Antidepressants are drugs that can help relieve symptoms of depression, social anxiety disorder, seasonal affective disorder, and dysthymia or mild chronic depression.

They aim to correct chemical imbalances in neurotransmitters in the brain that are thought to be responsible for mood and behavioral changes.

Antidepressants were first developed in the 1950s. Their use has become more frequent over the past 20 years.

Types of antidepressants

Antidepressants can be classified into five main types:

SNRI and SSRI antidepressants

This is the most commonly prescribed type of antidepressant.

Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are used to treat depression, mood disorders and possibly, but less commonly, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety disorders, menopausal symptoms, chronic fibromyalgia neuropathic pain.

SNRIs increase levels of serotonin and norepinephrine, two neurotransmitters in the brain that play a key role in stabilizing mood.

Examples include duloxetine, venlafaxine, and desvenlafaxine.

Selective inhibitors are the most commonly prescribed antidepressants. They are effective in treating depression and have fewer side effects than other antidepressants.

Selective serotonin reuptake inhibitors (SSRIs) block the reuptake of serotonin in the brain. This makes it easier for the brain cells to receive and send messages, resulting in more stable moods.

They are called "selective" because they seem to affect primarily serotonin and not other neurotransmitters.

SSRI and SNRI can have the following side effects:

• hypoglycemia, or low blood sugar
• low sodium content
• nausea
• dry mouth
• constipation or diarrhea
• weight loss
• sweating
• tremor
• sedation
• sexual dysfunction
• insomnia
• headache
• dizziness

It has been reported that people using SSRIs and SNRIs, especially those under the age of 18, may have suicidal ideation, especially when they first start using.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are so named because they have three rings in the chemical structure of these drugs. They are used to treat depression, fibromyalgia, certain types of anxiety, and can help control chronic pain.

Tricyclic antidepressants can have the following side effects:

• seizures
• insomnia
• anxiety
• arrhythmias or abnormal heart rhythm
• hypertension
• nausea and vomiting
• abdominal cramps
• weight loss
• constipation
• retention of urine
• increased eye pressure
• sexual dysfunction

Examples include amitriptyline, amoxapine, clomipramine, desipramine, imipramine, nortriptyline, protriptyline, and trimipramine.

Monoamine oxidase inhibitors

This type of antidepressant is usually given before the administration of SSRIs and SNRIs.

It inhibits the action of monoamine oxidase, an enzyme in the brain. Monoamine oxidase contributes to the degradation of neurotransmitters such as serotonin.

If less serotonin is destroyed, there will be more circulating serotonin. In theory, this results in more stable moods and less anxiety.

Doctors now use MAOIs if SSRIs don't work. IMAO is usually used for when other antidepressants do not work because IMAO interacts with several other drugs and certain foods.

Adverse reactions include:

• blurred vision
• seizures
• swelling
• weight loss or weight gain
• sexual dysfunction
• diarrhea, nausea and constipation
• anxiety
• insomnia and drowsiness
• headache
• dizziness

Examples of IMOs include phenolzine, translylcypromine, isocarboxazid, and selegiline.

Norepinephrine and specific serotonergic antidepressants

They are used to treat anxiety disorders, certain personality disorders, and depression.

Possible side effects include:

• constipation
• dry mouth
• weight gain
• drowsiness
• blurred vision
• dizziness

More serious side effects include seizures, decreased white blood cells, seizures, and allergic reactions.

Examples include Mianserin and Mirtazapine.

Which antidepressant is right for you?

Are you confused when choosing antidepressants? Find one that works so you can enjoy life again.

Antidepressants are popular for treating depression. While antidepressants cannot cure depression, they can reduce symptoms. The first antidepressant drug you try may work well. But if it doesn't relieve your symptoms or cause side effects that bother you, you may need to try something else.

So don't give up. There are many antidepressants and chances are of finding one that works well for you. Sometimes a combination of medications can be a good option.

Finding the Right Antidepressant

There are several antidepressants that work in slightly different ways and have different side effects. When you are prescribed an antidepressant that may work for you, your doctor may keep in mind:

• Your specific symptoms. Symptoms of depression can vary, and an antidepressant may relieve some symptoms better than others. For example, if you have trouble sleeping, an antidepressant that mildly acts as a sleeping pill may be a good option.
• Possible side effects. The side effects of antidepressants vary from drug to drug and person to person. Unpleasant side effects such as dry mouth, weight gain, or sexual side effects can make treatment difficult. Discuss possible side effects with your doctor or pharmacist.
• Did it work for a close relative. If the antidepressant helped a parent or sister, it may work well for you as well. Also, if an antidepressant has been effective for your depression in the past, it may help again.
• Interaction with other medicinal products. Some antidepressants can cause dangerous reactions with other medicines.
• Pregnancy or breastfeeding. The decision to use antidepressants during pregnancy and lactation is based on a balance of risks and benefits. In general, the risk of birth defects and other problems in mothers taking antidepressants during pregnancy is low. However, some antidepressants, such as paroxetine, can be misused during pregnancy.
• Other health problems. Some antidepressants can cause problems if you have certain mental or physical health problems. On the other hand, some antidepressants can help treat other physical or mental conditions along with depression.

Side effects

All side effects are likely to occur within the first 2 weeks and then gradually disappear.

Common effects are nausea and anxiety, but this will depend on the type of medication used, as mentioned above.

If the side effects are very unpleasant or if they involve suicidal thoughts, the doctor should be informed immediately.

In addition, studies have linked the following side effects to antidepressant use, especially in children and adolescents.

Excessive mood swings and behavioral activation. This can include mania or hypomania. It should be noted that antidepressants do not cause bipolar disorder, but they can reveal a condition that has not yet been identified.

