Antidepressants - Causes, symptoms and treatment. MF.
Opinions of doctors and patients about pharmacotherapy can be different. About 20 years ago it was believed that antidepressants should be used for depression, but then it turned out that antidepressants have not only a curative but also a preventive effect. After discontinuation of reception very quickly removed from the body and depression can recur. It was established that the duration of treatment should be 6-12 months. Supportive or prophylactic treatment is prescribed in those cases when patients had more than three depressive episodes in a short period of time or those who had more severe manifestations of the disease and did not return to a completely normal state, also in cases of hereditary predisposition to dysphoria, in difficult lifea situation that provokes the development of stress.
Depression is diverse in its forms, so the effects of taking antidepressants can be completely different, the process of restoring patients also looks different.
Antidepressants affect all symptoms of depression or lead to their complete disappearance. Often the first sign of the action of drugs is to improve sleep. Sleep becomes deep, nightmares disappear. In another case, a more sedative effect is more pronounced. The irritability decreases, the symptoms of fear and anxiety decrease. But it will take at least a week or even a month before the patient begins to feel better mood, serenity, full and deeper peace.
In the process of treatment, a favorable trend always prevails. More significant improvements occur 3-4 weeks later, and completely depressive symptoms disappear after 1 -2 months. There are exceptions, when the patients feel much better starting from the second day of taking antidepressants.
In the vast majority of cases, treatment with antidepressants is characterized as being essentially effective and recommended for all patients with mood disorders.
What are the antidepressants
1. Tricyclic antidepressants: amitriptyline, amoxapine, doethiepine, doxepin, imipramine, clomipramine, lofepramine, nortriptyline.
The main group of antidepressants for fighting depression. The mechanism consists in the reverse capture of norepinephrine and serotonin by presynaptic cells, which are responsible for a stable, good mood. Thus, the concentration of these conductors increases and accumulates and the normal operation of the synapse( contact) is restored.
2. Heterocyclic antidepressants: maprotiline, mianserin.
Similar in effect to tricyclic, the distinctive feature is that they also participate in the synthesis of substances that help to inhibit the destruction of serotonin.
3. Irreversible nonselective monoamine oxidase inhibitors: isocarboxazide, tranylcypramine, phenelzine;reversible: moclobemide, selegiline.
The mechanism of action of this class of drugs is based on inhibiting the activity of the monoamine oxidase enzyme involved in the destruction of norepinephrine, serotonin and dopamine. This allows to increase the concentration of conductors in the synapse and restore the normal activity of the nervous system.
4. Selective serotonin reuptake inhibitors of the first generation: paroxetine, sertraline, citalopram, fluoxetine, fluvoxamine, second generation: escitalopram.
Block the destruction of serotonin, thereby eliminating its deficiency, but does not affect the synthesis of this substance in the neuron.
5. Selective norepinephrine reuptake inhibitors: reboxitin;serotonin and norepinephrine: venlafaxine, milnacipran.
This group of drugs is used to treat mild to moderate depression. The mechanism of action of this group also relies on suppression of reuptake of serotonin, norepinephrine, increasing their concentration.
6. 5-HT2 and antagonists: nefazodone, trazodone.
7. Atypical antidepressants: mirtazapine, bupropion.
It is known only that they do not act on the reuptake of serotonin and norepinephrine. To the end, mechanisms for increasing their concentration have not been studied.
Reminder for the patient about treatment with antidepressants
• Depression is a real disease that can be effectively treated with antidepressants. The goal of pharmacotherapy is to get rid of the symptoms of depression and return the patient to a normal state.
• Antidepressants are not addictive.
• The right antidepressant is the key to success. Do not succumb to the tricks of advertising, listen to the treating doctor, do not impose your opinion on the treatment.
• Antidepressants work slowly, and the antidepressant effect is the result of many days or even weeks.
• Take antidepressants regularly, as directed by a doctor. Chaotic technique reduces the therapeutic effect.
• The first antidepressant effect can be expected in the near future after two weeks of admission, after which the psychiatrist reassesses the effectiveness of treatment.
• Full antidepressant effect usually develops within 4-8 weeks of use, and in the elderly is much later.
• Treatment of depression is a long process. The optimal duration of treatment depends on many factors and is consistent with the psychiatrist.
• Premature discontinuation of antidepressants is not recommended, the risk of relapse is very high.
• It is not recommended to reduce dosage independently, this can lead to unpleasant and alarming symptoms.
• A positive reaction to an antidepressant is noted in 50-70% of patients - the rest need additional treatment or a change in the dose of the drug.
• Some antidepressants may affect the ability to drive. Always ask your doctor if you can take the drug to drive vehicles.
• The use of certain antidepressants may be contraindicated in certain somatic( bodily) illnesses, so be sure to tell the psychiatrist about all diseases and observation from other doctors.
• Some antidepressants can cause severe side effects when interacting with alcohol. Always ask a psychiatrist about the possibility of drinking alcohol during treatment with antidepressants.
