"Imipramine" is the first pharmaceutical product that was used in the composition complex treatment depressive syndrome. Its unique effect, aimed at improving mood, was revealed as a result of studies conducted in the mid-fifties of the twentieth century. Studying the effects of this drug made it possible to create a unique drug group, called "tricyclic antidepressants". Medicines included in this group are often referred to using the term “tricyclics” or the abbreviation “TCA”. In this article, we propose to discuss what antidepressants are and what they are needed for.
With depression, a person loses all interest in life, feels overwhelmed and tired all the time, and cannot make a single decision.
Tricyclic antidepressants get their name because their structure is based on a triple carbon ring. Today, this category of medicines includes more than three dozen different medications. Their positive effect on emotional condition the patient is explained by the fact that the main components of the medications help increase the synthesis of serotonin and norepinephrine in the body. Also, the use of antidepressants helps stop the uptake of neurotransmitters, and has a positive influence on many internal systems, including cholinergic and muscarinic.
In the first years, after their mass distribution, drugs from the blood pressure category (antidepressants) were used to treat the following pathologies:
- diseases of the central nervous system complicated by mental disorders;
- diseases of somatic nature;
- endogenous disorders;
- psychogenic pathologies.
Besides treatment depressive disorders, panic attacks and anxiety ailments, medications from this group were used as part of the complex treatment of chronic depressive syndrome. Antidepressants were often prescribed as prophylactics to prevent relapse of the disorder.
According to many Western researchers, tricyclic antidepressants are one of the the best means to eliminate a severe form of depressive disorder, which is accompanied by the emergence of suicidal tendencies.
In the nineties of the last century, scientists believed that the use of TCAs as part of the complex treatment of endogenous depression could achieve lasting results. According to statistics of that time, the effectiveness of Amitriptyline was about sixty percent. The choice of a specific drug used in the treatment of pathology depended on clinical manifestations depressive disorder. According to experts of that time, intellectual inhibition and disorders motor functions, provoked by psychological pathologies and neurological disorders, were easily eliminated with the help of Melipramine. In the case of anxious personality disorder, Amitriptyline was used.
Depression is dangerous because it can affect the entire body, causing irreversible changes in individual organs. Why are antidepressants dangerous and why are they so rarely used today? In approximately thirty percent of cases of use of first-generation tricyclics, severe side effects occurred. In comparison, newer drugs cause negative effects only in fifteen percent of cases.
Tricyclics are used in the treatment of depressed states caused by depressive disorder. Today they are used for the following purposes:
- treatment of depressive and anxiety personality disorders;
- eliminating panic attacks;
- reduction in the severity of involutional melancholy;
- therapy for depressive syndrome of organic nature.
In addition, this category of medications is used as part of the complex treatment of diseases caused by somatogenic factors and the use of potent antipsychotic drugs. TCAs can be used for manic-depressive psychosis, as well as for the prevention of depressive syndrome.
Most of the drugs included in this group, in addition to their antidepressant effects, have sedative effect. Such medications are used as part of a complex treatment for disorders of the functionality of the nervous system. "Azafen" is one of the most effective means in this group, it is often used for pathologies in cardiac activity that occur against the background of a depressive disorder. This medication can be used in cases of alcoholic depression, which is accompanied by increased lethargy and anxiety.
It is important to note that antidepressants should not be used in combination with MAO inhibitors. The latter can be used only a few days after completing the course of taking TCAs. Among the contraindications to tricyclic antidepressants, individual intolerance to their composition should be highlighted.
TCAs can increase and promote the transmission of norepinephrine and serotonin Side effects of drugs
The principle of action of tricyclic antidepressants is based on inhibition of the process of uptake of serotonin and norepinephrine. Despite the fact that these drugs show high effectiveness in the treatment of depression, they have negative impact to work internal organs and systems. Let's look at the most common types side effects.
First of all, it should be said that the antihistamine effect helps reduce blood pressure, which leads to drowsiness. In addition, many patients experience rapid weight gain. Inhibition of the process of norepinephrine uptake provokes the development of tachycardia, and also negatively affects ejaculation and erection. It is important to note that most drugs in the blood pressure category have a negative effect on libido.
The anticholinergic effect can lead to flatulence and delayed urine output. In isolated cases, this process leads to disruption heart rate and provokes loss of consciousness. The seizure of dopamine and serotonin contributes to stimulation of the nervous system, loss of appetite and the appearance of attacks of nausea. Negative effects on the central nervous system may manifest as seizures. It should be noted that long-term use of drugs included in the TCA group has a negative effect on the heart muscle, which is expressed by conduction disturbances.
In a situation where the human body has increased instability to this category of medications, patients experience liver dysfunction, metabolic disorders and the development of other dangerous pathologies. It is important to note that antidepressants without side effects and addiction do not exist today.
The best drugs in the TCA category
In Russian pharmaceutical market more than several dozen available various means from the category of tricyclic antidepressants. In the list below, we have collected the most common pharmacological products that are highly effective and have a low likelihood of side effects.
Tricyclics inhibit the uptake of norepinephrine, serotonin, and the manifestation of anticholinergic and antihistamine effects Tricyclic antidepressants, list of drugs:
"Azafen"- a drug from the group of tricyclic antidepressants, which is used in the composition complex therapy various forms of depressive disorder. This medication demonstrates high effectiveness in the treatment of depressive conditions that are combined with chronic diseases somatic etiology.
"Saroten Retard"- a unique medication used to eliminate signs of depression, sleep problems and anxiety disorders. Experts prescribe this medication for diseases such as dysphoria, alcoholic, endogenous or reactive forms of depressive syndrome.
"Amitriptyline"- a derivative medicine manufactured on the basis of Imipramine. This drug can be considered one of the first representatives of TCAs. Used as part of complex treatment of depression and anxiety disorders.