Suicidal thoughts. There are several reports of a higher risk of suicidal ideation when using antidepressants for the first time.

It could be due to medication or other factors, such as when the medication was taken, or possibly undiagnosed bipolar disorder, which may require a different approach to treatment.

These drugs are used not only to treat depression but for other conditions as well.

The main or approved uses of antidepressants are:

• excitement
• obsessive compulsive disorder (OCD)
• infantile enuresis
• depression and major depressive disorder
• generalized anxiety disorder
• bipolar disorder
• post-traumatic stress disorder (PTSD)
• social anxiety disorder

Prohibited uses of antidepressants include:

• insomnia
• migraine

Studies have shown that in 29% of cases, the antidepressant is used without indications.

How long does the treatment take?

5 to 6 people out of 10 will get a significant improvement after 3 months.

People who use the medicine should continue taking it for at least 6 months after they feel better. Those who stop may see symptoms return.

Those who have had one or more relapses should continue treatment for at least 24 months.

Those who regularly experience rheumatoid depression may need to use the drug for several years.

During pregnancy

Your doctor can help you assess the pros and cons of taking antidepressants during pregnancy.
The use of SSRIs during pregnancy is associated with a higher risk of fetal loss, premature birth, low birth weight, and congenital malformations.

Possible birth problems include excessive maternal bleeding.

After birth, the newborn may experience lung problems known as persistent pulmonary hypertension.

A study of pregnant women shows that the use of SNRIs or TCAs during pregnancy may increase the risk of pregnancy-induced hypertension or high blood pressure known as preeclampsia.

The results of a study published in JAMA in 2006 suggested that nearly 1 in 3 babies whose mothers used antidepressants during pregnancy had neonatal withdrawal syndrome. Symptoms include sleep disturbance, tremors, and high crying. In some cases, the symptoms are severe.

A laboratory study showed that rodents that were exposed to citalopram, an SSRI antidepressant, just before and after birth, showed significant brain impairment and behavior.

However, for some women, the risk of continuing treatment is less than the risk of stopping, for example, if depression can cause an effect that could harm themselves or the unborn child.

Alternative substitutes for antidepressants

Here are some good herbs you can use before starting antidepressants:

St. John's wort

St. John's wort appears to help some people with depression. It is available over the counter as a supplement. It is often used as a tea. It should not be taken with antidepressants!

However, it should only be taken after consulting a doctor as there are some potential risks.

When combined with certain antidepressants, St. John's wort can lead to a potentially life-threatening rise in serotonin.

This can worsen the symptoms of bipolar disorder and schizophrenia. A person who has or may have bipolar depression should not use St. John's wort.

This can reduce the effectiveness of certain prescription drugs, including birth control pills, some heart medications, warfarin, and some HIV and cancer treatments.

It is important to tell your doctor or pharmacist if you are planning to take St. John's wort.

Valerian, mint and hawthorn

Hawthorn, hawthorn, and valerian have been used for centuries to relieve anxiety and sleep problems. Tea and supplements help for stress, depression, and abdominal cramps. The active ingredients in these herbs have a number of good effects on the body, making it an easy and safe alternative.

Diet and exercise

Some research suggests that a healthy, balanced diet, plenty of exercise, and staying in touch with family and friends can reduce the risk of depression and relapse.

Depression is a serious medical condition that may require medical treatment. Anyone experiencing symptoms of depression should seek medical attention.

Catad_tema Depression - Articles

Depression in general medical practice (clinic, diagnostics, drug therapy)

Methodological guide for doctors
2006

Authors: Professor of the Department of Psychiatry, Narcology and Psychotherapy of the FPK and PPP, Doctor of Medical Sciences P.B. Zotov, M.S. Umansky
Reviewer: Head. Department of Medical Psychology and Psychotherapy of the Tyumen State Medical Academy, MD B.Yu. Prilensky

FGOU HPE "Tyumen Medical Academy of Roszdrav" Faculty of continuing education and teaching staff

The methodological manual examines the main issues of diagnosis, clinical features and drug therapy of depression in general medical practice.

INTRODUCTION

Depression- a mental disorder characterized by a pathologically low mood with a negative, pessimistic assessment of oneself, one's position in the surrounding reality, one's past and future.

Depressive mood changes, along with distortion of cognitive processes, are accompanied by motor inhibition, decreased motivation for activity, somato-vegetative dysfunctions [Smulevich AB, 2001].

The importance of detecting and treating depression is due to the fact that she:
- reduces the adaptive capabilities of the individual;
- worsens the course or provokes a somatic illness;
- increases the risk of complications and mortality in somatic pathology;
- disrupts the microsocial functioning of the individual (in the family, collective);
- reduces the quality of life;
- increases the risk of suicide;
- can lead to a decrease in social status and job loss; increases the risk of disability.

The prevalence of depression in the general population is from 3 to 6%, and among patients seeking help in the institutions of the general medical network clinically outlined, typical forms of depression are detected in at least 12-25% of cases [Smulevich AB, 2001]. Among women, the frequency of depression ranges from 18 to 25%, among men - 7-12%, while the average duration of untreated emotional disorders is up to 6-8 months. Most often, depression is present in stroke patients, patients of cardiology and oncology clinics.

Prevalence of depression (%)

Diagnosis of typical forms of depression in most cases is not difficult, however, low rates of their detection can be due to a number of reasons:
- low awareness of the general practitioner about the clinic for depression;
- "displacement" of diagnosis solely on the detection of a somatic disease;
- use of diagnoses: neuro-circulatory dystonia, diencephalic syndrome, astheno-vegetative disorders, etc.
- bias of the patient and / or doctor against ascertaining a mental disorder

CLINIC OF DEPRESSION

In the classic version, the clinical manifestations of depression include the following groups of symptoms:
- the time limit allotted to a general practitioner to examine a patient.

