- In Health
Since the 1980s, diagnosing and treatment for depression has come to be a big part of recovery for millions of addicts. The controversy surrounding medication for depression and when and how it is determined necessary has created an ongoing conversation that can, from time to time, be addressed with fresh information.
The cumulative, long-term effects
The dangers lie in belief that this is an open and shut situation for anyone, especially when it comes to the neurological damage caused by addiction, the fact that many addicts have self-medicated underlying mental health issues, and the difficulty of diagnosis for early recovery.
Of course there is a plethora of material touting the use of antidepressants. Anyone who suffers the crippling effects of depression, whether it is long-term, chronic depression or a shorter-term, situational depression can testify that medication can be a God-sent assistant in navigating daily life. For some, it allows functioning in a world that appeared sinister and overwhelming to accommodate.
However, the challenges for those who are in early stages of recovery from addiction to substances that alter their brain function for months or years are in appropriately being diagnosed for said mental health issues.
What are the Challenges of Diagnosing Addicts?
Alcohol, some benzo (Benzodiazepines), Opiates, and Central Nervous System (CNS)-Depressant medications may cause long-term damage to the synapse responses in the addict's brain over long periods of abuse. How and when those functions are returned to homeostasis is questionable. Diagnosing these addicts as depressed may be tricky, if not impossible, during the early stages of recovery.
Many addicts have lied to their providers when asked about alcohol and drug use. An addict using these substances is going to present symptoms that are being created by the drug, not the addict's natural mental state.
Addicts who have been abusing stimulant medications over a period of time may present with symptoms of depression when newly eliminating these drugs from their system. They feel depressed, because their continual state of hyper-alertness, caused by the drugs they were abusing, is missing. This may go on for up to a year after they stop drug use. Treating these symptoms with medication may not be the best way for them to stabilize and return to homeostasis.
For that purpose, it is important to question the use of medications during this period, as well as to determine a shorter period of use of medications, due to the changing brain chemistry of the addict overall.
What are the specific issues of use of antidepressants?
For anyone facing the question of whether or not use of antidepressants is their best bet, there are several pieces of information to consider. There are many articles and much information about the side effects of various antidepressant medications, which will not be addressed in this article. These should be weighed by the person who is considering medication.
They may need to try more than one medication before the appropriate fit is found for their personal use. It is highly recommended by doctors and pharmacists that the patient work closely with their physician to find the appropriate medication, dose and term of treatment. Staying on top of your use of medication requires a team effort. DO NOT ATTEMPT TO STOP USE OF MEDICATION WITHOUT MEDICAL SUPERVISION.
Any and all use of medications during the taking of anti-depressant medication needs to be consulted with a physician to determine best course of action. MAKE SURE YOUR DOCTOR KNOWS ABOUT ALL MEDICINE, EVEN OVER-THE-COUNTER VITAMINS OR SUPPLEMENTS BEING TAKEN.
Why is this a personal decision?
In March, 2010, a report made by Dr. Charles Raison, a psychiatrist at Emory University Medical School for CNN spoke of cataracts being caused in long-term use of medications used for treatment of depression. In addressing this finding, Dr. Raison stated his opinion that few long-term studies had been conducted to find long-term effects of medications because there are so many variables in patients. Another reason is that there is no baseline for "normal" in the human brain or one established for all of the factors that may lead to the "causal" nature of depression, much less the lifestyle variables and conditions for each patient.
Given these factors, it is important to remember that not everyone:
(a) Is appropriately diagnosed,
(b) Is willing to make lifestyle changes that will enhance recovery options,
(c) Is suffering the same levels of depression,
(d) Has the same state of homeostasis in their brain chemistry,
(e) Understands what depression feels like,
(f) Recognizes the responsibility they have to work through their issues to recover.
These are all roadblocks that must be understood, recognized and navigated when treating depression. If the condition exists in co-occurrence with addiction, the challenges are multiplied.
What is known about side effects with long-term use?
Research has indicated several things that need to be recognized with side effects of anti-depressant medication.
- Weight gain: Over any period of time, health issues surrounding body weight gain are many. These must be addressed with use of anti-depressants, because new health risks may occur.
- Some types may cause heart problems such as arrhythmia and palpitations.
- Drug interactions that can be fatal, especially when combined long-term.
- Most medications are designed to be used only by those who maintain abstinence from other drugs. Addicts in relapse create additional risks for adverse effects of these medications.
- Loss of effectiveness. After months or years, the brain becomes less responsive to the medication, a condition known as tolerance. This can cause a return of depressed symptoms, as well as the need for an increased dose or change to another type of medication for treatment.
- Nausea and other digestive problems seen with use of anti-depressants can become chronic and cause additional digestive conditions when medication is used over years.
- Recognized sexual difficulties seen with anti-depressant medication can lead to relationship difficulties, and may require the use of other medications; thereby increasing risk of harmful drug interactions. In a long-term sense, these may also create permanent breaches in relationships between sexual partners.