"Fluoroacyzine"- a drug that, in addition to antidepressant effects, has a sedative effect. Despite the increased central and hololytic activity, this medication reduces the excitation of the nervous system.
Zoloft- a drug from the tricyclic category, which is used for severe depressive disorder. As an active component, this product uses sertraline, which is one of the most powerful antidepressants. Due to the accelerated rate of serotonin uptake, this remedy is one of the best in this category of drugs.
"Lyudiomil"- a medicine with a wide range of therapeutic effects, used to reduce anxiety, relieve lethargy and improve mood. Besides, this drug has the ability to eliminate many somatic symptoms characteristic of depressive syndrome.
"Lerivon"- the effect of this medication is aimed at blocking alpha adrenergic receptors. In addition, this medication has a pronounced sedative effect. Lerivon can be used for both mild and severe forms of depressive syndrome.
"Anafranil"- the uniqueness of this remedy lies in its wide range of therapeutic effects. This medication is used as part of complex therapy for masked, neurotic, endogenous, organic and reactive forms of depressive disorder.
"Clomiprimine"- a drug from the TCA category, used in the treatment of reactive, masking and neurotic forms of depressive disorder. Clomiprimine can be used as part of complex therapy for personality disorders and schizophrenia.
Tricyclic antidepressants cause a lot of side effects "Melipramine"– used in the treatment of various forms of depressive disorder, which are accompanied by the appearance of anxiety. The use of this drug is allowed in the case of bipolar and unipolar personality pathologies.
"Imizin"- a tricyclic with antipanic, antidiuretic and antidepressant effects.
"Doxpepin"- a drug included in the TCA group, used as part of a complex effect on depressive syndrome. In addition to its analgesic and antidepressant effects, this drug eliminates itching, prevents the development of panic attacks and the appearance of ulcers on the skin.
It is also worth mentioning such antidepressants as Elavel, Saroten and Clofranil, which, in addition to their antidepressant effect, have a sedative effect.
Where can I buy
You can purchase tricyclic antidepressants only in pharmacies, with a prescription from your doctor. The need for a doctor's prescription is explained by the fact that drugs from the TCA category are harmful to the body. Their long-term use leads to the development of glaucoma and tachycardia, and also provokes disturbances in accommodation and urination. One of the main side effects of such drugs is drying of the mucous membranes.
Many patients taking antidepressants experience abnormal heart rhythms and decreased performance blood pressure. It was these negative factors that led to the sale of drugs only with a prescription.
Conclusion
The approximate price of drugs included in the group of tricyclic antidepressants varies from three hundred to a thousand rubles. Please note that independent use Such drugs can lead to the development of negative side effects. In the case of depression, it is more advisable to replace antidepressants with drugs belonging to the category of sedatives.
It is recommended to start a course of treatment with antidepressants with minimum dosage. This approach to taking medications significantly reduces the risk of side effects. Experts recommend regularly taking blood tests throughout the course of treatment in order to be able to take control of the percentage. active ingredients medicine in the body. In the case when this indicator rapidly increases, there is a high probability of developing negative side effects.
The first antidepressants were synthesized in the fifties of the twentieth century. Nowadays, pharmacological companies continue to work on the creation of new groups of antidepressants, taking into account modern scientific ideas about mental illness. These medications affect the painfully depressed mood that is observed with.
How do antidepressants work?
Mental illnesses, including depression, are still largely unexplored territory. There are many hypotheses explaining the nature of these diseases. According to the generally accepted monoamine theory of depression, the disease occurs due to a deficiency of monoamine neurotransmitters (serotonin, dopamine, norepinephrine). Accordingly, in order to overcome depression, it is necessary to restore the normal metabolism and balance of these neurotransmitters. This is the mechanism of action of antidepressants.
Neurotransmitters- these are substances that transmit information from a neuron to another cell (nervous, muscle, etc.). The contact area between these cells is called a synapse. Neurotransmitters are produced in the presynaptic membrane of the neuron. Then from there they are released into the synaptic cleft - the space between neighboring neurons. Most of neurotransmitters enter the adjacent neuron through the postsynaptic membrane. A minority of the remaining neurotransmitters are captured back into the presynaptic membrane. According to the monoamine theory of depression, the disease causes increased reuptake of monoamine neurotransmitters, in particular serotonin. That is, neurotransmitters are produced, but do not reach their destination. Because of this, it is disrupted mental activity, apathy and bad mood appear.
Such a group of antidepressants as selective serotonin reuptake inhibitors (SSRIs) it precisely prevents the reuptake of this neurotransmitter by the presynaptic membrane. That is, the amount of serotonin in the synaptic cleft increases, and accordingly the postsynaptic membrane receives it in the proper amount. This is how the antidepressant effect is realized.
There is also such a group of antidepressants as monoamine oxidase inhibitors (MAO). Monoamine oxidase is an enzyme that breaks down monoamine neurotransmitters. Thus, the use of MAO inhibitors helps to suppress the activity of this enzyme, which is why neurotransmitters are not destroyed and, accordingly, their concentration increases.
Types of antidepressants
Exist various classifications antidepressants. This is how the classification looks like according to the mechanism of action of drugs:
- Drugs that block the neuronal uptake of monoamine neurotransmitters
- Non-selective (non-selective) actions that block the reuptake of serotonin and norepinephrine (Amitriptyline, Imipramine);
- Selective (selective) actions that block the capture of only a specific neurotransmitter:
- Blocking serotonin reuptake, this group is also called SSRIs (Fluoxetine, Paroxetine, Citalopram);
- Blocking norepinephrine reuptake (Maprotiline).
- Monoamine oxidase inhibitors (MAO):
- Non-selective action (Nyalamide);
- Selective action (Pirlindol, Moclobemide).
