactly the same for everyone and sometimes, well, “it hits the fan” and gets ugly when changing, modifying, tweaking and testing to try and improve things. We used to get bitter and angry about these times – especially when what seemed like a very minor tweak had really serious results ending in a 2 month stay at the local mental health hospital – but we now understand that sometimes this will happen.
I am curious on your thoughts of illness’s morphing or becoming used to a certain level of medication. I often hear of I was on so and so for years and then all of a sudden I started having issues……
With my wife we were able to determine this was caused by entering menopause and hormone level changes etc but there is not always an explanation.
Just wondering….
Please keep up your amazing work. Your are a source of inspiration hope and courage to so many.
Best Regards
Ian
Loved the post and love your blog. I found the post to be extremely informative. No matter how long one is biplar there are always new things to learn. I am signing up for your e-mail with many thanks, Elizabeth.
Hi Elizabeth,
Thanks.
I often think of myself as “knowing everything” about my little area of mental illness, but really, there is no such thing. I learn new things every day. Glad I could pass some along.
– Natasha Tracy
I’m in the midst of withdrawal from seroquel at the moment. Ive been stable for 5 yrs and have had enough of the side effects and think its about time I gave my body a break. It may bite me on the arse and then I’ll have to go back on them I suppose but I owe it to myself to try to go without – I’m trying potent omega 3. IT works for some, not all. I’ll find out soon enough. I’m coming off slowly. I feel ok right now, headaches and fatigue mainly. Dizzy spells.
I’m neither for or against meds – I’m all for personal choice and doing whatever works for mental and physical health. Physically, I felt the compromise had become too high. I also looked at my life now compared to how it was before when I was at my worse. My life is so much more settled and secure then ever before. Im happy and have support. All this makes it more likely that I’ll cope better with mood fluctuations than I did. My niece has been without meds for years, though she’s diagnosed Bipolar 1. I just need to give it a go. I realizes though that i’ll be lucky to live without some kind of medical support.
Thanks for linking this post up at my Monday Madness – ITs going to clarify the arguments for all who read it.
Shah. X
Hi Shah,
I hope you know Omega-3 is in no way like Seroquel. Omega-3s are only shown effective in unipolar depression, although even the data on that isn’t consistent or conclusive. The jury is mostly out on bipolar but it doesn’t appear unsafe (in my non-medical opinion).
I would recommend reading this: http://psycheducation.org/depression/meds/Omega-3.htm
(Note, I’m not saying it’s bad.)
“Physically, I felt the compromise had become too high.”
Completely reasonable. Good for you for being proactive.
“I also looked at my life now compared to how it was before when I was at my worse. My life is so much more settled and secure then ever before. Im happy and have support.”
I feel compelled to mention that this might be because of the medication. One of the things people doing well on medication think is, “gee, I’m feeling better, why do I need those pills?” but of course it was the meds making them feel well and going off them destabilizes them.
I’m not saying that will happen, I’m just saying it’s a possibility.
I don’t want to seem doom and gloom or anything I just think it’s important to have realistic expectations. It might all work out well for you in every way! Hopefully you’ll come back and tell me about it.
“Thanks for linking this post up at my Monday Madness – ITs going to clarify the arguments for all who read it.”
No problem. I think it does really clarify some arguments. And it lends support to those who are forced to defend their medication decisions.
Positive thoughts for a quetiapine-free you.
– Natasha Tracy
I do not mock people Natasha and have been a follower of you for several years now. I am well aware of the benefits of medication compared to no medication for those with Mental Illness. My point was – too many people seek out the comfort of the medication to handle their daily life’s issues and problems than to try and work on figuring why they are having the problem in the first place.
Folks do not wake up, naturally, anxious. Something has to have occurred to trigger that emotion and anxiety is an emotion that triggers a physical response. Yet, too many run to the cabinet and down pills to “calm” the anxiety rather than try to do something else non-medicated that would likely – if tried – help even a wee little bit. The first reaction is to kill the emotion/feeling… not to try and figure why it’s happening.
No therapy doesn’t work in all settings or all situations but if you never try, then it will certainly never work. In that your blogs are predominately med supporting… I could say that you mock those who try to use more psychotherapy than meds.
