List of the best pills for depression in adults and children. Treatment of depression

How to treat the best thing - words or drugs? There are two opinions on this matter. Psychiatrist, Deputy Chief Physician of the Moscow Regional Clinical Psychiatric Hospital, Candidate of Medical Sciences Valery Yakovlevich EVTUSHENKO talks about the pros and cons of antidepressants.

Today, approximately 20 percent of our country's population is at risk of developing depression. Every eighth person experiences depression at least once in their life. Depression is a serious illness. Sooner or later it may go away on its own, which is why many patients do not come to the attention of doctors. Women suffer from depression much more often than men. This is explained by the characteristics of the female psyche, which is more unstable and susceptible to external influences.

Depression. How to treat?

Meanwhile, today medicine has a sufficient amount drugs for treating depression. Now about 100 varieties of them are known in the world. Modern medicines are different from the stimulants that were used in the past for drug treatment of depression- caffeine, morphine, opium preparations. Modern remedies and medications for the treatment of depression They do not give euphoria, but only eliminate a depressed state of mind. They restore normal human activity and perception of life, lost during depression. All antidepressants can be purchased at pharmacies only with a doctor's prescription..

The most common medications to treat depression, so to speak, basic drugs are melipramine and especially amitriptyline. Both are used for typical forms of depression, when a person is in a depressed mood, does not want to move or talk, and all thoughts revolve only around the events that caused the depression.

All new drugs and treatments for depression mainly affect the release of the “pleasure hormone” in the body - serotonin. For these forms of depression, it is clearly not enough. Most interesting Prozac and its varieties. Abroad, it is the No. 1 antidepressant. It gives a very quick effect - it improves vitality and mood literally in the first 3 to 5 days of use. A new drug with a similar effect is Paxil. It has a powerful antidepressant effect, but, unlike Prozac, it begins to act no earlier than after 2 weeks of use. However, its effect is softer and deeper, and most importantly, paxil has far fewer side effects in the treatment of depression in women.

Types of depression

Those types of depression in which motor and speech lethargy predominates are treated with antidepressants with an activating effect, for example drugs of the melipramine group. They have a greater effect on the metabolism of norepinephrine, a hormone that increases motor activity. For the treatment of such depression, very popular drugs are similar to amitriptyline and melipramine, but have a narrower spectrum of action - lerivone and anafranil. They are used for atypical depression, when, in addition to those mentioned, there are also symptoms of causeless anxiety. Such depression can be either hereditary or caused by some experience in early childhood. As a rule, there is no obvious reason for depression in such cases.

Lidiomil used for severe depression accompanied by unreasonable fear, anxiety, mania or obsessions. Not uncommon depression in women in the period before menstruation or during menopause, in older people who are depressed by the futility of existence. In such cases, the new drugs Aurorix and Kaoxil can be used.

In some cases, all of these medications are prescribed simultaneously with tranquilizers. These depression treatments have a calming effect on the nervous system, complementing and enhancing the effects of antidepressants. Amitriptyline is often combined with Relanium, phenazepam or Xanex. Side effects of psychotropic drugs most often depend on the individual characteristics of the patient. When taking amitriptyline, the first thing that occurs is drowsiness. But this is a temporary phenomenon, disappearing on the 5th - 7th day. Antidepressants sometimes cause dry mouth, and women may experience urinary retention. In case of any side effect, you should first adjust the dose of the drug - this will be done by your doctor.

Typical depression, even if left untreated, lasts 4-6 months, then goes away. Self-healing of depression is inherent in its nature. True, there is also depression, lasting for years. It is impossible to condemn a person to such long suffering and deprive him of the opportunity to get out of this state in a short time. Many modern drugs, such as fluoxetine, are specifically designed for the treatment of prolonged forms of depression. Many people blame their long-term depressed state on life circumstances or their character. No matter how effective all medications are, treating depression is still unthinkable without psychotherapy.

A Moscow resident expresses his opinion about antidepressants and the treatment of depression. private psychotherapist, psychiatrist by training Marina Yakovlevna KUKULIEVA.

For several years I worked as a doctor in a psychiatric clinic. And during this time I have not seen a single patient who was completely cured of mental illness with the help of pills.

A person suffering from depression usually has disrupted relationships with the outside world. It is very difficult for him to communicate with people. Antidepressants finally eliminate even a weak desire to communicate with loved ones, with nature, with the whole world.

Any psychotropic drug contains sedatives that affect vitality. Patients live as if in a dream; they are deprived of purposefulness and vitality. After stopping the course of medication, they live in a relatively favorable state of mind. But the feeling of completeness and meaningfulness of life rarely returns to them. This is noted by the patients themselves. True, this no longer worries them, but it begins to bother their relatives and friends.

How long does it take to be treated for depression?

Antidepressants provoke psychological dependence. The course of treatment for depression is usually 1 - 3 months. During this time, the patient has time to get used to the medications. Depression ends, but at the first stressful situation or any experiences you will need the pills again.

The reason I see is that these medications for depression They only temporarily alleviate the patient’s condition, but do not affect the internal source of depression. Any mental disorder requires special emotional contact between the doctor and the patient. Only then is a positive treatment result possible. Psychotherapy seeks to restore a person’s lost need for communication. Helps to understand the reasons that prevent him from living a full life. Negative relationships and impressions left over from childhood, troubles in the family and at work traumatize the psyche. A person wants to forget about them as soon as possible. But they may be the underlying causes of mental pathologies. A person becomes painfully susceptible, he is more susceptible to stress and emotional disorders.

The basis of any depression is, first of all, a secret fear of the world, of the possibility of suffering. The very name of this disease suggests that something is suppressed and muffled in the psyche. If there is pain in the soul, first of all you need to find out its cause. Of course, with the help of antidepressants you can suppress it for a while. But time will pass, and the disease will still manifest itself. And it can get so bad that the pills won’t help.

The process of self-discovery is often painful, and the patient must be prepared for this. Modern psychotherapy has several methods that allow you to look at yourself from the outside, re-evaluate your capabilities and believe in your strength. This allows you to find those positive aspects of existence that are most important for the patient and helps to concentrate all your attention and efforts on them.

The psychotherapist helps the patient to see his hidden capabilities and what hinders their realization in his character, upbringing, opinion of himself and others, determines ways to overcome these obstacles. Of course necessary depression treatment method in each specific case is selected individually.

Physiological reactions of patients, side effects from long-term use of antidepressants can also be very serious. This includes tooth loss, metabolic disorders, obesity, and constant drowsiness. But the main ones are psychological disorders. A person taking such drugs is immediately visible by his external lethargy and indifference to everything around him. This is a way to live an illusory, plant-like life with the help of pills. Without incentive, without purpose, without the necessary activity in overcoming difficulties.

Helps to reveal in the soul what was previously deeply hidden. There is a psychological term for difficult periods of life - “the path in the cold zone.” But, having walked this path consciously, the patient will better know his strengths, get rid of fear and anxiety, and be able to look at himself and life more confidently. And, I think, he will not have the desire to “escape from life” with the help of pills.

Attention site readers! This article is for informational and educational purposes. If you and your relatives, friends and acquaintances have similar problems, then contact a psychiatrist at the psychoneurological dispensary at your place of registration, the emergency room of a psychiatric hospital, or the registry office of the Institute of Psychiatry. We do not diagnose or treat psychiatric diseases! We provide individual psychological counseling services.

This article is informational for general familiarization with the topic of treating depression. If you find similar symptoms in yourself or your loved ones, please contact a psychiatrist or psychotherapist in person at the clinic.

In this article, we want to explain why, in case of depression, seeking emotional support from a psychologist not only does not make sense, but is also dangerous for a person’s well-being. We will also tell you why depression can be treated by a specialist who has studied psychiatry - a psychiatrist or a psychiatrist-psychotherapist working in a clinic with a medical license for psychotherapy.

Depression has its own laws of development. Without treatment it progresses. With treatment, the dynamics of symptoms are reversed. This is precisely the point of drug treatment for depression.

Signs of depression severity

A sign of a significant increase in depression is thoughts about the meaninglessness of life and even suicide. A general feeling of not wanting to live (stage 1 of severe depression), thoughts about the meaninglessness or purposelessness of life, more pronounced suicidal thoughts (stage 2), plans (stage 3) and intentions (stage 4) appear consistently in case of severe depression.

The appearance of these symptoms in you or your loved ones is an indication for urgently contact a psychotherapist or psychiatrist in a clinic in person. In this condition, it is important to begin drug treatment for depression as quickly as possible under the supervision of a doctor in an adequate dose.

With treatment, in most cases, symptoms will begin to develop in the reverse order. If left untreated at stage four, the risk of suicide is high.

Depression with the appearance of suicidal thoughts are treated in a clinic under the supervision of a doctor. In Moscow, such treatment can be obtained at the National Center for Clinical Prevention of the Russian Academy of Medical Sciences, the Research Institute of Psychiatry, the crisis department of the 20th City Clinical Hospital, etc. Severe depression should not be treated on an outpatient basis.

