Taking antidepressants and the main mistakes made by patients. The harm of antidepressants on the human body, why they are harmful and dangerous. Can an antidepressant start working earlier?
Many people whose profession has nothing to do with medicine or pharmacology know little about antidepressants or have a very vague understanding of such drugs. When prescribing such medications, a person faces many questions and concerns.
Can antidepressants be addictive? How effective are such drugs? Are they capable of changing a person's personality? Do they improve your mood? This article will provide answers to these and other popular questions about such medications that can be prescribed by doctors of various specialties.
Indications for prescribing antidepressants
People who cannot cope with melancholy and apathy on their own may be prescribed antidepressants.Antidepressants are prescribed to patients who cannot independently cope with signs of anxiety, melancholy, apathy and depression. The main indication for the use of such drugs is depression. Drugs from this series can be used to prevent and treat anxiety and obsessive-compulsive disorders, bipolar personality disorders, sleep disorders, etc.
How do antidepressants work?
Antidepressants can increase the levels of serotonin, norepinephrine, dopamine and other neurotransmitters that affect a person’s mood. In addition, they slow down their decay.
There are several types of such medications. Depending on the clinical case, the doctor may prescribe an appointment:
- antidepressants-stimulants - such drugs stimulate the psyche in cases of lethargy or apathy;
- antidepressants-sedatives - such drugs help eliminate anxiety or panic and have a sedative effect;
- antidepressants of balanced action - the effect of these drugs depends on the daily dosage of the drug.
Why do many people think that being treated for depression is shameful?
Unfortunately, many people have a stereotype that has been established for decades - it is a shame to seek help from a psychiatrist or psychotherapist. This fact, according to such people, means recognition of their own mental inferiority. However, depression is not a sign of intelligence level; such a patient will not be registered at a psychoneurological dispensary and no one will report his illness to work. In addition, it should be noted that not in all cases a person with depression can overcome this condition on their own. This disease can affect the patient’s life in the most negative way:
- performance decreases;
- relationships with loved ones and surrounding people deteriorate;
- sleep is disturbed;
- life goals are lost;
- sometimes depression causes suicide attempts.
Contacting a specialist in such cases radically changes the development of events. Properly prescribed treatment relieves the patient of painful symptoms. The treatment plan also includes taking antidepressants. And in case of severe depression, in addition to taking such medications, the patient may be recommended observation at a crisis center.
Is it possible to do without taking antidepressants?
Antidepressants are rarely prescribed for mild cases of depression because their side effects may outweigh their benefits. In addition, in such clinical cases, treatment may consist of psychotherapy and lifestyle changes.
Such medications can only be prescribed by a doctor who takes into account all the pros and cons. Typically, such drugs are included in the treatment plan when the psychotherapeutic methods used do not give the desired result and the patient cannot get rid of the depressed state.
Is taking antidepressants very harmful?
Antidepressants belong to the group of potent drugs, and this fact means that if used incorrectly, they can lead to dangerous consequences. Their harm to the body is determined by the type of drug and its dosage.
Common negative side effects of antidepressants include the following:
- tremor;
- anxiety;
- lethargy;
- sensory disorders;
- sexual dysfunction;
- deterioration of cognitive abilities;
- lethargy, etc.
After a long course of taking such drugs, withdrawal of the drug should be carried out gradually. If you stop taking it abruptly, a person may experience withdrawal symptoms.
Are antidepressants addictive?
Taking antidepressants is not addictive even when prescribed such drugs for 1-2 years. After stopping treatment, the patient may experience withdrawal syndrome, which will make itself felt for 2-4 weeks. It is during this period that all components of the drug will be eliminated from the body. Dependence on antidepressants is a myth. This fact is confirmed by both doctors and patients themselves taking such medications.
Often, people who are prescribed a course of treatment with such drugs are afraid not only of becoming addicted, but also afraid that their character will change. Experts completely deny the possibility of such a consequence. Taking antidepressants can affect a person’s concentration, memory, and activity. However, the characteristics of a person’s personality do not change when taking them. When depression develops, a person should think about something else - it is the condition itself that can have a negative impact on character, and not the drugs to treat it.
Can you buy antidepressants without a prescription?
Only a doctor can prescribe antidepressants. Self-medication is unacceptable. As mentioned above, only a doctor should choose an antidepressant drug for treatment and calculate its dose and duration of use. Self-medication with such drugs can aggravate the course of depression or other mental disorders. The patient must understand that each person has his own antidepressant threshold, and if the chosen drug does not reach it, then taking the medicine will be in vain. This is why antidepressants are sold in pharmacies only by prescription.
Answers to the most popular questions about antidepressants help to understand that taking such medications is indicated only in specific clinical cases. When prescribed correctly, they are beneficial, but self-medication with such drugs can be either useless or harmful to health. Antidepressants are always selected by a doctor individually, and only a specialist can determine the drug and its dose that will help the patient get rid of depression or other disorders.
