Abuse and misuse of antidepressants

Abstract

BackgroundRates of prescription drug abuse have reached epidemic proportions. Large-scale epidemiologic surveys of this under-recognized clinical problem have not included antidepressants despite their contribution to morbidity and mortality. The purpose of this review is to look specifically at the misuse of antidepressants and how this behavior may fit into the growing crisis of nonmedical use of prescription drugs.MethodsWe conducted a comprehensive search on PubMed, Medline, and PsycINFO using the search terms “antidepressant”, “abuse”, “misuse”, “nonmedical use”, “dependence”, and “addiction”, as well as individual antidepressant classes (eg, “SSRI”) and individual antidepressants (eg, “fluoxetine”) in various combinations, to identify articles of antidepressant misuse and abuse.ResultsA small but growing literature on the misuse and abuse of antidepressants consists largely of case reports. Most cases of antidepressant abuse have occurred in individuals with comorbid substance use and mood disorders. The most commonly reported motivation for abuse is to achieve a psychostimulant-like effect. Antidepressants are abused at high doses and via a variety of routes of administration (eg, intranasal, intravenous). Negative consequences vary based upon antidepressant class and pharmacology, but these have included seizures, confusion, and psychotic-like symptoms.ConclusionThe majority of individuals prescribed antidepressants do not misuse the medication. However, certain classes of antidepressants do carry abuse potential. Vulnerable patient populations include those with a history of substance abuse and those in controlled environments. Warning signs include the presence of aberrant behaviors. Physicians should include antidepressants when screening for risky prescription medication use. When antidepressant misuse is detected, a thoughtful treatment plan, including referral to an addiction specialist, should be developed and implemented.

Patología dual en Depresión: recomendaciones en el tratamiento

“…*Estudios incluidos en metánalisis anteriores tencial de abuso, siendo aquellos con propiedades estimulantes o sedativas los que presentan mayor riesgo. A continuación se describen los antidepresivos con mayor riesgo y con los que se debe tener especial cuidado en los pacientes con TUS (Evans y Sullivan, 2014;Haddad, 1999;Jasinski, Faries, Moore, Schuh, y Allen, 2008;Reeves, Ladner, Perry, Burke, y Laizer, 2015;Volkow et al, 2005) -IMAO: tranilcipromina y fenelcina han presentado abuso por vía oral relacionado con su estructura similar a las anfetaminas; sobre todo se han descrito series de casos con tranilcipromina. -Tricíclicos: abuso por vía oral, sobre todo de aquellos que tienen propiedades sedantes y anticolinérgicas.…”

Venlafaxine as the ‘baby ecstasy’? Literature overview and analysis of web‐based misusers′ experiences

“…It is a reason of concern, however, that when combining venlafaxine with amphetaminetype stimulants, both an increase in related stimulant effects (e.g., anxiety and restlessness) and the risk of occurrence of the serotonin syndrome can be observed (Fisher and Davis, 2002;Houlihan, 2004;Boyer and Shannon, 2005). Onset of tolerance (Sattar et al, 2003;Quaglio et al, 2008), inability to control drug use (Eşsizoğlu et al, 2012;Namdari, 2013), and a withdrawal syndrome when venlafaxine administration is abruptly discontinued (Evans and Sullivan, 2014) were here reported in both the online fora and the published literature, with withdrawal occurrence being possibly facilitated by the molecule relatively short half-life (Campagne, 2005).…”

“…This has been associated with ease of access to a range of 'no-prescription websites', offering controlled/prescribed substances to customers with disregard to issues such as federal/local laws, provision of a valid prescription, and access to medical and pharmacist guidance/supervision (Forman et al, 2006;Schifano et al, 2014). Antidepressants are thought to possess only limited addictive liability levels (Haddad, 2005;Evans and Sullivan, 2014), but molecules such as bupropion (Vento et al, 2013) and amineptine (Quaglio et al, 2008) have been associated with withdrawal symptoms, tolerance, and a tendency to drug seeking behavior. On the other hand, for other commonly used psychotropics, like pregabalin, cases of abuse and dependence have been reported (Carrus and Schifano, 2012;Martinotti, 2012).…”

Challenges in Conducting the Study to Adapt and Test the Psychometric Properties of the Psychological Vulnerability Scale in a Sample of 267 Portuguese Higher Education Students

“…Fármacos psicotrópicos. Os fármacos psicotrópicos -tranquilizantes e os estimulantes são frequentemente consumidos pelos EES sem prescrição médica, e usados em doses excessivas ou para efeitos não médicos (Evans & Sullivan, 2014;Kapil, Green, Le Lait, Wood, & Dargan, 2014). Também a combinação e/ou o uso simultâneo de substâncias lícitas e ilícitas, com e sem prescrição, é uma prática habitual entre EES (Oliveira et al, 2013).…”

“…Para avaliar o padrão de sono incluiu-se itens quantitativos relativos a hábitos de sono categorizados por intervalos de tempo dormido (nº de horas dormidas em tempo de aulas) e, itens qualitativos relativos à satisfação com nº de horas dormidas. Este método é habitualmente usado para estudar padrões de sono em EES (Evans & Sullivan, 2014;Mason, Zaharakis, & Benotsch, 2014;Serras et al, 2010;Taylor et al, 2013). Em Portugal não se conhecem estudos preditivos sobre o sono em EES, mas os existentes mostram percentagem elevadas de problemas associados ao sono (Gomes et al, 2009;Lopes et al, 2013;M.…”