Drug treatment for depression

Some mild forms of depression can be treated on an outpatient basis by a psychotherapist. Drug treatment for depression can be prescribed if the level of depression is 48 points or more (if the level is above 60, drug treatment is mandatory). The therapeutic effect is due to the influence of the drug on the metabolic system of serotonin (the hormone of happiness and pleasure), dopamine, norepinephrine and GABA (gamma-aminobutyric acid). acids) etc.

Against the background of a stable mood, it is much easier to solve psychological problems and resolve conflict situations.

Often people are afraid to take antidepressants because... They believe that these drugs develop addiction (dependence on the drug). But this is not true, to antidepressants there is no addiction at all. Strong sedatives and hypnotics from the group of tranquilizers (benzodiazepines) cause addiction. Depression is treated with fundamentally different drugs from a different group - antidepressants.

Antidepressants

IN depending on the shade of depressed mood The psychotherapist prescribes various antidepressants. There are antidepressants that work against anxious depression. Other drugs are intended to treat apathetic depression, etc.

With the correct dosage of medications, after three to four weeks, depression begins to reverse - the desire to act actively appears, and mood stabilizes.

Antidepressants begin to work at the end of the second or third week. Having felt an improvement, many people stop taking the antidepressant in the fourth week, and, as a result, the depression returns after a few weeks. To completely cure depression, it is important endure the entire course treatment prescribed by a psychotherapist.

The duration of treatment with antidepressants is determined by a psychotherapist individually in each specific case. But, as a rule, the course of treatment with antidepressants lasts from 4 months to a year, sometimes longer. Sometimes a psychotherapist, after the main course of treatment, may prescribe a course of maintenance treatment in order to consolidate the effect. Depression lasting less than six months is the easiest to treat. If a person delays treatment for two to three years, or even eight to ten years (chronic depression), then the course of treatment increases significantly, and can reach one and a half years with one and a half years of maintenance therapy. If, when taking antidepressants prescribed by a psychotherapist on an outpatient basis, there is no pronounced effect within 3-4 weeks, it is necessary for the person to be additionally examined by a psychiatrist.

The final decision on making a diagnosis is made by a psychiatrist

Depression is a nonspecific symptom. How to understand what a nonspecific symptom or syndrome is: it can be compared to high fever in the practice of general diseases. A high temperature in itself is not a diagnosis, it only indicates a disease. When the temperature rises, a person goes to the doctor, and the specialist finds out whether it is the flu, appendicitis or something else.

Only a psychiatrist can make a final diagnosis and determine drug treatment tactics in complex cases.

Psychiatrists offer opinions (and we support), that it would be better if all patients with symptoms of depression were first examined by a psychiatrist, just in case. If there were no problems in their profile, he would refer them to a psychotherapist, and he would prescribe a course of psychotherapy and/or refer them to a psychologist. This would allow us to avoid serious diagnostic miscalculations. This way, people who need serious drug treatment would receive professional help immediately.

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5 thoughts on “ Treatment of depression. When to see a doctor.”

Elena
Thank you for the excellent selection of useful articles - there are no sites on the Internet where everything would be so detailed and competently presented. You are doing the right thing!
....
I have also heard the opinion that depression is the lot of those who have nothing to do, in other words, lazy people. This is true?
Irina
Natalya, thanks for the comment and the article as a whole. I received a lot of information that simply isn’t available anywhere. For example, I didn’t know that antidepressants are not addictive. Yes, and I received support after reading the article that there is no need to be afraid, you just need to take care of yourself, because life in fear and apathy is not life, but a demo version with reduced functions

He must make a diagnosis, decide whether he can manage the patient on an outpatient basis, and if not, then refer him to a specialist or send him to inpatient treatment.

Signs that determine referral to hospital treatment or to a specialist for depression:

A) Referral to a specialist doctor:

Uncertainty about diagnosis

The risk of suicide is not reliably determined

Lack of relevant competence

b) Referral to inpatient treatment:

Resistance to therapy, transition of the disease to a chronic form

Special treatment measures

Lack of medical care

Acute mania (switching/inversion

Drawing up a unified treatment plan: the essence of therapeutic measures is focused on the clinical picture and the ongoing development of the disease.

Basics of psychotherapy for depression:

“Reassuring confidence” (the patient is not an isolated case, the disease has been studied)

Empathy, there is always time for the patient (!)

“Release from responsibilities”, unloading

Do not force the patient to make decisions!

The principle of small steps (gradual establishment of previous functions)

Informing loved ones and relatives and involving them in the therapeutic process

Three phases of treatment:

I. Emergency medical care

II. Maintenance treatment (6-8 months)

III. Prevention of relapses (protection from relapses)

Initially, the question arises what type of treatment will be: outpatient or inpatient. The key to addressing this issue is assessing suicidality. The next step is to determine the severity of depression:

Mild depressive disorder (ICD-10 F32.0): supportive psychotherapy, as an additional remedy it is possible to use phytotherapeutic drugs (hypericin)

The more severe and profound the depressive symptoms, the more important the role of drug treatment with antidepressants.

Clinical and pharmacological classification of antidepressants by action

Tranylcypromine (Jatrosome N)

Reboxetine (Edronax, Solvex)

I. Emergency medical care for depression

Biological/Drug therapy for depression. An overview of antidepressants is presented in the table above.

The criteria for choosing an antidepressant are as follows:

a) retrospective determination of an effective antidepressant in the anamnesis (response at an earlier stage of disease development)

b) cross-sectional results of psychopathological examination/status presents (sleep disorder, anxiety, obsessive symptoms, etc.)

c) side effect profile, contraindications, toxicity (anticholinergic effect, excessive activation/inhibition; patient at risk, high risk of overdose)

d) degree of severity

e) treatment costs (financial costs)

Important: Organized, regular medication intake is extremely important.

Treatment of specific forms of depression:

Delusional depression: trimipramine or “dual therapy” antidepressant + antipsychotic; electroconvulsive therapy

So-called atypical depressions: classic or reversible: MAO inhibitors

For so-called seasonal depression (autumn-winter depression), light therapy can be used (course dose 00 lux).

Severity of response to treatment with antidepressants (response assessment: more than 50% reduction in the severity of the main symptoms according to rating scales, for example, HAMD); remission rate is about 65% (remission = HAMD-17<7, HAMD-7<3, MADRS<10); составляет около 45%.

The corresponding response rates for placebo are up to 45% and up to 25%, respectively, suggesting that antidepressants are clearly effective (Level A). The level of response to placebo in confirmed deep “endogenous” (not psychogenic-reactive) depression is significantly lower.

Depression in old age (involutional) often lasts longer and tends to become chronic.

Patients with a high body mass index (obesity) have a significantly worse response to antidepressants.

Treatment approaches for treatment-resistant depression:

Frequency of occurrence 30%!

Adequate dosing/plasma concentration determination (many patients are treated with insufficient doses!)

Infusion therapy with antidepressants

Switching to the next antidepressant with a different neurobiochemical mechanism of action

Additional treatment for insomnia

Application of lithium salts

Cognitive behavioral therapy:

a) correction of negative assessments of reality and negative self-esteem

b) step-by-step construction of different types of activities according to the principle of reinforcement

c) promoting self-confidence and social skills

d) learning the ability to cope with (inevitable) everyday and life problems

Behavioral therapy for depression:

Strict adherence to the daily routine

Building Positive Activities

Reduce depressive activities (rumination, crying)

Increased sense of self-confidence

Cognitive behavioral therapy (Beck) for depression:

Erroneous, illogical interpretations

Step-by-step correction of judgments

Replacement of dysfunctional disorders with corrected concepts and interpretations

Cognitive behavioral therapy for depression:

Analysis of mental distortions and erroneous conclusions

Development of models of “thoughts-feelings-behavior” relationships

Exercises to check the correspondence of conclusions to reality (keeping a diary)

Developing positive self-esteem and alternative reasoning

Involving loved ones and relatives

Elements of cognitive behavioral therapy for depression:

1. Essential elements:

Interacting Workers' Union

Structured, problem-oriented

Increasing ways to have enjoyable hands-on experiences

Reduce burdensome practical experience

Social Perception Training

Detecting Absurd Depressive Inferences

Preparing for possible crises

Testing in everyday life

Interpersonal psychotherapy (IPT): among other things, the therapeutic effect of the interaction of the depressed patient with his immediate environment

Mistakes in communicating with patients with depression (according to Hell):

Gentle behavior, guardianship

Irritability, impatience, excessive activity

Psychotherapy based on depth psychology or psychoanalytic psychotherapy: when psychodynamic conflicts persist after the disappearance of acute symptoms

II. Maintenance treatment for depression

After the disappearance of depressive symptoms, it is usually recommended for 6-18 months. continue maintenance drug therapy with antidepressants, while maintaining the required dosage of drugs in full, since it is during this period of time that there is a high risk of relapse.

