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Like July 4th in this country, recovery is a celebration of freedom: freedom from drugs and alcohol, yes— but also the freedom to be and do what gives you purpose and passion, without having to rely on one or more substances just to function. Such freedom demands tuning in to life, not numbing out.
That’s one reason I’m so concerned about the following trend, which I’ve seen firsthand in many of the clients I treat: namely, a worrying link between addiction and psychiatric medications, antidepressants especially. It’s a link that too few people know about. Yet they need to know because the issue has a direct bearing on the treatment and prevention of substance abuse and can pose problems in recovery.
Here are some key things to know about the link between addiction and antidepressants:
Antidepressants and other psychiatric medications are far too over-prescribed to people with drug or alcohol addiction. I’ve personally seen a high prevalence of people come to us for addiction treatment who are on psychiatric medications. (I’d venture to say, in fact, that as many as roughly 80 percent of the clients I treat are on psych meds, primarily antidepressants.) Many of these clients were prescribed an antidepressant during a previous attempt at recovery.
The more typical scenario goes as follows: in the absence of their drug(s) of choice, a loved one in early recovery experiences depressive symptoms and other mood changes; their family notices, gets worried and takes them to the doctor; the doctor then prescribes Lexapro or another SSRI antidepressant. Worse yet, in many of these cases, the patient is misled to believe that once they are on the antidepressant, they will no longer have a problem with drugs or alcohol. This couldn’t be more wrong. Read on to learn why.
There may be a causal relationship between antidepressant use and addiction. Worryingly, many of the patients who come to me for help with an addiction, and who are already on an antidepressant, developed their addiction after being on antidepressant medication for an extended period of time.
For example, just the other day, I saw a patient who at the age of 78 had developed a drinking problem after she had been on an antidepressant for six months. When I asked her how her drinking problem began, she told me she was feeling so worn down that one day she said to herself, “Let me have a drink.” And from there the drinking spiraled until one day she got a DUI.
People who are prescribed an antidepressant may, in fact, be putting themselves at risk of addiction, relapse and other risky behaviors. Antidepressants share at least one common feature with alcohol and other drugs of abuse: they shut down the brain’s production of the “feel good” neurotransmitter dopamine. Lower dopamine levels can intensify cravings. Antidepressants also numb emotions. Low motivation and apathy—also known as “amotivational syndrome”—can result, leading to drug-seeking behaviors in an effort to self-medicate the feelings of emptiness.
But addiction and relapse are not the only potential risks, based on my experience treating incarcerated patients with addiction and other mental disorders. From my own admittedly anecdotal experience among this population, I’ve noticed that patients with the most serious charges (for violent crimes like rape and murder) tend to be on psychiatric medications and using drugs. Whereas chronic alcoholics not on psychiatric meds tend to have minor offenses, people with addiction who end up on psych meds—whether antidepressants, Adderall or another psychotropic drug—are committing more serious crimes.
If recovery requires tuning in to life—not numbing out—then the link between antidepressants and addiction is worth considering. Thankfully, there are a number of over-the-counter alternatives to SSRI antidepressants and other more prescribed psychiatric medications that I’ve prescribed clients with very good results.
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