Factors affecting the development of depression can be of a different nature.

Among them are:
1. Psychogenias - stress factors (conflicts in the family, at work, social).
2. Somatic diseases - can themselves determine the development of depression, be their consequence or proceed independently of each other. Depression worsens the course of a physical illness and, at the same time, complicating the clinical picture, leads to an increase in the frequency of seeking medical help and a significant number of unnecessary studies.
3. Taking medicines [Wayne AM, 2002]:
- antihypertensive drugs - reserpine and its derivatives, clonidine, methyldopa, beta-blockers - obzidan, propranolol, calcium channel blockers - nimotop, nimodipine;
- cardiac drugs - cardiac glycosides from the digitalis group of drugs, procainamide;
- hormonal agents - corticosteroids, anabolic steroids, oral contraceptives, progesterone, estrogens;
- drugs with an anticonvulsive effect - clonidine, barbiturates;
- analgesics and non-steroidal anti-inflammatory drugs - indomethacin, phenacetin, butadione;
- antibiotics - cyclosporine, griseofulvin, nalidixic acid;
- anti-tuberculosis drugs - ethionamide, isoniazid.
4. Endogenous factors (impaired metabolism of serotonin, norepinephrine, ACTH, cortisol, endorphins, etc.)
5. Organic diseases of the central nervous system (damage to the vessels of the brain in atherosclerosis, hypertension, the consequences of stroke, craniocerebral trauma, etc.).
6. Nutritional features.

1. Decreased mood, obvious in comparison with the patient's norm, prevailing almost daily and most of the day. At the same time, the state of low mood is little subject to changes during the day. A decrease in mood is often combined with anxiety. Can also be observed:
- decrease / loss of interests and the ability to have pleasure (anhedonia);
- low self-esteem and self-confidence;
- gloomy, pessimistic vision of the future;
- ideas of guilt and self-deprecation;
- suicidal ideas, attempts;
- decreased ability to concentrate;

2. Somato-vegetative disorders:
- increased fatigue;
- dizziness;
- violation of the heart rhythm;
dry mouth;
- constipation;
- decreased appetite;
- decreased sexual potency or frigidity;
- violation of the menstrual cycle, etc.

3. Sleep disorders:
- sleep disorders;
- shallow sleep with frequent awakenings;
- nightmares;
- loss of a sense of satisfaction from sleep.

In general practice, there are various variants of depressive disorders, among which depression prevails, combined with anxiety disorders. In terms of severity, mild forms are more common.

Typical Simple Depression characterized by a moderate severity of symptoms and a predominance of a depressed mood (sadness, despondency, sadness). The past, present and future are perceived by the sick in a gloomy light. Sleep disturbances, decreased appetite, and constipation are noted. Patients complain of lethargy, fatigue. For the successful treatment of these conditions, the appointment of amitriptyline, azafen, fluoxetine, rexetine, cipralex, pyrazidol and other antidepressants in moderate doses is usually sufficient (see table 1).

Anxiety-depressive option- the predominance of anxiety, vague anxiety, uncertainty about the future. Patients cannot sit in one place for a long time, they touch their fingers, bite their nails. With a sufficiently pronounced anxious component of depression, psychosomatic symptoms are associated with a sharper autonomic dysfunction and a predominance of sympathicotonia: tachycardia, chest pain, shortness of breath (tachypnea), a feeling of shortness of breath, dilated pupils, tremor, hyperhidrosis, pallor of the skin, dry mouth, nausea diarrhea, decreased appetite, feeling hot or cold, insomnia (mainly difficulty falling asleep), nocturia, increased blood pressure and blood glucose.

Astheno-depressive variant characterized by a predominance of asthenic complaints, sensory hyperesthesia, emotional lability, a special type of asthenic thinking, in which rapid exhaustion is noted, understanding of the complex relationship between phenomena suffers, and general lethargy, weakness, rapid fatigue, i.e. elements of physical asthenia, but most important in the morning hours. Irritability is easily replaced by tears. The mood is low, motor skills and speech are somewhat slowed down, however, the most painful patients experience their intellectual impotence. When choosing drugs, preference should be given to antidepressants with a stimulating effect (imipramine, fluoxetine, anafranil, cipralex).

Apato-depressive variant- in the foreground is the absence or decrease in the level of motivations (motivations), interest in the environment, emotional response to current events, indifference, energy or lack of volitional impulses with the inability to overcome oneself, to make an effort on oneself, to make a certain decision. In this type of depression, antidepressants with a stimulating effect are also preferred.

OPTIONS FOR SOMATIZED DEPRESSION

I. With dysfunction of internal organs:

1. Disorders of the cardiovascular and respiratory systems - most often found in somatic practice and qualified by therapists as vegetative-vascular or neurocirculatory dystonia.

Patients complain of dizziness, weakness, sweating, pressing headaches, compression / burning in the region of the heart, hot flashes, cold extremities, lack of air.

The condition can periodically be interrupted by raptus with functional disorders of the cardiovascular and respiratory systems (lability of the pulse and blood pressure, arrhythmia, tachycardia, ECG changes, respiratory rhythm disturbances), similar to angina attacks, myocardial infarction, stroke, bronchial asthma, and accompanied by fear of death ...

2. Masks in the form of gastrointestinal tract pathology. In this case, patients complain mainly of dyspeptic disorders (dry mouth, nausea, vomiting, flatulence, constipation or diarrhea) and abdominal pain. Functional disorders are usually found in the form of various dyskinesias (spasms of the pharynx and esophagus, dyskinesia of the biliary tract, small and large intestines), spastic or atonic phenomena (spastic colitis, atony of the large intestine, etc.).