Educational video about how antidepressants work:
And when it comes to antidepressants, we are sure: this is not about us, we are normal, but everyone can be sad. This is why an educational program is needed: what antidepressants are, when they are prescribed and why you shouldn’t be afraid of them. Meanwhile, according to World Health Organization forecasts, by 2020 depression will be one of the top three causes of disability. Its main symptoms are loss of interest in what used to be fascinating, a decrease in the feeling of joy without serious reasons and objective reasons, reluctance to communicate with people, a feeling of loss of energy, sleep disturbances (both shortening and lengthening), changes in appetite, a feeling of physical malaise, pain syndrome, digestive disorders, etc. So, if you find yourself with at least three of the listed signs, do not neglect them, but consult a psychiatrist or psychotherapist, and if you need to take antidepressants, do not worry, because...
Psychotherapist at Atlas Medical Center
Antidepressants are always carefully selected by a doctor
These are not remedies that are prescribed to everyone equally. The doctor will take into account many factors (degree of depression, age, lifestyle, concomitant diseases and others) before prescribing medications.
Antidepressants normalize serotonin levels
Serotonin is mistakenly called a hormone, but it is a neurotransmitter - a substance that transmits impulses between nerve cells and directly affects our ability to enjoy and perceive the positive aspects of life.
Antidepressants - non-hormonal drugs
Having heard something about serotonin, many people decide that antidepressants are hormones, and “it’s better not to take hormones.” So, these drugs are not hormonal, and their action is discussed in the paragraph above.
Antidepressants are not addictive
Often it seems to us that the doctor prescribed too long a course of treatment, and when it becomes easier, we boldly stop taking the medication. Due to these characteristics of drug use, the myth has apparently arisen that antidepressants are addictive. The fact is that processes in nerve cells proceed very slowly, and in order for serotonin levels to truly normalize, it is necessary to take antidepressants for about a year on average, gradually reducing the dosage under the supervision of a doctor. If you stop taking them at the first signs of improvement, depression will gain strength again.
Antidepressants won't turn you into a vegetable or a battery-powered hare
Any drug has side effects, and in this regard, antidepressants are no better or worse than other drugs. By taking antidepressants, you will be able to continue your normal lifestyle: work, drive, play sports.
You don't need to take antidepressants all the time
A full course of taking these drugs, as a rule, effectively resolves the issue. However, there is a caveat: some people are prone to chronic depression and may need to take antidepressants for longer courses or on an ongoing basis.
There are more people taking antidepressants than you think
Depression is one of the top five most common disorders, and many people treat it successfully. However, due to the fact that in our country depression is still considered a “shameful” disorder, they hide it. So, if you have been prescribed antidepressants, do not consider yourself a black sheep. Perhaps one of your friends has been successfully taking them for a long time, just, like you, they are embarrassed to talk about it.
And finally, advice on how to avoid depression and leave knowledge about antidepressants only in the theoretical field
Prevention of depression is similar to the prevention of many other diseases: you need to adhere to a rational diet and diet, and be sure to alternate work and rest. And it is also very important to rejoice! For example, a job well done, a little rest, communication with interesting people, creativity and time spent with family. And most importantly, start getting rid of perfectionism.
Popular
The idea for this article appeared a couple of weeks ago, but since the material is quite large, I kept putting off writing it. But now I have no excuses anymore :) So read on, and I hope that this topic will become clearer to you.
Personally, I tried a fairly large number of antidepressants (in fact, I became a guinea pig for doctors, since few people agree to take pills voluntarily, so they had almost no experience in this matter). My doctor was so happy when I agreed to try a new drug. Well, what am I? I don’t have pharmacophobia, I’m always for experiments. True, at some point we got to the point where I almost started to experience psychosis, so if they change your pills frequently, don’t agree, you should change them rarely and only after you are absolutely sure that they don’t help. I will write more about this below.
Who needs antidepressants?
- People with moderate or severe
- People with panic attacks
- People with mild depression who are unable to start
- People with increased anxiety and anxiety-depressive disorder
- People with chronic pain
These are not all indications for taking antidepressants, but only the main ones. I will dwell on each point in more detail.
Almost always, in cases of moderate and severe depression, you need to use pills. Yes, psychotherapy will also help, but before you start it, you need to relieve the acute condition in which the therapist simply cannot finish shouting to you. You are in your cocoon, and even if it hurts your forehead, you will still hold on tightly to your condition. So the doctor needs help, and it is best if you start taking antidepressants. They should also be taken by those who do not have the opportunity to go to psychotherapy - for any stages of depression, even mild ones. Remember that depression brings with it real illnesses, and therefore it must be dealt with in any way.
