Editor’s note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide & Crisis Lifeline by dialing 988 to connect with a trained counselor, or visit the 988 Lifeline website.
CNN
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When Robert F. Kennedy Jr. answered questions about his stances on antidepressants at a recent US Senate confirmation hearing before becoming US Health and Human Services secretary, he sparked discussion on whether the medications are as addictive as some commonly abused drugs.
“I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than people have getting off of heroin,” Kennedy said during the January 29 hearing, referring to the class of antidepressants known as selective serotonin reuptake inhibitors. Kennedy told committee members that he was addicted to heroin for 14 years when he was younger and has been in recovery for 42 years.
Are antidepressants addictive? The short answer is no, say experts who spoke with CNN.
There are differences between addiction to (addictive) drugs and a dependency on medications that treat mental health disorders, they said.
What is true, and what Kennedy seemed to be getting at during the hearing, is that some people experience difficult withdrawal symptoms when quitting antidepressants. There are a few reasons why, but it’s not because they’re addicted to antidepressants, experts said.
How we communicate about medications is important not only for the purpose of accuracy but also so as not to contribute to the stigma that can prevent people from seeking help for mental health problems, said Dr. Gail Saltz, clinical associate professor of psychiatry at Weill Cornell Medical College in New York City.
“What he said is true, but I think the context of it (is important),” said Dr. Josef Witt-Doerring, a psychiatrist and cofounder of TaperClinic, a private practice that is primarily based in Palm Desert, California, and dedicated to assessing and treating patients experiencing adverse reactions to taking or quitting psychiatric drugs.
“If you weren’t knowledgeable about that, you might hear that and suspect that everyone’s going to have a harder time than coming off heroin,” Witt-Doerring said. “And that’s not true. It’s just for the people who are very vulnerable to withdrawal, and it’s a lot of them.”
Accordingly, acknowledging the diversity of experiences with antidepressants is also important when making treatment decisions, Witt-Doerring said.
CNN has reached out to the US Department of Health and Human Services requesting comment from Kennedy.
Why antidepressants aren’t the same as addictive drugs begins with the neurochemical nature and functions of each, experts said.
All addictive drugs — including heroin and other opioids, cocaine and alcohol — are providing intense reward mediated through the brain’s dopamine system, said Dr. Keith Humphreys, who studies addiction as the Esther Ting Memorial Professor in the department of psychiatry and behavioral sciences at Stanford University in California. This reward is intensive relative to other rewards humans have evolved to enjoy, such as eating when hungry, cuddling a baby, getting warm when cold or having sex when aroused.
“The addictive drugs can produce big spikes in dopamine; they’re substantially bigger than all those important things,” Humphreys said. “That’s why they have a potential to hijack the brain, because the brain thinks, ‘Wow, this must be really important. That’s more important than eating and taking care of my baby.’”
“That’s a totally different mechanism from how antidepressants work, which are not driven by dopamine at all,” Humphreys said. The chemical system that selective serotonin reuptake inhibitors — the most used form of antidepressant — primarily target is serotonin.
“They’re increasing the amount of time that serotonin spends in the synapse of the brain,” he added. Antidepressants accomplish that by inhibiting the reuptake or absorption of serotonin by the synaptic nerve ending that secreted it.
“And that — for reasons that are, frankly, poorly understood — helps many people do better with their mood and anxiety,” Humphreys said.
Antidepressants don’t give people that reward or on top of the world high; they just help most people feel more stable. The medications are therefore “purely therapeutic,” said Dr. Ragy Girgis, professor of clinical psychiatry at Columbia University in New York City. “They have no real abuse potential. People wouldn’t crave them.”
The addictive nature, and thus the craving, points to another key distinction between the use of addictive drugs versus antidepressants.
The former leads to “the repetitive engagement in seeking and using the drug despite the consequences,” Humphreys said. That comes with feelings of being unable to control consumption. These feelings consume an immense amount of brain space, making people who are addicted to drugs obsessively think about when they’re going to get their next hit, when they’re going to use it, how long it will be effective and what to do when the high wears off.
That reward-seeking behavior, and the health issues drugs can cause, can interfere with a person’s functioning at work, at home or socially to the point at which they have destroyed their lives, experts said. And given the tendency for the brain’s tolerance of a drug to grow over time, people can also begin to use increasingly greater amounts to reach the same high they initially experienced.
People can experience less and less reward from natural experiences — such as eating or having sex — they used to enjoy. All these patterns are why addiction is clinically known as substance use disorder.
