Table of Contents

I. The Basics of Antidepressant Addiction

This guide explains the effects, trends, and dangers of antidepressant use, as well as an unbiased analysis of the medicinal and behavioral treatment methods for antidepressant addiction based on current research and publicly available statistics.

Primary Antidepressant Dangers

  • Addictiveness: In 2007, the Lancet published the results of a study conducted by Nutt et al. The study aimed to determine the addictive potential of 20 substances, ranging from illicit drugs to psychotherapeutic medications. Although Nutt et al. did not specifically analyze antidepressants, they did include benzodiazepines in their study. When Tiller et al. compared diazepam, a benzodiazepine, with a proven antidepressant (moclobemide), they found that diazepam was even more effective than moclobemide for improving depression ratings after four weeks. Thus, they concluded that diazepam could be classified as an antidepressant. In their study, Nutt et al. found that benzodiazepines had a higher addictive potential than amphetamine, LSD, cannabis, and ecstasy, highlighting the dangers of misusing substances with antidepressant properties.
  • Risk of overdose: Antidepressants are often used in cases of self-poisoning. In the United Kingdom, for example, antidepressants are involved in 20% to 30% of nonfatal overdoses and approximately 20% of all poisoning suicides. The risk for overdose is higher for some classes of antidepressants than others, as demonstrated in a study by Hawton et al. In this study, the researchers determined that tricyclic antidepressants have a higher level of toxicity than noradrenergic and specific serotonin antidepressants (NaSSAs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs).
  • Unintended side effects: People who misuse antidepressants may experience a wide range of unintended side effects. Some of these side effects, such as diarrhea and skin rashes, are fairly mild; however, antidepressants are also associated with adverse events. For example, taking SSRIs can reduce the amount of serotonin in platelets, which are cell fragments that help the blood clot after an injury or surgical procedure. Without the right amount of serotonin, the platelets aren’t as effective in blood clotting, which can lead to severe bleeding.
  • Legal risks: Antidepressants are not subject to the provisions of the Controlled Substances Act, so they’re not included in the drug schedules published by the U.S. Drug Enforcement Agency, however, it’s still illegal to possess or use prescription medication without a valid prescription. Thus, anyone who uses an antidepressant without a prescription may be charged with a misdemeanor and penalized with fines, court-ordered drug rehabilitation, or even jail time.

Antidepressant Background Information

Derived FromDerived from both organic and synthetic substances; method of synthesis depends on the class of antidepressant
Ways UsedIngestion, under the tongue (sublingual), rectal, intramuscular, intravenous, crushing, and snorting
Scientific NameSerotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine, duloxetine, desvenlafaxine, levomilnacipran, milnacipran

Tricyclic antidepressants: Doxepin, amitriptyline, nortriptyline, clomipramine, imipramine, nitroxazepine

Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine, citalopram, sertraline, escitalopram, paroxetine, fluvoxamine

Serotonin antagonist and reuptake inhibitors (SARIs): Trazodone, nefazodone

Serotonin modulator and stimulators (SMSs): Vortioxetine, vilazodone

Slang/Street Names for AntidepressantsHappy Pills, Wonder Drug, Miracle Drug, Bottled Smiles
How Long in Bodily SystemHalf-life:

SSRIs: 24 hours to six days

SNRIs: 5 hours to 12 hours

Tricyclic antidepressants: Average of one day

Punitive Legal Measures: Using/PossessionAlthough antidepressants are not controlled substances, it’s still illegal to possess them without a valid prescription from a medical professional. Therefore, an individual who uses or possesses an antidepressant without a prescription may be charged with a misdemeanor. Depending on state law, the penalties may include fines, community service, participation in a court-ordered treatment program, and/or a jail sentence.
Punitive Legal Measures: Selling/DistributingIn the United States, it’s illegal to sell or distribute prescription medications without a license. Therefore, selling or distributing antidepressants is a serious criminal offense. An individual arrested for this crime is usually charged with a felony, which is punishable by several years in prison.
DEA Drug RatingN/A

II. Signs of Abuse

Behavioral Symptoms of Antidepressant Usage and Abuse

How antidepressants affect the brain

The different classes of antidepressants have different effects on the brain. SSRIs prevent the neurons from reabsorbing serotonin, which increases the amount of serotonin in the brain. Serotonin is a neurotransmitter, which is a chemical used to transmit messages between the brain’s nerve cells. Tricyclic antidepressants block the effects of acetylcholine and increase the amounts of serotonin and norepinephrine in the brain. Acetylcholine, serotonin, and norepinephrine are all neurotransmitters. SNRIs prevent the nerve cells from reabsorbing serotonin and norepinephrine, increasing the amounts of these chemicals in the brain.