3. Disorders of the genitourinary system - frequent urination, urge to urinate at night, impotence in men, frigidity in women, decreased libido.

Clinically well-defined depressive disorders are not a problem for general practitioners to detect. Usually, difficulties arise in the diagnosis of the so-called somatized, masked or larvae variants of depression, characterized by the dominance of somatic and / or autonomic symptoms in the clinical picture. In these conditions, in patients, the characteristic depressive symptoms are present in an erased form or absent altogether. Masked depression can account for 10 to 30% of all chronically ill patients in general medical practice (Mosolov S.N., 1995).

II. Algic variant- complaints of pain manifestations of various localization prevail:
- headaches and facial pains;
- toothache;
- back and spine pain;
- intercostal neuralgia;
- lumbago, etc.

III. Depression masks in the form of functional movement disorders.

In the foreground are various paresthesias, neurological and muscle pains with a fairly clear localization ("restless legs syndrome", various tics, muscle twitching, blepharospasm, etc.).

IV. Depression with a predominance of sleep disturbances occurs mainly in outpatient practice. Patients complain mainly of sleep disorders, loss of sleep and sleepiness during the day. At the same time, the fear of not falling asleep can become obsessive. This option is often found at the beginning of the development of depression and in the future can be replaced by the appearance of more typical symptoms. In the therapeutic plan, doxepin, mianserin, trazodone help well with dyssomnic depressions.

DIAGNOSTICS OF DEPRESSION

Diagnosis of depression is largely based on the correct collection and analysis of patient complaints, medical history data and life history.

A clinical interview with a potentially depressed patient is a rather complex process that requires a certain patience and skill from the doctor. This is due to the fact that many patients deny, do not realize or do not want to talk about their psychological problems and emotional experiences, and therefore, direct questions about low mood, melancholy or anxiety are usually answered negatively. In addition, patients often find it difficult to verbally describe their state of mind and use more familiar somatic terminology, i.e. describe painful or senestopathic sensations of various modalities and almost always emphasize their unusualness and connection with an emotional state (most often anxious or melancholy experiences).

Therefore, the first question after listening to the patient's complaints should be the question of the influence of these symptoms on his daily life (whether they interfere with his professional activities, studies, family life, leisure). Here you can clarify whether the patient enjoys the entertainment.

The next task of the doctor is to clarify the characteristics of the patient's personality in order to exclude hysterical disorders or attitudinal behavior (simulation). Then you can ask if there are any disturbances in sleep, appetite (whether there is a decrease in body weight), genital area, mood fluctuations during the day. And, finally, it is necessary to specifically clarify whether the patient's circle of interests has narrowed, how pessimistic he is about his situation (also the future and the past), whether any unpleasant (stressful) events preceded the development of symptoms, etc. Complaints in combination with the answers to these questions in most cases allow the doctor to determine the presence or absence of depression in the patient.

In order to develop further treatment tactics, it is important to understand the relationship between affective disorders and the underlying somatic pathology. In this case, the following options can be distinguished:
1) somatic illness was the direct cause of depression (for example, hypothyroidism often causes depressive symptoms);
2) somatic illness accelerates the development of depression in predisposed individuals (for example, Cushing's disease contributes to the onset of an extended depressive episode):
3) depression develops as a reactive state to a serious somatic illness (for example, in cancer, myocardial infarction, etc.);
4) medical illness and depression are not related to each other.

In all cases, psychotherapeutic work is a mandatory component of therapy, and the use of psychotropic drugs is determined by the nature and severity of affective disorders.

Improvement of the condition or complete cure of a somatic disease does not always lead to the disappearance of depressive symptoms. In 60% of patients, complete reduction of depressive symptoms does not occur and the prognosis of the course of somatic pathology with persistence of depression significantly worsens. Therefore, in the absence of an effect from adequate somatic therapy for a sufficient period of time, or if the patient has an incurable chronic disease (diabetes, rheumatoid arthritis, cancer) under medical control, and the persistence of depression, an appropriate thymoanaleptic and psychotherapeutic effect should be started.

PREFERRED CHOICE OF ANTI-DEPRESSANT DEPENDING ON THE CHARACTER OF DEPRESSION

When choosing drug therapy, it is important to take into account several main points, the leading of which are the nature and structure of the depressive syndrome and the features of the clinical effect of the antidepressant.

This group of medicines is usually subdivided into 3 main categories:
1) antidepressants with a stimulating effect (preferred for depression with asthenic, apathetic components);
2) antidepressants of balanced action (have a wide polyvalent spectrum of action);
3) antidepressants with a sedative effect (preferred for depression with anxious affect and dysphoria).

Somatogenic depressions can be divided into organic, developing as a result of morphological changes in the brain, and symptomatic, accompanying non-cerebral somatic diseases or resulting from exposure to any substances (medicinal, narcotic, etc.).