III. Preventive anti-relapse treatment of depression

The indication for prescribing preventive anti-relapse treatment is the presence of 3 or more depressive episodes. According to a meta-analysis of controlled long-term studies, the risk of relapse when using placebo is more than 41%, when taking the active/active substance - up to 18%.

Thus, with the use of placebo, the risk of relapse increases by 2-3 times, and with the use of antidepressants, the risk of relapse is reduced by 70% (evidence level A). Procedure:

Continued use of an effective antidepressant that relieves acute conditions, or prophylaxis with lithium preparations.

The Commission of the German Medical Society for Medicines and the Working Group on the Treatment of Depression and the World Union of Biological Psychiatry have developed recommendations for the treatment of primary forms of the disease and preventive anti-relapse treatment, presented in the diagram below.

Important: In recent years, treatment with antidepressants in combination with cognitive psychotherapy has gained recognition.

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III. Help for depression

The modern approach to the treatment of depression involves a combination of various methods - biological therapy (drug and non-drug) and psychotherapy.

Drug treatment

Prescribed to patients with mild, moderate and severe symptoms of depression. A necessary condition for the effectiveness of treatment is cooperation with the doctor: strict adherence to the prescribed therapy regimen, regular visits to the doctor, a detailed, frank report about your condition and life difficulties.

Antidepressants.

Proper therapy can, in most cases, completely eliminate the symptoms of depression. Depression requires treatment from specialists. The main class of medications for treating depression are antidepressants. (see antidepressants) Currently, there are various drugs in this group, of which tricyclic atidepressants (amitriptyline, melipramine) have been used since the late 50s. In recent years, the number of antidepressants has increased significantly.

The main advantages of new generations of antidepressants are improved tolerability, reduced side effects, reduced toxicity and high safety in case of overdose. Newer antidepressants include fluoxetine (Prozac, Profluzac), sertraline (Zoloft), citalopram (Cipramil), paroxetine (Paxil), fluvoxamine (Fevarin), tianeptine (Coaxil), mianserin (Lerivon), moclobemide (Aurorix), milnacipran (Ixel) , mirtazapine (Remeron), etc. Antidepressants are a safe class of psychotropic medications when used correctly as recommended by a doctor. The dose of the drug is determined individually for each patient. You need to know that the therapeutic effect of antidepressants can appear slowly and gradually, so it is important to have a positive attitude and wait for it to appear.

Antidepressants do not cause addiction and the development of withdrawal syndrome, unlike drugs from the class of benzodiazenin tranquilizers (phenazepam, Relanium, Elenium, Tazepam, etc.) and Corvalol and Valocordin, widely used in our country. In addition, benzodiazepine tranquilizers and phenobarbital, which are part of Corvalol and Valocordin, with long-term use reduce sensitivity to other psychopharmacological agents.

Main stages of therapy.

Determining treatment tactics: choosing an antidepressant taking into account the main symptoms of depression in each patient, selecting an adequate dose of the drug and an individual treatment regimen.

Carrying out the main course of therapy aimed at reducing symptoms of depression until they disappear, restoring the patient’s previous level of activity.
Carrying out a maintenance course of therapy for 4-6 months or more after general normalization of the condition. This stage is aimed at preventing exacerbation of the disease.

What usually interferes with drug treatment:

Misconceptions about the nature of depression and the role of drug treatment.
A common misconception about the absolute harm of all psychotropic drugs: the emergence of dependence on them, a negative effect on the condition of internal organs. Many patients believe that it is better to suffer from depression than to take antidepressants.
Many patients stop taking it if there is no immediate effect or take their medications irregularly.

It is important to remember that numerous studies have been conducted confirming the high effectiveness and safety of modern antidepressants. The toll depression takes on a person's emotional and material well-being is not comparable in severity to the minor and easily treatable side effects that sometimes occur with antidepressant medications. It should be remembered that the therapeutic effect of antidepressants often occurs only 2-4 weeks after starting treatment.

Psychotherapy

Psychotherapy (see Psychotherapy) is not an alternative, but an important addition to drug treatment for depression. Unlike drug treatment, psychotherapy involves a more active role for the patient in the treatment process. Psychotherapy helps patients develop emotional self-regulation skills and subsequently cope more effectively with crisis situations without falling into depression.

In the treatment of depression, three approaches have proven to be the most effective and scientifically proven: psychodynamic psychotherapy, behavioral psychotherapy and cognitive psychotherapy.

According to psychodynamic therapy, the psychological basis of depression is internal unconscious conflicts. For example, the desire to be independent and the simultaneous desire to receive a large amount of support, help and care from other people. Another typical conflict is the presence of intense anger, resentment towards others, combined with the need to always be kind, good and maintain the goodwill of loved ones. The sources of these conflicts lie in the patient's life history, which becomes the subject of analysis in psychodynamic therapy. Each individual case may have its own unique content of conflicting experiences, and therefore individual psychotherapeutic work is necessary. The goal of therapy is awareness of the conflict and assistance in resolving it constructively: learning to find a balance of independence and intimacy, developing the ability to express one’s feelings constructively and at the same time maintaining relationships with people. Behavioral psychotherapy is aimed at resolving the patient’s current problems and relieving behavioral symptoms: passivity, refusal of pleasure, monotonous lifestyle, isolation from others, inability to plan and engage in purposeful activity.

Cognitive psychotherapy is a synthesis of both of the above approaches and combines their advantages. It combines work with current life difficulties and behavioral symptoms of depression and work with their internal psychological sources (deep ideas and beliefs). The so-called depression is considered as the main psychological mechanism of depression in cognitive psychotherapy. negative thinking, which is expressed in the tendency of depressed patients to view everything that happens to them in a negative light. Changing this way of thinking requires careful individual work that aims to develop a more realistic and optimistic view of yourself, the world and the future.

Additional forms of psychotherapy for depression are family counseling and group psychotherapy (but not just any therapy, but specifically aimed at helping depressed patients). Their involvement can provide significant assistance in treatment and rehabilitation.

What usually prevents you from seeking psychotherapeutic help?

Low awareness of people about what psychotherapy is.
Fear of introducing a stranger to personal, intimate experiences.
Skepticism that “talking” can have a tangible healing effect.
The idea that you need to cope with psychological difficulties yourself, and turning to another person is a sign of weakness.

In modern society, psychotherapy is a recognized, effective method of helping with various mental disorders. Thus, a course of cognitive psychotherapy significantly reduces the risk of recurrence of depression. Modern methods of psychotherapy are focused on short-term (10-30 sessions depending on the severity of the condition) effective assistance. All information that the psychotherapist receives during the session is strictly confidential and remains confidential. A professional psychotherapist is specially trained to work with difficult experiences and difficult life situations of other people, he knows how to respect them and provide assistance in coping with them. Every person has situations in life (for example, such as illness) that he cannot cope with on his own. The ability to ask for help and accept it is a sign of maturity and rationality, not weakness.

Helping loved ones overcome depression

The support of loved ones, even when the patient does not express interest in it, is very important for overcoming depression.

In this regard, the following advice can be given to relatives of patients:

remember that depression is a disease that requires sympathy, but in no case should you plunge into the disease with the patient, sharing his pessimism and despair. You need to be able to maintain a certain emotional distance, all the time reminding yourself and the patient that depression is a transitory emotional state
Studies have shown that depression is especially unfavorable in those families where many critical comments are made towards the patient. Try to make the patient understand that his condition is not his fault, but a misfortune, that he needs help and treatment
try not to concentrate on the illness of a loved one and bring positive emotions into your life and into the life of your family. If possible, try to involve the patient in some useful activity, rather than removing him from activities

Patient Guide

Compiled by the Moscow Research Institute of Psychiatry of the Ministry of Health of the Russian Federation

Candidate of Psychological Sciences A.B. Kholmogorov

Also, don’t forget to thank your doctors.

psychiatrist7 23:05

Bipolar disorder is characterized by mood swings rather than psychosis. Amitriptyline is an old drug and, moreover, is rarely prescribed for bipolar affective disorder. A tranquilizer is not needed here at all, especially if sleep is not disturbed. We need special medications prescribed for this mental disorder. I also don’t hospitalize patients with bipolar disorder very often. But constant medication is necessary. Take your mother to the doctor or call a psychiatrist at home. Moreover, all medications necessary for treatment are in prescription form.

It is impossible to assess the patient’s condition in absentia, much less prescribe an adequate treatment regimen.

Treatment of depression with medication

A common mental disorder characterized by decreased mood, impaired thinking and motor retardation is called depression. Treatment of this condition begins with identifying the cause and involves a comprehensive approach. Drug treatment for depression is carried out in parallel with psychotherapy and social therapy.

Features of pharmacotherapy

The drug is selected by the doctor based on the symptoms and stage of the disorder. The patient is prescribed antidepressants that have a stimulating, sedative effect. Medicines that make the patient sleepy are prescribed at night. It is recommended to take stimulant medications in the morning.

