Well good for the Daily Mail to call a spade a spade, but really it would be preferable if a slightly more up-market mainstream publishing outlet were also broadcasting this issue in some way. Still we shouldn't be choosy about who is taking the time to get this out before the public. It needs to be shouted from the rafters in any and all ways possible. This is a public health issue of enormous proportions and it's bankrupting and breaking health care systems of all stripes around the world. I think addiction to legal substances long ago surpassed illegal drugs as a problem although few observers recognize it and the people who are in a position to do research don't really care or want to know.

the company hid the fact that Paxil (Seroxat in the UK) was addictive.

... Paxil, Seroxat and Aropax.
These are the three names paroxetine is sold around the world.
I don't understand why they have to change the name.
Perhaps in order we have to open the parenthesis:
Seroxat (Paxil in US and Aropax in some countries...)
Could you please not do it again GSK?
Some people have cognitive impairments because of Paxil (Seroxat in UK and Aropax in some countries...) and it's of great help to save some bits and bites.
Thank you!

I'm not surprised with the number of people addicted to these drugs.
Benzos are sold since the 70ies and people use painkillers to cope with some situations.
Antidepressants will be he next... I hope...
I cannot hope because for sure the next drug that people will insist they are addicted, although they are surely not, are antipsychotics.

I just think it's ridiculous how the pharma's and the doctors get away with it. Both keep passing blame back and forth. Both are to blame, the doctors should be boycotting the pharmaceutical companies. None of Glaxo's drugs should be on sale. If you can't trust them to be honest with one drug then they cannot be trusted with the information they provide on any of their drugs. They have lied and deceived and they will keep passing blame as long as they can so as not to take responsibility!

The whole situation is a diabolical farce and would be hilarious if it was not such a serious issue. People's lives are at stake here, and the medical community and drug industry continue their game of "pass the psych drug time bomb" parcel!

Utterly shameful ...

As much as I do not want to reply in the comments section, to educate readers who are interested in the definitions here, I offer this clarification:

Dependency is when the use of a substance causes physiological need, and the responses of tolerance and withdrawal will occur as use continues. Tolerance means there is need for a higher amount of the substance to get the same effect, and withdrawal means there will be at least uncomfortable, if not dire physiological responses when the substance is discontinued, usually abruptly. There is argument to the role of psychological responses in withdrawal, but the risk of lethality is minimal in my opinion and experience.

Addiction includes the above, but this term also infers there is a primary or secondary gain to the use of the substance, usually to feel psychological alterations that are seen as euphoric, mind altering, "high", escape from reality, you call it what you want.

As examples: propranolol is a beta blocker used for treating hypertension, heart arrythmias, and for psychological application, situation anxiety like public speaking. Put someone on more than 160mg a day for months and then stop it abruptly, that could induce withdrawal symptoms that could be life threatening depending on the patient's medical issues; I have also seen some tolerance effects with it, but not too dramatic overall. Now let's look at benzodiazepines, like alprazolam (xanax) as a second example: put someone on 1.5 or more a day for a month or more and then stop it, and you will most likely see withdrawal, not so much a risk for lethality, depending on the daily dose used, but misery is guaranteed. Tolerance? With people who's only agenda is to abuse it, definitely. I have seen people go from 1mg a day to greater than 10mg a day in a week.

So, is propranolol as bad as alprazolam? From a strictly physiological point of view, yes, it could be. Have I seen someone "addicted" to propranolol? Not in my clinical travels.

So, to relate it back to this posting: antidepressants are not drugs of addiction, but yes, they can be drugs of dependency. The way I read this posting, I do not agree they can be included with the other groups. Is a psychiatrist being careless to prescribe SSRIs to patients without discussing dependency as a possible risk factor? I would say yes on the whole. Is a psychiatrist feeding addiction by prescribing these meds? No, I do not.

My advice: if you use terms loosely, be prepared to be called on it. If you want to provide vignettes that show an abuse potential with antidepressants, I am more than willing to read and accept them as examples.

Haven't read one yet, though.

