Addiction and withdrawal

Am I addicted to my medication?

This page should help you to understand the difference between being addicted to a drug, and taking a medication that isn’t addictive, but shouldn’t be stopped suddenly.

People often worry that they are going to get addicted to their medication. Especially when they are told that they shouldn’t stop their medication suddenly.

Usually, you shouldn’t stop your medication suddenly because you may get extra side effects called a ‘discontinuation reaction’, not because you are addicted.

So what is the difference between addiction and withdrawal, and a discontinuation reaction? How can we define Addiction?

How can we define Addiction?

Addiction can occur when someone repeatedly uses or misuses certain substances (which can include prescribed medication) over a period of time.

Addiction is not having control over doing, taking or using something harmful. As well as drugs and alcohol, a person can become addicted to activities as well (eg gambling).

What does being addicted to a drug mean in real life?

You have a strong desire or craving to keep taking the drug when the last dose "wears off"
Taking the substance gives you a "reward" (e.g. a good feeling). Drugs that people can become addicted to (or dependent on) if they take them regularly include;
Nicotine - increases dopamine in parts of the reward system by up to 8 times normal levels
Alcohol- acts on several different systems in the brain and boosts the activity of GABA and dopamine
Benzodiazepines (to help you sleep or for anxiety)- boost the activity of GABA in the brain
You find it difficult not to keep taking the drug- even if you know that it is making you unwell
You find you need more and more drug to get the same effect as time goes on (you develop a tolerance to the drug)
You make the opportunity to take the drug more important that other activities in your life (such as meeting and going out with friends)
You will experience withdrawal symptoms if you stop taking the drug (sometimes withdrawal symptoms will occur if you reduce the amount of the drug you are taking too)

Withdrawal symptoms are what you feel if you stop an addictive drug suddenly

Withdrawal symptoms are unpleasant, nasty or uncomfortable effects that can happen if you stop an addictive substance or drug quickly.

Withdrawal symptoms can occur with some medicines prescribed by your doctor (for example morphine-like pain killers or benzodiazepines) if you have been taking them for a long period of time and stop them suddenly.

Other medicines (such as antidepressants or antipsychotics) can also make you feel unwell if you stop them suddenly. However, these medicines are not thought to be addictive. This is why the symptoms you may get when stopping them are called a ‘discontinuation reaction’ instead of ‘withdrawal symptoms’. For more information go to ‘Stopping medication and discontinuation reactions’.

Withdrawal symptoms occur because your brain gets used to and adapts to a drug or alcohol being present. If you have been taking a drug or drinking alcohol regularly and suddenly stop the body has to get used to it not being around anymore, and you will experience ‘withdrawal symptoms’. The type of symptoms and when they occur can differ depending on which drug you were taking.

These can make stopping a drug very hard (even if you want to) because as well as craving the drug you are also likely to experience withdrawal symptoms. It can be tough to break the cycle!

Withdrawal symptoms may only be mild and not last long, but they can be very severe and dangerous. If you have taken bigger and bigger amounts of a drug over a long period of time the symptoms are more likely to be worse. This is why it is always important to seek help and support on how to reduce and stop taking drugs safely.

So, what about Discontinuation Reactions – why are they different?

Stopping Medication and discontinuation reactions:

If your medication has worked well and helped you to get better, that’s great news- but don’t be in a rush to stop it!

No one wants to take medicine for longer than they need to- but stopping medicine too soon or too quickly can cause unpleasant symptoms and may increase your risk of becoming unwell again in the future.

It may be helpful to compare this to riding in a car- and you want to get out. If the car stops suddenly or you open a door and jump out while it is still moving, it will hurt and could be very dangerous. It is much better for the car to slow down gradually and stop so you can get out safely.

The same is true when stopping medicines. Treat yourself and your brain with respect. The medicine has an effect on your brain- which is why it helped you to get better…....so stopping your medicine gradually gives the brain time to adjust.

A ‘discontinuation reaction’ or ‘discontinuation symptoms’ describes the symptoms which you may get when a medication (which is not an addictive drug) is stopped suddenly. Discontinuation symptoms may also occur if the dose of medication is reduced, or if doses of medication are missed.