Indications for drug therapy

Treatment of depression with medication is prescribed by a doctor for:

Vivid symptoms.
High suicidal risk.
Social maladjustment against the background of the disorder.
Endogenous depression.

Drug therapy is carried out under the strict supervision of a psychiatrist. The effect of some medications appears later. If depression is severe, treatment is carried out in an inpatient setting.

Types of pharmacotherapy

Modern antidepressants are divided into 3 groups:

The first group includes Amitriptyline, Aphazen, Imipramine. Amitriptyline has a sedative effect and calms the central nervous system. Its use helps relieve anxiety, inhibition, and reduce motor agitation.

In the second group are Pamat and Nardil. They are taken for all types of mental disorders, high anxiety, uncontrolled appetite, and drowsiness.

The third group includes drugs such as Luvox, Prozac, Celexa, Paxil, Zoloft. Medicines in this group are prescribed more often because they rarely cause side effects. Medicines are prescribed to patients for depression, bulimia nervosa, social phobia, panic attacks, manic-depressive psychosis.

Patients suffering from high blood pressure or who cannot tolerate antidepressants are prescribed Coaxil. Mild depression can be treated with herbal medicines.

Medicines are taken for 6 months. This period is sufficient to normalize the metabolism of neurotransmitters. After completing the therapeutic course, the dosage of the medication is gradually reduced until its use is completely stopped.

Vitamin therapy

Taking vitamins for depression helps speed up the healing process. When the body receives food containing carbohydrates and sugar, tryptophan is produced. This amino acid, involved in the formation of melatonin and serotonin, helps improve mood. Being a natural antidepressant, tryptophan relieves symptoms of stress and reactive depression. The daily requirement for this amino acid is 0.25 g. When a person is in a stressful situation, the need for tryptophan reaches 1 g.

Tryptophan is found in:

Biotin deficiency contributes to the development of depression. This vitamin is found in pork liver, chicken meat, kidneys, eggs, and flounder.

The use of vitamin complexes

Knowing which vitamins to take for depression, a person will protect himself from painful symptoms. The doctor who prescribed the treatment recommends taking:

Neuromultivita;
Bodrovita;
Vitrum Superstress;
Doppelhertz active Magnesium.

The use of these remedies helps improve overall well-being. Nervous tension is relieved, appearance improves, and insomnia symptoms disappear.

What vitamins should women take?

Young ladies suffer from depression 2-3 times more often than men. They are usually diagnosed with a postpartum or menopausal disorder. This is due to hormonal imbalances.

Nursing mothers are prescribed vitamin complexes containing zinc, vitamins A, B, and omega-3 fatty acids. The normalization of the functioning of the nervous system is facilitated by the use of vitamins B9. Zinc and vitamin D reduce aggressiveness.

Brain function improves with regular use of vitamin B6. Women suffering from increased nervous excitability are recommended to take MagneB6. This drug helps relax muscles and relieve symptoms of stress.

Taking vitamins for depression in women should be combined with a change in diet. After giving birth, a young mother should regularly eat fish, walnuts, pumpkin, and spinach. Vitamin C is found in vegetables, fruits, rose hips, cabbage, dill, and pepper.

During menopause, women are recommended to take vitamin complexes “Osteo-Vit” and “Osteomed”. Osteo-Vita contains vitamins B6 and D, which provide support to the body during hormonal changes. Osteomed contains calcium citrate.

Vitamin therapy for stress

Food products do not contain enough microelements necessary for the body. In order to compensate for their deficiency in case of neuroses and stress, vitamins “Neuromultivit” and “Stress Aid” are prescribed. Stress-Aid contains folic acid, which helps neutralize stress. Prolonged depression and chronic sleep disorders are treated with Vitrum Superstress.

A person suffering from neuroses needs vitamin B4, which nourishes the protective layer of cells. The use of vitamin B5, which helps calm the processes occurring in the brain, is recommended for people suffering from mild depressive conditions.

Neurotics suffering from heart or vascular diseases are recommended to take vitamins B12 and B6. Taking these vitamins helps dilate blood vessels and thin the blood. To stimulate blood flow, it is recommended to take vitamin B3.

Vitamin B1 helps calm the nervous system. It provides cells with additional nutrition, which helps normalize the central and peripheral nervous system. The vitamin is found in fennel, parsley, chamomile, clover, and sage infusions.

Development of drug-induced depression

A disorder that develops while taking certain medications is called drug-induced depression. The main provocateurs of this pathology include:

Cardiac, antihypertensive medications.
Cardiac glycosides, antiarrhythmic drugs.
Antibacterial drugs.
Hormonal drugs.
Chemotherapy drugs.
Interferons.
Psychotropic drugs.

Cardiac and antihypertensive medications include Verapamil, Obdizan, Dopegit, Clonidine, Reserpine, Raunatin. Antiarrhythmic medications include Digoxin and Novocainamide. Isoniazid and Ethionamide can provoke affective disorder. Depressogenic hormonal drugs include Hydrocortisone and Prednisolone.

The development of a mental disorder is facilitated by the use of Methotrexate, Vinbalstine, Vincristine and other drugs prescribed for the treatment of cancer. Symptoms of depression appear while taking Aminazine and Diazepam.

After diagnosing drug-induced depression, the doctor stops taking the drug that caused it. If this is not possible, the dosage of the depressogen is reduced. The patient is then prescribed antidepressants. The drug is selected based on the presence of concomitant pathologies and the severity of symptoms of drug-induced depression.

Features of non-drug treatment

The main non-drug treatment for depression is psychotherapy. If the disorder is severe, it is combined with the use of psychotropic drugs. Most often, patients are prescribed to undergo:

Psychoanalysis has a remarkable effect. With the help of a doctor, the patient analyzes experiences that arose in childhood and analyzes the psychological trauma received then.

When undergoing existential-humanitarian psychotherapy, a person learns to properly build relationships with others. Classes are conducted both individually and in groups. People in similar situations can offer sage advice. Group classes include art therapy. Visualizing the problem through drawing or modeling helps get rid of painful symptoms. More complex cases require undergoing Gestalt therapy and NLP.

Often, treatment for a mental disorder involves physical activity. Aerobic exercises, dancing, horseback riding, cycling, swimming, and running are shown. For panic attacks and neuroses, it is recommended to do breathing exercises. Seasonal depression is treated through light therapy.

Prevention of depression

It is important to radically reconsider your diet. People prone to neuroses and stress should give up alcohol and foods rich in “bad” cholesterol. The work and rest schedule should be normalized. A person should sleep at least 7 hours a day.

Stressful situations should be avoided whenever possible. The appearance of negative emotions is often facilitated by watching the news and various television programs. It is advisable to abandon them in favor of light films and cartoons.

Social support is very important. Relatives and friends play the main role in overcoming this mental disorder.

Very good article, our clinic itself has been treating depression for many years. We use an integrated approach: drug treatment and psychotherapy. This approach gives the best results.

Depression. Treatment. Consequences and prevention

Treatment of depression

At the same time, according to the nature of the impact, a distinction is made between drug treatment and psychotherapy.

Drug treatment for depression

The most preferable are antidepressants, which are prescribed both during the period of active treatment and after. There are several groups of these drugs, which differ both in the chemical formula and principle of action, and in the effect they produce.

There are first and second generation antidepressants.

Includes tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). The mechanism of action of TCAs is based on blocking the reuptake of neurotransmitters (serotonin, norepinephrine, dopamine). In this case, the concentration of these mediators accumulates in the synaptic cleft. Drugs from this group are effective in severe, resistant depression. Their effectiveness reaches more than 70 percent, which explains why they remain reserve drugs. TCAs are used when other antidepressants do not provide clinical effect. However, treatment with these drugs is accompanied by numerous side effects (negative effects on the cardiovascular system, gastrointestinal tract). In addition, TCAs do not combine well with other drugs, which limits their use.

This group includes drugs with great neurochemical selectivity. This means that they selectively act on a certain type of neurotransmitter. Thus, there are serotonin reuptake inhibitors (fluoxetine) and norepinephrine reuptake inhibitors (mianserin). The effectiveness of these drugs is much lower, and therefore they are used for mild to moderate severity. However, they are much easier to tolerate and do not produce many side effects.

However, most of the newest drugs have recently been banned due to the fact that their inversion effect has been proven. This means that some drugs from this group can provoke suicidal behavior. The maximum risk of such a side effect is observed in the younger generation.

Stages of treatment for depression

One antidepressant is prescribed in an average therapeutic dose, usually from the group of SSRIs (serotonin reuptake inhibitors). This may be fluoxetine, sertraline or paroxetine. If there is no positive dynamics within 2–3 weeks, the next step is to increase the dose of the antidepressant to the maximum. At the same time, drugs from the category of nootropics or stimulants are prescribed.

If after increasing the dose of the drug there is no improvement, then a change in the antidepressant is recommended. It is recommended to choose a drug from a group with a similar mechanism of action, while remaining within the same group. It is not recommended to change a drug from the SSRI group to TCAs or MAO inhibitors.