For those of you who want to go at it with my comment, enjoy. Well read readers will see through falsehoods.

Just an opinion: but one of experience.

I agree with you therapyfirst, and had the same reaction about the conflation of addiction with dependency. I usually feel like a nitpicking pedant around here and have learned to shrug off inaccuracies to avoid conflict, but have to say I appreciate the effort in making significant distinctions, and this one doesn't detract from the message of the OP, which is always a treat.

TF,

To digress, you don't understand why FS readers get upset with your posts. Well, telling people to be prepared to be called on the use of a term and calling things falsehoods comes across as very arrogant even if that wasn't your intention.

You seem to realize what you're doing when you say, "for those of you who want to go at it with my comment, enjoy" Why would you say that otherwise?

Back on topic - You said "Addiction includes the above, but this term also infers there is a primary or secondary gain to the use of the substance, usually to feel psychological alterations that are seen as euphoric, mind altering, "high", escape from reality, you call it what you want."

As one who is experiencing horrific withdrawal symptoms from
reducing Remeron, my primary gain from use of the substance such as going back to the previous does would be to not feel withdrawal symptoms. Seems like that makes these drugs addictive.

Also, many psychiatrists take their patients off of benzos due to the addictive nature. It has nothing to do with them wanting to escape from something. So many of your colleagues would disagree.

Finally, even if you are right, how is your post helping those of us who are suffering horribly from these withdrawal symptoms? As one of those folks who is suffering in spite of only cutting 5% from the last dose, I really could care less what the true definition of addiction is. Please stop focusing on what I feel are smokescreen issues and start showing an understanding of what we have been through. Maybe then, you'll start receiving more positive comments.

Dependency/addiction -- really I do not see that much difference. If you want to nitpick go right ahead. Sure maybe patients don't experience a craving for increased doses of SSRIs, at least in an obvious way, although they certainly do experience "poop out" but stopping is sure as heck at least as dangerous as stopping some addictive (in the traditional sense) drug. In fact one can go "cold turkey" on illegal substances more safely than medication -- so I call that addiction. You can call it dependency. Whatever you call it it's a public health problem of epidemic proportions. Especially when the addiction/dependency is involuntary and unanticipated.

Just a personal story re: benzos

I've been taking Xanax for 9 years and have been recently tapering off of it. It has taken 3 solid months for my body to stop feeling withdrawals after tapering down .5mg from the 1.5mg I was taking. The withdrawals are sheer hell, like riding out a massive storm, with no mental dependence, it was all physical symptoms, and then what shocked me was a severe depressive episode that felt like nothing I ever felt before.

The taper of .5mg was so hard to deal with I stopped the taper and will not continue it until I know I can deal with that loss of time from my life again.

TF, I am always amused that docs like you try to refine terms away from their common usage so that things will be softened how and you can preserve your right to prescribe these drugs. addiction, dependence, whatever. it all leads to the same bogus place

I wouldn't exactly classify antidepressants as addictive, either, but they do create dependence.

But, as others have said whether you want to call it addiction or dependence makes no difference to me. What matters to me is that patients be told prior to ever ingesting these pills about the probability of dependence & that this may lead to a hellacious withdrawal. I have yet to talk to anyone who had a psychiatrist discuss with them the dependence potential PRIOR to handing out the script. Wouldn't it be nice if that happened & then the patient could make an informed decision?

In US dictionaries the terms are synonyms, have roots in different languages so there are bound to be some etyological differences.

Addiction is described as the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming to such an extent that its cessation causes severe trauma.

Dependency incorporates the concept of developing tolerance in addition to habitual formation. It also has other soft or benign contextual meanings which contrasts with societal connotations of addiction.

Addiction is used when an emotive response is desired, dependence when it is not.

That's my take.