- Various (blocker of serotonin and alpha2-adrenergic receptors - the drug Mianserin, agonist of melatonergic receptors - Valdoxan).
In addition, there is also a classification of antidepressants according to their effect. In addition to the antidepressant effect itself, antidepressants have an additional effect: sedative or psychostimulant. Based on this, we distinguish antidepressants predominantly with a sedative effect(Amitriptyline, Mianserin), predominantly with a psychostimulating effect(Fluoxetine, Moclobemide). Antidepressants are also available balanced action(Paroxetine, Sertraline, Duloxetine). The doctor takes these aspects into account when selecting a drug for a particular patient, because in some people depression occurs with apathy, slow motor and mental activity, and for some with high anxiety and psychomotor agitation.
Indications for use
Just by the name of the group of drugs, you can understand that they are used in the fight against depression. However, the range of prescriptions for modern antidepressants, namely SSRIs, is quite wide. They are also prescribed for the following conditions:
- Anxiety disorder;
- Panic disorder;
- Obsessive-compulsive disorder;
- Complex.
Thus, SSRI antidepressants are widely used in general medical practice. Antidepressants are prescribed by a doctor and only if there are objective indications.
Many people are afraid to take antidepressants, even despite doctor's orders. They are driven by fears caused by popular myths about these drugs. So, many people believe that antidepressants are drugs that you can’t get off later.
In fact, antidepressants are not narcotic drugs. Their use can only influence pathologically depressed mood. They do not cause euphoria and are not able to improve the mood of people who do not suffer from depression. That is, if healthy man If he takes an antidepressant, he will not feel any effect. In addition, antidepressants are not addictive .
Features of application
The use of antidepressants has its own characteristics. We are so designed that we want to immediately get rid of unpleasant symptoms with one pill. However, this will not work with antidepressants. The fact is that the antidepressant effect when using this group of drugs occurs after approximately two to three weeks.
Much earlier, the additional effect of the drug is realized: calming or stimulating. This is why SSRI antidepressants are used in the treatment of anxiety disorders, because anxiety and restlessness decrease quite quickly.
Note! Due to the fact that the antidepressant effect does not develop immediately, many people stop taking the medication on their own, considering it useless. You can't do that. You can definitely say about the effectiveness of the medicine after a month. If the medicine really turns out to be ineffective, the doctor will replace it with another medicine.
The dose of the medication is increased gradually, achieving the required clinical effect. That is, the dose is selected individually for each patient. The course of taking antidepressants is quite long. Initially, their use is aimed at eliminating the painful condition; this takes an average of two to three months. After eliminating depressive symptoms, antidepressants are not stopped and are taken as maintenance therapy for another four to six months. If the condition normalizes, the doctor discontinues the drug. This should be done gradually, gradually reducing the dose of the medicine. In general, the course of taking an antidepressant is at least six months. Sometimes treatment can take a year or even two.
Important! The path to recovery from depression can be quite long, but you shouldn’t give up. By following your doctor's instructions and working on yourself, you can get rid of painful symptoms and enjoy life again!
Side effects
First generation antidepressants(tricyclic antidepressants, irreversible MAO inhibitors) had many side effects. These are urinary retention, orthostatic hypotension, edema, cardio- and hepatotoxic effects, headaches, tremor,.
Antidepressants of the latest generations have fewer side effects, but they still need to be taken into account. First of all, at the beginning of treatment with the drug, increased anxiety, restlessness, etc. may be observed. This is due to the stimulating effect of the drug. To prevent such side effects, antidepressants are often prescribed with tranquilizers at the initial stage. Treatment should take place under the supervision of a doctor.
Side effects of SSRI inhibitors are also due to the fact that serotonin receptors are found in many organs. Receptor stimulation can cause the following side effects:
- , constipation;
- Daytime sleepiness;
- Apathy;
- Fast fatiguability;
- Tremor;
- Sweating;
- Decreased libido, anorgasmia.
Side effects occur in the first weeks of treatment and usually disappear as therapy continues.
Note! The use of any antidepressants is associated with the risk of developing manic states. Therefore, antidepressants should be used with caution in bipolar disorder.
Popular drugs
The most modern and widely used antidepressants are SSRI drugs. They are tolerated by patients much better than antidepressants of other groups. Their use has fewer contraindications and side effects. In addition, they can be used not only for depression, but also for anxiety disorders.
Amitriptyline
A drug from the group of tricyclic antidepressants (TCAs). Available in tablet form and solution for injection. The medicine quickly has a pronounced antidepressant effect. It also has a calming, anti-anxiety, and hypnotic effect.
Amitriptyline is less tolerated by patients than SSRIs. Its main side effects are:
- Dry mouth;
- Pupil dilation;
- Violation of eye accommodation;
- Constipation;
- Urinary retention;
- Hand tremors;
- Heart rhythm disturbances.
Amitriptyline is contraindicated in high intraocular pressure, cardiac conduction disorders, prostate adenoma, epilepsy.
The drug is not as widely prescribed as SSRIs. Amitriptyline is used in the treatment of severe endogenous depressions. Treatment with the drug should be carried out in a hospital under the supervision of a doctor.
Fluoxetine
This is a popular SSRI antidepressant, also known as trade name Prozac. The drug normalizes mood, reduces anxiety and fear. However, fluoxetine is classified as a psychostimulant antidepressant. Accordingly, it is prescribed for depression that occurs slowly motor activity And thought processes. In patients with psychomotor agitation and severe anxiety, the drug may aggravate pathological symptoms. Prescribed for moderate depression and anxiety disorders. Suitable for outpatient treatment.
The drug does not cause orthostatic hypotension, does not have a toxic effect on the heart, unlike Amitriptyline. However, taking Fluoxetine is not without adverse reactions at all. These may include headaches, daytime sleepiness, nausea, vomiting, and dry mouth.
