SSRIs and Drug Dependence: How do SSRIs Work and What are the Risks?


Today, anxiety and depression are at an all-time high, with one in every ten Americans on antidepressants. While this may suggest that mental health has taken a sudden turn for the worse, this is likely the product of heightened awareness about mental health in recent years. Rather than suffering alone, many have gained access to treatment, which has become increasingly available. However, this statistic does raise another concern. Doctors are well aware of the risks of these medications, so this is not a question of whether these medications are overprescribed, but rather whether the general public has been sufficiently educated about how these drugs work. Since the specific category of antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed type, it is critical that there is widespread awareness of the risks associated with them. Thus, answering common questions like ‘Are SSRIs addictive?’ and ‘What are the associated risks?’ can help to ensure the safety of individuals taking SSRIs and shed some light on the misconceptions surrounding these drugs.

SSRIs interfere with processes involving Serotonin, a neurotransmitter molecule which regulates mood and anxiety (Scaccia, 2020). While the exact mechanism behind this remains somewhat elusive, there are some theories as to how these drugs alter the biochemical processes in our bodies. Although some SSRIs like Lexapro target serotonin transporters and bind to them directly, recent research suggests this may not be their main function.  It has recently been discovered that these medications may target DNA to influence gene expression (Brogaard, 2017). By inhibiting the transcription of genes that code for serotonin transporter proteins, they can decrease serotonin reuptake by the axon terminal of the presynaptic neuron.  This increases the amount of the neurotransmitter left in the synaptic cleft which will then bind to receptors on the postsynaptic neuron.

In more simple terms, the more serotonin that is left in the space between nerve cells, the more it can impact the neighboring cell. However, there are transporter molecules at the ends of our nerve cells constantly working against this process and taking serotonin out of this space called the synapse, putting it back into the cell it came from (Silverthorn, 2019). This can be problematic because in order to achieve the mood-regulating effects, it must be sensed by the next cell, so it is better to have more of it in the synapse. It is now believed that SSRIs block the expression of genes that code for these transporter molecules, telling cells to make less of the things that are depleting serotonin levels in the synapse, allowing serotonin to reach the next cell. This would explain why it takes weeks to see the impact of SSRIs while drugs like ecstasy and cocaine, which work on the same transport molecules, have almost immediate effects. Just blocking these transport molecules is a lot faster than telling the body to alter its biological processes to produce less of them. 

Although the effects of SSRIs take a while to kick in, this should not necessarily be associated with milder effects. SSRIs are prescription medications used to treat anxiety and depression, and for reasons still unknown they only work in about 30 percent of patients. These drugs are also not generally classified as addictive, but this does not suggest that they do not have profound impacts on the body or that they are never abused or misused. Because their impact is more delayed and they lack the rush sensation that drugs like cocaine can elicit, they aren’t as appealing to addicts who crave this high. For this reason, they are also prescribed as a safer alternative to benzodiazepine (Brogaard, 2017). However, the problem arises when SSRIs are used for long periods of time, as their effects may begin to weaken. Patients can start taking more than prescribed by their doctors because they feel that a higher dosage is needed in order to alleviate their symptoms, and this can lead to an overdose. 

If a patient recognizes they are in a situation where they are becoming dependent on SSRIs to function normally or reach a point where no dose can seem to take away the pain that they are living with, they may become inclined to quit taking them. However, this is a challenging process which should only be undertaken with the supervision of a medical professional. It can also be difficult for patients to discern where they lie on this slippery slope, and they may not know when it’s time to seek help. If a patient finds that the SSRIs are taking too long to kick in or they begin to see a decline in their effectiveness, dealing with their symptoms of depression and anxiety in the meantime is also discouraging. Because these individuals have already sought out help from doctors only to be disappointed, research suggests that when feelings of helplessness emerge, they may be more susceptible to turn to other drugs and alcohol to numb their pain. This is also concerning because taking drugs and drinking while on antidepressant medication can cause serious symptoms like dangerously high blood pressure, intense sedation, and overdose (Antidepressant, 2020).

It is important to note that when used with caution and under the instruction of a doctor, SSRIs have allowed so many people to claim back their lives after long battles with their mental health. However, this is ultimately a balancing act. Educating people about how these drugs work and the dangers of their misuse works to ensure that these individuals aren’t controlled by their anxiety, their depression, or their medication. Unfortunately, despite the prevalence of SSRI prescriptions, there is still a stigma associated with these drugs and the mental health conditions that they are used to treat. On top of working to fight poor mental health and possibly drug dependence, these individuals are also forced to cope with judgement, so they often hide these internal battles from the world. This creates a vicious cycle that can just exaggerate the severity of their conditions. If you know someone struggling with their mental health, providing them with support, acknowledging their struggles, and encouraging them to seek help when needed are helpful courses of action. If everyone does their part to remain informed, it helps to ensure the safety of all individuals on these medications.

 

References

Antidepressant addiction and abuse. (2020, November 30). Retrieved March 13, 2021, from https://www.addictioncenter.com/stimulants/antidepressants/

Brogaard, B. (2017, February 08). Number one reason ssris take four to six weeks to work. Retrieved March 13, 2021, from https://www.psychologytoday.com/us/blog/the-superhuman-mind/201702/number-one-reason-ssris-take-four-six-weeks-work

Scaccia, A. (2020, August 19). Serotonin: Functions, normal Range, side effects, and more. Retrieved March 13, 2021, from https://www.healthline.com/health/mental-health/serotonin

Silverthorn, D. U., Johnson, B. R., Ober, W. C., Ober, C. E., Impaglizzo, A., & Silverthorn, A. C. (2019). Human physiology: An integrated approach. Harlow: Pearson.

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