TF - What would you call this?: I take Seroquel and luckily since it is so debilitatingly mind alreting (sedating to the point of non-functioning) I have only taken it at night, BUT I start jonesing for my nightly dose if I wait to late just as bad as I do for an oxycontin when I'm using opiates. I get not only a ceratin amount of "control" over my Bipolar Symptoms from the Seroquel but also that "secondary gain" of being able to get loaded out of my mind each night so that the worries of the day fade to black. I quite enjoy that effect. Also, I can not quit the stuff no matter how many times I have wanted to. I've gained a lot of wieght 75pounds, and have become waaaaay too apathetic on the stuff, PLUS it's triggered me into becoming more and more easily lulled into using opiates and going thru that cycle many more times than I believe I would have without the drug, so I have good reason to want to quit... I just haven't been able to step down my dose for long befor I start getting depressed and such, sort of like when you try to taper of opiates EXCEPT I have found quitting opiates EASIER than quitting seroquel. So would that be addiction?, because I DO feel enslaved to the drug cause I can not quit it, or would it be dependancy?

Definately I think ANY drug can cause addiction because people are different and there is bound to be someone who tries any drug and ends up having some wierd euphoric or other enjoyable reaction to it and becomes addicted.... some drugs just don't as easily physicaly re-inforce that addiciton with bad withdrawal syndromes, so maybe these people don't get noticed due to the ease of quitting the drug physiologicaly when they realize they have a problem.

Neato though that Seroquel just happens to be more physiologicaly addictive, with a worse withdrawal syndrome in, my case (I've missed doses and it is HORRIBLE) than even my quitting a 180mg oxycontin habbit over the course of two weeks. Then again I am a freak of nature because I can quit opiates and benzo quite easily without much suffering, yet SSRIs and seroquel, your "non-addictive" psych meds have been LIVNG HELLS when I have quit or missed doses.

People really should be warned ahead of time that these drugs can cause WD syndromes worse than opiates and benzos, so they can think twice about wether or not thier depression is really that bad.

BipolarBunny,
I was on 600 mg of Seroquel. I could only withdraw 400 mg.

So I take 200 mg at night.
What do you feel if you miss a dose?
If I miss this pill I feel as if I was going to loose my mind.
I've tapered off Efexor for 2 (two) years. Yep! Two years... when I reached the end of the process I had to go back to the drug.
I was put on many drugs because I've searched for psychiatric help to withdraw Klonopin that I was prescribed and used it for a long time.
I still take 2 mg Klonopin.
Dependence, addiction... use the name you want.
But I will have to take these drugs... for the rest of my life because I could not withdraw.
If I miss the morning Effexor I have nightmares.

Oh come on, quoting the Daily Mail? If they're writing about it, it's practically guaranteed to be scaremongering of the first order.

Antidepressants alter physical processes; of course there are adjustment effects if you stop taking them, as with any drug taken habitually. But for most people, these are minor and short term. Cases with severe problems are unusual.

Yes, the industry would do well to acknowledge and support those people.

But to write as if antidepressants carry the same risk of severe problems as some other drugs seems to me irresponsible: it can put people off trying meds that on balance are more likely to help than harm them.

Above commenters are quite correct in the way they make the distinction between addiction and dependence, but I think it absolutely is pedantic: the story here is about the huge percentage of people who are STUCK on psych drugs. A major factor in creating this sorry state is that pharma companies and psychiatrists loudly claim that the drugs are "not addictive," knowing full well that the public takes "not addictive" to mean that they don't have to worry about getting STUCK on it.

While there is an important distinction between drugs that will make people miserable when they try to reduce the dose and drugs that will lead people to prostitute themselves to get more of, but the difference between the meaning of the words "addicted" and "dependent" only exists in their technical senses: my dictionary defines "addicted" as "dependent on a particular substance and unable to stop taking it without incurring adverse effects."

Zoologists could claim that tigers aren't dangerous if they started defining the word "dangerous" in some technical sense that wouldn't apply to tigers, and then they could berate the public's ignorance after people got mauled.

I think that the 'clarification' that the drugs don't cause 'addiction,' they just cause 'dependency' really only serves to obscure the true risks and make it even more impossible to accurately weigh the risks vs. benefits.

Pedants need love too. The defensive responses seem gratuitous, since therapyfirst and me didn't take anything away, seems to me we enlarged the pool of understanding.