People with panic attacks (I also plan to write an article on them) may not have depression, but they will still be prescribed antidepressants. If you haven’t prescribed it, go to another doctor, because tranquilizers alone will not cope with panic, which generally cannot be prescribed for a long course. Antidepressants for panic attacks are not prescribed for such a long course as for depression, and they help avoid relapses even after the end of the course of treatment.
Everything about anxiety is clear - almost all antidepressants have indications for the treatment of anxiety disorders. They help a person calm down and not stress himself out endlessly.
For chronic pain, you may also be prescribed antidepressants, and do not rush to argue with your doctor. There are pills that have proven to work well for pain, especially chronic pain. In addition, if something hurts for a long time, then sooner or later you will still fall into depression and anxiety, and it is far from a fact that you will notice it.
How long should you take antidepressants?
As a rule, the course of treatment can last up to six months for anxiety, pain and panic attacks, and up to a year or more for depression, especially severe ones. Some will have to take antidepressants for life, and there is nothing wrong with that. Believe me, with your depression and neuroses you will feel much worse than if you took pills for life. Don't be afraid for your liver - modern pills are very good friends with it. There are people who need to take heart medications or hormones for life, and no one has died. Compared to hormones, antidepressants are garbage.
You always need to evaluate your condition - if you feel better, then you should not quit the pills, you must definitely complete the course.
How do you know if antidepressants are not helping?
This is quite a complex topic, and doctors often stop the pills after a week without seeing any improvement. And after a couple of days of taking it, we ourselves begin to think that since all the symptoms have not gone away, then we need to quit. But you can say that an antidepressant is not helping you only if you take it for 3-4 weeks at the maximum dosage.
I especially focus on this - to the maximum! Doctors quite often prescribe very low doses of antidepressants, and I can't understand why they do this. At low doses, you will get all the side effects, but you are unlikely to get any results. For example, the same amitriptyline is prescribed for the most part at 75 mg per day, when its antidepressant effect begins to appear only at 150 mg, that is, at a dose twice as high! And I have experienced this myself, so I can say with confidence that low doses practically do not work. If in my blog entries you have come across my experiments with low doses of the same amitriptyline, then do not rush to take this into account - I have an excellent placebo effect, that is, I don’t care what to take and in what doses - the effect will be from the very fact of taking it . And mild depression is perfectly relieved by this. So if you have no effect from a low dose, increase your dosage! And if there is, rejoice, you are also subject to the placebo effect.
How soon do antidepressants begin to help?
This is also a very important point. There will be no immediate results. You will have to wait at least a week to evaluate the effect. After a week, paroxetine, for example, begins to act, and therefore it is considered the drug of choice if a quick effect is needed. You can also feel quick relief from tricyclic antidepressants, but they have not yet developed their antidepressant effect, but only relieved anxiety and improved sleep.
The rest of the drugs begin to act after 2-3 weeks, not earlier. Be prepared for the fact that you will have to wait for the effect, and do not rush to change or even cancel the pills.
Side effects of antidepressants
Oh, this is a huge field for speculation. Antidepressants will almost always let you experience the side effects first hand, so you also need to be prepared for this and should not be afraid of it. You will not die, although sometimes it will seem to you that you are leaving for another world.
The side effects of antidepressants are especially severe in those suffering from panic disorders and anxiety. In the first days, all this can greatly intensify, and at the same time, patients run to the doctor and demand that the drug be discontinued, or, worse, quit it themselves. This should only be done if the side effects are intolerable. Well, you just die and don’t see the white light. Then yes, you need to cancel. And then try another drug. If you had a bad time at one, it doesn’t mean that it will be bad at all the others too. Sometimes it takes almost the tenth time to find an antidepressant.
Almost all side effects can be smoothed out with not very large doses of tranquilizers. If you have a competent doctor, he will definitely prescribe them. If you are not very literate, then ask to write it out. Tranquilizers should not be taken for long, two weeks maximum, then your body will get used to the antidepressant and they can be discontinued.
The most common symptom that occurs when taking antidepressants is drowsiness. You begin to sleep at night, and during the day, and at work, and at home - generally everywhere. You shouldn't be afraid of this. The drug makes you restore strength, which comes to us in our sleep. Drowsiness may also appear if anxiety is suddenly removed.
Many antidepressants also cause dry mouth. There is nothing wrong with this either - you can chew gum, and then this side effect will not be so pronounced. Dilated pupils, a not very confident gait - this can also happen, so from the outside you will look like a drug addict :) Don’t be afraid of this - everything will gradually pass. It is best to generally take a vacation while you get used to a new antidepressant, so that you can get a good night’s sleep and not scare everyone with your drunken appearance.