Cipralex
Belongs to the SSRI group, the active substance is escitalopram. Indicated for depression and panic disorder. The antidepressant effect develops after approximately 2-4 weeks. During treatment panic disorder The maximum therapeutic effect can be achieved after three months of treatment.
The medicine is used with caution when treating people with,.
Paroxetine
The drug belongs to the SSRI group and has a pronounced anti-anxiety effect. The range of uses of Paroxetine is very wide: from depression to post-traumatic stress disorder. This medicine is preferred for anxiety disorders. In case of depressive disorder with motor retardation and apathy, the drug can aggravate these symptoms.
Grigorova Valeria, medical observer
The modern “crazy” rhythm of life, the endless flow of information that a person needs to process daily, just like many others, for the most part negative factors, lead to the fact that the body and psyche cannot stand it. Insomnia and stress, impaired performance and communication, often ignored, and most often drowned out by medications or other potent substances, ultimately lead to such complex diseases as syndrome chronic fatigue(CFS) and various depressions. According to the forecasts of medical analysts, by the 20s of this century depression will outstrip the leaders of the 20th century in terms of the number of cases of illness - infectious diseases and diseases of cardio-vascular system. Used in the fight against depressive disorders various drugs, created on the basis of both natural and synthetic components.
Antidepressants - what are they? What are they and can these medications cure depression or only alleviate its symptoms? What are the advantages and disadvantages of such drugs? In this article we will try to answer these and other questions about antidepressants, the effect of their use and the consequences of taking them.
What it is?
As their name suggests, antidepressants (also called thymoleptics) are psychotropic medications that work against the symptoms of depression. Thanks to such drugs, increased anxiety and excessive emotional stress, apathy and lethargy, insomnia are significantly reduced and even disappear completely. The drugs included in this group vary according to chemical structure both composition and mechanism of action.
How it works?
Let's figure out what antidepressants are: destruction of the body or help to the exhausted human psyche. Let's look at how these drugs work. The human brain consists of many neurons - nerve cells that constantly exchange information with each other. To carry out such information transfer, special intermediary substances are required - neurotransmitters that penetrate through the synaptic gaps in the space between neurons. Modern researchers have identified more than 30 different mediators, but only three of them are “directly” related to the development and course of depression: serotonin, norepinephrine (norepinephrine) and dopamine. According to research data, depression occurs when there is a significant quantitative decrease in neurotransmitters at the sites where neurons interact. The action of antidepressants is aimed at increasing the amount of necessary mediators and normalizing the biochemical balance of the brain.
A little history
Before we start reviewing modern groups and types of antidepressants, we will briefly talk about the history of their discovery.
Until the mid-twentieth century, depressions and various neurotic conditions with similar symptoms were treated with a variety of herbal preparations. To “lift the mood,” various stimulant compounds were used, which included caffeine, ginseng, or opiates. They tried to “calm down” the nervous excitement with bromine salts or medications based on valerian officinalis. Also used different kinds gymnastics and physiotherapeutic procedures, the effectiveness of which was rather insignificant.
In the early 50s of the twentieth century, the drug "Promethazine" was created, initially used for anesthesia for surgical operations. Pharmacologists tried to enhance the inhibitory and suppressive effect of this medication, as a result of which by 1951 Chlorpromazine was obtained, which became widely used in medical practice treatment of depression. Today this drug is known as Aminazine.
At the end of the 60s of the last century, Swiss doctors treating patients with tuberculosis noted a rather unusual side effect of a drug such as Iproniazid. Patients receiving it varied high mood. Gradually they began to use it in psychiatric practice, since it helped very little against tuberculosis. Around the same time, German researcher Ronald Kuhn discovered the drug Imipramine.
The discovery of the first thymoleptics led to rapid development pharmacological research in this area and the creation of new medications aimed at combating the symptoms and causes of depressive disorders.
Modern classification
Depending on the effect the use of antidepressants has on a depressed patient, they are divided as follows:
Group | Main action | Drugs |
Sedatives | Relieving psycho-emotional stress without a hypnotic effect | "Gerfonal", "Amitriptyline" |
Balanced action | They can only be taken as directed and under the supervision of a physician, since when taking large doses a stimulating effect occurs, but medium doses have a calming effect | "Lyudiomil" "Pyrazidol" |
Stimulating | Used in the treatment of depressive conditions with symptoms of lethargy and apathy | "Aurorix" "Melipramine" "Anafranil" |
In addition, there is a classification based on how the action of antidepressants affects the course of biochemical processes in the human body:
- TCAs are tricyclic thymoanaleptics.
- MAOIs - monoamine oxidase inhibitors:
Irreversible ("Tranylcypromine", "Phenelzine");
Reversible (Pyrazidol, Moclobemide).
- SSIs - selective serotonin uptake inhibitors;
- IOSSIN - serotonin and norepinephrine reuptake inhibitors;
- NaSSA are noradrenergic and specific serotonergic antidepressants.
There are also a number of antidepressant drugs that cannot be classified into any of these groups.
TCA: what is it?
Tricyclic drugs such as Nortriptyline, Imipramine and Amyltriptyline get their name from the underlying triple carbon ring. These antidepressant drugs help increase the amount of neurotransmitters in the brain such as norepinephrine (norepinephrine) and serotonin (the happy hormone). This is achieved by reducing the level of their consumption by nerve cells - neurons.
Because these medications block more than just essential neurotransmitters, many different side effects occur. Taking tricyclic antidepressants can cause the following side effects:
- lethargy;
- drowsiness;
- nausea;
- dry mouth;
- weakness;
- dizziness;
- increased heart rate - pulse;
- constipation;
- decreased potency and libido;
- worry or anxiety.
Such medications, as a rule, are prescribed by doctors first, since they are the most studied and the consequences of their use are well known.
