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Drug therapy can be used as a short- or long-term intervention for people who experience any level of depression. It is thought to be most useful for people whose depression is mild or moderate – those with severe depression may benefit from other interventions but drugs may also be used.
The table below outlines the types of antidepressant medication that someone may be offered. All have the same aim of reducing or eliminating symptoms of depression but all work in slightly different ways
| Type of antidepressant | How it works |
| Selective serotonin reuptake inhibitors (SSRIs) | This type of drug helps to block the reuptake of serotonin meaning that more is available in the brain to be absorbed. A lack of serotonin is thought to be linked to low mood, as it is a ‘feel-good’ chemical. This is the most commonly prescribed type of antidepressant. |
| Serotonin and noradrenaline reuptake inhibitors (SNRIs) | This drug works in a similar way to SSRIs but prevents the reuptake of both serotonin and noradrenaline, which makes them available for absorption for a longer period of time and thus enhances mood. |
| Monoamine oxidase inhibitors (MAOIs) | This drug prevents the monoamine from working properly, as monoamine breaks down both serotonin and noradrenaline after they have been released. By making it more difficult for monoamine to work, more serotonin and noradrenaline are available and therefore moods should lift. |
| Tricyclics (TCAs) | These are a much older type of drug and prescribed much less commonly than in previous years. They boost the effect of serotonin and noradrenaline and so these chemicals are available in the brain for longer periods; again, this is what lifts the person’s mood once the drugs take effect. |
Drugs as a treatment for addiction
Using drugs as a treatment for addiction (often to drugs) may seem like a strange way of treating the condition but they can be very useful, although this will depend on the actual addiction and its severity.
Treatment of substance addiction
Drugs can be taken to help people when they are experiencing the effects of detoxification, which can be so adverse that people will return to the source of their addiction just to stop them. Many addictive substances such as heroin and alcohol can cause nasty side effects when people stop using them and medication can help to reduce the severity of the side effects, encouraging people to continue to abstain from abuse.
Withdrawal refers to the symptoms that someone experiences when the substance to which they are addicted starts to leave their body. Those who are addicted to drugs may find that they begin to sweat profusely, cannot stop shaking and will have headaches and a serious lack of energy. This makes trying to detoxify very difficult but drugs can help people to reduce these symptoms and thus prevent relapse.
Trying to reduce cravings for a substance can be hard because many people with an addiction will not feel ‘normal’ until they take whatever it is that they are addicted to. Again, medication can be used in order to try and control these cravings, such as naltrexone to prevent cravings for alcohol, and methadone which is used as a substitute for opiates such as heroin. The medication acts in the same way as the substance but without the harmful effects.
If a person with an addiction has another mental health condition, which is very common, drugs may help with the other condition, such as antidepressants, in order to boost overall feelings of well-being, which may motivate the person to prevent relapse.
Treatment of behavioural addiction
Although some behavioural addictions are not recognised as actual addictions by the ICD, this does not mean that they are not as destructive as addictions to other things, such as drugs or alcohol.
Although it is a fairly new way of treating behavioural addiction, medication may be useful, so drugs normally used to treat other addictions are now being used to treat behavioural addictions. For example, naltrexone, commonly used to help with alcohol addiction, is now prescribed for serious gambling problems as the cravings to gamble work in the same way as cravings for alcohol.
SSRIs are thought to be useful in controlling urges to take part in addictive behaviours although it is unclear why they actually help, and research into this continues.
Strengths of drugs for depression and addiction
- Drugs help to stabilise a person’s mood when they have depression so that they are more receptive to other types of treatment, such as therapy, as their motivation and general mood will be better
- Success rates for medication to treat depression are thought to be as high as 60% in some cases (researchers compared this to people who were given a placebo (fake) drug whose success was only up to 30%)
- Naltrexone is thought to be helpful in up to 75% of cases where people are addicted to gambling compared to 24% of people who were given a placebo drug
- Medication may help in the long term because people can stabilise their behaviour, just like with depression, whilst they access other forms of treatment.
Weaknesses of drugs for depression and addiction
- Drugs are not useful in helping to sort out the cause of depression, only the symptoms, so they are not a long-term solution when used by themselves because when someone stops taking them, the symptoms simply return
- Side effects can be a problem and many people stop taking medication as they report that the side effects are actually worse than the symptoms of depression as their quality of life is severely affected
- Tricyclics can be dangerous and are only offered if other types of antidepressant do not prove to be useful
- Evidence for the effectiveness of medication is mixed and therefore we cannot be sure that it is a very useful way of working with addiction
- Giving medication to people who already have addictions to substances is considered to be ethically questionable, with some arguing that it promotes further drug use rather than stopping it.