Also, some drugs contribute to weight gain. And then you have to decide - either you get fat or you suffer. Some people agree to do anything to make the depression go away. Well, someone, looking at their protruding tummy, will panic. Well, you can always change your antidepressant. There are some among them that will make you lose weight. Most often, your weight will remain the same as it was.
Well, plus side effects may include nausea, headache, dizziness. This is also normal. However, if you are vomiting all day, it is better to change your antidepressant.
By the way, if you have suicidal tendencies, then in the first weeks of taking the pills the desire to quit can become simply unbearable. In this case, I recommend immediately turning yourself over to the doctors and going to the hospital. Or you should have a loved one who will hide all the pills prescribed to you and give them one at a time. Well, plus he should grab your hand if he catches you on the ledge. Don't refuse the help of your friends!
How to end the appointment?
Let's say you finished a course of antidepressants, the doctor told you that you need to gradually reduce the dose and get off. If he hasn’t outlined a regimen for you, then I can tell you that you need to reduce on average a quarter of your dose per week, or even less. If you reduce it and feel unwell, go back to the old dose. Then start decreasing again, but at an even slower pace. You may still experience withdrawal symptoms, but it will not be as pronounced. By the way, you may well have to stay on the minimum dose for a long time, since further reductions will cause your symptoms to return. And there is nothing wrong with that; many people take a maintenance dose for years.
Antidepressants: reviews
Oh, how many of them I have read. Most often, all negative reviews look something like this: “my neighbor advised me to drink this, I took a quarter of the tablet and I felt sooo bad, don’t drink this poison!”
So what's wrong here? First, the antidepressant was prescribed by a neighbor, not a doctor. Your neighbor doesn't know you like a doctor who will ask you a lot of questions before writing a prescription. Next - low doses. Yes, you need to start with these in order to minimize side effects. However, even if a quarter of a tablet has such an effect on you, this does not mean that you should not continue to take this drug. Remember that side effects always increase in the first days? And remember about the advisable use of a tranquilizer. Here we are dealing with self-medication, which is absolutely illiterate.
However, there are plenty of good reviews on antidepressants. Thanks to them, many people got out of such a hole that they were then ready to pray for them. As a rule, these people took the pills under the strict supervision of a doctor, and therefore received the desired effect. I can say for myself that antidepressants are a great thing. They help you get back on your feet and look at the world from a completely different angle.
Can you buy antidepressants without a prescription?
Strange as it may seem, it is possible. Some pharmacies meet customers halfway and sell. However, is this necessary? An incorrectly prescribed antidepressant may make you feel worse and you will become disillusioned with them all. You will also need a tranquilizer, and it is much more difficult to ask for it without a prescription (most generally follow strict records, that is, the pharmacist will take your prescription for reporting, while a prescription for an antidepressant will most likely be returned to you, and you will He still has to buy pills for another year). You need to monitor the dosage - reduce it somewhere, add it somewhere. Are you capable of doing this yourself? Same thing. So go to the doctor, there will be no problems with prescribing you a prescription.
So, let's summarize. Antidepressants must be prescribed by a doctor. You should start with a low dosage, preferably “covering up” with a tranquilizer to minimize side effects. It may get worse in the first days. The tablets will begin to work in at least a week, most often in two to three weeks. If during this time you have increased the antidepressant to the maximum dose, but there is no effect, you should change it. You need to take an antidepressant for a long time, up to a year or even several years, or even your whole life. It should be withdrawn very, very slowly.
Phew, finished. I hope you find this useful. I plan to write the next article about what types of antidepressants there are. So if you are interested, then subscribe to updates.
The Campaign Against Depression recommends that GPs take a holistic approach to treating the condition: a compassionate approach to the patient combined with a variety of psychotherapy options, both orthodox and complementary. When prescribing medications, special attention should be paid to anxiety, mood swings, phobic and panic symptoms.
It is useful to recall the signs of depression (Table 1). Knowing them helps make a diagnosis, determine the severity of depression and assess the risk of suicide.
As for drug therapy, diagnosing a full-blown episode of depression means that 70-80% of such patients will successfully undergo treatment with modern antidepressants, which are relatively safe even in overdose.
The most common antidepressants. They are divided into four main groups: tricyclic antidepressants, new tricyclics and related antidepressants; selective antidepressants and monoamine oxidase inhibitors (MAOIs), including new reversible monoamine oxidase inhibitors (MOMAO-A).
This year, two new groups were added to the list of 31 most common antidepressants. Both belong to a new, selective type, but act on different receptors - in fact, the group of selective antidepressants is divided into four subgroups.
The term “selective” is key in understanding this new group of antidepressants. They have very high affinity for either norepinephrine (NA) or serotonin (S) synaptic receptors and very low affinity for other receptors, such as acetylcholine, which are the most commonly observed side effects in patients taking tricyclic antidepressants.