In the absence of positive dynamics at the second stage, it is recommended to switch from monotherapy (treatment with one drug) to combination therapy (treatment with several drugs). Most often it is a combination of two antidepressants or an antidepressant and a tranquilizer. For severe endogenous depression, a combination of antidepressants and antipsychotics is recommended.

Involves the use of electroconvulsive therapy. This method is used in cases of depression that has proven resistant to pharmacotherapy.

Pills for depression

Representatives and their average therapeutic and maximum doses

Most common side effects

(Selective serotonin reuptake inhibitors)

Citalopram - initial dose – 20 mg, maximum – 40 mg;
Paroxetine - initial dose – 10 mg, maximum – 50 mg;
Sertraline - initial dose – 25 mg, maximum – 200 mg;
Fluoxetine - initial dose – 20 mg, maximum – 80 mg.

Sexual dysfunction in the form of weakened erection, delayed ejaculation, anorgasmia.

(Selective norepinephrine reuptake inhibitors)

Mianserin - initial dose - 30 mg, average maintenance dose - 60 mg.

(Selective norepinephrine and serotonin reuptake inhibitors)

Venlafaxine - initial dose – 75 mg, maximum – 375 mg;
Ixel – 100 mg.

(Monoamine oxidase type A inhibitors)

Pirlindol - initial dose - 25 mg, maximum - 400 mg;
Moclobemide - initial dose - 300 mg, maximum - 600 mg.

Sleep disorders, increased excitability,

visual disturbances, nausea, stool upset.

Amitriptyline - initial dose – 50 mg, maximum – 150 mg;
Imipramine - initial dose – 25 mg, maximum – 75 mg;
Clomipramine - initial dose - 75 mg, maximum - 250 mg.

increased blood pressure, changes in blood picture.

Drugs from other groups are also used in the treatment of depression. Most often these are sleeping pills, tranquilizers and nootropics. The use of sleeping pills is disputed by experts in this field. Insomnia, many believe, is a symptom of depression that disappears with proper treatment of the disorder itself. Sleeping pills only eliminate insomnia, but not the disease itself. Tranquilizers are anti-anxiety drugs that come to the aid of severe anxiety. Nootropics are also successfully used - neurometabolic stimulants that are designed to stimulate brain function.

diazepam;
lorazepam;
alprazolam.

Diazepam 2.5 mg ( half a tablet) twice a day.

Lorazepam 2–4 mg per day.

Alprazolam 0.5 mg two to three times a day.

andante;
somnol.

Andante half a tablet ( 5 mg) half an hour before bedtime.

Somnol took half a tablet 15 minutes before bedtime.

Mexidol;
bilobil;
noofen.

Mexidol is administered intramuscularly, one ampoule ( 100 mg) once or twice a day.

Bilobil is used two tablets per day.

Noofen is used in doses of 250–500 mg ( one to two tablets) per day. The dose is divided into 3 doses.

Psychotherapy for depression

There are a large number of psychotherapy methods. The optimal technique is selected individually for each patient, depending on the reasons that caused depression. The choice of psychotherapeutic method is also influenced by factors such as the severity of symptoms, the general condition of the patient and the presence of other diseases.

cognitive behavioral therapy;
interpersonal therapy;
psychodynamic therapy;
existential therapy;
Gestalt therapy.

Cognitive behavioral therapy

The basic principle of this method of treatment is the assertion that a person’s feelings, thoughts and actions are closely related to each other. Correction of one of these areas leads to positive changes in the others. A distinctive feature of cognitive behavioral therapy is the fact that treatment does not require identifying the causes of depression. Using various techniques, the therapist identifies, analyzes and corrects the patient's erroneous beliefs. As a result of this, the patient’s thinking changes, which allows him to cope with situations that previously seemed insurmountable to him.

tracking your own negative thoughts and beliefs;
recognizing the connection between destructive thoughts, emotions and behavior;
developing true and realistic beliefs;
application of acquired knowledge in practice.

Interpersonal therapy

The principle of this method of psychotherapy is based on improving the patient’s relationship with the outside world. Interpersonal therapy is most effective in cases where depression is triggered by factors such as divorce, problems in relationships with the opposite sex or with children. Often this method is used when the cause of the disorder is the loss of a social role due to retirement, job loss, or severe injury. During the treatment process, the patient acquires skills to solve problems with loved ones, learns to develop and maintain communication with his environment. Most often, interpersonal therapy is carried out in the form of a group, when not only the patient, but also members of his family take part in the treatment.

The objectives of this type of psychotherapy include establishing a connection between the patient’s past and the depression that bothers him. Often the cause of the disorder is experiences and regrets about the events that happened. Often trigger factors for depression are traumas experienced in childhood or mistakes made in youth. During treatment, the therapist helps the patient change his attitude towards the past and teaches him to correctly perceive the present.

This method of psychotherapy is based on the assertion that a person’s life consists of a number of internal conflicts and his tasks include resolving them. Experiencing negative experiences, a person reconsiders the meaning of life and finds new ways for his development. Depression in existential therapy is considered as a necessary stage of loss of life priorities, leading to the acquisition of new values. The therapist’s task is to bring the patient to the realization that if he is “stuck” at the current stage of his life and does not let go of the problem, he will not be able to rise to the next stage of his development. Existential therapy is most preferable for cases in which depression develops against the background of age-related crises and problems associated with lifestyle changes, transition to a new job, and decrease in social significance.

In this type of psychotherapy, depression is seen as a consequence of the patient's unmet needs. According to Gestalt therapy, the human body has a self-regulation system, which is why it independently copes with emerging disorders. In the absence of the opportunity to satisfy any of your needs, an incomplete gestalt is formed. The accumulation of a large number of unclosed gestalts leads to the fact that the self-regulation mechanism fails and depression develops. During the treatment process, the doctor determines exactly what unmet needs of the patient led to the disease and works to close the gestalts.

How to get out of depression on your own?

determining the cause of depression;
analysis of identified causes;
eliminating factors that cause depression;
working with destructive beliefs;
auto-trainings.

Determining the causes of depression

In order to get out of depression on your own, it is necessary to determine the cause of this disorder. This can be either a specific event (divorce, dismissal, death of a loved one), or a combination of several factors. To establish the cause of depression, it is necessary to analyze all significant aspects of life (work, personal relationships, friends). To make the analysis more effective, it is recommended to keep a special diary in which you need to record your own thoughts and reflections. In the future, the diary can be used to record measures taken to eliminate depression.

When identifying the main causes of depressive disorder, it is necessary to analyze their nature and take measures to eliminate them. Conventionally, all trigger (provoking) factors of depression are divided into two groups.

The first category includes reasons that a person cannot eliminate on his own (the death of a loved one, an unfavorable situation in the country, an oppressive boss). In such cases, in order to get out of depression on your own, it is recommended to change your attitude towards these circumstances. Auto-training and working on certain character traits are effective.

When identifying causes of depressive disorder that can be eliminated on their own, it is necessary to work to eliminate them. In most cases, factors of this kind are often interrelated and have a complex effect that contributes to the development of depression. Thus, worries about appearance lead to self-doubt and problems with the opposite sex. Difficulties in relationships can also be influenced by selfishness, desire for dominance, and other character traits of the patient.

As experts note, many patients with depression have common character traits. Therefore, when fighting this disorder on your own, you also need to work with the mental aspects of the personality. If attitudes that contribute to depression are identified, measures should be taken to correct them.

Perfectionism. A person who is determined to obtain only an ideal result rarely receives satisfaction in life and is constantly in a state of tension.
Polar thinking. Such people think according to the “all or nothing” principle. They only recognize gold medals (and not silver or bronze), and “excellent” grades (and not “good” or “satisfactory”).
Pathological sense of duty. Individuals with this trait are constantly confident that they owe something to someone (to be a good mother, a sympathetic friend, a first-class professional).
Catastrophization. This trait is expressed in the tendency to exaggerate the significance of negative events. For example, a D grade received by a child can be regarded as his complete incapacity in learning, which entails the absence of any professional prospects.

Auto-trainings

Auto-training is an effective tool in cases where the patient cannot influence the causes of depression. Autotraining is an exercise during which the patient independently enters a state close to trance. This state is achieved at the moment of maximum muscular and mental (mental) relaxation. Then, against the background of such an altered consciousness, certain attitudes are introduced, which subsequently change the personality of the patient with depression. In other words, auto-training is an independent coding of the psyche in order to get rid of negative emotions and thoughts.

It is necessary to conduct auto-training in a comfortable environment, limiting the influence of external factors that can interrupt the session. To do this, you should turn off your phone and other means of communication, and also make sure that no one at home distracts you. The body pose can be any. The main thing is that the position of the body does not interfere with relaxing the muscles and does not cause discomfort.

Having taken a comfortable position, you need to distract yourself from extraneous thoughts and relax your muscles. To achieve complete relaxation, you should use mental affirmative formulations.