• Initiation of antidepressant medication is sometimes insured by another maintenance drug. For example, benzodiazepines( xanax, nitrazepam).
• Taking any antidepressant can be complicated by side effects depending on the drug.
For the new generation of drugs, most side effects appear only in combination with an auxiliary drug. Side effects usually disappear after a few days and prolonged use of the drug is not burdensome.
• The use of certain antidepressants may lead to sexual dysfunction.
Vitamin D. Canadian researchers found that vitamin D has a strong correlation with depression. People with vitamin D deficiency are eleven times more likely to be depressed than those who have a normal level. Contained in sour-milk products, egg yolks, seafood, mackerel, cereals( oatmeal), parsley, potatoes, and in some herbs( alfalfa, dandelion, nettles, horsetail).
By itself, vitamin D can be synthesized in the body under the influence of ultraviolet radiation. Therefore, the treatment of depression has found use of light therapy. Just as easily it can be found in the pharmacy network. It is part of many multivitamins, such as centers, alphabet, complement, vitrum. And sold separately under the names, calcium D3, calcemin, aquadetrine, calciferol.
Omega-3 fatty acids. Studies confirm that people who use less omega-3 fatty acids suffer from depression more often. Flax seeds, walnuts, soybeans, dried oats, wheat germ, beans, common, fish and other marine mammals. The pharmacy meets under the name of all known fish oil, as it contains preparations with a similar name of omegad3 from different manufacturers. The most budget option is fish oil, especially since now it does not need "to eat spoons," it has a convenient dosage form and is available in capsules.
Amino acids. Depression and anxiety occur when the work of neurotransmitters in the brain is disrupted. Their building components are amino acids. Sometimes they are used as an alternative treatment for depression, with intolerance to antidepressants. High efficiency and absence of side effects are noted. There are about 300 different amino acids, but the main ones are only 20. They are contained in almost all products, depending on the amino acid. Basically, in food of animal origin, legumes, nuts. Finished preparations, the whole set of amino acids, it is more convenient to buy in sports nutrition stores under the names of BCAA, AMINO5500, SYNTHA-6, SUPER AMINO, PWER SYSTEM and so on.
Melatonin. With depressions complicated by insomnia, as a regulator of circadian rhythms of sleep. Stimulates the immune system, participates in biochemical processes, as an antioxidant, plays an important role in the formation of nervous processes. The precursor is tryptophan, which is found in bananas, pumpkin seeds, nuts, chicken and turkey meat, white and black mustard seeds, corn, rice, barley, ginger, pomegranate, strawberry. It is sold in pharmacies in the form of phytomelatonin, and under the same name of different manufacturers.
Caffeine, theobromine, theophylline - psychostimulants, are effective for drowsiness, hypodynamia, reduced work capacity, as well as with mental loads. Contained in coffee, cocoa, tea. Caffeine is a part of such drugs as ascophene, migrenium, caffeine-benzoate sodium. It is used with caution if depression is associated with a deficiency of Mg and K, since it helps to remove them from the body.
St. John's Wort acts as an antidepressant, is available as an oily solution or alcohol tincture, in a dry form, brewed as a tea or in a water bath.
Ginkgo biloba - strengthens blood vessels and improves blood flow, so it is recommended for depression in the elderly.
Siberian ginseng improves resistance to stress and improves the functioning of neurotransmitters in the brain( dopamine and serotonin).In the form of alcohol tincture, decoction, tablets.
Griffonia ( Griffonia - a wood curly shrub) is a fairly rare plant that can raise serotonin levels and balance mood swings. It is recommended for bipolar depression. This drug is antipained to patients with depletion as a result of depression, since it further reduces appetite. Produced in the form of dietary supplements.
Echinacea Purple is a psycho-immune stimulant, effective for physical and mental overwork. Tinctures, broths and extracts of a plant are applied, there is a tablet form in the form of dietary supplements.
Peony has a sedative and anticonvulsant effect. It is used as a sedative, with increased excitability, improves sleep, increases efficiency. In the pharmacy network is most often found in alcoholic infusions.
Rosemary regulates neural processes and endocrine depression, is effective in the depression of a burdened menopause. It is popular in the form of essential oils.
Eleutherococcus is used for vegetovascular disorders and low blood pressure, physical and mental fatigue, weakness of the body, as a means of increasing tone. The shortcoming is a short-term effect, up to several hours. Produced in alcoholic infusions, broths.
Aralia is used with general weakness and reduced pressure, nervous exhaustion, impotence, strengthens the body as a whole. It also stimulates the central nervous system. They use bark, prepare infusions, decoctions.
Be wary of taking Leonurus, hawthorn, valerian, cyanosis, as they have a strong sedative effect and can aggravate depression and reduce activity! It can be used to ease falling asleep and in acute stressful situations.
Drugs are best purchased in the pharmacy network, after consulting with the doctor in accordance with the instructions, since different tinctures and solutions contain a different percentage of the active substance obtained from the plant!
Doctor psychiatrist Kondratenko NA