Clinical classification of antidepressants
[according to S.N. Molosov. 1995] *

* From top to bottom, the stimulating effect increases, sedation weakens

Antidepressants - sedatives
Amitriptyline (tryptisol)
Mianserin (lerivon, tolvon)
Azafen (pipofezin)
Alprazolam (Xanax, Cassadan)
Fluoxamine (fevarin, floxifral, miroxime)
Femoxedin (Malexil)
Opipramol (Insidol, Pramalon)
Medifoxamine (cledil, gerdaxil)
Medazofan (serzon)

Balanced antidepressants
Venlafaxine (Effexor)
Maprotiline (ludiomil)
Noxiptyline (Agedal, Nogedal, Dibenzoxin)
Dibenzepine (ecatril, noveril)
Tianeptine (stablon, coaxil)
Midalcipram (milnacipram, ixel)
Propizepine (Vagran)
Sertraline (Zoloft)
Paroxetine (Rexetine, Paroxetine, Paxil)
Clomipramine (Anafranil, Hydifen)

Antidepressants - stimulants
S-adenosylmethionine (heptral)
Iprindol (galatur, prondol)
Inkazan (metralindol)
Imipramine (Melipramine)
Nortriptyline (nortrilen)
Protriptyline (Concordin, Vivactil)
Citalopram
Fluoxetine (Prozac, Processed)
Indopan
Sydnofen
Nialamid (nuderal)
Iproniazide (iprazide)

A. SYMPTOMATIC DEPRESSION

Depression in coronary artery disease most often occurs in patients with myocardial infarction (up to 65%). These depressions are prone to protracted course and, as a rule, last at least a year. Moreover, compared with the usual course of the postinfarction period, these patients have a higher level of disability, suicide attempts and mortality. These patients are characterized by fixation on anxious and painful sensations, the development of cardiophobia and anxiety of expectation.

With masked depression, the pain syndrome is rarely paroxysmal and does not depend on physical stress. Such patients often prefer to relieve pain with validol or valocardin, rather than nitroglycerin, which is poorly tolerated and does not bring the desired relief.

The basic rules for the use of antidepressants in cardiological practice do not differ from those in the treatment of depression and somatoform disorders. When choosing a drug, first of all, one must be guided by the correspondence of the spectrum of its action to the psychopathological structure of depression, i.e. with the predominance of fear, anxiety, anxiety, phobic formations, use sedative antidepressants (amitriptyline, azafen), and with the predominance of melancholy and other nuclear hypothetical manifestations (sad, depressed mood, anhedonia) - drugs with balanced properties and a distinct thymoanaleptic effect (resetin, fluoxetine, fluvoxamine, etc.) and, finally, with the predominance of apathetic, asthenic and adynamic manifestations of depression - antidepressants with a stimulating component of action (imipramine, fluoxetine, cipralex).

The best effect of antidepressants is observed with exertional angina. In the course of therapy, in addition to relieving the depressive and anxiety-phobic manifestations themselves, the severity of the pain syndrome decreases (a decrease in the duration and intensity of pain in the region of the heart) and a decrease in the number of angina attacks.

The course of antidepressant therapy is on average 1-2 months, but with a good effect (a decrease in the severity of depressive symptoms and angina pectoris, as well as the absence of side effects), treatment in combination with anginal therapy should be continued for several months. Dose reduction and discontinuation of antidepressants should be carried out gradually in order to avoid psychovegetative manifestations of the withdrawal syndrome.

With hypertension typical depressive syndromes develop with formalized affects of melancholy, anxiety or dysthymic affect. Anxiety-phobic (including panic), obsessive-phobic and hypochondriacal disorders often join. At the remote stages of the course of hypertension, dysphoric affective disorders associated with the emerging psychoorganic syndrome may come to the fore.

The choice of an antidepressant for hypertension is determined by three main factors:
1) the phenomenology of depression in accordance with the general principles of thymoanaleptic therapy;
2) the severity of the hypotensive effect of the drug;
3) interactions with various antihypertensive drugs.

In order not to enhance the effect of the main therapy, it is advisable to choose among antidepressants drugs with minimal hypotensive properties such as selective inhibitors of presynaptic serotonin uptake (fluoxetine, fluvoxamine, rexetin, sertraline, cipralex, etc.), mianserin (lerivon, miansan), pyrazidol, doxepin and others.

With gastric ulcer and duodenal ulcer depressive symptoms come to light in the form of shallow anxious and anxious-phobic (including carcinophobic) or anxious-hypochondriac experiences with characteristic senestoalgic manifestations (burning, pressure, dull pain). In some patients, hypochondriacal fixation on their sensations reaches an overvalued level. The presence of depression significantly complicates the course of peptic ulcer disease. Almost constantly there is nausea, vomiting, constant burning sensation in the abdomen, which are not amenable to the effects of conventional antiulcer drugs. At the same time, the severity of clinical symptoms often does not correspond to (exceeds) the actual changes found in the gastrointestinal tract, for example, during endoscopic examination. Therefore, the correction of mental disorders is essential for the success of the entire treatment as a whole. The main role among psychotropic drugs in the complex therapy of patients with peptic ulcer disease belongs to tranquilizers (diazepam, phenazepam) and neuroleptics (eglonil, frenolone, etc.). However, with the appearance of a distinct depressive, anxiety-phobic or hypochondriacal symptoms, the addition of antidepressants is also important. A good effect is observed with the use of antidepressants with a sedative effect (trimipramine, doxepin, azafen, amitriptyline) and balanced drugs (rexetin, anafranil, cipralex, lyudiomil, etc.).

When prescribing antidepressants for gastroenterological diseases, it is necessary to choose drugs with minimal side effects (especially gastrointestinal) and the absence of drug interactions with antiulcer drugs.

With bronchial asthma often, various degrees of severity of depression develop, mainly with typical anxiety-phobic or hypochondriac symptoms. At later stages of the development of the disease, obsessions may join. It is important to note that, unlike the tranquilizers widely recommended in such cases for relieving anxiety (phenazepam, sedudksen, etc.), which depress the respiratory center and worsen pulmonary function in obstructive conditions, heterocyclic antidepressants (amitriptyline, lyudiomil, azafen, etc.) are capable of improve respiratory function and reduce the phenomena of bronchospasm. In patients with a distinct agoraphobic component, a good effect is observed when prescribing anafranil, resetin, fluoxetine, setralin, cipralex, etc. in standard doses.