By increasing the amounts of serotonin and/or norepinephrine in the brain, antidepressants elevate the individual’s mood and make it easier to cope with the stressful aspects of everyday life.

Behavioral signs of antidepressant usage and abuse

An individual who misuses antidepressants may exhibit a variety of behavioral symptoms. According to the Tennessee Department of Mental Health & Substance Abuse Services, engaging in secretive behavior is one of the main behavioral signs of drug abuse. Individuals may lie about their whereabouts or hide what they have been doing to prevent their friends and family members from finding out about antidepressant use. Engaging in risky behavior is another sign of drug abuse. This may include driving recklessly, driving while intoxicated, or having unprotected sex while under the influence of antidepressants or other substances.

Sudden changes in professional or academic performance are another potential sign of drug abuse. Adults may struggle to perform their job duties, arrive at work on time, or show up for work at all. Adolescents who misuse antidepressants may stop doing their homework, get lower grades than usual, or skip school. Finally, sudden relationship changes may indicate that an individual is misusing antidepressants. An individual may stop spending time with friends, have arguments with close family members, or give up their favorite social activities.

Physical Symptoms of Antidepressant Abuse

How antidepressants affect the body

By increasing the amounts of serotonin and norepinephrine in the brain, antidepressants have several physical effects on the body. Serotonin is involved in the secretion of hormones from the pituitary gland. Therefore, taking antidepressants that increase the amount of serotonin in the brain can stimulate the release of hormones, which may affect an individual’s sleep-wake cycle (circadian rhythm).

Norepinephrine helps the heart muscle contract normally and is also involved in the contraction of skeletal muscle. Therefore, an increase in the amount of norepinephrine in the brain can cause an individual’s heart rate to increase. An increase in norepinephrine levels can also trigger the release of glucose into the bloodstream.

Early physical effects of antidepressants

Antidepressants can produce several physiological effects within as little as 30 to 60 minutes of taking a dose. Some of these effects can be dangerous, especially for users who have preexisting medical conditions.

This table illustrates the possible short-term physical effects associated with antidepressants.
Short-term Physical Symptoms
Initial (direct effects of drug, 30 – 60 min.)Sweating
Nausea
Lingering (within an hour of taking the drug)Indigestion
Difficulty sleeping
Dry mouth
Dizziness
Fatigue
Headache
Shaking (tremor)
Post-Use (several hours to days after use)Reduced libido
Inability to ejaculate
Numbness/tingling
Delayed ejaculation

Severe and long-term physical effects of antidepressants

Long-term use of antidepressants can have some severe physical effects, particularly in individuals with a history of heart problems. Antidepressants are associated with changes in heart rhythm, and sudden cardiac death has also been known to occur. Patients with heart disease are also more likely to have adverse events when using antidepressants.

Antidepressants are known for having sexual side effects, particularly in men. The use of these medications has been associated with decreased sexual desire, delayed ejaculation, and inability to ejaculate, all of which can interfere with a man’s sexual satisfaction. In women, antidepressants can also delay orgasm or make it difficult to have an orgasm.

Long-term use of antidepressants may also lead to adverse events caused by interactions with other substances. Like many medications, antidepressants are metabolized by the liver. As a result, taking antidepressants with another substance may cause elevated levels of either substance in the blood. It may be necessary for an individual to stop taking the antidepressant to avoid this risk.

This table illustrates the possible long-term physical effects associated with antidepressants.
Long-term Physical Symptoms
CasualNausea
Drowsiness
Fatigue
Increased appetite
Dry mouth
Blurred vision
Chronic

Including all of the above effects for casual use

Decreased libido
Constipation
Insomnia
Weight gain
Erectile dysfunction
WithdrawalAnxiety
Vivid dreams
Tiredness
Irritability
Dizziness
Headaches
Chill
Muscle aches
Worsening symptoms of depression

Further Resources

Both MedlinePlus and the Centers for Disease Control and Prevention offer in-depth information on the use and effects of antidepressants.

III. Antidepressant Usage

Two of the top three countries with the highest rates of antidepressant use are in Europe. Researchers attribute the increase in antidepressant use to the introduction of SSRIs; since these medications were introduced, antidepressant use “has continually increased in most European countries.” Iceland, Denmark, and Portugal have the highest rates of use, but Belgium, Norway, Finland, and Spain also report a high number of daily doses per 1,000 inhabitants.

