Will I Become Addicted to Psychiatric Meds?

This is Dr. David Baldes, board-certified psychiatrist, practicing in Duluth, Minnesota. And today I want to talk to you about an important question. Are psychiatric medications addictive? Well, the answer is it depends, like most things in life. So we put every psychiatric prescription into a basket and paint them all as addictive. Not only is it inaccurate, but it keeps people away from care.

And so we want to avoid doing that and the main difficulty here comes with two words that can get mixed up or two ideas that can get mixed up and that is dependence or habituation versus addiction and so some psychiatric medications a body will adjust to it and stopping suddenly can cause withdrawal or discontinuation symptoms and that can happen with many different kind of medications, including some that are not psychiatric medications at all. There are some blood pressure medications that cause rebound elevated blood pressure.

Addiction, however, is compulsive use of the medication, craving loss of control of the use of that substance and continuing use despite obvious harms to the person. And so your body adjusting to a medication is not the same thing as being addicted to it. That's why in the context of a treatment relationship, we plan changes together instead of making changes suddenly and certainly avoid stopping medication suddenly.

So if we go class by class, antidepressants, so this would be SSRI medications, serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and other antidepressant medications. These are not considered addictive. They don't cause a high, they don't cause euphoria, they don't cause craving. However, stopping them abruptly can cause discontinuation symptoms that are uncomfortable and unpleasant and could even lead to hospitalization. Symptoms of discontinuation can include dizziness, flu-like feelings, irritability, changes in sleep.

Some patients that I've met with will describe a feeling of an electrical zap or sensation going through their head, and so there's a very good reason that you would want to taper this medication under a doctor's supervision, but that's not a sign of addiction to that substance, but rather that the body and brain have become habituated to its presence, and it does have physiologic, cause physiological changes in the system which lead to its clinical benefit. And so when we're discontinuing that medication or moving away from it, we need to taper wisely.

Now, a class of medications that are quite obviously addictive are benzodiazepine medications, anxiety pills, typically pills that are used for acute anxiety. These are medications that are sometimes used prior to medical procedures, or dental procedures, and they're oftentimes prescribed for panic attacks. You can think of medicines like lorazepam, Ativan, alprazolam, Xanax, clonazepam, Klonopin.

Now these medications are safe to use in the appropriate context with the appropriate patient with appropriate parameters on their usage, but long-term they can lead to tolerance and dependence and so we oftentimes prescribe these medications on a short term basis or as needed and if they've been taken for a long time they definitely need to be tapered off. Thankfully there are protocols that we can use to safely and slowly taper a person off of benzodiazepine medications in a way that is comfortable to them.

The important thing to understand is that I don't mean to say that benzodiazepines are never the right tool. But like any wise doctor, we want to make sure that we use them on purpose and with a plan.

Now a third medication that comes up sometimes are a group of medications that comes up are stimulant medicines that are prescribed for ADHD. These are controlled substances and it is true that people can misuse these medications. I won't give examples of how they might be misused but it's clear that at excessive doses they can have euphoric effects and certainly can have addictive properties.

Now research shows from the National Institute of Mental Health that misuse or dependence is unlikely when the medications are taken as prescribed and under medical supervision but that risk goes up when the medications are misused like using more than prescribed, taking them a different way than prescribed or using somebody else's prescription. And so it's really, really, really important if a person is taking a stimulant medication to have honest, open communication with the doctor and use medication clearly as prescribed.

Now, we do use some other medications in psychiatry of different classes. There are mood stabilizing medicines. Divalproex, also called Depakote, which is also a seizure medicine. Topiramate, Topamax, which is also a seizure medicine. Lamotrigine, Lamictal, this is a seizure medicine. We use them for their mood stabilizing properties. These medications are not addictive as such, and they don't cause euphoria or craving. However, if a person is taking a seizure blocking or anticonvulsant mood stabilizing medicine. At a therapeutic dose for a prolonged period of time, there is a risk of seizure if the medication is abruptly discontinued.

Antipsychotic class medicines are also used for treatment of certain mood disorders like bipolar illness, and also for psychotic illnesses like schizophrenia. These are generally not considered addictive. although some of them are prone to overuse because of sedative side effects.

So if you're worried about getting hooked on medication bring that worry to your appointment with me because you're the expert on how you feel on what you value and the good questions to ask are what class of medication is this can it cause dependence, what will happen if we want to lower the dose or stop it, would we have a plan.

Now I'm talking about medication classes in general, not your own personal prescription, and you never ever ever should stop or change your medicine just because of video online. You talk with your own doctor and by all means if you're in crisis you call or text 988 or call 911 and if you're interested in learning more about how I work or potentially working with me, you can find me online at davidbaldesmd.com. Thank you.