For the depressive disorders described below, the following groups of antidepressants are used.
Serotonin antidepressants are prescribed as adjuvant medications for anxiety and obsessive compulsive disorder because serotonin is a transmitter closely associated with anxiety and repetitive behaviors such as obsessive thoughts.
Norepinephrine is a transmitter responsible for motivation. NA antidepressants are especially effective for depression, where the leading symptom is a slowdown in motivation and, as a consequence, behavior.
MAO inhibitors and IOMAO-A can be very effective when other antidepressants have no effect. OIMAO-A do not require diet, but interaction with sympathomimetics remains. The list of indications includes phobias (especially social ones), hypochondria and somatic manifestations. New in the prescription of antidepressants. In 1997, there were five important innovations in the medical approach to antidepressant treatment.
Firstly, it has been proven that the effect of the prescribed dose of an antidepressant does not develop immediately - at least within eight weeks. In practice, this means that the doctor may wait a long time before changing the dose or type of antidepressant.
Second, there is evidence to suggest that an initial dose of selective serotonin reuptake inhibitors (SSRIs) is sufficient to treat most patients with depression. However, in some cases, for early-generation SOIDS, the initial dose may not be enough and needs to be increased (Table 2).
Fourth, although doctors are confident that the newer antidepressants have fewer side effects, many patients refuse to take them. A meta-analysis showed that 30% of patients stopped taking tricyclic antidepressants, while 27% took SSRIs. Discontinuation rates due to side effects alone were 20% for tricyclic antidepressants and 15% for SSRIs.
Some of the earlier antidepressants, namely the second-generation tricyclic antidepressants, have the same efficacy and safety as selective antidepressants and fewer anticholinergic side effects than the earlier antidepressants.
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Fifthly, today the side effects of selective antidepressants acting on serotonin receptors are summarized. Serotonergic syndrome is caused by a direct effect on unprotected postsynaptic serotonin receptors in the brain and intestines. Side effects include nausea, insomnia, nervousness and agitation, extrapyramidal disorders, headaches and sexual dysfunction. The serotonergic syndrome is similar to the well-known anticholinergic syndrome that occurs with TCAs.
Suicidal risk. According to the recommendation of the Committee against Depression, patients should be asked about suicidal ideas/thoughts/intentions/impulses/plans in a benevolent and gentle manner, this facilitates mutual understanding. In practice, this means that the doctor should first of all establish trust between him and the patient - too early intervention leads to the patient’s refusal to communicate with the doctor, while a timely conversation helps to achieve frankness from the patient.
The Safe Prescribing Campaign for Suicide Risk was launched by the London Poisons Unit, whose most recent study dates back to 1995. According to this study, approximately 300 people died from antidepressants in 1995, mainly due to the cardiotoxic effects of amitriptyline and dothiepine.
Ineffective treatment. Double-check the diagnosis and make sure the patient is taking the prescribed medications in the right doses.
In our practice, cases of hidden alcohol intake are very common. Check to see if the patient is currently experiencing any stress or has a history of stress. It may turn out that the deterioration is due to an exacerbation of post-traumatic stress.
The doctor has at his disposal various information booklets, audio and video recordings with which he can provide the patient.
Counseling can help clarify or resolve the problem. Cognitive therapy is sometimes helpful, although its role is not yet fully understood, and is particularly useful in cases of chronic and moderately severe depression.
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Attention should be paid to insomnia, anxiety, panic, phobias, psychotic disorders, each of which can dominate the picture of the disease as an independent disease.
Additional sedative therapy may be necessary, since selective antidepressants do not have side sedative effects. Thus, at the beginning of treatment, you may need a sleeping pill or a daytime relaxant, such as thioridazide or diazepam. Relaxation therapy and complementary treatments also have beneficial effects.
The group of difficult-to-treat patients consists of patients with somatic disorders. As a rule, they are distrustful of the diagnosis, are difficult to persuade to take medications, and when they agree, they show increased sensitivity to side effects. In this group, low doses of drugs, even those considered subtherapeutic, can be successfully prescribed.
The longer the period of depression that occurred before the start of treatment, the longer it takes to cure it.
Referral to a Mental Health Association or secondary care psychiatrist for consultation and therapeutic assistance. If the possibility of suicide cannot be excluded, longer consultations are necessary to help relieve despair and suicidal hopelessness. Recently, the organizer of psychotherapeutic courses for general practitioners remarked on this matter: “If we manage to make a person understand that we care about him, hopelessness immediately goes away and the healing process begins.”
One study showed that early, adequate antidepressant therapy can significantly reduce the number of secondary referrals to a specialist, the need for hospitalization and the incidence of suicide.
Persistent depression. Sometimes there is a need for additional medications, increasing the dose of an antidepressant taken or replacing it.