Rates of antidepressant use are much lower in South America, Asia, and Africa than they are in North America and Europe. In 2016, the Organisation for Economic Co-operation and Development studied global antidepressant use and ranked the countries studied based on the number of people who use antidepressants per 1,000 inhabitants. Korea ranked lowest on the list, with just 13 daily doses of antidepressants taken for every 1,000 inhabitants of the country.

The OECD researchers also found that only 13 out of every 1,000 inhabitants of Chile take some type of antidepressant. In contrast, the top two countries on the list reported more than 100 daily doses of antidepressants for every 1,000 inhabitants of each country. No African countries were included in the OECD list.

Antidepressant Use Throughout the World
HighestSecondThird
Countries with the Highest Rates of Antidepressant UseUnited StatesIcelandAustralia
Regions with the Highest Number of Daily Doses of AntidepressantsNorth AmericaWestern EuropeAustralia

Antidepressant Usage Demographics in the U.S.

According to OECD research, the United States has the largest number of antidepressant users anywhere in the world, with more than 100 daily doses of antidepressants for every 1,000 Americans. This high rate of use can be attributed to several factors, including depression rates, economic stability, and the availability of quality healthcare.

Within the United States, antidepressant use varies by state. In Utah, healthcare providers prescribe antidepressants at a rate of nearly twice the national average. Antidepressant use is also prevalent in Oregon and Maine.

The use of antidepressants and other prescription drugs is also common among adolescents. As part of the Monitoring the Future Study, researchers surveyed 12th graders to determine if they had used prescription drugs within the past month, within the past year, or at any point in their lives. For 2019, nearly 15% of the students surveyed stated that they had used a prescription drug at some point; 8.6% revealed that they had used one within the past year.

Demographics of Prescription Usage
Past Year (2018)Lifetime
8th grade (14-15 yo)No data collectedNo data collected
10th grade (15-16 yo)No data collectedNo data collected
12th grade (17-18 yo)8.6%14.6%

IV. How to Find Help

Credentialed Alcoholism and Substance Abuse Counselor Jeremy Barnett explains, “Addiction to antidepressants is not nearly as common as addiction to controlled medications – such as opioids and benzodiazepines – but, nevertheless, is always a possibility, especially with people who have a history of addiction. Antidepressant medication is sometimes prescribed to help stabilize newly recovering addicts struggling with post-acute withdrawal symptoms, such as euthymia, insomnia, and lethargy. However, there are increasing reports of abuse of Wellbutrin and Gabapentin, as they can provide similar effects to other drugs, such as cocaine and other amphetamines. Thus, people in recovery taking antidepressant medication should always be monitored closely for medication compliance.”

Antidepressants are helpful for managing the symptoms of depression, but they can also cause serious physical and psychological side effects, especially when used for long periods of time. Mixing antidepressants with alcohol and other substances increases the risk of these adverse effects, making antidepressants especially risky for nonmedical users.

Even if an individual wants to stop using antidepressants, it can be difficult to do so because of the withdrawal syndrome that sometimes occurs. This syndrome causes increased levels of anxiety, worsening symptoms of depression, and other withdrawal symptoms. Enrolling in a rehabilitation program that includes a tapered withdrawal process can help users avoid some of these symptoms and withdrawal from antidepressants in a safe manner. To learn more about this tapered withdrawal process, read our comprehensive antidepressant rehabilitation guide.

Staging an Intervention

If you have a loved one who’s struggling with addiction, staging an intervention is often the first necessary step towards sobriety, but it’s important to be strategic and loving in your approach. Even the most well-meaning of interventions can have a negative effect if they aren’t handled correctly.

5 Tips for Staging an Intervention

1. Don’t Do It Alone. A professional interventionist is always the most qualified to guide a successful intervention. Also, rely on non-addict family and friends – especially those who have a close relationship with you or the addict.
2. Research Ahead of Time. It’s best to do plenty of research ahead of time to gather insight on the addiction and how it affects the addict. Also, be prepared with local resources for getting help.
3. Write Out Your Statement. During the actual intervention, emotions will likely be running high, so it’s best to have a statement of how the person’s addiction has impacted you and your relationship with him or her. These statements should be honest, yet written from a place of love – no personal attacks.
4. Offer Help. It’s important for everyone attending the intervention to offer tangible help and support as the person works through detox and rehabilitation.
5. Set Boundaries. If the person refuses to seek help and take the next steps outlined, it’s important that they understand that everyone present will end codependence and enabling behaviors.

V. Sources