I feel a pleasant heaviness throughout my body;
my arms and legs are getting heavy, I can feel it;
I feel warmth in my right palm (or any other part of my body);
I feel my forehead become cool.

Each installation is pronounced several times until the goal specified in it is achieved.

The next stage of auto-training is the pronouncement of various commands (affirmations), the purpose of which is to eliminate the depressive mood. The structure of the commands and the words used may be different and are selected individually depending on the reason that caused the depression. The meaning of affirmations comes down to building self-confidence, a positive outlook on work, personal relationships and other circumstances.

I am attractive/attractive;
I am confident in my charm;
I am successful with men/women;
I am loved/loved.

If the cause of depression is not established or the disorder was triggered by a number of factors, general affirmations can be used.

I am satisfied/satisfied with my life;
I stop worrying about my future;
I get rid of negative thoughts.

When drafting formulations, you must adhere to certain rules. All statements must be positive, brief, and not contain “not” particles.

The basis of successful auto-training is the regularity of sessions and the patient’s persistence. Quite often, having achieved complete relaxation, a person falls asleep without having time to move on to affirmations. To prevent this from happening, it is recommended to take a sitting position and perform exercises in the morning or throughout the day.

How to cope with depression and stress?

improvement of physical condition;
elimination of external irritants;
proper resistance to stress.

Improved physical condition

timely and adequate rest;
proper nutrition;
physical activity;
therapy of somatic (bodily) pathologies.

Timely and complete rest

Depression deprives a person not only of his mood, but also of his physical strength. When fighting this disorder, the body must be given the opportunity to restore resources. Carrying out daily responsibilities at work and at home requires a lot of effort. Therefore, for a certain period, you should make some changes to your daily routine in order to allocate time for rest. At the same time, you should not encourage your own passive behavior and idleness. Rest during depression involves doing things that bring pleasure and allow you to restore the body's reserves.

relaxing baths;
performing self-massage;
conducting meditations;
listening to soothing music;
pursuing a hobby;
carrying out cosmetic procedures (at home or in a specialized institution).

All household chores should be completed several hours before going to bed to ensure a complete night's rest.

The distribution of tasks will help to rationally use physical resources in the workplace. It is recommended to plan larger and more important tasks for the first half, since during this period the body has more strength. During the working day, you need to take a break for lunch, and when working at a computer, take a break every 2 to 3 hours.

The feeling of hunger is a significant stress factor. Therefore, to cope with depression, you should ensure that your diet is complete and varied. The daily menu should include the required amount of protein (1.5 grams per 1 kilogram of weight), fat (approximately 100 grams for women and 130 grams for men) and carbohydrates (from 300 to 500 grams depending on the level of physical activity).

A sufficient level of physical activity is a must in order to cope with depression. If possible, it is recommended to join a gym or any sports section. An alternative could be morning jogging and/or evening walks. In addition to systematically performing certain exercises (walking, jogging), it is recommended to increase energy expenditure during the day. When working sedentarily, you need to do a small 10-minute exercise (arm swings, squats, jumping) every 1 to 2 hours. You can also perform household chores while listening to rhythmic music, walk more, and give up the elevator.

Pain is a stress factor that provokes irritability, anger, and dissatisfaction. In addition, physiological discomfort makes a person worry and worry about his own future. Therefore, in order to cope with depression, you should take time to diagnose and treat existing diseases.

Elimination of external irritants

dripping faucet;
drafts, cold;
protruding corners of furniture;
inconvenient location of office equipment;
increased noise level in the room.

Eliminating or limiting the influence of these factors does not require much effort, but can be of great help in the fight against depression.

The right way to deal with stress

analyzing the situation and changing attitudes towards it;
getting rid of negative emotions;
creating an optimistic attitude.

Analysis of the situation and change in attitude towards it

In many cases, a person's reaction to stressors is exaggerated. To understand the true meaning of the event, it is recommended to analyze the situation. To do this, you should use special questions.

What are the real consequences of the event?
what would have happened if the event had not happened?
What are the names of the emotions I experience?
What is my true role in what happened?
Was it in my power to change the situation?
What would be the best outcome for me?

Sometimes a person experiences stress not about what happened, but about an expected event. In such cases, questions should be asked in the future tense. Finding answers to questions will allow you to look at the situation objectively and change your attitude towards it.

Some conflict situations require a person not to show true emotions. Constant suppression of anger serves as a favorable environment for the development of depression. Unexpressed dissatisfaction or anger does not disappear, but accumulates, gradually destroying a person’s mental health. Therefore, after a conversation with your superiors or another situation in which you had to restrain yourself, you should get rid of negative emotions.

Diary. By rewriting a traumatic event on paper, a person thus transfers negative emotions to the outside world and gets rid of them.
Punching bag. Instead of a pear, you can use a pillow or a rolled blanket. It is necessary to hit the bag until physical fatigue sets in.
Scream. To conduct this exercise, you need to draw on a piece of paper a person or event that caused negative emotions. After this, you need to hang the drawing at eye level and express your true opinion in a loud voice, turning to shouting.

Forming an optimistic attitude

As experts note, people with a pessimistic attitude experience stressful events more acutely and are more susceptible to depression. Fixation on the negative aspects of life and one’s personality provokes constant anxiety and a dissatisfied state. Therefore, in order to cope with stress, you need to learn to distinguish not only negative, but also positive aspects.

praise yourself even for small achievements;
do not blame others for your failures;
avoid communicating with whiners;
don't live in the past;
watch humorous programs;
listen to classical music;
smile more;
take care of your appearance;
perceive problems as new experiences;
Don't blame yourself for the mistakes you made.

Consequences of depression

The risk group includes those people whose relatives have already attempted suicide. The likelihood of suicidal thoughts increases if you have experienced physical or sexual violence, the death of a loved one, or the presence of drug or alcohol addiction.

What does depression lead to?

deterioration in appearance;
decreased performance;
relationship difficulties;
sexual disorders;
social isolation.

Deterioration in appearance

Depression leads to various negative changes at the physiological level. Because of this, patients begin to lose hair, their skin condition worsens, and weight problems arise. At the same time, a person loses the incentive to take care of his appearance. All this leads to the fact that as the disease progresses, the appearance of a patient with a depressive disorder ceases to meet generally accepted evaluation criteria.

With depression, the body's physical resources are depleted, so it becomes more difficult to perform functional duties at work or at home. Patients' concentration decreases, memory deteriorates, and lethargy appears. The situation is aggravated by the fact that the patient has no desire to work. This leads to the fact that the quality of the work performed is significantly reduced. This behavior affects income levels and often leads to demotion or loss of job.

Decreased need for communication is one of the symptoms of depression. Lack of interest in loved ones and their problems leads to problems in relationships with the environment. Inability to perform household responsibilities and indifferent attitude towards family members often causes serious conflicts, some of which end in divorce.

Prolonged depression in adults (more so in women) often affects relationships with children. In addition to communication difficulties, parental depression leads to serious mental disorders in children. Such children are more susceptible to various emotional disorders, have difficulty adapting, and withdraw into themselves. Failure to fulfill parental responsibilities negatively affects a child's academic performance and behavior.

Problems in intimate life are a common co-factor of depression. One of the reasons for this phenomenon is a reduced level of a hormone in the body that increases sexual desire (dopamine). Suppression of sexual activity is also influenced by reduced self-esteem and other manifestations of this disorder. During sexual intercourse, a patient with depression does not receive complete satisfaction, which also negatively affects the quality of intimate life.

Depression leads to the fact that the patient’s social circle is significantly narrowed. Such patients stop attending sports clubs, do not come to friends’ birthdays, and do not take part in corporate events at work. The restriction of the circle of communication occurs in two directions. On the one hand, the patient breaks off previous contacts and stops meeting new people. On the other hand, due to the lack of sincere interest in the environment and self-absorption, colleagues and acquaintances themselves interrupt communication with such people.

Prevention of depression

Healthy holiday

Purification of consciousness. Many people tend to analyze the past day before going to bed, focusing on mistakes made or stressful situations experienced. As a result, the time required to fall asleep increases, and going to bed occurs in a depressed state. Therefore, one of the effective measures against depression is to give up negative thoughts and thoughts before going to bed.
Relaxing baths. Baths before bed help relieve physical stress and help you fall asleep faster. In order for water procedures to promote relaxation, the water temperature should not exceed 37 degrees. You need to take a bath 20-30 minutes before bedtime. You can increase the effectiveness of the bath by adding infusions of chamomile, lavender, and linden to the water.
Quitting alcohol. Alcoholic drinks stimulate the function of the nervous system, so alcohol intake should be avoided 2 hours before bedtime. Strong black or green tea, coffee, and tobacco products have a similar effect on the body.
Drinking herbal tea or milk. Chamomile or mint tea will help you relax and fall asleep faster. Warm milk with honey helps you fall asleep quickly. To make the drink work faster, it is recommended to drink it slowly and through a straw. This happens because when sucking, a person’s natural reflex is triggered, and he falls asleep faster.
Listening to music. For a quality night's rest, it is recommended to avoid watching TV or spending time on the computer for 2–3 hours before going to bed. You can replace these activities by listening to calm music. According to numerous studies, classical music has a pronounced therapeutic effect. Thus, the music of Wolfgang Mozart helps lower blood pressure and normalize the pulse, which helps you fall asleep faster.
Walking before bed. You need to take a walk in the fresh air 1-2 days before going to bed. Before leaving the house, it is recommended to leave the window in the bedroom open for ventilation.
Preparing the bed. According to statistics, in approximately 15 percent of cases the cause of unsatisfactory sleep is a poorly organized sleeping place. For quality rest, it is recommended to sleep on semi-rigid orthopedic mattresses. The pillow should be low, and it is better to choose bed linen from natural materials. The colors that help you fall asleep quickly are white, blue and green. If you have problems sleeping, psychologists recommend avoiding bedding in red, yellow and black colors.