It's a matter of a person's relationship to language, some take satisfaction in precision, exploration and the sheer pleasure in the playground of ideas, which may not be for everyone but is welcomed at this blog, based as it is on a story by Raymond Carver.

Addiction and dependency are 2 real things and showing respect for the body of scholarship that gave us understanding about their similarities and differences is something. And so is disdaining the pursuit of knowledge. I'd like to know what people are defending.

Flawedplan:

AMEN! thank you for your support and well spoken ways.

therapyfirst

Flawed Plan,

Even though I am sure your intentions were not malicious, calling people's responses pedantic and gratuitous does nothing to add to the discussion and show a lack of respect for people. No one in their response who objected to this discussion resorted to name calling so please refrain from doing that.

As the daugher of a recently deceased mother who was an English major, I understand what you're saying. Judging from the well written posts on this blog, my guess is that other people have the same understanding.

But when you are suffering terribly from an issue in which the support from medical professional is near zilch, the last thing you want to read from someone like TF is an argument about what is an addiction and what isn't. If she had expressed some compassion for what we were going through, than that would be a different story. But she didn't.

Let me ask you the same question I asked TF which she avoided answering. How does this discussion on what is an addiction help advance the cause in getting doctors to understand true withdrawal issues so they quit doing things like tapering patients too quickly?

To AA and the rest who have been fairly hostile and rigid in discussions:

I decided to break my committment to not be involved in these threads after Philip made comments in this posting that only reinforces a misconception about addiction versus dependency.

As far as I am concerned, I am tired of the projection and rationalizations by the core of the group that roams here, and I see no benefit to engage in an alleged effort to debate when the retorts by many of you only overgeneralize and diminish honest efforts on my end to present a different viewpoint from what are unfortunately pathetic mainstream psychiatric services that suck for most these days. You do not have to agree with what I have offered, but the responses have often not only shouted me down but come across as having an expertise that gives their position equal or greater value to what I note as a board certified psychiatrist.

Well, from what I have gleened from the writings here for the long three months I had participated, I do not sense any of my protagonists are clinically trained professionals. Being patients or family members of patients gives experience, but for the sake of a quick analogy thought of while writing, if you have had several surgeries, does that make you an expert in surgery? The answer is no. You have a valid experience to provide opinion and debate to further interventions, but not to dictate the treatment process. That is where a lot of you fail in presenting yourselves as valid dissenters in this dialogue. You are not experts in clinical care, just well experienced people. It was interesting how even Dr Carlat was somewhat rudely dimissed in an earlier posting when he was doing what I thought I was offering when I first started here in June.

So, to you specifically AA, I am a man, and I would dialogue if asked to clarify or detail further if it was done to promote discussion, not defense. I stand by what I wrote at the beginning of this thread; I did not expect most of the readers to like it or accept it, but my target audience are the silent readers, who I know come here as this site has been given validity from other sites that promote dialogue and discussion, not rants and mob assembly.

I am sorry to Philip to forward this comment, but I just don't get your "choir" when you report such important information that might be even stronger if these threads offer more than just the daily bash fests how psychiatry is so evil and wrong. Another analogy: if someone generalized that blog sites are just extremist soundboards and advised readers to ignore them, wouldn't that piss you off?

I hope you as the group that frequent this site are forwarding as much fact and detail to Grassley's committee so his investigations will hopefully have an impact on ending inappropriate behaviors and actions by those guilty of malpractice and malfeasance. Then you are making a difference.

By the way, philip, I advised Dr Carlat to read your recent posting on Lilly's financial corrupting of the APA and others, so I try to spread the word. Maybe he knows this already.

To conclude, my mistake for showing an interest and trying to help. For those of you who know so much more, sorry to waste your time and energy. Just remember, if I make comments in the future, I speak to the readers who are looking for debate. I hope you will ignore me if I am not a valid resource to you, and if there are facts and documentations to your opposing viewpoints to share further, you will offer them for those silent readers to seek and digest.

