The use of drugs in the particular area of mental health is one of the tools, along with psychotherapy, available to us to deal with the emotional disturbances that we are all likely to suffer throughout life.
These are drugs that are widely used in Western society., Which motivated many reflections on intolerance to psychological pain and refusal to go through difficult times that are also part of his existence.
The truth, however, is that they can sometimes be exceptional therapeutic allies; because under certain health conditions its use is inevitable (at least for part of the process). That is why it is essential to know its most important side effects.
In this article, we will only focus on their addictive properties, if any, or related phenomena if they are appropriate. This reality has been called drug addiction, And is the key especially in anti-anxiety drugs.
What is drug addiction?
By drug dependence is meant a situation in which the administration of a drug has resulted in the joint of research and consumption behavior that does not adapt to therapeutic doses, And it ends up causing serious damage to the person’s life and their environment. This is, in general, a special situation, since the most common is that the occurrence of the problem has its roots in a therapeutic use of the compound (which ultimately resulted in pathology).
Although these are substances that aim to prevent, reduce or cure one of the many disorders that can affect the mental health of people; It should not be forgotten that this is a pharmacological group that is particularly sensitive to this problem, because its action deliberately pursues a psychotropic effect (modulating the way in which internal experiences are manifested). Dependence on these drugs is a complex pathology and about which we have more and more knowledge every day.
When considering addiction to psychotropic drugs, three different dimensions must be taken into account: the individual (biological particularity, life experiences, personality traits, etc.), the environment (social network, spaces in which it takes place daily life), etc. .) and the compound itself (pharmacokinetics / dynamics, effects on the mental sphere, etc.). In this text, the emphasis will be precisely on the last of them, emphasizing what the literature tells us in this regard on the various psychotropic drugs.
Can Psychotropic Drugs Be Addictive?
Psychotropic drugs are, without a doubt, the family of drugs with the greatest capacity to generate dependence on all those administered today to regain health. Of all, those that have received the most attention are anti-anxiety drugs (Especially the benzodiazepines, which are practically the only ones that continue to use them), because they are administered en masse to a society which has recently faced very difficult situations (economic crisis, unemployment, etc.).
When we talk about addiction, we are referring to three different phenomena, more specifically: tolerance (need to use an increasing dose of the drug to achieve the effect obtained at the beginning), abstinence syndrome (unpleasant sensations that occur when you stop its administration) and addictive behavior (belief that the drug is necessary to be well or to feel safe, with anxious search for it).
Because of that the actions of each of the psychotropic drugs on the brain are differentIn this article, we will review the currently available evidence on the addictive potential of the three most commonly used: antidepressants, antipsychotics, and anxiolytics (benzodiazepines). The first advice that can be given in this text, however, is that the doses and times should always be adjusted to the doctor’s indication, otherwise the risk of dependence will increase considerably.
Antidepressants are a group of drugs that are used to treat all mood disorders and also for many of those that fall under the general category of anxiety, so their effects are not just eutymizing. As for the latter, they are particularly useful in cases where there are cognitive-type components, Such as social phobia or generalized anxiety disorder. Of all those used today, none deserve a significant risk of addiction.
Selective MAOIs (which inhibit the action of monoamine oxidase A / B), which are currently hardly prescribed for depression (except in cases where other alternatives do not improve), have never been considered. like substances. in the literature in which they have been misused. However, in old and new MAOIs, the main prevention is usually with regard to dietary factors, as consumption of foods rich in thiamine can lead to hypertensive crisis.
The same can be said of tricyclic antidepressants, for which almost no case of dependence has been described in the literature. these drugs they inhibit the reuptake of serotonin and norepinephrine, And block a constellation of receptors (muscarinic, alpha adrenergic, etc.), promoting a cascade of side effects of various kinds. This is the main reason why, at present, it is preferable to administer drugs with a safer secondary profile; although in aggregate terms, they have the most beneficial effect on depressive symptoms.
Finally, SSRIs (selective serotonin reuptake inhibitors), which are arguably the most prescribed for depression and anxiety, do not have addictive properties either. However, it has been estimated that up to 20% of those who consume it for six months or more may experience withdrawal syndrome when abruptly discontinuing their use. Symptoms, very similar to those that might be predicted in a withdrawal syndrome, involve: flu-like, insomnia, imbalances, nausea, and headaches. They are usually mild and go away upon reintroduction of the drug or with gradual withdrawal.
In the case of SSRIs, the possibility has also been described that in a minimum percentage of cases a tolerant effect will occur. In this case, continued use of SSRIs would reduce the effects of the same dose, altering its effectiveness and the way it should be administered. In this sense, it can also happen that the symptoms of depression increase during this period, so that the doctor will have to adapt the guideline to the new needs of the person.
An exceptional case would be that of bupropion, which is used for depressive symptoms and for smoking, causing effects on the noradrenergic and dopaminergic systems. In this case, its use in elite athletes as a legal stimulant was noted, which led to its inclusion in the list of anti-doping agencies for its submission to further monitoring. The potential addictive properties of the drug are due to its impact on the reward system, Although in most of the cases examined it was administered by snorting (taking advantage of the dense vascularity in the area), which is not the conventional form for medical use. Despite all of the above, it is generally considered that its addictive potential is low.
