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anti-anxiety agents

Psychologically and Physiologically Addictive Medications

Are antidepressants psychologically or physiologically addictive? – Kind of – but not in the way that you think!

For many years, most of the medical community have held steadfast to the idea that antidepressants were not “addictive.” But many Prescription Pain Medicationof those, not in the medical community or those with no personal experience of drug abuse or psychiatric illness, were convinced that those happypills were subject to abuse.  In fact, both were wrong.  Antidepressants are not “abusable“, but they are sort of “addiciting“.

To be clear – antidepressants are not subject to abuse.  They do not produce a “high” or anything like intoxication.  There is no immediate reward for taking antidepressants; in fact, one of the most troublesome things about antidepressants is that they take several weeks to actually work.

However, there is a difference between “abusabledrugs and “addictivedrugs.  Addiction is generally thought of as a psychological illness – in the way that marijuana and cocaine are psychologically addictive.  There is little evidence that either drug is physiologically addictive.  The body does not become dependent on the drug… the brain may – but not the body.

On the other hand, some medications are physiologically addictive – without being psychologically addictiveHormones are an example of this.  Once you start taking hormones (such as estrogen replacement), your body will adjust to the presence of the Psychologically Drug Addicted Dreammedication – and if suddenly discontinued, will not function normally.  There are many other examples of this, but you get the point.

Drugs like heroin, alcohol, and tobacco are psychologically addictive – but they are also physiologically addictive.  In addition to the brain “wanting” them, the body “needs” them to function normally.  If you suddenly take away the heroin, a severe withdrawal syndrome will begin.  If you suddenly take away alcohol – you may have seizures and a number of life-threatening conditions.

Prescription pain medications and anti-anxiety agents, when taken inappropriately can also be both psychologically and physiologically addictive – like heroin and alcohol.  When taken as prescribed, they are often still physiologically addictive.

Back to the antidepressants.

Certainly, years ago, sudden withdrawal of prescription antidepressants was known to be dangerous. But, with the development of selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and many others, most people have believed that there was no chance of physical addiction, and there would be no withdrawal.

Over the years, I would hear about people who complained of “withdrawal” symptoms which I dismissed – like most people in the medical community.  Many of these patients also had a myriad of complaints – generalized pain, foggy thinking, and other things that were considered to be indicative of a hypochondriac or chronic complainer.  Turns out maybe I was wrong.

SSRIs and other “next generation” antidepressants CAN cause withdrawal symptoms.  Some (not all but some) patients may experience symptoms of withdrawal such as Anxiety.

  • Anxiety
  • Anxiety and irritability
  • Depression and mood swings
  • Light-headedness and dizziness
  • Fatigue, headache and flu-like symptoms
  • Electric shock sensations
  • Loss of coordination, tremors and muscle spasms
  • Nausea and vomiting
  • Nightmares and difficulty sleeping

Most people don’t experience these – or have only a mild reaction.  Unfortunately, even “tapering” down won’t make that much difference as the symptoms may take a long time to go away – but the withdrawal is real and shouldn’t be dismissed!

Melissa Lind

Obsessive Compulsive Disorder – OCD

Collecting, Organizing, Checking, Washing…. Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder.

OCD - Bug ObsessionIt is composed of two parts: Obsession and Compulsion.  Obsession is the portion of OCD that occupies your thoughts such as excessive concerns about cleanliness (my kids call this germophobia), extreme social fear, fear of harming someone, preoccupation with organization or other intrusive thoughts that create anxiety.  Compulsion is the physical manifestation of needing to do something about the obsessionsCompulsion results in behaviors such as ritualistic behaviors like excessive hand washing, repeatedly checking to make sure the stove is off, counting steps and other extreme behaviors such as hoarding.

OCD the Good
Once I while participating in a wedding, I was attending the rehearsal dinner at the home of the bride whose mother made the appetizers for over 200 people.  I was amazed at her management skills that made her capable of preparing appetizers from a single kitchen – right up until the time that when looking for the restroom adjacent to the laundry, I opened the pantry door.

There, staring at me were over 100 spice containers, of all the same brand, all the same size and all angled at a precise 45-degree angle so that the labels were all pointed exactly at my head.  I was so dumbfounded that I continued to stare and found that on the other shelves there were precise pyramids of 5 cans each of various vegetables – all the same brand, all the same size, with all the labels facing exactly the same direction.