Perhaps the irony at the end here is what is addiction versus dependency in being involved in the blog process. If Stephany reads this, isn't it fitting that my first protagonist, Supremacy Claus, challenged me at Dr C's site I would come back because "you're addicted". Maybe; I would agree at least dependent. The withdrawal to just stop reading is a bitch!

Have a nice weekend.

Yes, TF I remember supremacy claus.

Reading blogs like this are an interactive news source; I mean where else can we talk back to the news article and have someone else respond? hah, the first thing I do when I turn on the comp is check this site, often before I check mine for comments.

Hands down it's the best site around and the mayhem that comes with it in the comment section is part of the popularity.

All in all I think we are all interacting pretty good. Families squabble, round table discussions are exciting.

I love the diversity and appreciate the differences we all have, because as Philip wrote before, we all come here in agreement of one thing: psychiatry and the industry needs tweaking!

I think it's good to hear from everyone's viewpoint, and frankly I'd never thought about addition and dependency before.

So it allowed me to look at my Xanax experience and say, yeah the withdrawals are definitely physical symptoms, but that's just my own personal experience.

TF your specialty is duel diagnoses if I remember correctly, so your input is valuable in this discussion.

I also appreciate the stories every one tells, anecdotal stories are extremely important and therapeutic to know others have been in the same situation.

So this site is also therapeutic in many ways, besides a learning tool.

Sorry this got off topic!

The hell? No, you don't understand what I said, AA.

Even though I am sure your intentions were not malicious, calling people's responses pedantic and gratuitous does nothing to add to the discussion and show a lack of respect for people

I was clearly referring to myself as the pedant. And yet managed not to melt into a puddle of tears.

Your entire comment above, is it gratuitous or not? What, quoting you, did your scolding of me personally add to discussion and show vis a vis respect? Gah.

TF, my apologies for the gender mixup.

Not to belabor the points but personally attacking someone by calling them hostile and rigid adds nothing to the discussion. I never attacked you personally nor did I bash psychiatry so that is completely unwarranted. I did object to what you said but that is a big difference and I am surprised that someone with your credentials doesn't understand the difference.

TF, what do you know about compound pharmacies and .001g digital scales for the purpose of tapering off of meds? That is a serious question by the way and is not meant to come across as being hostile. I am just trying to make a point.

I have never disputed that there is a technical difference between dependency and addiction but none of the commenters here who belabor the distinction have really addressed the difference it makes clinically to a person trying to stop a drug that causes one or the other.

Flawed Plan,

Let's try again ok? My apologies for any misunderstandings on my part. I am not saying that to be flippant but I am just too tired to go back and review who said what. But obviously, Judging by your response, I blew it somewhere and I apologize.


.

The issue I was trying to raise but didn't do a good job of doing is that even if you appreciate the differences in the English Language, that when you are sufferering withdrawal symptoms, it really don't matter if what you are suffering is withdrawal vs. addiction. My only question is what are you going to to help with the sufferening?

I haven't read your blog too thoroughly so forgive me if I am falsely leaving you out of the discussion as my memory is poor. But many people, including me have gotten no help from their psychiatrists/doctors with withdrawal symptoms. We have been on our own. That is why we reacted negatively to this discussion.

Withdrawal aside, think of a situation that upset the living daylights out of you. Would you want someone to tell you you were using a word wrong if that came up in your discussion?
Peace?

AA

Hey, I love pedants as much as anyone. (Nit-pickers I admire from afar.) I was going to write to expand on the idea that linguistic distinctions can clarify the truth but can also be used to muddy the waters. I think that would be interesting to discuss, and germane because I see that later happening a lot in psychiatry.

But then I read TF's last post, and now I can't stop laughing. He writes indignantly that the responses to his posts "come across as having an expertise that gives their position equal or greater value to what I note as a board certified psychiatrist."

He's here to school us non-board-certified yokels, and if we don't accept that our views have a lesser value than his, he'll do his best to construe them that way with constant whining that those who dare to try to debate him from an equal footing are just a mob of rigid, psychiatrist-hating group-thinkers.

Too funny.

