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.
Will I get addicted to antidepressants?
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And I knew people often took antidepressants for long periods of time, sometimes forever.
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:
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- Substance Abuse
- Substance Dependence
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.
Similarly, bipolar disorder mood stabilizers are mostly anticonvulsants and we’re not getting dependent or addicted to those (or lithium) either.
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.
Next time I’ll talk about psych med dependence of sedatives, sedative-hypnotics and antipsychotics.