Are Antidepressants Addictive?
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Q:  Are Antidepressants Addictive?

Are there any anti-depressant meds that are addictive? A close family member who denies I have bp disorder firmly believes that anti-depressants (such as Zoloft) are addictive.

Dear Jenna --
The standard answer would be: definitely not. Antidepressants are not at all like medications we typically agree on as "addictive", namely the opiates (heroin relatives, like methadone, or pain medications like oxycodone) and the benzodiazepines (Valium relatives, including lorazepam, oxazepam, and a bunch of others, all of which are quite a bit like alcohol in the style of their "addictiveness").

Instead, one can generally stop anytime one wishes, without the risk of physically dangerous withdrawal as can occur with alcohol or benzodiazepines (opiate withdrawal is not so dangerous, just awful to go through). HOWEVER, a "withdrawal" syndrome from antidepressants has been recognized, and that's probably what your family member is referring to.

Antidepressants in the serotonin-reuptake group (paroxetine/Paxil; sertraline/Zoloft; venlafaxine/Effexor are the best recognized for causing this problem; Wellbutrin doesn't cause it; and the older TCA antidepressants can cause some gastrointestinal problems on stopping but not this "withdrawal" pattern) are now well-known to cause an odd syndrome in some people when they are stopped, especially if stopped abruptly. Fluoxetine/Prozac is less likely to cause this because it tapers itself out of the blood stream much more slowly, yet even it can still cause similar problems.

What is "withdrawal" like? Some people get a flu-like syndrome of low energy, muscle aches, headache, and/or dizziness, that kind of thing. Many variations seem possible. Some people have electric shock like sensations. Some have mood symptoms, including easy tearfulness. Now, from there, you're entering a very controversial realm.

Some people have associated this "withdrawal" syndrome with much more serious symptoms and behaviors. For an extreme example, read this one wherein paroxetine withdrawal was used as a defence against legal charges. It's a pretty bizarre story.

Finally, there is a separate syndrome called "antidepressant-withdrawal induced mania". Ali I would think that might come closer to describing what's going on in the British legal case above. This is not fairly attributed to the antidepressant as such and should not be included in "withdrawal" discussions, in my view. It is one of the risks of using antidepressants in bipolar disorder, however.

So, the answer is "no, but yes, or sort of", okay? It's not very straightforward, is it. No wonder there's some confusion.

Dr. Phelps

Published December, 2003


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