Opiate Addiction Withdrawl vs. SSRI Discontinuation Syndrome

[MaddieMay]

I posted this in the psychiatry forum two weeks ago, got 187 peeks and no replies. I hope I'm not a tool.

I'm trying to find books, articles, studies, anything to help me understand (and explain to someone else) how withdrawal from opiate addiction, for instance is not the same as Discontinuation Syndrome when tapering off of Paxil, from a brain chemistry POV.

I'm also looking for an unbiased source for information about addiction vs dependence vs habituation and the most up to date unbiased info on Discontinuation Syndrome.

Thanks, guys!

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[michalita]

I posted this in the psychiatry forum two weeks ago, got 187 peeks and no replies. I hope I'm not a tool.

Stinkin' psychiatrists...

Ummm... it sounds like a complicated question (at least the second part) and I'd love to learn the answer. I will try to ask one of the psychiatrists I work with (@ dual-diagnosis inpatient unit). He likes to teach people so he's likely to actually answer.

 

[erg923]

I'm interested why you separate addiction from dependency. How can you have an "addiction" without dependency, either physiological or psychological? Although even psychological dependence ends up manifesting physiological symptoms (i.e., anxiety, sweating). How can you have a dependency (on a substance) and not have an addiction?

 

[MaddieMay]

Yep, that's one of the things I'm wondering. Is dependency a sign of addiction or a symptom? I don't know if the terms are synonymous or not. We talk about "a sign of addiction is using a substance despite negative consequences" but that's not part of the dictionary definition.

And then there's "habit-forming."

People have "withdrawal" symptoms from discontinuing either heroin or Paxil but we don't consider people to be addicted to Paxil. Although the people who are suing Paxil toss these terms around.

Just trying to sort it all out.

 

[erg923]

What exactly is the difference between "sign" and "symptom" the way you are conceptualizing it?

I think you are just getting caught up in semantics here. According to the DSM-IV, withdrawal and/or tolerance of a substance are necessary to diagnosis a dependence. I assume with is how you are thinking of "addiction," no? This is how psychiatry views addiction anyway, although that term is not used in the DSM-IV. "Withdrawl" refers to a physiological state. There are many forms of it. Paxil is a very mild case, heroin is a very extreme case. Does this answer your question? Sorry, still kind of confused on what your looking for.

 

[myelin]

I'm interested why you separate addiction from dependency. How can you have an "addiction" without dependency, either physiological or psychological? Although even psychological dependence ends up manifesting physiological symptoms (i.e., anxiety, sweating). How can you have a dependency (on a substance) and not have an addiction?

What about with marijuana? Can an individual develop chemical dependency from THC?

Marijuana? You in he-yah for some marijuana?! Boo this man!! Boo!

 

[EquestriAnn]

What about with marijuana? Can an individual develop chemical dependency from THC?

Can open, worms everywhere. This has been debated a fair amount....

I agree you are getting caught up in the wording, much of what you are saying are the same things with different vocabulary. You may not call someone a Paxil addict, but if they go through withdrawal they were dependent on the drug. I don't hear habituation used to describe drug use very often, usually it's tolerance and sensitivity. I'm in the addiction field and I haven't heard of this term "Discontinuation Syndrome," though I can figure out what it means and I would assume it's just withdrawal. Withdrawal from an SSRI with a long half-life would obviously be much different from something like cocaine which has much more extreme effects, but it is withdrawal nonetheless. As for sources, Pubmed is your friend

 

[myelin]

Can open, worms everywhere. This has been debated a fair amount....

Indeed. What are your thoughts?

 

[EquestriAnn]

Indeed. What are your thoughts?

Well I feel like the only way to know for sure would be to do it a lot and see how I feel haha. But based on what I've learned and seen, I think there is a very strong psychological addiction but less of a physical one. I'm sure if you always have THC in your system and then all of a sudden you don't, you will feel weird but not in the same way as if you stopped injecting heroine or something. But I have seen people talk about how it is a part of their life and they need it to fall asleep or feel normal, so I definitely recognize how hard it would be to stop. That said, I'm not extremely well versed in marijuana addiction, so I'm sure if I read up I would have some different opinions.

 

[MaddieMay]

What exactly is the difference between "sign" and "symptom" the way you are conceptualizing it?

I think you are just getting caught up in semantics here. According to the DSM-IV, withdrawal and/or tolerance of a substance are necessary to diagnosis a dependence. I assume with is how you are thinking of "addiction," no? This is how psychiatry views addiction anyway, although that term is not used in the DSM-IV. "Withdrawl" refers to a physiological state. There are many forms of it. Paxil is a very mild case, heroin is a very extreme case. Does this answer your question? Sorry, still kind of confused on what your looking for.

