Are medicines addictive?
It is still a common fear that "antidepressants are addictive", and also that many other mental health medicines may be addictive too. This is quite rightly a serious concern for many people. This page will hopefully explain why these medicines are not addictive as such, but still need to be treated with respect.
For a chemical (medicine or drug) to be addictive, or for someone to become dependent on it, it must cause:
Desire or craving i.e. the person must crave another dose when the previous one is wearing off, or has worn off.
Withdrawal symptoms i.e. a set of symptoms which start when the drug wears off and which disappear when the next dose is taken.
Tolerance i.e. where the same dose gives less effect after a while. [This happens if e.g. we live near a busy road and get used to the sound of cars, or when we become less aware of e.g. contact lenses or a watch. The result with tolerance to a drug is that the person needs a higher and higher dose to get the same effect.]
An immediate effect or reward. It is very hard to be addicted to a drug if you don't know if you've taken it or not!
NB. We didn't just make these up. They come from the WHO (World Health Organisation) definition of dependence.
One way to look at this is to draw a chart like the one below. You can add in almost anything you want e.g. medicines, illicit drugs, shopping, facebook or football (or even sex!). See what you think about each of these, then look at our answers below:
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Does it produce craving or desire? |
Can you get withdrawal symptoms? |
Does the effect wear off? (tolerance) |
Is there a reward or immediate effect? |
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Alcohol |
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Caffeine |
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Smoking/nicotine |
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Amphetamines |
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Heroin and other opiates |
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Cannabis |
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Hypnotics |
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Benzodiazepines |
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Antidepressants |
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Antipsychotics |
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Lithium |
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Medicines for high blood pressure |
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Gambling |
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Chocolate |
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This is our set of answers:
|
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Does it produce craving or desire? |
Can you get withdrawal symptoms? |
Does the effect wear off? (tolerance) |
Is there a reward or an immediate effect? |
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Alcohol |
Yes |
Yes e.g. "DTs" |
Yes |
Yes |
|
Caffeine |
Yes |
Yes e.g. headaches |
Yes |
Yes |
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Smoking/nicotine |
Yes |
Yes |
Yes |
Yes |
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Amphetamines |
Yes |
Yes |
Yes |
Yes |
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Heroin etc. |
Yes |
Yes e.g. "cold turkey" |
Yes |
Yes |
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Cannabis |
Yes |
Yes, but usually only from high doses taken for a long time |
Yes |
Yes |
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Hypnotics |
Sometimes, but only for the sleep |
Sometimes e.g. "rebound" insomnia |
Sometimes |
Yes |
|
Benzodiazepines |
Sometimes but usually not with appropriate use |
Sometimes |
Sometimes to the sedative effect |
There can be |
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Antidepressants |
No |
Not usually ‡ |
In about 5% people |
No |
|
Antipsychotics |
No |
No, if done gradually ‡ |
No |
No |
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Lithium |
No |
No, if done slowly over 4 or more weeks ‡ |
No |
No |
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Tablets for high blood pressure |
No |
Yes. Can produce rebound hypertension |
No |
No |
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Gambling |
Yes |
? |
Yes |
Yes, when you win |
|
Chocolate |
Yes |
No |
No |
Yes |
‡ A few antidepressants, lithium, antipsychotics/neuroleptics and benzodiazepines may produce some "discontinuation" or "adjustment" effects if stopped suddenly. Gradual stopping usually solves the problem. Please see the question and answer for each individual medicine on the website for more information on this.
As you can see, generally speaking the well-known drugs of abuse can produce craving, withdrawal symptoms, tolerance to their desired effects, and people take them for their immediate effect or reward.
Most prescribed medicines do not cause craving, do not have major withdrawal symptoms (but see above) and usually no tolerance to the effects are seen. And, apart from sleeping tablets and some treatments for anxiety, very few have a quick reward.
Regardless of this, we think that nearly all medicines should, where possible, be started slowly and stopped slowly. If you think about it, if you take anything important away from anyone suddenly, they will feel strange for a while. A younger relative of mine recently suffered withdrawal symptoms such as irritability, anger, tearfulness, poor sleep, change in appetite and frustration. Not from a drug, but 2 weeks without the internet in her flat. Imagine suddenly not having music, a walkman, mobile phone, computer, television, company, car or even glasses?
Another way to look at it is that most ‘addictive' drugs increase the amount of dopamine in the brain's (mesolimbic) ‘reward' or ‘pleasure' centres:
Opiates e.g. heroin, morphine, methadone - these stimulate opiate receptors in the brain, which boosts dopamine in the reward system
Cocaine - boosts dopamine in the reward system and blocks its recycling
Nicotine - produces an eight-fold increase in dopamine in parts of the reward system
Cannabis - stimulates cannabis receptors in the brain, which boosts dopamine in reward system
Amphetamines - boosts dopamine from nerve endings and directly boosts dopamine receptors in the reward system
Alcohol has a different and far more wide ranging sedative effect on the brain, and LSD and Ecstasy probably boost some serotonin receptors in the brain.
Very few of the usual medicines used in mental health boost dopamine in the reward system. So, they do not have the "reward" that the addictive drugs do. [The only exceptions to this are the stimulants to treat ADHD or hyperactivity.]
The medicines we use in mental health care mostly try to help correct imbalances in transmitters in the brain, where too much or too little is causing symptoms e.g. too little serotonin will make you feel depressed, too much dopamine will make you hallucinate or become psychotic.
Steve Bazire 11.10