With diabetes mellitus deployed depressions are 2 times more common than with other somatic diseases. Moreover, the prevalence of depression is the same both among patients with insulin-dependent and insulin-independent forms of diabetes; more common in women. Depressions in diabetes are protracted and tend to recur. In the early stages of diabetes, asthenic-depressive and anxious depressions are more common, and hypochondriacal and obsessive-phobic depressions are observed in the distant stages. When diagnosing depression, the main attention should be paid to identifying its cardinal symptoms (low mood, anhedonia, melancholy, anxiety, ideas of little value, unpromising vision of the future, etc.).

In diabetes mellitus, it is better to use selective serotonin reuptake inhibitors, since they have better physiological tolerance (Rexetin, Ixel, Cipralex, etc.). A good effect is observed with the use of reversible MAO inhibitors (pyrazidol, moclobemide, etc.).

At the oncology clinic psychogenic depressive disorders of varying severity occur in almost all patients at the stage of diagnosis. Symptoms lasting 1-2 weeks after the detection of the disease should be considered as an adaptive response, and psychotherapy is the main method of assistance in most patients. In the event of severe depressive disorders, the question of prescribing antidepressants is individually decided.

In the subsequent period, the development or maintenance of depression can be provided by special methods of anticancer treatment (surgery, chemoradiation therapy), tumor intoxication, pain syndrome, and factors of social ill-being. These patients are distinguished not so much by a hypothetical affect, but by a dysphoric mood tone, a feeling of helplessness and hopelessness, low self-esteem and a desire to die. In these patients, a good effect is observed with the appointment of heterocyclic antidepressants (amitriptyline, imipramine, azafen, anafranil, etc.) and serotonin reuptake blockers (resetin, cipralex, ixel, etc.).

It should be noted that an indication for the use of antidepressants in oncological pathology can also be pain syndrome, since most anidepressants, acting on the central mechanisms of pain, themselves cause an analgesic effect, and can also potentiate the action of central analgesics.

For chronic pain syndromes the antinociceptive effect of antidepressants can be realized through three main mechanisms:
1) reduction of depression;
2) potentiation of the action of exogenous or endogenous analgesic substances (opiate peptides, etc.);
3) own analgesic effect.

In general clinical practice, chronic pain most often manifests itself in the following forms: headache, back pain, trigeminal neuralgia, diabetic neuropathy, postherpetic pain, pain in diseases of the musculoskeletal system, oncological pathology, etc.

An analgesic effect is observed with the use of tricyclic antidepressants (amitriptyline, anafranil), norepinephrine drugs (desipramine, lyudiomil) and selective serotonin reuptake inhibitors (resetin, cipralex, ixel, etc.).

B. ORGANIC DEPRESSION

With cerebral stroke or heart attack depression occurs in up to 40% of cases and lasts about 1 year on average. In the pathogenesis of these depressions, depending on the localization of the cerebral catastrophe, the proportion of psychogenic and organic components is different. Of the psychotropic drugs for these disorders, mainly neurometabolic drugs (nootropics) and tranquilizers are used. Antidepressants are more effective in the late stages of the disease if depression persists despite objective improvement in impaired motor and cognitive functions. In these cases, it is usually sufficient to prescribe antidepressants with a balanced or sedative effect (resetin, azafen, etc.).

In a number of patients in the post-stroke period, "pathological crying syndrome" develops - sudden attacks of crying, provoked by the slightest reason, which are accompanied by specific facial paroxysms and can suddenly be replaced by uncontrolled laughter. This phenomenon is painfully experienced by the sick. A good therapeutic effect in these patients can be achieved with the appointment of small doses (50-75 mg / day) of amitriptyline and fluoxetine and citalopram (in standard dosages).

Depression in Alzheimer's Disease observed in 30-40% of patients. In the early stages of the course of the disease, reactive components are involved in the genesis of depression, which in subsequent periods may disappear altogether. The most common are anxious, anxious-hypochondriacal and complex depressive-delusional states. In these cases, along with specific therapy, antidepressants with a selective effect (fluoxetine, resetin, citalopram, etc.) can be used.

Depression in epilepsy observed in 19-31% of patients, which are characterized by short (2 to 6 weeks) depressive episodes with dysphoric coloration. The use of antidepressants is mainly aimed at correcting dysphoria, especially in asthenic forms, accompanied by depression of mood, irritability, sometimes more distinct melancholy or anxiety, as well as senesto-hypochondriacal inclusions and vegetative symptoms. Among antidepressants, amitriptyline and doxepin are preferred, used in conjunction with antiepileptic therapy.

Characteristics of some antidepressants
[according to S.N. Mosolov, 1995]

Azafen(pipofezin) - antidepressant of the tricyclic group, has a distinct antiserotoninergic effect; the anticholinergic activity is practically absent.

Azafen belongs to the "minor" antidepressants and combines moderate thymoanaleptic and sedative (tranquilizing) effects.

The main "target" of azafen are states that occur with a decrease in mood in combination with asthenic and other neurosis-like symptoms - affective disorders in the form of irritability, emotional lability, a tendency to mood swings in different ranges - from mild emotional instability to irascibility, explosiveness, and incontinence of affect.

Patients in whom asthenic and depressive phenomena are combined with lethargy, lethargy, adynamism, and a decrease in energy potential are also sensitive to azafen. It is also used to treat symptomatic depressions in alcoholism and to correct sleep disorders in outpatient depression, since the drug has a mild hypnotic effect. The drug is used for vascular, somatogenic, reactive depressions, neurotic asthenic-depressive states, depressive states of menopause.