Lining the floor were plastic bins, spaced 2 inches apart…exactly, containing 3 bags each of a variety of pasta, flour, rice…. all of course the same brand, carefully placed in the bin, with the label in exactly the same location.

This is OCD at its best – at least for others.  She had an obsession and a compulsion that created this superbly organized pantry.  Likely though, even this “good” OCD manifestation took up a lot of her time – and had a negative impact on her daily life and that of her family’s.

OCD is not always at its best however and can result in the opposite – hoarding.  I don’t have to go into this but if you haven’t seen it, you should watch “Hoarders” or “Hoarding, Buried Alive” for some insight.

OCD the Bad
In addition to situations like hoarding, OCD can also interfere with life in other ways.  I have a cousin with OCD, who before he was medicated, found himself unable to leave his driveway due to fears that he would back over a child with his car.  This caused him to spend hours – literally hours every morning starting the car, looking in the rear view mirror, getting out of the car to look behind it, getting back in the car, looking in the rear view mirror, getting out of the car….  He eventually found himself unable to work.

Obsessive Compulsive Disorder - OCD Confused MindOthers have found that OCD has limited their lives in similar ways.  Howie Mandel, a well-known comic, has talked about his Obsessive Compulsive Disorder.  It prevented him from appearing in public for many years, in part due to social fear but also due to fear of infection.  Even today, while his disease is “under control,” he does not ever shake hands or allow others to touch him.

How do I know if I have OCD?
A lot of people have rituals – such as specific routines before bed.  A lot of people have extreme concerns which may consume thoughts for a while – such as excessive concerns over money.  The difference in “normal” rituals and “normal” concerns is that they don’t typically impair normal life and they don’t become paralyzing.

Thoughts and behaviors that might indicate OCD:
•    Repeated thoughts or mental pictures about things such as
o    Germs
o    Dirt
o    Intruders
o    Violence
o    Hurting others
o    Embarrassment
o    Disorganization
o    Religious beliefs
•    Repeated behaviors such as:
o    Washing hands
o    Disinfecting surfaces
o    Locking and unlocking doors
o    Counting
o    Repeating steps over and over
o    Keeping unneeded things
o    Excessive grooming
•    Lack of ability to control or stop unwanted thoughts and behaviors
•    Repeated behaviors provide temporary relief from anxiety that is caused by obsessive thoughts
•    Repeated behaviors don’t provide any pleasure other than temporary relief
•    Spending at least 1 hour a day on thoughts and behaviors, creating a negative impact on daily life

The International OCD foundation reports that it takes around 15 years for most people to be diagnosed.  This may be due to hiding of symptoms – but it may also be due to lack of awareness of both the public and health professionals.

What can be done about OCD?
OCD can be treated – it usually cannot be cured but can be controlled.  First line treatment for OCD includes working with a properly trained therapist – most beneficially, one who is trained in cognitive behavioral therapy (CBT).  CBT uses “exposure to” unpleasant stimuli, carried on to the “what if” stage.  “What if” I touch that faucet without disinfecting it?  “What if” I get into the elevator without opening the door 10 times?  The “exposure” period is followed by “response prevention” where the patient chooses NOT to perform the behavior that the “exposure” usually causes.  Over time, the obsession and compulsive thoughts and behaviors become more manageable.
In other cases, medication may be needed – usually given in combination with CBT.  Some antidepressants (not all) will help with OCD.  Anti-depressants that have been shown to help include:
o    Luvox (fluvoxamine)
o    Prozac (fluoxetine)
o    Zoloft (sertraline)
o    Paxil (paroxetine)
o    Celexa (citalopram)
o    Lexapro (escitalopram)
o    Effexor (venlafaxine)

Other medications may also help but have not been “approved” to treat OCD.  Doctors who have found them helpful may use them regardless of whether they are officially approved to treat OCDMedications such as Cymbalta (duloxetine) have been reported to be helpful – and some patients may benefit from short-term use of anti-anxiety agents.

It is important to know that all medications may cause side effects and you should tell your doctor about any other medications you are taking.

Melissa Lind

Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety and by repetitive behaviors aimed at reducing that anxiety.

Obsessive Compulsive Disorder can be treated!