Selective Serotonin Reuptake Inhibitors (SSRIs) are one of the most frequently prescribed drugs for Major Depressive Disorder (MDD). Depression is more common among addicts and alcoholics than other groups. During recovery, symptoms can worsen. If you’ve been diagnosed with depression, SSRIs can potentially improve brain chemistry and ease recovery.
SSRIs are in a class of drugs that don’t have the same addictive qualities as opioids and benzodiazepines (Xanax). Their onset is gradual, and the effects can take weeks to take effect. In the rest of this article, we’re going to discuss how SSRIs behave in the brain and how to determine if they’re appropriate for you or your loved one while in recovery.
Many seeking recovery from alcohol and drug use are diagnosed with a co-occuring disorder. Many times, these co-occuring disorders include anxiety and depression. Treatment for co-occuring disorders is very common within the realm of addiction recovery.
How SSRIs Work
Serotonin is known as the “happy,” “feel-good” neurotransmitter because it increases feelings of general well-being. SSRIs treat depression by temporarily preventing serotonin from being reabsorbed into the bloodstream. When serotonin is absorbed into the bloodstream it gets returned to the inside of your brain’s neurons. To be actively influencing how you feel, serotonin needs to be outside of your brain’s neurons and in the synaptic gap between them. Once here it can get to work at making you feel happy. SSRIs work by allowing serotonin molecules to stay suspended in the synaptic gap for an extended period before reabsorption.
Serotonin has multiple functions in the body and brain, but its main job is to keep you upbeat and content. Folks that have too little serotonin in the synaptic gaps between neurons are more prone to feelings of depression and nervousness.
How Depression Influences Addiction
Someone who’s chronically depressed early in life is more likely to self-medicate with drugs and alcohol. This gets the ball rolling, and genetic tendencies for addiction pick up the momentum from there.
Not all people with depression have low serotonin, and not everyone with low serotonin is depressed. Depression can also be caused by imbalances of dopamine and norepinephrine. For people who are both depressed and low in serotonin, SSRIs can be helpful at managing symptoms during alcohol and drug recovery.
How Recovery From Addiction Impacts Brain Chemistry
Recovery throws your brain chemistry into chaos. In a state of addiction, the brain relies on substances as an external source of the happy neurotransmitters it would otherwise produce on its own. In the depths of addiction, your brain balances on shaky legs. When you stop taking drugs and alcohol, those legs get kicked out from under you. Recovery is the process of re-establishing healthy brain chemistry that isn’t dependent on substances.
This transitional period can last over a year before your brain returns to its pre-addiction baseline. It’s during this time that untreated depression can create the most risks for recovering addicts.
Depression Increases The Risk Of Suicide In Recovering Addicts
One study suggests that the suicides of alcoholics contribute to 25% of the total suicides nationwide. John H. Krystal, M.D. is the chair of the Department of Psychiatry at Yale University School of Medicine. In his opinion, although therapy alone can be helpful, persistent depression is best treated with a combination of therapy and antidepressants.
Antidepressants Can Increase The Risk Of Suicide
For some recovering addicts, taking SSRIs can increase the risk of suicide. For others, taking antidepressants can significantly decrease the risk. This makes it critical to work closely with a psychiatrist who’s experienced in dealing with both depression and addiction. The first few weeks of taking SSRIs, and anytime that doses are changed, are high risk periods for suicide. During this time, depression can get worse before it stabilizes. Patients ages 25 and under report the highest occurrences of such episodes.
SSRI Side Effects
The biggest risks associated with SSRIs are suicide and decreased sex drive. Aside from these, SSRIs can cause the following side effects: weight gain, nausea, nervousness, dry mouth, fatigue, rash, diarrhea, increased perspiration, trouble sleeping, and headaches.
The goal of recovery is to live a long and happy life. For people with depression, taking SSRIs can be lifesaving in its ability to decrease suicidal thoughts. While abstaining from antidepressants may be appropriate for people with mild or intermittent depression, chronically depressed individuals should rely on the opinion of their psychiatrist to help them make the final call. If you or someone you know lives in the Phoenix, AZ area and is in need of treatment for addiction, our 10-week Intensive Outpatient Program is here to help support you through this challenging time.