MAOIs - monoamine oxidase inhibitors
The drug "Iproniazid", which was one of the first to be discovered, as well as other medications in this group, such as "Isocarboxazid", "Tranylcypromine", suppress the enzymatic reaction of monoamine oxidase contained in the nerve endings. Thanks to this, neurotransmitters responsible for our mood, such as serotonin, tyramine and norepinephrine, are not destroyed, but gradually accumulate in the brain.
Most often, MAOI antidepressants are prescribed when or when medications of the tricyclic group are not suitable and do not have the required effect. The advantage of medications in this group is that they do not have a suppressive effect, but, on the contrary, stimulate mental processes.
Just like tricyclics, MAOIs do not have an immediate effect on a person’s condition - the effect of antidepressants begins several weeks after starting to take them.
Due to the fact that they have many side effects (and also easily interact with cough and cold medications and can provoke a life-threatening increase in blood pressure), and also because of a rather strict diet when taking them, these are prescribed drugs are used quite rarely, when other treatment methods have not helped.
Selective serotonin uptake inhibitors
The groups of TCAs and MAOIs we considered are, for the most part, long-discovered and well-studied drugs. But the “old” generations of antidepressants are gradually being replaced by more modern medicines, the action of which does not block all mediators, but only one - serotonin, preventing its re-uptake by neurons. Thanks to this, its concentration increases and it turns out healing effect. IIPS include the following: modern drugs, like Fluoxetine, Sertraline, Zoloft, Paroxetine and others. Medicines in this group have fewer side effects, and they do not have such a strong effect on the human body.
Serotonin and norepinephrine reuptake inhibitors
These are fairly new drugs that are already considered to be the third generation of antidepressants. They began to be produced in the mid-90s of the twentieth century.
Drugs such as Cymbalta and Effexor block the reuptake of not only serotonin, but also noripinephrine, while drugs such as Wellbutrin and Zyban prevent the reuptake of norepinephrine and dopamine.
The side effects of medications in this group are much less than those of others, and they are rather mild. After taking antidepressants based on inhibitors such as Duloxetine and Bupropion, weight gain and slight dysfunction in the sexual sphere may be observed.
Noradrenergic and specific serotonergic antidepressants - NaSSA
Another modern group of antidepressant drugs is NaSSA, which slow down or completely stop the uptake of norepinephrine at the synapses of nerve cells, thereby increasing its concentration. Medicines such as Remeron, Lerivon, Serzon block serotonin receptors.
When taking medications of this group, mild unpleasant side effects such as drowsiness, dry mouth, increased appetite and associated weight gain. Cancellation of antidepressants from this group proceeds without any serious problems.
In addition to the main groups of antidepressants presented above, there are a number of drugs that cannot be classified as one of them. They differ as chemical composition, and the mechanism of action. These are, for example, drugs such as Bupropion, Hypericin, Tianeptine, Nefazodone and many others.
Alternative Methods
Today, foreign specialists are increasingly using drugs to treat depressive conditions that affect not neurotransmitters and neurotransmitters, but the condition of such organs endocrine system, like the adrenal glands, hypothalamus and pituitary gland. Some of these drugs, for example, "Aminoglutethimide" and "Ketoconazole", block the synthesis of the hormone cortisol by the adrenal glands, but they have many side effects and have a negative impact on the endocrine system.
The second group usually includes antagonists of antalarmin receptors, which combine positive traits, which have tranquilizers and antidepressants.
Besides drug treatment depressive conditions, methods such as periodic normobaric hypoxia and plasmapheresis, light therapy, as well as many others are increasingly used to help reduce manifestations and alleviate symptoms.
Pros and cons
Most people who have taken antidepressants agree that they are very effective medications, especially if they are taken at the same time as a specialist course of therapy. It should be remembered that these drugs, as well as their dosage, can only be prescribed by a doctor, under whose supervision they should be taken. Don't expect immediate improvement. As a rule, a feeling of hopelessness and loss of interest in life, as well as lethargy, apathy and sadness disappear within 3-4 weeks after the start of systematic use.
One of the biggest disadvantages of these medications is antidepressant withdrawal syndrome, which occurs when you stop taking them abruptly and uncontrollably.
How to apply it correctly?
1. If you have been diagnosed with heart, kidney or liver disease, be sure to tell your doctor.
2. Antidepressants act individually, so a specialist will select a drug that is suitable specifically for you.
3. In some cases, medication alone is not enough; your doctor may prescribe simultaneous administration several (tranquilizers and antidepressants, antipsychotics and any anticonvulsants). Based on the diagnosis and monitoring your somatic condition, the specialist will select drugs that can complement each other and will not have a negative effect on the human body.
4. You should not stop taking antidepressant medications suddenly and without consulting a specialist, as this can aggravate the course of depression and cause various unpleasant physiological reactions.
5. Many people ask whether they can drink together. All instructions for medications indicate that this is strictly unacceptable, as it can lead to serious damage nervous system, even to death.
Withdrawal syndrome or addiction?
If you have taken antidepressants long time and then abruptly stopped for any reason, may occur discomfort such as emotionally unstable behavior, increased fatigue, muscle pain, dizziness. All of these symptoms are known as antidepressant withdrawal syndrome.
That is why doctors recommend gradually reducing the dose of medication taken and doing this under the supervision of specialists. Only professionals will help relieve discomfort by selecting the necessary normotonics and plant-based preparations. If the drug was taken uncontrolled, and then its use was abruptly stopped, such withdrawal of antidepressants can lead to sleep disturbances, increased anxiety, and problems with the cardiovascular system. In addition, the following symptoms may occur:
- unreasonable fears;
- flu-like symptoms;
- nausea, vomiting;
- spasms and pain in the gastrointestinal tract;
- loss of coordination and dizziness;
- nightmares;
- tremor of the limbs.