Lithium can be added to an antidepressant. The safety of this drug has been proven in practice, but patients should be informed of its nature and mechanisms of action.
Lithium should be given once at night. To avoid possible differences in bioavailability, only high-quality drugs should be prescribed.
Before treatment, it is necessary to conduct a study of the iron-binding capacity of the blood, determine the function of the kidneys and thyroid gland. During the first month of treatment, drug concentrations in the blood and electrolyte balance are determined every 7-14 days, then monthly, once every three months, and finally once every six months. It is better if the lithium level is relatively low, around 0.4 mmol/L (compared to 0.8 mmol/L). The duration of treatment is eight weeks.
Duration of treatment. Depression is a relapsing illness, and the main predictor of relapse is a past episode of depression. You can successfully use the following data as a guide: with a single episode of depression, the probability of relapse is 50%, with a second - 70%, and with a third - 90%.
After a single episode, relapse can be prevented, but there is no consensus on how long antidepressants should be given.
Some doctors advocate three-, four-, six-, or even nine-month courses of therapy. The World Health Organization recommends prescribing a full dose of antidepressant for two, three or four months, followed by a half dose for several months. This approach requires additional study and observation.
Patients with anxiety, obsessive and phobic symptoms need to take antidepressants for a long time, although in general practice it is often difficult to persuade patients to even start taking them.
It appears that as the condition improves the patient becomes more sensitive to side effects. In practice, it makes sense to determine how long an antidepressant should be prescribed based on how severe the depression was at the time of treatment.
I always warn patients about the possibility of relapse and advise them to resume taking antidepressants as soon as they feel worse—even before they can see me. As a rule, the more relapses a patient has in history, the longer the required course of treatment.
Older patients are more susceptible to severe, prolonged depression that lasts for years. There is a significant proportion of depression-related deaths in this group, and long-term antidepressant treatment is often required in these patients. Any patient with prolonged severe recurrent depression should be treated in the same way, regardless of age.
The response to antidepressant withdrawal is different from the relapse of a depressive disorder. It can develop with the use of any antidepressant, but only after 6-8 weeks of therapy, which may indicate the involvement of adaptive processes in the central nervous system.
Literature.1. Donoghue J. M. Prescribing patterns of Selective Serotonin Reuptake Inhibitors in primary care: a naturalistic follow up study // J. Serotonin Res 1996; 4: 267-270.
2. Anderson I. M., Tomenson B. M. Treatment discontinuation with Selective Serotonin Reuptake Inhibitors compared with tricyclic antidepressants: a meta-analysis // BMJ 1995; 310: 1433-1438.
3. Henry J. A., Alexander A. A., Sener E. K. Relative mortality from overdose of an tidepressants // BMJ 1995, 310: 221-224.
4. Antidepressant drug withdrawal // BNF September l997; No. 34: p. 174.
Note!
- One out of every three adults experiences an episode of depression at least once in their life; it is detected in one in six new patients in general practice
- The effect of the prescribed dose of antidepressant does not appear immediately - it occurs, as is commonly believed today, within eight weeks. In practice, this means that the doctor should wait before changing the dose or type of antidepressant
- Many doctors are confident that the newer antidepressants have fewer side effects, but very often patients refuse to take them. According to studies, 30% of patients stopped taking tricyclic antidepressants, while 27% took SSRIs. Discontinuation rates due to side effects alone were 20% for tricyclic antidepressants and 15% for SRIs.
- Serotonergic syndrome is caused by a direct effect on unprotected postsynaptic serotonin receptors in the brain and intestines. Side effects include nausea, insomnia, nervousness and agitation, extrapyramidal disorders, headaches and sexual dysfunction. The serotonergic syndrome is similar to the well-known anticholinergic syndrome that occurs with TCAs.
- Patients should be asked about suicidal ideas/thoughts/intentions/impulses/plans in a supportive and gentle manner - this facilitates mutual understanding. In practice, this means that the doctor should first of all establish trust between him and the patient
- If depression does not respond to treatment, double-check the diagnosis and make sure the patient is taking the prescribed medications in the right doses. Cases of taking additional medications and alcohol are very common
- Lithium can be prescribed for persistent depression once at night. The effect can be achieved at moderately low doses, approximately 0.4 mmol/l. It is advisable to continue treatment for eight weeks
Antidepressants are often prescribed for VSD in order to reduce its unpleasant manifestations, mainly depressive mood, anxiety and irritability.
These drugs are highly effective and have an equal number of side effects, which are especially common when the recommended dosage is violated or the drug is prescribed without authorization.
How do antidepressants work?
The effect of antidepressants on the human body is the result of the multifaceted effects of active substances, it is expressed as follows:
- increasing the concentration of serotonin in the blood and slowing down the processes of its breakdown;
- an increase in the amount of neurotransmitters such as dopamine and norepinephrine, which are responsible for a person’s positive mood;
- reduction in symptoms of anxiety;
- stimulation of the psyche (in the presence of lethargy or apathy)
There are several groups of antidepressants:
- Tricyclic (Amitriptyline, Imipramine, Mianserin).