- Sluggishness and lack of energy caused by medication may create trouble for those with depression, because they are using medication to offset some of these symptoms, which may persist or worsen with use of anti-depressant medication.
- Sleep pattern disruptions are another source of trouble. Many depressed patients report trouble with sleep on anti-depressant medication. This causes further sluggishness and lack of energy, thus exacerbating the problem.
- Medications may have some opposite effects, such as agitation, nervousness, twitching and involuntary muscle movement. Long-term use may worsen or create greater frequency of these problems.
- Headaches have been reported after initial use of anti-depressant medication, and may continue or develop into chronic, episodic events in long-term use of medications.
Specific conditions recognized by long-term use
One of the things seen to be occurring over long-term use of anti-depressants is seen through a group of published papers in Minnesota. They were specifically looking for an answer to the question of whether medications worsen the condition of depression over the course of long-term use. This was a concern first addressed in the late 1960s and early 70s.
A term called "chronification" of depression was coined to address the condition being recognized by an Italian psychiatrist by the name of Giovanni Fava. In a description of how anti-depressants work on the brain, he spoke to the mechanism that was created when the brain developed what he called "oppositional tolerance".
As the brain seeks stability when being medicated and brain function is altered, it may begin to overcompensate for the medication's interference, thus creating a worsening of the brain malfunction that creates the condition to begin with.
The human body and brain will always seek to maintain homeostasis. In battling the introduction of medication, the brain may create a counter-balance effect in response. Numerous scientists have explored this theory over the course of the ensuing 40-50 years.
Treating depression that was NOT labeled major depressive illness, or those who had symptoms that were other than a chronic type of depression actually created brain responses to medication-intervention that simulated depression. This is caused by the oppositional forces of medication, even after it is discontinued in those persons who had initial success with the medication. After an initial stabilizing effect, continuing the use of the medication may create what one doctor termed "pro-depressant effect". This doctor is El-Mallakh, a physician who began his research shortly after reading about "oppositional tolerance". The effect takes place often in those who relapse and stop use of their medication, those who suffer from anxiety, panic disorder or those with no symptoms who take the medication after being misdiagnosed or who have acted as "controls" during trial drug tests. While they may not have presented with symptoms of acute depression of a major type, they develop these symptoms after use of an anti-depressant medication. Some of these symptoms may last for long periods after discontinuing medication and may not be completely reversible.
How is this important to addicts?
Recognizing serious depressive disorders is challenging for those in early recovery, due to the many factors involved in their brain and body conditions during that time. For that purpose, it is imperative to determine appropriate treatment and to alter the treatment to fit the newfound stability of the patient.
Because symptoms may mimic depression and other mental illness diagnoses, it is important to monitor how medications are affecting these patients. For that reason, most doctors continue to recommend counseling or therapy, along with medication in order to shorten the time of use of medication if possible.
Working closely with mental and physical health providers will ensure that appropriate care is provided for those who suffer from depression. Medications for treatment of depression are most effective when used for short periods of time. They may become ineffective when not needed by the person taking them.
Another danger of long-term use of anti-depressant medications is seen when tolerance is created. Patients are then much more likely to relapse into depressed states. This danger escalates with potency of the prescribed dose, along with the length of use. Also important to note are the side effects when withdrawing from the medication; which also increase incrementally, depending on dosage and length of time the patient has used the drug.
Dr. Peter Breggin, a psychiatrist educated at Harvard, summarizes Dr. El-Mallakh's body of research in an article whose main focus is finding the balance each patient must come to when considering treatment for depression. His pivotal message is: that when viewing the preponderance of evidence showing the side effects that, for many patients outweigh any benefits; it becomes increasingly important to understand and explore all possible options before prescribing or taking medication of this type.
 CNN.com. Ask the Expert: What are antidepressants' long-term effects? Retrieved online from: http://www.cnn.com/2010/HEALTH/expert.q.a/03/16/antidepressants.long.term.effects/index.html
 Web MD.com. How Long Should You Take Antidepressants? Retrieved online from: http://www.webmd.com/depression/features/antidepressants
 Psychology Today. Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria
New research on why antidepressants may worsen long-term outcomes. Retrieved online from: https://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria
 Harvard Health Publications: Harvard Medical School. What are the real risks of antidepressants?Â Retrieved online from: http://www.health.harvard.edu/mind-and-mood/what_are_the_real_risks_of_antidepressants
 Huffington Post: Healthy Living. New Research: Antidepressants Can Cause Long-Term Depression. Retrieved online from: http://www.huffingtonpost.com/dr-peter-breggin/antidepressants-long-term-depression_b_1077185.html
Kelly McClanahan has an MSW in clinical social work and a CATC IV in addictions counseling. She teaches meditation and mindfulness, specializing in addiction and trauma. She also leads workshops and seminars on treatment of addictive disorders and stress reduction.