Instead of a conclusion
From all of the above, we can conclude how strong and quite dangerous drugs such as antidepressants are, that these are modern drugs that can cope with depression. However, before you start taking them, be sure to consult with a specialist - a psychiatrist or neuropsychiatrist, who can find out what form of the disease you have and what medications will help you cope with it.
Antidepressants are needed to stabilize mood and eliminate symptoms of depression. They act quickly enough nervous system patient and are often combined with various medications. Before using any of these drugs, you should consult your doctor. Only he will find out exactly why psychological problem, will help you choose suitable medications, will determine the duration of treatment required and the correct dose. Drugs that do not have strong impact, are dispensed at a pharmacy without a doctor’s certificate, but when prescribing potent antidepressants (monoamine oxidase inhibitors), the doctor writes a prescription.
The drug relieves depression different types and degrees of severity, eliminates anxiety.
- Indications. Paxil helps during panic attacks, agoraphobia, nightmares. Used during stress disorders in the post-traumatic period.
- Application and dosage. One tablet is taken after eating food, 20 mg daily for a couple of weeks, the dose can be increased every week by 10 mg (maximum up to 50 mg per day). The minimum course of medication use is 4 months.
- Side effects. Nervousness, insomnia, pain in the head, convulsions, complications of depression, and dry mouth may occur. Bleeding, nausea, and fainting may occur.
- Contraindications. Not recommended for use under 18 years of age, during lactation or hypersensitivity to this type of medication.
- Analogues. Adepress, Plizil, Sirestill, Rexetine.
Mianserin belongs to the group of psychoactive drugs. The drug has an antiemetic effect and stimulates appetite.
- Indications. Various mental disorders, feeling constant anxiety, deep depression.
- Application and dosage. Swallow the tablets with water (do not chew), preferably before bedtime in a couple of doses, dividing 60 mg daily dose twice (30 mg each). For elderly people, 30 mg is enough, followed by increasing the dosage. The course of treatment is usually about 4 weeks.
- Side effects. Constipation, a feeling of dryness in the mouth, drowsiness, headache, some weakness, and slight dizziness occur. The patient may begin to gain weight, it is possible painful sensations in the joints, rashes, arthritis.
- Contraindications. Severe sensitivity to this medicine, liver dysfunction, previous heart attack, pregnancy, lactation. It should be taken very carefully if you have kidney disease, glaucoma, or diabetes.
- Analogues. Miansan, Lerivon.
The drug Mirtazapine is sold in the form of convex, oval-shaped tablets with a special film coating applied on top. They have a yellow-brown color.
- Indications. Prescribed by a doctor during periods of depression with noticeable lethargy, weight loss, insomnia, and suicidal thoughts.
- Application and dosage. The tablet should be taken once a day, swallowed with a small amount of water. Reception does not depend on food consumption. For patients under 60 years of age, 15 mg per day is enough, increasing the dose to 45 mg. Treatment for depression lasts about 6 months.
- Side effects. Slow reaction, anxiety, weakness, convulsions, hallucinations, epileptic seizures. Appetite may increase, body weight may increase, stomach pain may be felt, potency may decrease, vomiting is also possible, skin rashes, swelling.
- Contraindications. High sensitivity to this drug. Use with caution during pregnancy, breastfeeding and patients with high sugar levels.
- Analogues. Mirtel, Esprital, Mirazep, Mirtastadin, Remeron.
Azafen is a fairly common drug that is also prescribed as a sedative.
- Indications. Prescribed by a doctor for depression different types: alcoholic, senile, exogenous. Heals the feeling increased anxiety and deep stress.
- Application and dosage. The tablet should be swallowed with a little water. 25–50 mg per day (in two doses) is sufficient. If there is no effect, then the dose is increased to 200 mg per day. Treatment lasts more than one month, up to a year.
- Side effects. Headaches, allergies, dizziness, vomiting and bouts of nausea may occur.
- Contraindications. High sensitivity to the active substance, hepatic or kidney disease, previous stroke or heart attack, heart disease, infections, diabetes.
- Analogues. Velaxin, Normazidol, Esprital, Coaxil, Befol, Tetrindol, Deprim, Alventa, etc.
One of the most potent antidepressants is undoubtedly Amitriptyline, which has a characteristic sedative effect.
- Indications. The drug should be used strictly as prescribed by the doctor during periods of depression. Amitriptyline helps with acute feelings of anxiety.
- Application and dosage. Per day you need to take from 50 to 75 mg (divided into separate small parts), increasing the dose as necessary. It is optimal to take 200 mg per day, but in acute depression it can reach 300 mg. The drug is used for 2–4 weeks.
- Side effects. Deterioration of vision, poor urination, headaches, weakness, nightmares, constipation, insomnia. Possible tachycardia, fainting, vomiting, loss of taste, diarrhea, rash, brittle hair, sweating.
- Contraindications. Intolerance to the components included in the drug, heart disease, liver or kidney problems, pregnancy, ulcer, previous heart attack.
- Analogues. Tryptisol, Amirol, Saroten, Amizol, Elivel.
Modern antidepressants are highly effective with a minimum of side effects. They produce enough of them a large number of and it is not possible to list everything. It is only worth noting that any of the drugs used to treat various types of depression and all kinds of mental disorders requires consultation with a doctor, and self-medication of depression is fraught with consequences.
Myths and facts about antidepressants are told by Rina Dragunova in this video:
Today, depression affects not only adults, but also children and adolescents. This disease and methods of combating it have been the subject of many studies by specialists and great amount articles and books. If translated from “scientific” into ordinary language, depression is a loss of strength and desire to live. Symptoms of this disease are apathy and constant anxiety and fatigue, lethargy and gloom.