Azafen is prescribed orally with a gradual increase to 75-200 mg / day (the initial dose is 25-50 mg). The dose is evenly distributed over three doses. The presence of a tranquilizing effect allows you to prescribe the drug in the evening. After achieving a therapeutic effect, the dose is gradually reduced to 75 mg / day, which is often retained in outpatient therapy as maintenance therapy.

The drug is well tolerated by patients and only in rare cases causes side effects (dizziness, nausea, vomiting), which quickly disappear when the dose is reduced. Azafen has no cardiotoxic and anticholinergic effects. Due to this, the drug has found wide application, primarily in outpatient practice, as well as in elderly and somatically weakened patients.

Azafen can be combined with antipsychotics, tranquilizers and other antidepressants, with the exception of irreversible MAO inhibitors.

Ixel(milnacipran) is a new antidepressant that selectively inhibits the reuptake of serotonin and norepinephrine (SSRI) without directly affecting postsynaptic receptors, which increases its effectiveness against antidepressants that affect only the serotonergic system (SSRI).

Ixel has a balanced effect, is the antidepressant of choice for the treatment of all types of depression, including depressive disorders with predominance of anxiety and a high risk of suicide, as well as depressive disorders in socially active patients with a predominance of psychomotor retardation and adynamia.

The selective mechanism of action contributes to an earlier onset of the thymoanaleptic effect than that of traditional antidepressants, and a better tolerance profile - Ixel does not cause sexual dysfunction, does not adversely affect cognitive functions and the activity of the cardiovascular system. Ixel does not interact with the cytochrome P450 system, so it can be combined with most drugs most commonly used in psychiatry and in the treatment of somatic diseases. Ixel does not enhance the sedative effect of alcohol.

When evaluated using the Hamilton scale and MADRS during treatment with Ixel, it was shown that the drug significantly reduces the severity of suicidal tendencies: the actual number of successful suicides in patients receiving Ixel is approximately 3 times less than in the placebo group.

Ixel has a high degree of overdose safety: during clinical trials, there have been cases of deliberate overdose of the drug in excess of 2800 mg (i.e. 28 times more than the recommended daily dose). None of these cases were fatal or resulted in an irregular heartbeat or coma.

Currently, there is no data on the possible teratogenic or fetotoxic effect of Ixel. Its use during pregnancy and lactation is not recommended. Ixel should be used with caution with an increased risk of dysuria; it is contraindicated in prostatic hyperplasia and dysuria.

Cannot be used concurrently with MAO inhibitors. Ixel can be prescribed no earlier than 14 days after the withdrawal of MAO inhibitors. In addition, at least 7 days should elapse from the moment the drug Ixel is discontinued until the start of therapy with MAO inhibitors.

Dosing regimen: starting dose - 7-8 days 50 mg per day (1 caps 25 mg 2 times a day with meals). Subsequent reception of 100 mg per day (1 caps 50 mg or 2 caps 25 mg 2 times a day).

Release form: capsules 25 mg No. 56; capsules 50 mg No. 56.

Reksetin(paroxetine, paxil, aropax) is a potent and most specific serotonin reuptake blocker among selective serotonergic antidepressants and has been introduced into clinical practice in recent years. Like other drugs of the group of selective inhibitors, it has little effect on the main receptor systems, with the exception of muscarinic ones, and, therefore, has a moderate anticholinergic effect.

The main components of the profile of the psychotropic activity of the drug are thymoanaleptic and anxiolytic action with a fairly clear stimulating effect. The drug is equally effective in both classic endogenous and neurotic and reactive depression. Unlike other new generation antidepressants, Rexetin can be successfully used in severe cases (both in dreary and inhibited cases), not inferior in effectiveness to imipramine and even outstripping it in the speed of action (1-2 weeks of treatment). Reduction of symptoms gradually increases over several weeks and even months. Moreover, the drug is often effective in patients who are resistant to tricyclic antidepressants.

The drug has a good effect in anxiety states with depressive symptoms and does not cause hyperstimulation, increased agitation or sleep disturbances. Reksetin significantly reduces suicidal thoughts; is able to improve the sleep of depressed patients already in the early stages of treatment, without causing daytime sleepiness or lethargy. The positive effect of Rexetin was also found in pain syndrome in patients with diabetic neuropathy.

The absence of metabolites and a relatively short half-life ensure good tolerance and safety of its use, even in the elderly.

The doses used range from 10 to 40 mg / day. The most optimal dose, providing an almost complete absence of side effects and high therapeutic efficacy, is considered to be 20 mg / day (taking 1 tablet with food in the morning 1 time per day). When this dose is exceeded, nausea, dry mouth, constipation and other dyspeptic disorders, drowsiness, sleep disturbances, sweating, and visual accommodation disturbances occur more often than other side effects.

The combined use of Rexetin with MAO inhibitors, as well as in patients with symptoms of renal and hepatic failure and hypersensitivity to the drug, is contraindicated. The drug is not recommended for use during pregnancy and lactation.

Preparations of other groups

Mexidol(3-hydroxy-6-methyl-2-ethylpyridine succinate) is a modern domestic drug belonging to the group of direct-acting antihypoxants and antioxidants. The drug has undergone clinical trials in the conditions of the Research Institute of Pharmacology of the Russian Academy of Medical Sciences, the Research Institute of Neurology of the Russian Academy of Medical Sciences, the State Research Center for Social and Forensic Psychiatry, the Research Institute of Narcology and the Department of Gerontological Psychiatry of the National Center for Public Health of the Russian Academy of Medical Sciences with a proven mild tranquilizing effect.