Prescribing SSRIs (How Psychiatrists Evaluate The Need)
Only a psychiatrist can weigh in on the question of whether or not SSRIs are right for your recovery. More likely than not, if you were already taking SSRIs, your doctor will recommend you continue taking them throughout recovery. Discontinuing use will only create further chaos in a brain that’s scrambling to rewire itself post-addiction.
When deciding whether or not to start an SSRI, your doctor will look at your mental health history. If you weren’t consistently depressed leading up to getting clean, your psychiatrist will likely discourage the use of SSRIs.
If you do have a history of chronic depression, your psychiatrist may diagnose you with Major Depressive Disorder. This would warrant getting you started on an SSRI.
Finding Which Antidepressant Works For You
Most antidepressants take several weeks to build up in your system and become effective. This is a long time to be in limbo for someone struggling with depression, thoughts of suicide, and recovery from addiction. It isn’t unusual for a patient to spend an entire year rotating through different medications before finding one the works. The following are antidepressants that your psychiatrist may suggest for you.
Selective Serotonin Reuptake Inhibitors (SSRIs)
These are usually the first types of antidepressants that your psychiatrist will start you on. They tend to have the least side effects and highest success rates. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil, Pexeva), escitalopram (Lexapro), and citalopram (Celexa).
Serotonin And Norepinephrine Reuptake Inhibitors (SNRIs)
This class of antidepressants targets the neurotransmitter norepinephrine as well as serotonin. These include venlafaxine (Effexor XR), duloxetine (Cymbalta), levomilnacipran (Fetzima), and desvenlafaxine (Khedezla, Pristiq).
Tricyclic Antidepressants
Your psychiatrist will likely try other antidepressants before suggesting tricyclics due to their higher rates of complications. Examples of tricyclics include nortriptyline (Pamelor), imipramine (Tofranil), and desipramine (Norpramin).
Atypical Antidepressants
These are antidepressants that don’t fit nicely in any category. They include vilazodone (Viibryd), trazodone, mirtazapine (Remeron), bupropion (Wellbutrin, Aplenzin, Forfivo XL), and vortioxetine (Trintellix).
Monoamine Oxidase Inhibitors (MAOIs)
This is another class of antidepressants that your psychiatrist may wait to try. They can have serious side effects and require a strict diet when taking them. MAOIs don’t combine well with SSRIs.
SSRIs Don’t Get You “High”
SSRIs are notoriously slow at making an impact on brain chemistry. The best case scenario is that after several weeks the drug will begin positively impacting on how you feel. You never “get high” in the same way that you do with opioids or benzodiazepines. In fact, after being on SSRIs for a while, you probably won’t notice any change until you stop taking them.
SSRIs Don’t Cause Withdrawal Symptoms, But You Do Notice When They’re Gone
SSRIs aren’t considered addictive. You will start to feel different, however, if you miss a few doses or if you stop taking them altogether. Stopping SSRIs causes what the doctors call “discontinuation syndrome.” Discontinuation syndrome can result in nausea, dizziness, and flu-like symptoms in addition to feelings of uneasiness. Let your psychiatrist know if you want to stop taking SSRIs. He or she will put together a plan for gradually decreasing your dose in a way that minimizes undesirable symptoms.
Only you and your psychiatrist can decide whether or not taking SSRIs is right for you. For certain individuals, SSRIs can reduce depression and be a critical component of a safe and successful recovery. SSRIs’ lack of addictive properties makes them safe for recovering addicts to take, so long as they meet the right requirements and are closely monitored by health professionals. If you or anyone you love is currently dealing with drug or alcohol addiction, it’s vital to keep an eye out for developing dependence. Stonewall Institute Treatment Center is more than happy to answer any questions you may have. Call us today at 602-535 6468 or email us at [email protected].