This is true for many drugs - including general medical drugs e.g. treatments for high blood pressure (where the high blood pressure can get worse if the medication is stopped suddenly). A younger relative of mine recently suffered "withdrawal symptoms" such as irritability, anger, tearfulness, poor sleep, change in appetite and frustration. Not from a drug, but 2 weeks without the internet in her flat. Imagine suddenly not having music, a mobile phone, computer, television or even glasses? The internet isn’t addictive, you just miss it if it isn’t there.

What Discontinuation Symptoms could I get from Antidepressant medicines?

If you are taking an antidepressant medication (e.g. fluoxetine) to help you recover from depression it is recommended that you continue to take it for at least 6 months after your feel completely better. This is important because if your medication has worked well, stopping it too soon can increases the risk of your depression coming back.

(If you are prescribed an antidepressant medication for a different reason, e.g. to help with anxiety or obsessive compulsive symptoms, you may need to continue the medication for longer).

If you want to reduce or stop your medicine, it is always important to discuss this with your doctor first. When you do stop your antidepressant medication it is best to do this gradually rather than stopping it suddenly. Current guidance recommends gradually reducing and stopping medication over at least 6 weeks.

Stopping medication gradually increases the changes of you staying well in the future and may help to reduce or stop any discontinuation symptoms.

Antidepressants are not addictive, but if you have taken them eight weeks or more it is possible that you may experience a "discontinuation reaction" if you stop them suddenly. Unlike drugs of addiction, people do not get cravings to take antidepressant medicines (such as fluoxetine), although restarting medication (that was stopped suddenly) can help to stop “discontinuation symptoms”.

If you stop taking an antidepressant suddenly after taking it regularly for 8 weeks or more it you may get symptoms which make you feel unwell. These include:

Feeling anxious, annoyed or restless
Feeling flat, anxious and tearful (but some people report feeling excitable and jittery)
Dizziness
Unsteadiness (like being on board a boat)
Tiredness, feeling weak and no interest in doing things, difficulty in concentrating
Feeling sick (and rarely being sick)
Stomach pain and diarrhoea
'Electric shock’ like sensations
Runny nose
Sweating more

These symptoms are more likely to occur with medicines such as venlafaxine and paroxetine, but can after stopping any antidepressant, even fluoxetine.

Some of these symptoms may feel the same as you felt when you were unwell. This can be very upsetting and frightening. However- if you get these symptoms within a few days of stopping your medication, this is your body adjusting to you not taking the medication anymore and not because you are getting unwell again.

If you get any of these symptoms (and not everyone does) they are usually mild and only last for 1 to 2 weeks, but sometimes they can be quite bad or last for a long time. If you are worried or find it difficult to cope with any symptoms you get it is important to talk to your doctor.

Gradually reducing and stopping medication over a longer period of time (instead of stopping medication suddenly) will help to prevent these symptoms occurring.

What Discontinuation Symptoms could I get from Antipsychotic medicines?

If you are taking an antipsychotic medication (e.g. risperidone) to help you recover from an episode of psychosis, it is recommended that you continue to take it for at least 1 to 2 years after your feel completely better.

When you do stop your antipsychotic medication it is best to do this gradually rather than stopping it suddenly. Stopping medication gradually increases the changes of you staying well in the future; the number of people becoming ill again within 6 months of stopping medicine doubled if medication was stopped suddenly instead of being gradually reduced over at least 3 weeks.

Antipsychotics are not addictive, but if you have taken them for 8 to 12 weeks or more it is possible that you may experience a "discontinuation reaction" if you stop them suddenly. Unlike drugs of addiction, people do not get cravings to take antipsychotic medicines (like risperidone), although restarting medication (that was stopped suddenly) may help.

If you stop taking an antipsychotic medicine suddenly after taking it regularly over at least 8 to 12 weeks, you may get symptoms which will make you feel unwell. These include:

Feeling anxious, annoyed or agitated
Feeling more awake and restless
Not getting a good night’s sleep
Movement disorders- not being in control of all the movements your muscles make so parts of your body may move when you are not expecting it
Sweating more
Feeling sick or being sick
General feeling of feeling physically unwell
Rebound in symptoms you were taking the medication to stop

If you get any of these symptoms (and not everyone does) they are usually mild and usually only last for around 2 weeks, but sometimes they can be quite bad or last for a long time. If you are worried or find it difficult to cope with any symptoms you get it is important to talk to your doctor.

So, remember to avoid any Discontinuation Reactions and to avoid your illness coming back again: