Antidepressants in Addiction Recovery

Antidepressants are a useful tool for helping a person get through the initial stages of sobriety and to treat co-occurring disorders.

Antidepressants and other medications have traditionally been stigmatized in addiction recovery. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) used to oppose all medications believing that the person in recovery will abuse anything.

While coming from a place of good intentions, that view is naive and dangerous. Sometimes, a person struggling with addiction has a medical condition that would benefit from prescription drug treatment. Just because the medication treats a mood disorder does not make it is mood-altering.

The Drug Enforcement Administration (DEA) classifies drugs with abuse potential. Prescription medications that are “controlled” or “scheduled” are the ones that should be avoided by a person in addiction recovery. Examples of controlled medications include:

• Benzodiazepines for anxiety
• Dissociatives for anesthesia and surgery
• Opioids for pain
• Sedatives for sleep
• Stimulants for attention-deficit/hyperactivity disorder (ADHD)

Antidepressants are not habit-forming and may help a person treat common challenges in early recovery like depression and anxiety.

What Are Antidepressants?

Antidepressants are medications used to treat mood and anxiety disorders. They are mostly used to treat Major Depressive Disorder (MDD) and generalized anxiety disorder (GAD), but can also treat symptoms of bipolar disorder and schizophrenia.

The word “antidepressant” is misleading because it implies a common or shared mechanism amongst these medications. In truth, they all work in different ways and some work better or worse for certain people.

In contrast to mood-altering substances, antidepressants do not affect mood in the same way. The drugs work slowly to fix imbalances in mood-causing chemicals. Since the physiology of addiction is dependent on a cycle of euphoria, crash and craving, antidepressants lack the ability to generate addiction.

Antidepressants don’t cause euphoria and they take weeks to create mood changes.

Types of Antidepressants

The main types of antidepressants fall into the following categories:

• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin modulator and stimulator (SMS)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)

Each class of antidepressants contains numerous individual drugs, and each drug has specific situations in which it will work best.

Antidepressants Controversy

To address the stigma around medications, AA released a pamphlet titled “The A.A. Member – Medications and Other Drugs.” The pamphlet was reviewed by a group of physicians that are also members of AA. Physicians outside of the program reviewed it as well.

The pamphlet provides important bullet points for an AA member to consider:

• No AA member should “play doctor.” All medical advice and treatment should come from a qualified physician
• Active participation in the AA program is a major safeguard against sobriety setbacks
• Be completely honest with your doctor and yourself about the way you take your medicine. Let your doctor know if you skip doses or take more medicine than what was prescribed.
• Explain to your doctor that you no longer drink alcohol and you are trying a new way of life in recovery
• Let your doctor know at once if you have a desire to take more medicine or if you have side effects that make you feel worse
• Be sensitive to warnings about changes in your behavior when you start a new medication or when your dose is changed
• If you feel that your doctor does not understand your problems, consider making an appointment with a physician who has experience in the treatment of alcoholism

The pamphlet has personal stories of people that stopped taking important medication because fellow AA members told them to. One particularly heart-wrenching story involves a woman who stopped taking her medication and attempted suicide as a result. She was living with an undiagnosed psychiatric condition that was kept at bay by her antidepressant. The well-meaning, but misguided advice of a fellow member almost killed her.

Antidepressants do not get you high and do not have the potential for abuse.

While there is a real risk of someone with substance use disorder (SUD) abusing prescription medications, addiction recovery must be separated from other conditions. Letting a mental health disorder go untreated because someone struggles with addiction is poor medical advice.

Sometimes, depression or other psychiatric conditions are a contributing factor to why a person drinks or uses drugs. Treating the underlying mental health disorder may help prevent a setback in sobriety.

Feelings of depression or anxiety can lead to suicidal thinking. If you or a loved one is experiencing suicidal thoughts or tendencies, call the National Suicide Prevention Hotline at 1-800-273-8255.

Benefits of Antidepressants in Recovery

There are two main roles that antidepressants play in recovery: to alleviate depression or anxiety symptoms associated with withdrawal or to treat an underlying psychiatric condition.

In the first situation, an antidepressant may be prescribed short-term to help a person through the first few months of recovery. A standard length of treatment is about nine months, after which a person may choose to taper off the antidepressant if their symptoms improve.

The second situation describes a person with co-occurring disorders. For example, someone with co-occurring disorders may have depression and substance use disorder, or bipolar disorder and an SUD. Antidepressants can play a critical role for someone with a dual diagnosis by preventing a setback. Treating an SUD without addressing underlying mental health disorders can increase the chances of a setback occurring.

Risks of Antidepressants in Recovery

Antidepressants do not begin working right away. They sometimes take six to eight weeks or more to begin working. A person who starts taking one should have realistic expectations.

Antidepressants must be taken every day to work, and a person will not always notice if they are working. Typically friends and family are the first to notice a change.

Some antidepressants can suppress libido and sexual functioning, so this may impair recovery for some people.

Some can cause uncomfortable physical side effects like trouble sleeping, jitteriness and diarrhea. While these effects usually go away after a few weeks, they might hinder recovery for some. If the side effects of an antidepressant do not outweigh the benefits, a person should have an open discussion with their physician about switching or stopping using the drug.

A few antidepressants should not be prescribed to people who are suicidal. For example, a tricyclic antidepressant overdose can be fatal.

Alternatives to Antidepressants in Recovery

A person should not avoid antidepressants because of historical stigma, but they are not for everyone. Alternatives to antidepressants may include:

• Nutrition
• Exercise
• Mindfulness
• Therapy

Keep in mind these alternative treatments may not work for co-occurring disorders but can provide relief from other uncomfortable symptoms during recovery, especially those caused by the recovery process.

Editor – Thomas Christiansen

With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more

Medically Reviewed By – Dr. Conor Sheehy, PharmD, BCPS, CACP

Dr. Sheehy completed his BS in Molecular Biology at the University of Idaho and went on to complete his Doctor of Pharmacy (PharmD) at the University of Washington in Seattle. Read more