Antidepressants make up a large group of medications that adjust the release and/or absorption of neurotransmitters like serotonin, dopamine, and norepinephrine.
This helps stabilize and slightly elevate mood. When used in combination with psychotherapy to understand the roots of a person’s depression, antidepressants are very effective medications in the treatment of mood disorders, including depression.
As prescription of antidepressants has become more popular, therapists and physicians are finding other ways to use these medications, sometimes on an off-label basis. Antidepressants have been found to help in the treatment of substance use disorders. They can ease withdrawal symptoms, and in some cases, they can reduce cravings.
Types of Antidepressants
There are six types of antidepressant medications.
- Selective serotonin reuptake inhibitors (SSRIs): Currently the most popular and effective antidepressant class on the market, SSRIs work by blocking the reuptake of serotonin by neurons. They have fewer side effects than other antidepressants, and they are the frontline prescription choice for depression and some other psychiatric conditions. Popular SSRI brand names include Paxil, Zoloft, Celexa, and Lexapro.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): Like SSRIs, these medications change or reduce absorption of serotonin and also norepinephrine. This helps elevate and stabilize mood, as there is more of the neurotransmitter available. SSRIs are also one of the first kinds of drugs prescribed to treat depression, as they have fewer side effects than other antidepressants. Popular brand names include Cymbalta and Effexor.
- Norepinephrine and dopamine reuptake inhibitors (NDRIs): NDRIs are not as popular as SSRIs and SNRIs though they function similarly, acting on norepinephrine and dopamine receptors to reduce absorption. The most famous brand name in this small group is Wellbutrin, which has the generic name bupropion. This antidepressant is now more actively prescribed to help smokers end their addiction to nicotine.
- Tricyclic antidepressants: These medications increase the amount of neurotransmitters like serotonin, dopamine, and norepinephrine released in the brain. They have more side effects than newer antidepressants like SSRIs and SNRIs, but they are still occasionally prescribed for people who have tried newer antidepressants and not found them to be effective.
- Monoamine oxidase inhibitors (MAOIs): These medications were among the first antidepressants to be developed, and they are still prescribed on occasion, but they can cause serious side effects. They also require changes to diet, including the avoidance of certain foods, and they can interact with many other medications, making multimodal treatment difficult. While they are not used as a frontline defense against depression, PTSD, or anxiety, they are still prescribed for people who do not benefit from other antidepressants.
- Atypical antidepressants: This category includes a variety of other medications, including sedatives like Oleptro and Remeron, along with some antipsychotic medications.
How Are Antidepressants Used in Substance Abuse Treatment?
There are many potential applications for antidepressants in the treatment of substance abuse. Here are a few of the most effective uses:
- Bupropion and smoking cessation: The generic form of Wellbutrin, called bupropion, helps reduce cravings for tobacco when a person is attempting to quit smoking. Originally, Wellbutrin was marketed as an antidepressant, and it has been widely prescribed to treat a variety of depression symptoms; however, it is now more commonly used when a person decides to end their addiction to nicotine. Smoking specifically, and nicotine abuse in general, has been linked to a variety of types of cancer, such as lung and throat cancers, and it is also one of the causes of several lung diseases, such as emphysema. Although nicotine use is legal for adults aged 18 and over in the United States, it can be a dangerous and very habit-forming drug.Bupropion not only helps to ease withdrawal symptoms associated with ending an addiction to nicotine, such as cravings, it can also help reduce the drive to get the drug. This is one of the few antidepressants that directly affects an addiction. It should not be used when a person is overcoming an alcohol use disorder, due to potential interactions.
- Methamphetamine addiction: Some people may experience similar relief from cravings and reduced efficacy of methamphetamine when they take antidepressants. This is like using bupropion to end nicotine addiction; the medication seems effective in not just easing withdrawal symptoms, but also in reducing the psychological drive to get more of the drug. There is also some evidence that points to reduced euphoria when the person on antidepressants does abuse methamphetamines, which could help end an addiction to these drugs.
- Pain, headaches, and insomnia treatments: An article on Everyday Health examined off-label uses for antidepressants and found that many doctors prescribe antidepressants for issues such as insomnia, pain, and headaches. While the prescribing practices were not specifically geared toward treatment of substance abuse-related insomnia or pain, they could be a less addictive method to treat these conditions in people attempting to overcome an addiction to prescription painkillers or benzodiazepines.Benzodiazepines are sometimes prescribed for the short-term treatment of insomnia; however, when the prescription ends, the person may experience rebound insomnia as a withdrawal symptom. This, along with other habit-forming characteristics of these medications, could lead to illicit use of the drug to self-medicate. Additionally, many people become addicted to prescription painkillers after experiencing an injury or surgery. Opioids have wonderful pain-relieving qualities, but the prescription usually tapers off and ends. All narcotics are potentially habit-forming, so this could lead to illicit abuse too. During detox for either of these drugs, the person may benefit from the mood-elevating effects of antidepressants, as well as the effect these drugs can have on pain and sleep.