Modern pharmacology offers antidepressants to combat this disease. latest generation. How many generations of thymoleptics (also called drugs that work against depression) exist today, what do they have in common and how do they differ from each other, what is their mechanism of action? These and other questions will be discussed in the article presented to your attention.
What are antidepressants?
Thanks to which you can relieve symptoms and even prevent depressive conditions. The main mechanism of their action is aimed at adjusting the biochemical activity of the human brain. its components constantly interact with each other through special substances - neurotransmitters. According to one theory, depressive disorders occur when the brain, due to various reasons, the level of any mediator or biogenic amine decreases significantly: dopamine, norepinephrine or serotonin. Antidepressants of the latest generation, like all previous ones, have a regulating and corrective effect on the biochemical processes of the brain by changing the concentration of one or another biogenic amine.
What are they needed for?
In addition to the fact that modern antidepressants help cope with the symptoms of depression, they are often used to get rid of the following problems:
- various pains of unknown origin;
- appetite or sleep disturbances;
- severe fatigue or loss of strength;
- nervousness or feelings of constant tension;
- attacks of nervousness or anxiety;
- problems concentrating or remembering.
Generations of antidepressants
Before considering how many generations of anti-depression drugs have been created to today, we need to remember that antidepressants were discovered only in the middle of the 20th century. Today, depending on the time of invention and the beginning of use in clinical practice, as well as on the effect of antidepressants, it is customary to distinguish four generations of these drugs.
First generation drugs
The first generation, discovered in the 50s of the last century, is represented by cyclic tricyclic thymoleptics (TCAs). These include the following drugs: Amitriptyline (an antidepressant, the very first one discovered) and its derivatives, as well as the drugs Nefazodone, Anafranil and Melipramine. These compounds block the reuptake of norepinephrine, thereby increasing its concentration. However, TCAs blocked not only norepinephrine (norepinephrine), but also all other neurotransmitters that came in their way, which led to a large number unpleasant side effects, primarily such as a sharp increase in blood pressure and increased heart rate. Drugs in this group are quite toxic, and the likelihood of an overdose when using them is very high, which is why they are so little used in the treatment of depressive disorders today.
In addition, the first generation includes drugs that are no longer used today and contain irreversible monoamine oxidase inhibitors (MAOIs) - Iproniazid, Tranylcypromine, Isocarboxazid. Their action is based on suppressing the activity of the nerve endings of brain neurons, resulting in an increase in the concentration of serotonin and norepinephrine.
Second generation drugs
The second generation, unlike the first, has a more selective, but also weaker effect on neurotransmitters and the neurons themselves. It includes tetracyclic irreversible (MAO-B) and reversible (MAO-A) monoamine reuptake inhibitors, represented by drugs such as Lerivon, Ludiomil, Pyrazidol and a number of others. Due to the fact that many quite serious side effects occurred when taking them, as well as due to interaction with different drugs and unpredictability of effects, drugs in this group are used extremely rarely. It is quite difficult to find antidepressants from the group of monoamine reuptake inhibitors in pharmacies. But in some cases they are found under other trade names. So, experts say that the drug “Lyudiomil” is the same tablets “Maprotiline”, the price, manufacturer and country are just different.
Third generation
Modern researchers have found that about 30 mediators are involved in the functioning of the brain and nervous system, but only three of them are “involved” in depression: serotonin, dopamine and norepinephrine (norepinephrine). The third generation includes selective serotonin reuptake inhibitors (SSRIs), represented by the most commonly used modern antidepressants such as Zoloft, Citalopram, Prozac, Cipralex, Paroxetine, Plizil and many others. These medications do not block all mediators, but only one - serotonin. In terms of their potency, they are inferior to first-generation drugs, but they have significantly fewer side effects than any other predecessors. All SSRI drugs are very effective and should be tolerated approximately equally by patients. However, each of us has its own individual characteristics, and it is because of them that the number and severity of side effects will vary in each specific case. Doctors say the most common unpleasant consequences Third generation medications include insomnia, dizziness, nausea and anxiety.
SSRI drugs are quite expensive. Thus, for the fairly well-known and widely used drug “Citalopram”, the price in pharmacies, depending on the brand under which it is released, can vary from 870 to 2000 rubles.
Fourth generation antidepressants
These usually include drugs from the SSRI group (selective serotonin and norepinephrine reuptake inhibitors). These are the latest generation antidepressants, such as Cymbalta, Milnacipran, Remeron, Effexor, which block the uptake of both norepinephrine and serotonin. The drugs Zyban and Wellbutrin do not interact with serotonin, but retain dopamine and norepinephrine. The development of drugs belonging to this group began only in the mid-90s of the last century, and every year more and more new drugs appear.
Doctors cannot say unequivocally that it is in this group that there is the most best antidepressant, this is basically impossible, since for the treatment of various types of depressive disorders, medications are selected individually, taking into account the health characteristics of each patient.
Popular modern thymoleptics
Knowing about the serious impact of drugs in this group on the nervous system, it is necessary to remember that all possible - both positive and negative - consequences can be predicted and mitigated only by a qualified specialist - a doctor. Taking into account all the individual characteristics and having made a diagnosis, it is the doctor who will be able to prescribe exactly those antidepressants that can best help in your particular case, with minimal side effects. If any problems arise while taking the prescribed medication, it is the attending physician who will be able to adjust or change the treatment regimen. Today, most practitioners recommend drugs from the group of selective serotonin and norepinephrine reuptake inhibitors to patients with depressive disorders, the effective effects of which have been tested in practice. Medicines such as Milnacipran, Fluxen (Fluoxetine), Duloxetine, Velaxin (Venlafaxine) are the most typical and widely used antidepressants of the latest generation. Let's consider the most popular thymoleptics in the treatment of depressive disorders.