Playing sports

If you are prone to depression, it is recommended to exercise in a group, because communication with other people allows you to cope with the disorder faster. Therefore, if possible, you should join a gym or sports section. The optimal sports for depression are aerobics, sports dancing, and yoga. If circumstances do not allow visiting specialized sports institutions, then jogging, exercise, and complex exercises will be useful.

In order for exercise to be effective and help fight depression, it is recommended to follow some rules.

The main criterion that the chosen activity must meet is the pleasure the patient receives in the process of performing it.
You need to exercise regularly, 2-3 times a week.
When practicing on your own, you should start with training that is short in duration and intensity. Gradually it is necessary to increase the load, while monitoring your physical condition.
Playing sports should not cause rapid heartbeat, shortness of breath, or headaches. The only acceptable feeling is slight muscle fatigue.
To record your own achievements (weight loss, reduction or increase in body volume), it is recommended to keep a diary. It should also include missed workouts, how you feel after sports, and other points.

Relaxation

There are many methods that can eliminate muscle and emotional tension. They can be used individually or in combination. The optimal method of relaxation is determined individually.

breathing techniques (inhaling and exhaling according to a certain system);
visualization (imagining images that have a calming effect);
audio relaxation (listening to soothing music);
autogenic training (self-hypnosis using special formulas);
relaxation according to Jacobson (alternate tension and relaxation of body parts).

Depression is a serious mental illness that requires mandatory treatment. It is possible to do without drug therapy only at the initial stage of the pathology. In other cases, the psychotherapist prescribes medications that are dispensed from pharmacies only by prescription. Treatment of depression is long-term – from 3 months. The first improvements will appear no earlier than 2 weeks of regular use of the drugs. Tablets for depression are selected individually, their choice depends on the overall clinical picture of the disease.

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Antidepressants

Antidepressants are the mainstay of treatment for various types of depression. These drugs regulate the concentration of neurotransmitters - serotonin, norepinephrine and dopamine - and restore the biochemical background in the brain. Antidepressants help improve mood and activate psychomotor skills. Thanks to their use, the feeling of constant fatigue, anxiety, fear, apathy and anxiety goes away. Antidepressants are divided into the following groups:

Tricyclic.
Monoamine oxidase inhibitors (MAOIs).
Selective serotonin uptake inhibitors (SSRIs).
Serotonin, norepinephrine and dopamine reuptake inhibitors.

Treatment with antidepressants is undesirable for heart, kidney and liver diseases. In extreme cases, the doctor selects the safest medications with the minimum number of side effects. For severe depression, auxiliary medications may be needed to enhance the work of antidepressants.

If side effects occur after taking the tablets, you should inform your doctor about this. Stopping antidepressants is strictly prohibited, as this can worsen depression. The duration of the course of treatment is determined by the doctor individually.

Tricyclic

They are the most inexpensive and widespread. These are the first antidepressants that were synthesized in the 50s of the last century. Their action is to capture serotonin and norepinephrine in neurons. They have stimulating and sedative effects. Drugs in this group have a powerful effect and are used for depression of various stages. Tricyclic antidepressants include:

Amitriptyline.
Azafen.
Coaxil.
Imipramine.
Doxepin.
Clomipramine.

The disadvantage of these drugs is a large number of side effects. They often cause dry mouth, constipation, urinary retention and tachycardia. In older people, they can cause confusion, visual hallucinations, and increased anxiety. When taken over a long period of time, tricyclic antidepressants reduce libido and may cause cardiotoxicity.

MAOI

They block the action of the enzyme monoamine oxidase, which destroys serotonin and norepinephrine, which leads to an increase in these substances in the blood. The drugs are prescribed for the ineffectiveness of tricyclic antidepressants, atypical depression and dysthymia. The most common medications:

Melipramine.
Pyrazidol.
Bethol.
Tetrindole.
Metrolindole.
Sydnofen.
Moclobemide.

Monoamine oxidase inhibitors begin to act only after a few weeks of use. They can lead to fluctuations in blood pressure, swelling of the limbs, dizziness and weight gain. These drugs are prescribed quite rarely due to the need to follow a special diet and avoid foods containing tyramine.

SSRIs

Antidepressants of the modern class, the action of which is based on blocking the reuptake of serotonin. This group of drugs affects exclusively this substance, which makes them less aggressive to the human body. They have few side effects. Serotonin reuptake inhibitors include:

Sertraline.
Fluoxetine.
Paroxetine.
Prozac.
Fluvoxamine.
Citalopram.

These antidepressants are used for depression accompanied by obsessive thoughts, anxiety and panic. Their use makes a person balanced and adequate. In severe forms of depression, they may be ineffective.

Serotonin and norepinephrine reuptake inhibitors

The latest generation of drugs that act on 3 types of receptors - norepinephrine, dopamine and serotonin. They are not inferior in effectiveness to tricyclics, but have a minimal number of contraindications and side effects. Drugs in this group include:

Agomelatine.
Melitor.
Velaxin.
Alventu.

These antidepressants regulate human biological rhythms. With their help, you can normalize sleep and daytime activity within a week. They help with severe depressive conditions and in a short time remove feelings of anxiety, loss of strength and nervous tension.

Tranquilizers

For depression accompanied by anxiety, tearfulness, fear and insomnia, the treatment regimen may include tranquilizers. Therapy with these drugs is carried out only under the supervision of a doctor, as they can cause addiction and drug dependence.

When prescribing tranquilizers, the dose is increased gradually - from minimum to optimal to achieve a therapeutic effect. The course of treatment should be short and not exceed 2-3 weeks. The most powerful and effective tranquilizers include:

Chlordiazepoxide.
Elenium.
Diazepam.
Seduxen.
Lorazepam.
Bromazepam.
Phenazepam.

Taking tranquilizers affects the speed of psychomotor reactions and concentration. Side effects may include drowsiness, muscle weakness, tremors, constipation, urinary incontinence and decreased libido. It is prohibited to drink alcohol during treatment with these medications.

Neuroleptics

They have a pronounced antipsychotic effect and have a depressant effect on the entire nervous system. Their use is relevant for severe agitation, hallucinations, delirium and apathy. These drugs affect all organs and systems and should be taken only when there are pronounced changes in a person’s behavior. The list of the best antipsychotics includes:

Aminazine.
Tizercin.
Leponex.
Truxal.
Haloperidol.
Fluanxol.
Zeldox.

Antipsychotics lead to a decrease in dopamine levels, which can cause muscle stiffness, tremors, and hypersalivation. They can also cause increased drowsiness, decreased concentration, and decreased mental abilities. The safest antipsychotics with a mild effect are Rispolept, Clozapine, Olapzapine.

Nootropics

These medications normalize cerebral circulation and improve mental abilities. Unlike other medications used to treat depression, nootropics are not addictive, do not slow down a person’s activity and do not have a negative effect on the brain.

Their purpose is relevant when the level of vital activity and mental abilities decreases, and the adaptive function of the body is impaired. These drugs help stabilize mood and can be used for nervousness, short temper and impulsivity. Nootropics should be included in the treatment regimen for depression accompanied by mania.

The drugs are prescribed for asthenic-depressive conditions and as an adjunct to antipsychotic therapy to eliminate lethargy and drowsiness. They can be used for preventive purposes by healthy people who are often under stress. The cheapest and most common nootropics are:

Piracetam.
Nicergoline.
Nootropil.
Phenotropil.
Mildronate.

In most cases, nootropics are well tolerated. Sometimes they can cause headaches, agitation, sweating, dry mouth, tachycardia and euphoria. If side effects or individual intolerance occur, you should stop using the drugs.

Treatment of depression during lactation and pregnancy

During pregnancy, taking pills for depression is especially important. If the expectant mother is depressed, she endangers not only herself, but also the child. A nervous system disorder can trigger postpartum depression; this condition requires treatment under the supervision of a qualified specialist.

