Dual Diagnosis is a term applied to the condition of suffering from both a mental health condition like depression or anxiety and an addiction to drugs or alcohol. When people have a Dual Diagnosis, the best treatment outcomes are seen when the conditions are treated concurrently, in an integrated manner and preferably within the same treatment facility. People who have been diagnosed with depression are often prescribed medications, and it is common to develop some degree of dependence on them.
Developing Tolerance to and Dependence on Antidepressants
The human body is equipped with the ability to adapt in order to maintain biochemical balance. When people begin to take medication on a regular basis, the body’s adaptations can lead to tolerance, in which a drug loses its effectiveness and larger doses must be taken to achieve the results a lower dose once produced. The Merck Manual explains that drug tolerance is often related to liver enzyme levels. As a drug continues to be consumed, the enzymes involved with metabolizing it become more highly activated, and the drug is metabolized more quickly.
Drug tolerance may also be related to adaptations in the way in which the drug binds to cell receptors in the body. The body may reduce the number of receptors available or decrease the drug’s bonding ability. A particular type of rapid onset drug tolerance is known as tachyphylaxis, which is generally due to depletion of neurotransmitters involved in producing a drug’s effects.
Drug tolerance can lead to physical dependence. Physical dependence occurs when the body adapts to the presence of the drug to the extent that certain body chemicals and processes are only in balance when the drug is present. When drug levels begin to fall, the out-of-balance biochemistry can lead to withdrawal symptoms.
The most commonly prescribed depression medications are selective serotonin reuptake inhibitors, or SSRIs. Harvard Health notes that tolerance to the drugs may develop after years or only months. They report that discontinuing the medications can lead to a long list of symptoms, including insomnia, dizziness, blurred vision, fatigue, vivid dreams, tingling, burning and loss of coordination. Less frequently, people may experience flu-like symptoms, nausea, diarrhea, anxiety, irritability and crying spells.
Addiction to Antidepressants
True addiction often, but not always, involves physical dependence, but they are not the same thing. When people are addicted to a substance like amphetamine, they lose control over their consumption of it and continue to use it compulsively, despite experiencing negative consequences. Although people may develop psychological dependence or addiction to a wide range of substances and even activities, the current medical consensus is that depression medication is less likely to produce true addiction than many other substances are.
The idea that people generally do not get truly addicted to depression medication is not without its detractors. Scientists associated with the Nordic Cochrane Center, for example, note that discontinuation of SSRI depression medication can cause 37 of the 42 symptoms associated with discontinuation of benzodiazepine drugs, which are considered to have high addiction potential. The authors believe that categorizing the drugs differently is illogical.
Drugs with high addiction potential generally raise levels of dopamine in the body. How depression medications affect dopamine is not entirely clear. The medical website WebMD states that the way in which antidepressants improve depression symptoms is not fully known but that it is widely believed that they exert their effects by affecting brain circuits and neurotransmitters including serotonin, dopamine and norepinephrine. The antidepressant bupropion, commonly sold under the brand name Wellbutrin, directly targets the reuptake of dopamine. Other classes of antidepressants may affect dopamine levels in less direct ways.
Reducing or Ceasing Use of Antidepressants
Whether or not people who have become physically dependent on antidepressant medication are diagnosed with true addiction, they need help dealing with both the depression and the medication dependence. Doctors may help patients slowly taper off of a drug while monitoring symptoms. They may prescribe a drug in a different class or experiment with dosage levels. Sometimes a patient who wishes to discontinue antidepressant use will be switched to a similar drug with a longer half-life before the dosage is lowered.
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If you would like to talk to someone about treating both depression and a medication dependence or addiction like to amphetamine, give us a call. Our helpline is toll-free and available 24 hours a day. We can answer your questions and help you understand your treatment options. We can even check your insurance coverage for you if you wish at no cost or obligation. Help is available. Why not call now?
 “Tolerance and Resistance to Drugs,” Daniel A. Hussar, PhD, Merck Manual, Consumer Version, https://www.merckmanuals.com/home/drugs/factors-affecting-response-to-drugs/tolerance-and-resistance-to-drugs (January 27, 2016).
 “What are the Real Risks of Antidepressants?” Harvard Health Publications, June 2009, http://www.health.harvard.edu/mind-and-mood/what_are_the_real_risks_of_antidepressants (January 27, 2016).
 “Scientist: Antidepressants Cause Addiction,” Kristian Secher, Science Nordic, May 2013, http://sciencenordic.com/scientist-antidepressants-cause-addiction (January 27, 2016).
 “How Different Antidepressants Work,” WebMD, http://www.webmd.com/depression/how-different-antidepressants-work (January 27, 2016).