- Monoamine oxidase inhibitors (Nialamide, Pirlindol, Maclobemide).
- Selective inhibitors responsible for serotonin reuptake (Fluoxetine, Paroxetine, Sertraline).
- Selective norepinephrine reuptake inhibitors (Maprotiline).
- Other types (Mirtazapine, Ademethionine).
In addition to the classification indicated above, antidepressants are divided according to the types of effects they have:
- sedatives (Amitriptyline, Pipofesin);
- giving a balanced effect (Pyrazidol, Paroxetine);
- stimulants (Maclobemide, Imipramine).
Purpose of antidepressants
Each type of such drugs is responsible for performing a specific task, be it the functions of reuptake of norepinephrine or serotonin, their purpose differs according to the specific characteristics.
Tricyclics
This is the first generation of antidepressants that have proven effective in treating moderate to severe depression. Achieving a visible effect can be seen after 14-21 days of taking the medicine:
- eliminate sleep disturbances;
- calm down;
- reduce symptoms of depression;
- reduce excitement;
- eliminate the likelihood of suicide attempts.
The harm of antidepressants of this type lies in the following risks:
- arrhythmias;
- atrial fibrillation;
- sudden cardiac arrest;
- decreased blood pressure;
- the appearance of dryness of the oral mucosa;
- the occurrence of vision problems.
Drugs in this group have a stimulating effect on the nervous system, while simultaneously relieving a person of depressed mood and excessive lethargy.
The results of taking antidepressants can be:
- decrease in blood pressure numbers;
- toxic effects on the liver;
- insomnia;
- increasing anxiety.
While taking inhibitors of this group, the consumption of bananas, wine, chocolate, cheeses and smoked meats is prohibited. Otherwise, there is a high probability of getting a persistent increase in blood pressure.
Selective serotonin reuptake inhibitors
Drugs in this group have the ability to block the reuptake of the hormone serotonin without causing a sedative effect on the body. These drugs are somewhat easier to tolerate, mainly due to the lack of cardiotoxicity.
Side effects of antidepressants of this group include the following reactions:
- sexual activity disorders;
- digestive disorders;
- decreased appetite;
- sleep disorders.
Antidepressants of this group are not prescribed together with MAO inhibitors, which is fraught with increased blood pressure, seizures and coma.
Selective norepinephrine reuptake inhibitors
The antidepressant effect of these drugs is no lower than that of the tricyclic group. However, there is no pronounced inhibitory effect and cardiotoxicity.
Other types of antidepressants
Absolutely all groups of these medications have an effect on the human body. The remaining types of drugs block adrenergic receptors and increase the amount of serotonin entering the blood.
Antidepressants of this group are indicated in the presence of mild or moderate depressive conditions. These medications are quite easily tolerated without causing significant harm to the body.
Effect of antidepressants
When taking antidepressants, the benefits of which will appear if the necessary conditions for their use are observed, you should remember the possibility of addiction to such drugs.
Antidepressants help in the treatment of such pathologies:
- depressive states of varying severity;
- anxiety disorders;
- obsessive-compulsive disorders;
- pain of a chronic nature and phantom type;
- exacerbations of existing neuroses;
- eliminating hallucinations that occur due to alcohol intoxication;
- prevention of suicidal tendencies in patients in a state of severe depression.
Antidepressants or thymoanaleptics are taken for a long time. The minimum therapeutic course is 14 days.
If a patient stops taking a medication that, in his opinion, did not have an effect, without waiting for positive dynamics to occur, there is a high probability of developing adverse reactions from the body and even exacerbation of the existing condition with the occurrence of a depressive disorder of high severity.
Antidepressants have a direct effect on the central nervous system, normalizing the concentration of monoamines contained in neurons. This effect is quite strong, so dosage accuracy is very important when prescribing antidepressants.
A possible overdose of the active substance of thymoanaleptics can cause the death of the patient.
Children, even if they have symptoms of VSD, are practically not prescribed antidepressants. The immaturity of the central nervous system may be affected by the concentration of these substances, which will cause the development of mental disorders in the future.
Antidepressants are prohibited for use during pregnancy and lactation. They easily penetrate both the placental barrier and into breast milk, negatively affecting the development of the fetal nervous system and the infant’s mental state.
The main task of antidepressants is to create and maintain a balance of certain chemical elements contained in the human brain.
A wide variety of such drugs affect certain elements. The medicine prescribed by the doctor does not always give the expected effect. In this case, the patient has to try other remedies until the optimal active ingredient is selected.