Medicine "Flucosetine"
This drug is one of the first representatives of the SSRI group; it combines both antidepressant and stimulant effects. The medicine "Fluxen", also known as the antidepressant "Fluoxetine", helps reduce anxiety and tension, eliminates feelings of fear and improves mood. Its most effective use, according to practicing psychotherapists, is in cases of asthenic depressive disorders with apathy, as well as depression of varying severity and obsessive states. This medicine is also used in the treatment of bulimia. The antidepressant Fluoxetine was first registered in 1974 in the USA, and in the last decade it has become a top seller in the UK, only under a different trade name - Prozac. In Russia, this medicine is widely used, and many practicing doctors confirm that they prescribe it or its generics to patients for various depressive conditions.
The drug "Paroxetine"
This is the most powerful representative of the group of selective inhibitors of selective serotonin uptake, widely used in the treatment of anxiety states and depression. Today there are drugs active substance of which paroxetine is, there are quite a few. This includes the Russian drug “Adepress” from Veropharm, the drug “Plizil” from the Croatian company Pliva, the Hungarian tablets “Rexetine” from and many others. Regardless of the name of the drug "Paroxetine", reviews of it from both patients and doctors are mostly positive.
The drug "Wellbutrin"
Better known as "Zyban" or "NoSmoke". The active ingredient in all three drugs is bupropion hydrochloride, which increases the amount of dopamine and norepinephrine in the brain. Medicines containing this active ingredient not only relieve symptoms of depression, but also help overcome the emotional consequences of quitting nicotine. This medication improves mood and increases performance. Reviews from those who got rid of nicotine addiction with the help of drugs such as Wellbutrin, KnowSmoke and Zyban, they talk about the high effectiveness of these drugs during the period of smoking cessation.
Medicine "Cymbalta"
A drug of the fourth generation of antidepressants, which is an inhibitor of the reuptake of norepinephrine and serotonin, simultaneously carrying out a slight uptake of dopamine. This drug, the active ingredient of which is duloxetine, has a rather high speed of action compared to other antidepressants. According to reviews from both doctors and patients, a clear antidepressant effect appears by the end of the first - beginning of the second week of use. In addition, this drug is characterized by uniform action throughout the entire time of its use. However, there is a group of patients, according to whose reviews the effect of this medicine, if it occurs, is very weak. As already mentioned, individual characteristics of the course of biochemical reactions quite often lead to the fact that one or another medication prescribed by a doctor may not have the expected result.
What is the price?
Today it is quite difficult to talk about prices for medications. This is due to the fact that the foreign exchange market is extremely unstable, and new antidepressants for the most part come to us from foreign manufacturers, whose prices are presented in euros. That is why the table below presents the minimum and maximum prices in rubles, since it is simply impossible to average them. Some of the drugs that were received earlier are still sold at the old prices, while new ones are much more expensive.
Group | Active substance | Tradename | in rubles |
|
Tricyclic antidepressants | amitriptyline | "Elavel" | ||
imipramine | "Imizin" | |||
clomipramine | "Anafranil" | |||
maprotiline | "Lyudiomil" | |||
Selective serotonin reuptake inhibitors (SSRIs) | sertraline | Zoloft | ||
paroxetine | "Paxil" | |||
fluvoxamine | "Fevarin" | |||
fluoxetine | "Prozac" | |||
citalopram | "Cipramil" | |||
escitalopram | "Lenuxin" | |||
Serotonin and norepinephrine reuptake inhibitors (SSRIs) | bupropion | "Wellbutrin" | ||
venlafaxine | "Velaxin" | |||
duloxetine | "Cymbalta" | |||
If you carefully look at the table, you will notice that it does not contain second-generation drugs, namely MAOIs (monoamine reuptake inhibitors). It's not a mistake. The thing is that these antidepressants, which have a large number of unpleasant side effects and are incompatible with many drugs, are practically not used in European countries. In the USA, the medications “Isocarboxazid”, “Ugenelzin” and “Tranylcypromine” are used quite rarely, and in our country the drug “Nialamide” is used. All of the above medications are available only under the supervision of psychiatrists.
This table clearly shows that the price for “classical” tricyclic antidepressants is significantly lower than for newer drugs from the SSRI and SSRI groups. Thus, it is not possible to talk about the high availability of effective antidepressant drugs for the majority of the population. However, your doctor can help you choose a less expensive drug with similar properties, the so-called generic.
Interaction with other drugs
Antidepressants can interact with others, even those that seem absolutely safe and familiar to us. The most active in this regard are tricyclic thymoanaleptics and monoamine oxidase inhibitors, but drugs from the SSRI and SSRI groups practically do not interact with other medications. In any case, if your doctor prescribes you any medications against depression, be sure to find out whether you can combine them with the use of other medications, dietary supplements, and even teas and herbal decoctions.
Strange as it may sound, many people who need to take thymoleptics due to various reasons, they ask how often you can combine the use of “hot” drinks and pills for depression. The answer to this question is quite simple: do you want to risk your mental and physical health, and maybe even life, try it! The fact is that both alcohol and antidepressants have a serious effect on the central nervous system and the brain, and such double pressure can negatively affect both the “flight control center” itself, that is, the brain, and the organs and systems subordinate to it. Whether or not it is worth combining is a decision that you and only you can make.
Instead of a conclusion
You shouldn’t think and rack your brains about which antidepressants are better and more effective. If you feel that each new day is becoming more difficult to live than the previous one, that you don’t have enough strength even for the simplest and most mundane things, contact a specialist! The doctor will be able to diagnose your disease and prescribe necessary treatment by choosing the medications that are most suitable for you. These may not only be antidepressants. The arsenal of today's medicine is quite extensive: various types of psychotherapy, physical exercise and acupuncture, breathing practices and physiotherapeutic procedures.
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