Seroquel and Depakote are not equivalent to Warfarin or some of the other medications needed for literal body functioning. Yet, if you have been on a med for a long period of time, for example Seroquel to put you to sleep every night.. and then suddenly you miss a dose or 2… YOU WILL HAVE SYMPTOMS. That’s med dependence and you’ll have a psychological dependence because you’ll become frantic wanting your med.
I know of folks who will allow the electric to be cut off just so they can purchase their meds. I know of folks who will literally sleep in their car, than to allow their meds to be cut off. That is when, a dependence sets up.
Many folks suffer with their Bipolar symptoms, or any MI symptom, long before they ever take the 1st pill. So, the life-saving aspect is only a “feeling”.
I know the meds help but have they literally saved me? No. They take away the uncomfortable and the frightening… but they don’t keep me from dying. If they were the sole and only reason, then I’m a walking med cabinet.
Even folks that take a plethora of meds, every single day and swear on a stack of their most revered book… still kill themselves. Suicide is the leading cause.
We are talking dependence and dependence on anything can become a disorder even if it doesn’t create all the malfunctioning that is accepted to be considered as such. When your entire life is controlled solely on taking pills to make you “feel” one way or the other each 24 hour period… then there is, in fact, a dependence.
Hi Tabby,
I replied to your comment in a post: https://natashatracy.com/mental-illness-issues/antidepressants-addiction-dependence-talkback/
– Natasha Tracy
wow natasha, you’re a patient person. i couldn’t handle some of the crap you take from some of the people here so gracefully.. i’m bipolar (mixed depressive episodes) and it’s evident that the illness is different for everyone. right now i’m fucking up so much but one thing i can confidently proclaim is that meds have stabilized me so much. i’m still very suicidal in my thoughts but without antidepressants, mood stabilizers and beta blockers i have no doubt my life would already be over. i’m alcoholic as well but even that doesn’t stop me from taking my meds. i support u 100% because i can relate to EVERYTHING u talk about, from the suicidal nights at ur place to the hypomanic days when it’s near-impossible to function. one thing that’s very hard for me to face is that i’m not a genius when it comes to therapy. it takes all my effort and some to understand what’s going on with me and ur blog, hard as it is, is a reality check i require.
Ur an inspiration
Hi David,
Well thank-you. I’m sure graceful isn’t always the word that describes me but I try to remain professional and respectful of others.
I’m glad to hear you’re taking your meds and your treatment plan is working. Good on you. That’s not an easy thing.
As I’m sure you know, addiction is a mental illness and often occurs along side other mental illnesses. It’s one way someone with a mental illness copes, often before diagnosis, and before learning better ways to deal with the illness. I’m not sure if you’re saying that you’re drinking right now, but hopefully as you get your bipolar more under control, you’ll be able to get your substance use under control as well.
“one thing that’s very hard for me to face is that i’m not a genius when it comes to therapy”
Sometimes therapy is a wakeup call for people. No one is a genius when they start out looking inwards at who they are. That sort of thing takes practice. It’s a skill and you’ll get better with it over time. The real hope is that you’re _doing_ it. You’re actively working at bettering yourself. Congratulations. That’s a huge step.
Thank-you for your support and kind words. I’m glad I could help.
– Natasha Tracy
Feel like you’re arguing a semantic point since as you point out, addiction is not interchangeable with substance abuse disorder. Using cigarettes as example of dependency rather than addiction doesn’t make sense in that context since nicotene is incredibly addictive, as is caffeine. Mental health professionals do use the word “addictive” to describe properties of benzos like vallium and xanax which makes them take more care in prescribing them. That doesn’t mean people that take xanax are “addicts” by any means and obviously those drugs still can help people. Ritalin, for ADD is a totally different drug family, which is schedule II controlled substance so again needs extra care when being prescribed–would guess that one would probably be most abused psych med but again when taken as prescribed can potentially be helpful. Given the awful time you’re having with withdrawal from your current meds (which clearly have nothing to do with you abusing these drugs) doctors can’t always predict when that will happen, but it is a legitimate concern to have when asking about taking medication, especially since withdrawal effects aren’t as well researched.
Hi MMC,
I don’t particularly consider it semantic. Knowing the DSM definitions is actually reasonable and knowing antidepressant use doesn’t fall into a substance abuse category is useful. When you say someone is “addicted” to something you make them sound like a meth-head. People who take psych drugs aren’t meth-heads. I don’t consider that a minor point.