Antidepressants, on the other hand, help many people feel more stable and improve their lives, and are sometimes used to help them overcome substance use disorder.
When people are going through withdrawal from drugs, symptoms can generally include agitation, diarrhea, nausea, sweating, chills, stomach cramps, muscle aches, trembling, appetite changes, sweating, fatigue, depression, vomiting, seizures and intense cravings, experts said. Death from withdrawal, such as from related seizures or heart failure, is also possible, especially when someone has abruptly stopped taking the drug.
So, if antidepressants aren’t addictive, why do some people have a hard time when getting off them?
There’s a difference between dependence and addiction, Humphreys said. All dependence “means is that the body has adjusted in some way to a chemical that the person has taken repeatedly, such that in the absence of it, they go through a withdrawal syndrome” that’s usually the opposite of the effects of the drug, he added. People can experience withdrawal from various things they consume, even if they’re not drugs.
Antidepressants not letting your brain reabsorb serotonin is what causes levels of the chemical to be higher, Saltz said. In that setting, some of your brain’s serotonin-producing receptors may be reduced. When you quit a medication, ideally, you’d be returning to a normal amount of receptors, but your brain may need time to adjust. If your brain is not adapting at the same rate at which you’re reducing medication intake, that can lead to withdrawal symptoms such as dizziness, headaches, nausea, insomnia and irritability.
Most people taking antidepressants will not experience withdrawal symptoms when quitting the medications, experts said. But the amount who do ranges from 15%, according to a 2024 study, to 33%, Humphreys said.
One disconcerting symptom is what many patients call “brain zaps,” which feel like electric shocks traveling up and down their spine or in their brain, Girgis and Saltz said. Symptoms typically last from a few weeks to six months.
But there are also “hundreds of thousands of people who are suffering from something called protracted withdrawal” for years or decades, which may translate to up to 10% of long-term antidepressant users, Witt-Doerring said. Some of these people go into acute withdrawal that also entails ear ringing, light sensitivity, digestive problems, severe anxiety and cognitive impairment.
“Multiple people have taken their life because the symptoms from this can be so extreme it can drive people to suicide,” Witt-Doerring said.
Otherwise, you cannot die from antidepressant withdrawal, other experts said.
Some of those experiencing such symptoms mobilized, leading the United Kingdom’s National Health Service to add “protracted withdrawal” to its database of official medical terms in 2023. As a result, doctors can make a record of patients experiencing it and better collect information on symptoms and treatment. The NHS also founded a deprescribing clinic to help patients quit antidepressants safely.
Why some people experience withdrawal while others don’t is unknown, but there are a few solid predictors, experts said. All degrees of withdrawal typically occur when someone who has been on an antidepressant for at least several months abruptly or quickly stops taking it. It’s all too common for patients to decide they no longer want to take medication, then do so without talking to their doctors. How high the dose of the medication was also matters.
But providers tapering patients too quickly — within just one to three months — is also a regular occurrence, Witt-Doerring said. Some people may do OK with this method depending on how long they were on a medication, but Witt-Doerring thinks it’s best to taper gradually over nine to 18 months, which is rare, he said.
There may also be genetic or biological factors making people extraordinarily sensitive, which can’t be predicted, Witt-Doerring said. But most people can come off antidepressants without trouble if it’s done right, he added.
Saltz said that she wouldn’t “argue with RFK Jr. or anybody else” that quitting antidepressants is always a perfect experience, but that “comparing it to illegal drug use withdrawal is not a fair comparison physiologically, psychologically or in the summation of those two things in terms of the impact on your life and well-being.”
If you’re apprehensive about taking antidepressants due to worries about what could happen if you decide later to quit them, know that “you cannot know whether or not you’re going to benefit without trying, and there’s not a lot of risk in trying,” Humphreys said. “I would err on the side of trying, because depression is a rotten experience.”
That antidepressants don’t work for everyone or that the first one you try may not work for you is also true, he added. Try to be patient and make note of any adverse reactions you can share with a medical professional.
“The reality is that for some people, these are lifesaving medications — literally, they keep them from killing themselves or harming themselves. Or maybe they wouldn’t kill themselves, but they would destroy their lives,” Saltz said.
If you’re already taking antidepressants and want to quit, experts said, only do so under the guidance of your prescribing physician.
Editor’s note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide & Crisis Lifeline by dialing 988 to connect with a trained counselor, or visit the 988 Lifeline website.
