Antidepressants

Signs and effects of antidepressant misuse

When seeking care for a diagnosis of depression (or for diagnoses of anxiety, pain, or insomnia), your licensed medical professional can prescribe an antidepressant medication to be taken orally, used as a nasal spray, or worn as a patch. If you don’t feel relief from symptoms after four to eight weeks, your provider may adjust your medication or dosage. But any prescribed antidepressant comes with clear instructions on how much and how often to take the medication.

Several classes of antidepressants are prescribed to treat depression. They have varying potential for misuse, withdrawal, dependency, and other adverse health effects — including risk of overdose. The most common classes and well-known brand names of such medications include:

• Norepinephrine and dopamine reuptake inhibitors (NDRIs), which include Wellbutrin and Zyban.
• Monoamine oxidase inhibitors (MAOIs), which include Emsam and Marplan.
• Selective serotonin reuptake inhibitors (SSRIs), which include Prozac and Paxil.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), which include Cymbalta and Effexor.
• Tricyclic and tetracyclic antidepressants, which include Tofranil and Norpramin.

Misuse of antidepressants occurs when you consume these medications for reasons other than the original diagnosis, such as for a cocaine-like “high” (euphoria), for motivation, and for numbing or stimulant effects. Signs of antidepressant misuse include:

• Taking a higher dose than prescribed.
• Taking a medication that was prescribed to another person.
• Taking a medication for reasons other than its prescribed purpose.
• Taking the drug by crushing and snorting it, smoking it, or dissolving and injecting it.
• Failing to follow warnings against potentially dangerous interactions with food or alcohol and other drugs.
• Having more trouble functioning day to day at home, school, or work.
• Expressing a desire to reduce use of the drug.
• Experiencing cravings and withdrawal symptoms when not using the drug.

The short- and long-term side effects of antidepressant misuse can also include confusion or delirium, hallucinations, hypertension, irregular heartbeat, liver damage, psychosis, seizures, tremors, weight loss, and withdrawal. A dangerous, even deadly, condition called serotonin syndrome can result from combining different drugs that contain serotonin, which is a common ingredient in antidepressants and in pain medications for conditions such as migraines.

Antidepressant withdrawal symptoms

Experts advise managing use of antidepressant medication under the guidance of a licensed medical provider. Suddenly stopping certain medications can cause dizziness, headaches, and other withdrawal symptoms. Without the medication, depression symptoms could become worse or return.

Withdrawal from stopping antidepressants could also affect:

• Blood vessels (e.g., chills, flushing, perspiration, trouble regulating body temperature).
• Digestive system (e.g., diarrhea, nausea, vomiting).
• Mood (e.g., sudden crying or angry outbursts, irritability, agitation, panic, impulsivity, mood swings, anxiety, increase in suicidal thoughts).
• Nerves and muscles (e.g., tremors, muscle tension, muscle or nerve pain).
• Perception of reality (e.g., delirium, visual or auditory hallucinations).
• Senses (e.g., blurry vision or vision changes, altered sense of taste, an “electrical” or “zapping” feeling in the brain or body, chronic pain or burning sensation, itching).
• Sexual functioning (e.g., hypersensitivity, premature ejaculation).
• Sleep (e.g., insomnia, sleeping too much, nightmares, vivid dreams).
• Systemic functioning (e.g., flu-like feeling, drowsiness, dizziness or difficulty with balance, fatigue or weakness, headache).
• Thinking (e.g., confusion, disorientation, inability to concentrate, memory problems).

Negative effects of antidepressants on the brain: The brain relies on chemicals called neurotransmitters — including serotonin, dopamine, and norepinephrine — to send messages between neurons. Depression can result from a chemical imbalance in your brain; antidepressants may restore that balance and relieve your symptoms. However, misuse of these drugs can throw off the balance and create new problems.

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Treatment for antidepressant misuse

Recovery from antidepressant misuse is possible. To safely stop misuse of an antidepressant medication, you or your loved one can contact a licensed medical professional who can help develop a treatment plan and address underlying conditions.

Therapy: A licensed medical professional or mental health specialist may recommend care from a substance use disorder specialist. A health professional may also suggest group therapy, which has proved more effective than individual therapy in treating antidepressant misuse. Other effective therapeutic options include family counseling, 12-step and other support groups, and out- and inpatient residential treatment programs.

Medication: Instead of recommending that you stop using antidepressants altogether, your doctor may switch you to a different medication, schedule more frequent appointments, or prescribe your medication in smaller quantities.

Recovery: Recovering from misuse of antidepressants could involve complementary and alternative activities such as acupuncture, meditation, spiritual exercises, yoga, and art or music therapy.

Sources

Abuse and misuse of antidepressants, Substance Abuse and Rehabilitation, Aug. 14, 2014

Antidepressant Use Among Adults: United States, 2015-2018, National Center for Health Statistics, Centers for Disease Control and Prevention, Sept. 4, 2020

Antidepressant Withdrawal and Rebound Phenomena, Deutsches Arzteblatt International, May 17, 2019

Antidepressants and the brain, International Clinical Pharmacology, May 14, 1999

Bupropion hydrochloride (marketed as Wellbutrin, Zyban, and generics) Information, Food and Drug Administration, Dec. 8, 2016

Depression: How effective are antidepressants? NIH National Library of Medicine, InformedHealth.org, June 18, 2020

Depression Medicines, Food and Drug Administration, Nov. 18, 2019

Fluoxetine (marketed as Prozac) Information, Food and Drug Administration, Dec. 16, 2014

Managing antidepression overdoses, Emergency Medical Services, October 2004

Mental Health Medications, National Institute of Mental Health, National Institute of Health, June 2022

Neurotransmitters, Neuroscience, 2nd edition, NIH National Library of Medicine, 2001

Paroxetine (marketed as Paxil) Information, Food and Drug Administration, July 17, 2015

Serotonin syndrome, Mayo Clinic  

The Use of Art and Music Therapy in Substance Abuse Treatment Programs, Journal of Addictions Nursing, Dec. 17, 2014

What treatments are available for people who become addicted to antidepressants? Cleveland Clinic, Oct. 11, 2019