You need to be especially careful when choosing medications in the first trimester to avoid congenital anomalies of the fetus. Doctors often prescribe selective serotonin reuptake inhibitors to expectant mothers, which are the safest for the patient’s body. These include:

Fluxen.
Sertraline.
Paroxetine.

A few weeks before giving birth, it is necessary to stop using antidepressants so that the child does not inherit the addiction. During the entire course of treatment, the patient’s condition should be monitored by a doctor. For early-stage depression, doctors recommend avoiding taking serious prescription medications. They can be replaced with herbal medicines, which include St. John's wort, motherwort, valerian, and thyme.

When breastfeeding (BF), antidepressants and other psychotropic drugs can also have a negative effect on the child. The list of pills that are allowed during pregnancy includes:

Valerian preparations.
Motherwort.
Notta.
Glycine.
Novo-Passit.
Persen.

If herbal preparations during lactation do not have the desired effect and the nursing mother experiences a severe form of depression, the doctor prescribes antidepressants, and the newborn is transferred to artificial nutrition. During breastfeeding, therapy most often includes the following drugs:

Zoloft. The safest antidepressant for mothers during lactation. It has a pronounced therapeutic effect and in a short time helps to cope with feelings of anxiety and apathy.
Amitriptyline. The concentration of the drug in milk is low, but the antidepressant itself has a large number of side effects and can cause individual intolerance. It belongs to the very first drugs in the group and is sold only with a doctor’s prescription.
Fluvoxamine. An effective remedy, but while taking it it is necessary to stop lactation. This medication has not been sufficiently researched.

During pregnancy and pregnancy, taking tranquilizers and antipsychotics is prohibited; the course of treatment with antidepressants should be at least 6 months. The choice of dosage and drug is made by the doctor.

Medicines for children

Mild depression in children is treated with psychotherapy and natural medications. Doctors recommend taking the following safe medications:

St. John's wort.
Fish fat.
Novo-Passit.

For moderate and severe depressive disorders, the psychotherapist prescribes antidepressants. For children under 12 years of age, the safest and most effective drug is Fluoxetine. After 12, the list of medications increases and includes:

Cipralex.
Lexapro.
Escitopralam.
Tizercin.
Amitriptyline.

The difficulty in treating childhood depression lies in the fact that in 50% of cases the patient’s body is resistant to antidepressants. This can be noticed already from the second week of using the medication, when the positive effect of therapy is completely absent. In such cases, the doctor replaces the antidepressant. Also, medications in this group have a negative effect on the liver and increase the risk of toxic damage.

During antidepressant therapy, it is necessary to carefully monitor the child and discuss his condition with him. The effect of treatment occurs after 4-7 weeks, and the course lasts from 6 months. You should not stop taking medications on your own - before doing so, you need to consult with a psychotherapist who will help you correctly reduce the dosage and reduce the concentration of antidepressant in the blood to a minimum.

Treatment of depression should be carried out under the supervision of a physician. All psychotropic drugs are prescribed in individual dosages; it is impossible to choose an effective regimen on your own.

Thanks to studies of physiological and morphological changes in the body during long-term depression, it was possible to develop a number of new treatment regimens and methods. Despite this, long-term depression remains a serious illness that causes serious consequences, including suicide attempts. Most psychiatrists perceive severe depression as an emergency that requires immediate treatment. The criterion for the success of treatment is the rapid elimination of the main manifestations of depression. It is with this requirement in mind that modern treatment regimens for chronic depression have been developed.

A difficult problem still remains the presence of forms of chronic depression that are resistant to treatment. Discussion continues about the optimal duration of therapy and the need for maintenance medications after completion of the main course.

So, the main methods of treating chronic depression are psychotherapy. Let's consider their features.

Types of antidepressants prescribed to treat depression

Despite the similar expected treatment results, there are several groups of antidepressants that differ in their mechanism of action and chemical structure.

Serotonin reuptake inhibitors interfere with its absorption from synapses (nerve cell junctions). Serotonin accumulates, as a result of which the symptoms of depression decrease.
Dopaminergic antidepressants increase the concentration of dopamine at synapses. Dopamine is similar in action to serotonin and is also a substance that increases the overall level of mood.
Tricyclic antidepressants. They were among the first to be used in clinical practice. Increases the concentration of serotonin and norepinephrine in synapses. They have a number of side effects associated with the blockade of acetylcholine receptors - dilation of the pupils, retention of stool and urination, increased heart rate, dilation of the bronchi.
Serotonergic and noradrenergic antidepressants act similarly to tricyclics, and do not have the side effects of the latter.
Heterocyclic antidepressants, in addition to the accumulation of serotonin and norepinephrine in synapses, cause activation of adrenaline receptors, increasing the overall tone of the body.
NASA antidepressants mimic the effects of serotonin and norepinephrine, producing a similar activating effect.
Dopaminergic antidepressants lead to the accumulation of dopamine in synapses, which has an activating effect.
Noradrenergic drugs increase the concentration of norepinephrine with the same effect.
Melatonergic antidepressants affect the deep structures of the brain, resulting in the restoration of the daily rhythm of activity, increasing the overall tone of the body, normalizing sleep, and improving mood.
Monoamine oxidase inhibitors have stimulating and antidepressant effects. Based on the duration of the effect, there are reversible (the effect lasts several hours) and irreversible (the effect lasts two weeks) MAO inhibitors.

Treatment regimens for chronic depression

According to modern approaches, treatment of long-term depression should be carried out in three stages:

Active treatment of a depressive episode.
Maintenance treatment.
Preventive treatment.

The duration of therapy and the combination of medications depend on how long chronic depression has been present. Treatment begins with modern drugs that have minimal side effects.

The presence of suicide attempts, anxiety and restlessness are indications for inclusion of benzodiazepine anxiolytics in the treatment regimen.

The most effective for long-term severe depression are noradrenergic and serotonergic antidepressants. They are prescribed for a course of 6 weeks. At the end of the course, the result of treatment is analyzed and the issue of continuing it, replacing medications, or supplementing with other medications is decided.

If the condition improves on the initially chosen treatment regimen, anxiolytics are discontinued after 3 weeks of use, and antidepressant treatment is continued for up to 6 weeks.

If the desired effect cannot be achieved, they move on to prescribing antidepressants of earlier generations, in particular tricyclics. For the fastest possible effect and reduction of side effects, it is recommended to begin treatment with intravenous drips of the drug. The treatment regimen is chosen as for more severe depression.

If an episode of depression lasts more than 6-9 months, the initial treatment regimen must include mood stabilizers or lithium salts. The result is assessed after a month of taking the drugs; if it is satisfactory, treatment is continued for up to six months, sometimes up to 8 months. After a course of antidepressants, long-term prophylactic use of mood stabilizers is prescribed.

If the result of such a treatment regimen is unsatisfactory, more complex, individually selected regimens are prescribed.

Treatment of co-occurring disorders

In the presence of psychopathological symptoms, atypical antipsychotics are prescribed. They help cope with hallucinations, delusions, manic-depressive episodes, psychomotor agitation, slow down the progression or eliminate negative symptoms - unemotionality, apathy, passivity.

Atypical antipsychotics help cope with anxiety, paranoid ideas, and the perception of the world around us as unreal.

“Minor” antipsychotics are used to treat psychopathic conditions and neuroses accompanying depression.

Non-drug treatments

They are used to speed up healing, eliminate life-threatening manifestations, and bring about remission.

In case of active suicidal tendencies, refusal of food, or stuporous states, electroconvulsive therapy can be used.

Isulin-comatose therapy is used when pharmacological treatment is impossible, severe, life-threatening manifestations, especially if schizophrenia and chronic depression are combined. Treatment with these methods helps to significantly accelerate the onset of relative remission and move on to conservative therapy.

After a course of antidepressants, acupuncture (acupuncture and electroacupuncture), transcranial magnetic stimulation, light therapy, and physiotherapy can be used to consolidate remission.

Maintenance treatment

After achieving clear remission, it is recommended to continue treatment with an antidepressant with proven effectiveness for the patient for 4-9 months. If the duration and severity of depression before treatment was very significant, maintenance treatment can be extended up to 12 months.

When taking tricyclic antidepressants, side effects associated with the action of acetylcholine may occur during the stage of preventive treatment. Then they are recommended to be replaced with a new generation antidepressant, in particular, serotonin reuptake inhibitors, NASA antidepressants or heterocyclic and atypical antidepressants.

Preventative treatment

The usual duration of preventive treatment after an episode of depression is at least a year. In case of repeated episodes or suicide attempts, the duration of preventive medication can be increased to 5 years.

To prevent seasonal relapses, light therapy and reflexology are prescribed.

Psychotherapy

It is a mandatory component of all stages of treatment. Its role increases as severe symptoms are eliminated under the influence of pharmacotherapy. The following types of psychotherapy can be used:

Family
Behavioral
Cognitive
Problem-solving
Interpersonal
Short-term dynamic

Psychotherapy is an important factor in the prevention of relapse of depression during the after-treatment stage.

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