- Mood elevation during detox: Antidepressants are often used during detox when the person may experience depression and anxiety as withdrawal effects as they attempt to end their physical dependence on an intoxicating substance. With physician supervision, the person may receive a prescription for antidepressants to moderate and elevate their mood, in order to overcome some of the psychological effects of substance withdrawal. For example, a person overcoming an addiction to cocaine is likely to experience depression as a withdrawal symptom, since cocaine is a stimulant. Antidepressants can relieve the intensity of this symptom.
- Treating an underlying mental health condition: Mental health and substance abuse are intricately linked. People who struggle with conditions like anxiety and depression are at a greater risk of abusing intoxicating substances, specifically to self-medicate the symptoms of the disorders. If a person struggles with depression, which has led to their problems with substance abuse, part of their long-term treatment will likely involve antidepressants and psychotherapy; this treatment helps overcome both the addiction and the underlying depression. For example, if a person abuses marijuana to relax themselves and relieve the physical and psychological symptoms of depression, using an antidepressant to treat the underlying psychological condition while easing them off marijuana use can be very helpful.
- Depression induced by substance abuse: Long-term abuse of intoxicating substances can lead to changes in brain chemistry, which can induce psychological issues like anxiety or depression. In many cases, these mental health conditions will clear as the person overcomes their addiction, and their brain chemistry begins to stabilize. However, for some people, these brain chemistry changes could be more permanent and require a combination of medication and psychotherapy. During withdrawal, a regulated and physician-monitored dose of antidepressants could be very effective in tapering the person off their substance of abuse.
Risks Involved with Antidepressant Therapy
There are many types of antidepressants, and even without concurrent or previous substance abuse, reactions to these medications can be very individual. It can take time for the medication to work, and it can take more time to switch medications if the first prescription is not effective. A study published on PubMed reviewed comprehensive studies on the efficacy of antidepressants for treatment in specific cases of substance abuse and found that the only clearly effective result came from nicotine addiction treatment involving bupropion. Alcohol dependence, even with comorbid depression, was not helped by antidepressants; the efficacy of cocaine and opioid dependence treatments was unclear. It is possible that antidepressants may not be an effective substance abuse treatment for many drugs, including for addictions to increasingly popular synthetic cathinones and cannabinoids.
Research indicates that only about 60 percent of people with antidepressant prescriptions experience necessary relief of symptoms. Side effects from antidepressants, including reduced sex drive, weight gain, and fatigue can become more frustrating than the underlying condition, or could, for some people, contribute to increased symptoms of depression due to changes in personal life and appearance.
For people who struggle with co-occurring substance abuse, the continuation of symptoms along with brain chemistry changes could lead to relapse.
If a person is taking antidepressants to moderate withdrawal symptoms during detox, it is important to know that antidepressants themselves, including SSRIs, can lead to physical dependence. Although these drugs are less likely to become the target of abuse or addiction, they can still cause withdrawal symptoms when the person stops taking them. These symptoms include:
- Nausea or vomiting
- Flu-like symptoms, such as aches, sweating, palpitations, and weakness
- Reduced mood or mood changes
If a person struggles with co-occurring substance abuse and mental health problems, these side effects could lead to relapse as they return to old self-medicating patterns to manage the antidepressant withdrawal symptoms.
Benefits of Using Antidepressants in Substance Abuse Treatment
Although there are potential negatives with use of antidepressants, the benefits most often outweigh the risks. Antidepressants should be used alongside other therapies to overcome both depression and substance abuse. Antidepressants do not cure psychological disorders, including depression or addiction; instead, they are a tool in a full treatment plan to help the person overcome their other conditions.
They can be very effective in the treatment of specific drug issues involving nicotine or methamphetamine. If a physician monitors the patient’s mental health state, to ensure there is improvement in mood and stability in functioning, then the patient can receive appropriate treatment with antidepressants.
As substance abuse can cause many long-term health issues, it is important to get appropriate help to overcome the abuse. Antidepressants are one aspect of a larger treatment plan to overcome substance abuse for some people; this larger plan involves rehabilitation programs and psychotherapy, not simply detox.
Antidepressants can ease withdrawal symptoms in some people, including cravings and drug-seeking behaviors in people overcoming nicotine or methamphetamine addiction. They can also help people whose underlying depression led to substance abuse or whose substance abuse has induced depression. Detox, rehabilitation, therapy, and social support from family and friends are all necessary parts of the overall treatment plan to overcome addiction.