Yes, people use the word “addictive.” It’s commonly used in the Western lexicon at large. The correct term is an estimation of the potential for a abuse or the potential for dependence, but addictive is easier for people to understand. Although I will say, these days I hear most professionals saying abuse and not addiction, but people will equate it to addiction, even if that is not necessarily the case.
Yes, potential for abuse is taken into account when prescribing, absolutely.
The most abused meds are pain killers, and the most abused psych meds are benzos (if you go by the number of people for it in treatment centers). Uppers (like ADHD medication) are inappropriately used quite a bit but don’t tend to actually lead to a substance use disorder. (ADHD medication isn’t nearly as fun as most people seem to think.)
Withdrawal is a major concern, sure. No doubt. And doctors tend to downplay it. Sometime I’ll write a post on the ethics of such things, but they have their reasons (not that I necessarily agree).
– Natasha Tracy
Hi Tabby,
You are correct, some people do get very anxious if they miss their medication such as an antidepressant. That is to be expected. Any medication you take daily and then miss is going to produce symptoms. That is why any medication is tapered slowly. Cold turkey is never fun.
I would suggest psychotropic medications are as life-saving as blood thinners. People need them to survive. You may not need them, but many do. Many people are extremely suicidal before medication. Medication reduces or removes these feelings, which makes it, in my opinion, life-saving.
I did not say there wasn’t a physical dependency, what I said was that it was not a dependence disorder/addiction. A physical dependency develops with daily use of anything such as coffee, cigarettes, Nyquil, antihistamines, asthma medication or anything else you care to mention.
And one of the reasons people need their medication every day is to ensure a steady blood level of medication. Especially in bipolar disorder this can make a huge difference. It’s not just about whatever withdrawal you may experience it’s about maintaining consistency. It’s just like going out and partying one night. It’s only one night, but that can cause a huge problem for someone with bipolar disorder.
And you may mock people and tell them to use psychotherapy skills, but I would suggest that’s inappropriate. Many people, myself included, have many, many psychotherapy skills garnered through years and many types of therapy. That doesn’t mean it works in every case.
It’s not “all meds.” I would never say it was. But “all therapy” doesn’t work for many either.
– Natasha Tracy
I know of people who cannot go not 1 day without their medication and the medication not be a life saving med like a blood thinner but be a Anti-depressant. They become all anxiety ridden and panic filled because they just know that if they miss that 1 dose or those 2 doses for that 1 day… they will suffer horrendous depressive symptoms.
They can’t sleep and they get agitated and they get quite vile until they get that dose or doses. They resort to sobbing, they resort to melodrama of threatening suicide… just to get that 1 day’s worth of anti-depressants. Cause they just know that if they miss that 1 day.. that 1 day.. they just know they’ll be screwed.
I’m not talking about their klonopin or diazepam, that’s benzos or sedatives which have a addiction issue all their own. I’m not talking their seroquel which folks will become quite ferocious over if you don’t give them their nightly dose so they will sleep.
I’m talking a cymbalta, or a lexapro. I work in a MH agency and we have patients call cause they’ve gone 1 day without their prescription. They didn’t call 3 days before they ran out, they call the 2nd day they are out.
I am also one with Bipolar and when your entire day, or entire life, is solely dependent on whether you took your pill or pills that 1 day… I dare to say, you have a dependence.
Now… you have blood clots and you miss 1 day of your blood thinner.. then we may have a major issue. You miss 1 day of your Seroquel, or your Cymbalta, or your Depakote… seriously, it will be okay… if not, use your psychotherapy techniques. Oh, that’s right… not too many actually do psychotherapy… it’s all the meds baby.
i am so sorry that you need to keep using your considerable writing talent to help explain why those of us with mental illnesses need to take life-saving medication for a legitimate medical illness. It drives me crazy! But I do want you to know that what you are doing is so important to us all. I want to support you and will donate to that cause as soon as I am able.
Hi Martha,
That is very kind, thank-you.
Well, I think it’s important too. Yes, some days it feels like I just have the same conversation over and over but other days I know that I’m answering questions that I know people ask, and to which they deserve good answers.
Thanks for your appreciation.
– Natasha Tracy