🧠 Understanding the Difference Between Dependence, Tolerance, and Responsible Use

One of the most common concerns that patients and families voice during psychiatric consultations is this:

“Doctor, will I get addicted to these tablets?”
“What if I can’t stop them later?”

These fears are understandable. In a society where mental health still carries stigma, the idea of being “dependent on tablets” is often misunderstood. In reality, most psychiatric medications are not addictive, and the concept of dependence is often confused with long-term use or withdrawal effects.

Let’s explore what the research says, and how you can confidently use your medications without fear of becoming “dependent” in the way many people imagine.

🔍 Understanding the Terms: Addiction vs. Dependence vs. Tolerance

• Addiction involves a psychological craving, compulsive use, and continued use despite harm. It is often associated with pleasure-seeking substances like alcohol, nicotine, or opioids.

• Dependence means the body has adapted to the substance, and withdrawal symptoms occur if it’s stopped suddenly.

• Tolerance means over time, the body may need higher doses to get the same effect.

👉 Most antidepressants, antipsychotics, and mood stabilizers do not cause addiction, dependence, or tolerance in the same way as addictive substances do.

💊 What Does the Research Say?

1. Antidepressants are not addictive.
   According to the Royal College of Psychiatrists and the American Psychiatric Association, SSRIs and SNRIs do not cause addiction because they don’t create cravings or euphoria. However, some patients may experience discontinuation symptoms like dizziness, flu-like symptoms, or mood swings when stopped abruptly. These are not signs of addiction, but rather a signal to taper slowly.

2. Antipsychotics and mood stabilizers do not lead to substance dependence.
   Long-term use of medications like risperidone, olanzapine, lithium, or valproate has not been shown to cause addiction. In fact, stopping them too early increases the risk of relapse in conditions like schizophrenia and bipolar disorder (Leucht et al., Lancet, 2012).

3. Benzodiazepines and sleeping pills need caution.
   These are the only psychiatric drugs with a known potential for physical dependence if used beyond 2–4 weeks. That’s why they are:

   • Prescribed for short-term relief (e.g., severe anxiety, insomnia)

   • Carefully tapered or replaced with safer alternatives like SSRIs or CBT

4. Psychological dependence on medication is rare but can happen.
   Some individuals may feel they can’t function without the medication even when it’s no longer needed. This can be addressed through therapy, psychoeducation, and gradual weaning.

🛡️ When Long-Term Use is Necessary

Just like someone with diabetes might need lifelong insulin, some psychiatric conditions (like bipolar disorder, schizophrenia, or recurrent depression) require maintenance treatment to keep symptoms under control. Continuing medication in such cases is a form of self-care, not dependence.

💬 As a 2016 meta-analysis in The Lancet Psychiatry noted, long-term antidepressant use significantly reduces relapse rates, especially in people with two or more prior episodes of depression.

✅ How to Use Psychiatric Medications Responsibly

• Be honest with your doctor about fears and expectations

• Don’t stop medications abruptly—taper gradually under supervision

• Avoid self-medication or dosage changes

• Combine with therapy when possible for better long-term results

• Monitor for side effects and have regular follow-ups

🧠 Final Thoughts

You are not weak for needing medication. Just as no one feels ashamed to take tablets for thyroid or hypertension, there’s no reason to feel ashamed of psychiatric treatment. What matters is feeling better, functioning better, and leading a life with clarity and confidence.

Taking psychiatric medication doesn’t make you dependent — it helps you regain control.

Dr. Srinivas Rajkumar T
Consultant Psychiatrist
📍 Apollo Clinic, Velachery & Tambaram
📞 85951 55808