In summary, antidepressants are safe drugs in terms of addictive properties, in that they do not promote euphoria in healthy subjects because their effect is limited to restoring euthymia in those who are depressed (or to the regulation of cognitive components that maintain a disorder).
Antipsychotic drugs, which act as dopamine antagonists in different neurotransmitter pathways, they have no addictive potential. However, it was postulated if they could perhaps be involved in one way or another in the fact that a high percentage (47%) of the schizophrenic population uses at least one drug, the case of tobacco being particularly relevant. Such a finding would be important, because it is one of the factors that most often interferes with the treatment given to them and their prognosis in the medium and long term.
The dependence facilitated by antipsychotics would be indirect, explaining the use of substance due to the presence of symptoms of the pathology or the competition of side effects associated with these drugs. In this case, it would be self-medication to stop the discomfort, as most patients point out when asked about it. A common example might be the use of stimulants to combat negative symptoms, such as emotional flattening and / or bullying, whereby this abuse is not random (but would depend on subjective ‘complaints’). of the person).
In this regard, hypotheses have been formulated in which the drug is excluded from the equation, such as the overlap of the neuronal substrate: in this case, it would be understood that the neurological alterations underlying schizophrenia (especially associated with the mesolimbic pathway and the connections between the nucleus accumbens and the prefrontal cortex) would form a common mechanism of dependence and psychosis. So, the very fact of suffering from such a problem increase the risk of comorbidity with addictive disorders. This hypothesis, in which the participation of dopamine is deduced, is still being tried today.
Other authors have proposed the possibility that prolonged use of antipsychotics leads to changes in the brain reward system, with an increase in D2 and D3 receptors and their affinity for the putamen and nucleus accumbens. So it would be hypersensitivity to dopamine itself and its natural and / or chemical agonistsDrug-induced over time.
This problem would be added to other knowledge which derives from its chronic use; in particular motor, cognitive and endocrine (in the group of typical antipsychotics); and contribute to addiction to substances so common in this population.
Anxiolytics (which have both sedative and muscle relaxant and hypnotic properties) in common use, and in particular the benzodiazepine group, have been the subject of much criticism for their known addictive potential. These are drugs that act on GABA, the main inhibitory neurotransmitter in the nervous system, and the effects on the body are almost immediate. like that, relieves the physiological sensations that accompany anxiety after just a few minutes, which helps to “stick” to users.
The addictive potential of these compounds can be explained by three different dimensions: their half-life (time required to eliminate 50% of their concentration in the plasma), the time of consumption and the dose used. Thus, the greater the quantity of anxiolytic consumed and the longer its administration, the greater the risk of dependence. The dosage is also important, recommending intermittent use (to be consumed only in case of perceived need, within very strict limits and not strictly regulated).
For anxiolytics, the onset of tolerance (reduction of the sedative effect from the fourth month of consumption and the need to increase the dose to obtain the onset effect) has been described in detail. Abstinence (feelings similar to the original anxiety that occur when stopping use) and addictive behavior (belief that it is not possible to live without the medication and reassurance it is had at any time). “Symptoms of rebound” were also manifested by abruptly ceasing their occupation., Especially insomnia and overwhelming autonomic hyperactivation.
For all this, doctors who prescribe it are recommended to resort as much as possible to the lowest effective doses for their patient, and to keep in mind from the start of treatment what time it will be interrupted, treating to adjust. temporary security. windows (because from the age of four months, the risk of dependence is more and more important and the benefits of their use are minimized). It is essential to keep in mind that the addiction they cause is both physical and psychological.
Symptoms of anti-anxiety drug addiction are very varied, And often rush in those who experience re-use in order to reduce or alleviate them, which contributes to the establishment and reinforcement of the problem. In this sense, include: sadness, tremors, pain, sleep disturbances (both onset and maintenance and on early awakening), headaches, feelings of unreality (depersonalization and derealization), tactile hypersensitivity and motor tics. Cases of variable-length memory problems have also been observed, particularly in terms of the ability to “store” new content.
It is important to consider monitoring the emotional state for as long as the use of benzodiazepines is prolonged, as in some cases an increase in depressive symptoms has been detected. It is essential to warn that the concomitant consumption of alcohol can reinforce the effect that these substances would have separately, posing a risk of overdose, the consequences of which are ultimately very serious (depression of the nervous centers that make breathing possible, coma and even death).
- Evans, E. and Sullivan, M. (2014). Abuse and misuse of antidepressants. Drug addiction and rehabilitation, 5, 107-20.
- Samaha, AN (2014). Can Antipsychotic Treatment Help Addiction In Schizophrenia? Advances in neuro-psychopharmacology and biological psychiatry, 52, 9-16
- Umbricht, A. and Vélez, M. (2015). Abuse and dependence on benzodiazepines. Disease Burden: The Epidemiological Aspects of Addiction, 343-365.