My own experience:

Re: educating people? my psych has been educated by me via details on how exactly withdrawals from Seroquel (HELL)and Xanax went. He's taking notes and at my prompting, telling other patients what can happen if they (especially go cold turkey off Seroquel like I did).Being open-minded to patients and symptoms is completely necessary.

He was familiar with Xanax causing withdrawals,because they are what most ppl complain about.

It's the new age junkie they need to learn about, for example, my experience removing Seroquel was beyond horrific, to my shock, I totally believe the brain gets addicted to these drugs, not the person.

There is just no denying withdrawals exist, the brain zaps and sparks shooting from the numb fingers, diarrhea,vomiting, sweats and insomnia?

THAT is not mental dependency. (just my experience). Seroquel is just like Xanax as far as brain addiction, it's like a benzo withdrawal hands down.

My number one search that hits my blog every single day 24 hours a day is "seroquel withdrawals".

I've tapered Prozac, Zyprexa, Trazodone, Xanax, and Seroquel and ALL of them had withdrawals that were the same hell.

Stephany, I'm encouraged when I read that your psychiatrist is making an effort to understand what your withdrawals have been like rather dismissing the effects as mental illness. Support and empathy are so very important. I don't know that I would have made it through without my therapist - she's been an incredible source of support.

When I was dealing with the withdrawals from Effexor I remember wanting to bang my head against the wall to try to stop those awful brain zaps. I felt like electrical currents were short circuiting in my brain. I didn't know what was happening, and I didn't know if it would ever stop. It would be bad enough to deal with vomiting, diarrhea, insomnia, increased anxiety, brain zaps, etc. without depression - but trying to deal with all of that in the midst of depression is terrible. My support to all who are going through this.

I remember how relieved I was when I first found the websites where I read of people attempting to withdraw off of Effexor - up until that time I thought I was all alone in what I had experienced.

I really wish my doctor had warned me about this.

Yes, AA, peace, bless your sweet heart. Christ I don't even know who's side I'm on anymore but as for this -

My only question is what are you going to to help with the sufferening?

I laugh at it, don't know about you but I think I have a right to laugh at suffering, gallows humor being one of its perks.

Stephany, I am so glad you had a good pdoc. I am jealous! Unfortunately my experiences with drug withdrawals seem to echo Lisa's.

Every Pdoc I have ever seen in the 23 years since I was first diagnosed, has told me to quit the drugs COLD TURKEY!

If I complained of side effects, they told me to "buck up" and only seemed to care if I got dehydrated (which I did a lot) and then it was a trip to the emergency room to get hydrated again. The only doctor who seemed to give a hoot was when I went on Lamictal and developed the rash.

My own vet is more interested in my cat's health than the charlatans I have seen that have psychiatry diplomas in their office.What does that say for them?

I am so grateful to have found this site. I am grateful for the commenters on it. And I am so grateful for the collection of hyperlinks on it I have learned a lot since I got out of the hospital. It's been a real eye opener. Of course I don't agree with everything everyone writes, (that would be ridiculous) but I am gleaning a lot of information which is essential to my recovery, and taking it back from the big pharma pushing doctors I seem to keep encountering.

And for that I truly feel blessed.

Lisa,
It must have been terrible feeling Effexor withdrawal symptoms without knowing.
I have also tapered Seroquel Stephany and this is hell.

Effexor -

first I was over drugged on this and then another drug was added-I ended up in hos for 5 days-terrilbe withdraw sympotoms-it took me 6 months too feel more like myself-I also got into rages etc and thats just not me-

Addicts are starting too use Seroquel in NZ now-off the street-thats saying some-thing suree. As for ssri's-I cant see me ever coming off them-christ-I would rather come of methadome again than try too kick a SSRI-

In NZ they"re giving out Seroquel 4 every thing possible-drugging old ppls in homes-kids-
they say its -better-than benzos-I dont think so-theres a Bash the Benzos trend here I find Terrifying -

Ppls with out psy issues being given seroquel -not being told that its an anti-psycotic etc just that its not Addictive like the old drugs and it will help you sleep.

Wow -thats one of its main selling points here-