As a rule, a person can feel significant changes in his condition after 14 days of taking the drug; in other cases, at least two months of its use are required. If during this period there are no visible changes in the condition, you should contact a specialist to replace the medicine.
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Antidepressants in Russia
There are several brands of antidepressants, the most common in Russia. The effectiveness of treatment with these drugs depends on the accuracy of the selected treatment and the individual reaction of each person to the active substance.
- Prozac (Fluoxetine) is produced by the Cardiological Scientific and Educational Complex of Russia. This drug belongs to the group of serotonin reuptake inhibitors. It relieves depressive moods, has a stimulating effect on the central nervous system, improves mood, eliminates increased anxiety and tension, and unreasonable fear. Does not have a sedative effect on the body, is not toxic to the heart and blood vessels.
- Amitriptyline is produced by ALSI Pharma CJSC. It belongs to a number of tricyclic antidepressants, has a sedative and hypnotic effect on the patient, and relieves anxiety.
- Paroxetine (Paxil), manufactured in France. It has a pronounced anti-anxiety effect and belongs to the group of serotonin reuptake inhibitors.
In addition, the following drugs are often prescribed in Russia:
- Fevarin (made in the Netherlands);
- Sertraline (made in Italy);
- Coaxil (made in France);
- Anafranil (made in Switzerland);
- Azafen (made in Russia);
- Pyrazidol (made in Ukraine).
Self-medication with antidepressants is dangerous
According to recent studies by Canadian scientists, the widespread prescription of antidepressants to the population (even for the treatment of certain conditions of vegetative-vascular dystonia) is not scientifically justified.
The risks of adverse reactions and the body becoming accustomed to the active substances contained in such products are too high, which is why they do more harm than good.
Only a psychiatrist with sufficient qualifications can make a decision about the possibility of treatment with antidepressants. Naturally, unauthorized decision-making on the prescription of such funds is impermissible.
On your own initiative, you can only take vitamin complexes or placebo drugs, while antidepressants can cause serious damage to the nervous system.
From the point of view of American scientists, the safest are those that cause the synthesis of serotonin in the brain; they do not have a detrimental effect on neurons and contribute to the development of a minimum of adverse reactions.
Canadian scientists have confirmed that taking antidepressants increases the risk of heart attack or stroke by 14%. Moreover, even in people who have not previously had somatic diseases of the cardiovascular system.
Prevention of depression
Depression, a condition that often develops when a person has vegetative-vascular dystonia, is characterized by the following symptoms:
- depression;
- Bad mood;
- lack of interest in life;
- guilt;
- hopelessness;
- drowsiness;
- loss of strength;
- absent-mindedness;
- decreased libido;
- loss of appetite;
- arrhythmia;
- decreased performance.
Depending on the type of depressive disorder, the following characteristic symptoms of depression are distinguished:
- Agitated disorder: overexcitement, constant hysterics, revealing negative emotions.
- Adynamic: complete loss of strength for life, loss of mood, drowsiness, lack of will.
- Dysphoric: constant grumbling, fear of human society, irritability, causeless anger.
- Postpartum: decreased self-esteem, increased suspiciousness, increased tearfulness and sensitivity, self-pity.
A person in a state of depression is more susceptible to developing phobias and fears that have no basis, uncontrollable aggressive outbursts and very severe psychoses that undermine the nervous system.
There is no way to protect yourself from depression; it can happen to anyone. However, everyone can reduce the likelihood of such a condition; for this it is important to adhere to the following rules.
Preventing the onset of depression:
- drawing up and maintaining a reasonable daily routine, in which the load will be distributed extremely competently, without allowing a person to get physically tired or experience serious stress. If a person sets a plan for himself that he will stick to, it is easier for him to assess his own strengths and avoid overwork;
- Get proper rest every day. Night sleep is very important, during which serotonin is produced, which is responsible for a good mood. A well-rested person is better able to withstand stressful situations and irritants;
- Get physical activity regularly. Playing sports allows you to increase self-esteem; in addition, during training, adrenaline is released, which increases the tone of the body;
- eat right, including all necessary vitamins and elements in your daily diet. For this purpose, you should more often consume fresh fruits and vegetables, seafood, cereals, herbs and legumes. In addition to health benefits, proper nutrition helps you avoid obesity, which negatively affects overall self-esteem and can lead to the development of depressive mood;
- lead a healthy lifestyle, in which there is no place for smoking, drugs and excessive alcohol consumption;
- receive positive emotions while communicating with loved ones, playing together outdoors with children and pets.
If a person adheres to the rules of a healthy lifestyle, then depression may well bypass him. Otherwise, if VSD is aggravated by a depressive disorder, you should seek help from a psychotherapist who will prescribe antidepressants.
It is not permissible to begin self-medication using such drugs, so as not to cause serious harm to your own body.