It's hard for me to explain what I'm looking for because I am confused about the whole subject and its vocabulary. Don't trouble yourself, I'm looking for some references, not a debate.

 

[erg923]

edit

 

[erg923]

I think any text book on basic psychopharmacology would clear up the terminology issues. The DSM-IV definition of "dependence" is used instead if "addiction". The two are interchangeable and equivalent when talking about substances.

On the other hand, when a physician tapers Paxil slowly, it's to prevent the physiological rebound of the drug. Yes, this physio rebound is a mild withdrawal technically, but the effects are caused by a very different neurochemical process than the withdrawal experienced from opioids and benzos. These drugs (opioids and benzos) have the "final ingredient" so to speak, to form full blown addiction, in the behavioral sense of the word. That is, they form tolerance. SSRIs do not. The building of tolerance (which alos leads to severe withdrawal) leads to pathological and perseverative drug seeking that forms the behavioral component of "addiction." I think any psychopharmacology text book would explain these issues, but if you looking for peer reviewed studies, just do a pubmed search and see what pops up.

 

[MaddieMay]

Ah, I wish I had access to Pubmed... I'm in the middle of a year off from school. But I will check out the local U for some psychopharm texts.

Thank you!

 

[myelin]

Check it out. PubMed is free. However, Medline is not. You can still have access to abstracts though.

http://www.ncbi.nlm.nih.gov/PubMed

 

[MaddieMay]

Fantastic! Thank you.

 

[addictedtoSSRI]

Hi Maddie May,

Here's the best way to explain it to your friend: it's a lot worse. Here's why: the doctors that put you on the meds don't know how to take you off, you may kill yourself, the withdrawal symptoms will last for months if not years, there is no rehab for coming off an SSRI, you will be disabled but disability won't cover it, your health insurance won't cover it as it's not in the DSM.

Hope this helps. If you actually DO want to help people with mood disorders (depression, bipolar, etc.), meds are useless. Supplements such as magnesium, D3, and omega 3s are much more effective at dealing with the causes and do not result in physical addiction. In addition, diet and exercise are key. It would be great if a single med out there actually did more good than harm, but that's simply not the case today. If the industry doesn't even know what the underlying cause of depression is, how can it create meds to treat it? So, I'd also suggest you start looking for causes rather than focusing on extremely harmful medications that at best mask symptoms and leave patients in a world of hurt when they want to come off.

Best,

ADDICTED to SSRIs

 

[Atrum]

I'm interested why you separate addiction from dependency. How can you have an "addiction" without dependency, either physiological or psychological? Although even psychological dependence ends up manifesting physiological symptoms (i.e., anxiety, sweating). How can you have a dependency (on a substance) and not have an addiction?

First, I am not a doctor nor in school to be one. I am a Business Student. I have been an opiate addict for about 6 years now. My dependency on opiates ended about 2-3 months ago, but I will forever be an addict. This is the best I can explain it, I was both addicted and physically dependent on opiates. 2 cups of opium tea daily (60mg of methadone equivalent when Io went to the clinic. Went once, got clean, relapsed, went again, got clean relapsed. Used a mushroom trip in hopes of an ibogaine type effect and then a lot of xanax after. Got clean, staying clean.) I am now on 10mg of Lexapro for social anxiety disorder though towards the end of the dependency on opiates I was very depressed, I felt ashamed I had relapsed and felt worthless. Sorry for the life story but it could be relevant to my point.

I am clean, except lexapro, but there is that part of my psychology or mental status that still wants to get high. I think I will always want it. That is what I consider the addiction. Dependence, by my definition, is having to take the substance or go into withdrawal symptoms. Addiction is psychological, an addict will always be an addict, we will always crave the high.

 

[cara susanna]

Dependence and addiction are actually different, or so I learned in my psychopharmacology class. Physiological dependence refers to your body's chemistry changing as a result of using a drug, to the point where you need the drug to feel "normal." Addiction is just a compulsive need to surround yourself with, obtain, and use a substance. You can be dependent on non-psychotropic medications--for instance, diabetics are dependent on insulin, but they are likely not addicted.

Keep in mind that I've only ever heard dependence refer to physiological changes in a psychopharm context. I've only heard terms like "psychological dependence" outside of the classroom. I think that psychological dependence is what we would think of as interchangeable with addiction, and that's why I think it's kind of a useless term.

 

[Therapist4Chnge]

Excellent response cara.

Explanations of the physiological causes of each should be easily found in a review article or lit section of research. I'll see if I have a citation for either/both the next time I'm in my main office.