Mexidol has a wide spectrum of pharmacological activity, has neuroprotective, antihypoxic, antioxidant and antistress effects. The drug increases the body's resistance to the effects of various stress factors (hypoxia, ischemia, reperfusion, inflammation, shock, intoxication, including various drugs). Mexidol is effective in various types of hypoxia, protects nerve cells from death caused by ischemia, normalizes the metabolism of brain tissue, improves oxygen uptake in the brain tissue, enhances aerobic glycolysis in the brain, increases the body's resistance to oxygen-dependent pathological processes, increases the threshold of convulsive readiness of the brain, improves mnestic functions, reduces the toxic effects of alcohol.

At the same time, Mexidol has the property of stabilizing membranes inherent in all 3-hydroxypyridines and, unlike all preparations of exogenous succinic acid, facilitates the penetration of the molecule into the cell and the use of pyridine and succinate residues as energy substrates. It was shown that, in the presence of Mexidol, the succinate oxidase pathway of oxidation is activated, which, under conditions of restriction of NAD-dependent oxidation in the early stages of hypoxia, allows maintaining a certain level of oxidative phosphorylation in mitochondria. Activation of the succinate oxygenase oxidation pathway during hypoxia increases the resistance of brain, myocardium, and liver cells to oxygen deficiency and determines the mechanism of antihypoxic action of succinate-containing derivatives of oxypyridine. Mexidol inhibits peroxidation due to an increase in the reserve capacity of the antioxidant defense system, has a beneficial effect on the lipid spectrum of blood and the aggregation activity of platelets, reduces the increased hemostatic activity by increasing the deformability of erythrocytes, reducing blood viscosity. It has anxiolytic, anti-stress, nootropic, anti-alcoholic, cerebroprotective, antihypoxic, antiparkinsonian and vegetative protective effects.

The mechanism of action of Mexidol, in addition to inhibiting free radical oxidation of membrane lipids, is associated with an improvement in the energy metabolism of the cell, activation of the energy-synthesizing functions of mitochondria, an effect on the content of biogenic amines, and an improvement in synaptic transmission. The key elements of the drug's action also include modulation of the receptor complexes of brain membranes - benzodiazepine, GABAergic, acetylcholine receptors, increasing their ability to bind.

Mexidol, possessing a pronounced tranquilizing effect, contributes to the rapid reduction of emotional stress, anxiety, asthenic and autonomic disorders, and also has a therapeutic effect in sleep disorders of a presomnic, post-somnic and, especially, intrasomnic nature, increases the coefficients of social adaptation. This allows the drug to be used in the treatment of various emotional disorders, alcohol withdrawal syndrome with somato-neurological and mental symptoms, encephalopathies of various origins (diabetic, post-traumatic, etc.).

Mexidol has the ability to exert a potentiating effect on the effects of other neuropsychotropic drugs. Under its influence, the effect of antidepressant, tranquilizing, neuroleptic, hypnotic, anticonvulsant and analgesic agents is enhanced, which makes it possible to reduce their doses and thus reduce side effects. The use of Mexidol in the complex therapy of depression makes it possible to overcome the pharmacological resistance of depression.

In borderline psychiatry, indications for the use of Mexidol are:
anxiety disorders in neurotic and neurosis-like states;
mild cognitive disorders of eherosclerotic genesis;
intoxication with ethyl alcohol and relief of alcohol withdrawal syndrome;
acute intoxication with antipsychotic drugs (neuroleptics);
exogenous organic diseases of the brain (as a result of previously transferred neuroinfections, traumatic brain injury, etc.).

Mode of application: Mexidol is prescribed intravenously (jet or drip), intramuscularly and inside. When administered intravenously, the drug is diluted with water for injection or isotonic sodium chloride solution. Intravenous stream Mexidol is administered for 1.5-2 minutes, intravenously drip - at a rate of 80-120 drops per minute.

For anxiety disorders. Mexidol is used intramuscularly in a daily dose of 200-400 mg, divided into 2 doses for 14-30 days or 0.25 g orally (2 tablets 0.125 g each) twice a day for at least 4 weeks.

With neurotic and neurosis-like conditions. Mexidol is used at 100-200 mg (2-4 ml) intravenously in a stream on 10-16 ml of 0.9% NaCL solution, daily for 10 days. Perhaps intramuscular injection of the drug, 200 mg (4 ml), daily, 15 days. After injections, it is advisable to prescribe a tablet form of 0.25-0.50 g per day. The daily dose of the drug is divided into 2-3 doses. The course of treatment is 26 weeks. In this case, the course therapy is completed gradually, reducing the dose of the drug within 2-3 days.

With alcohol withdrawal syndrome. Dosage regimen: 200-400 mg (4-8 ml) intravenously in a stream, divided into two doses, in 16.0 ml of 0.9% NaCL solution, daily, for 10-15 days. Further, it is possible to switch to intramuscular administration of the drug at a dose of 200 mg (4 ml), daily, for 10 days, followed by a switch to a tablet form at 0.125-0.250 g two to three times a day, 4-6 weeks.

With cognitive disorders of atherosclerotic genesis

Mexidol is used intravenously or intramuscularly, in a daily dose of 200-400 mg per day, divided into 2 doses for 14-30 days or inside 0.25 g (2 tablets of 0.125 g) twice a day for at least 4 weeks.

Contraindications to the use of Mexidol: acute liver and kidney dysfunction; hypersensitivity or intolerance to the drug.

The interaction of the drug with other drugs has not been established. Mexidol potentiates the action of tranquilizers, analgesics, anticonvulsants and antiparkinsonian drugs, reduces the toxic effects of ethyl alcohol.

Release forms: solution for injection 5% in ampoules of 2 ml No. 10; coated tablets 125 mg No. 30.

Bibliography:
1. Aleksandrovsky Yu.A. Borderline Mental Disorders: A Study Guide. - M .: M, 2000 .-- 496 p.
2. Vein A.M., Voznesenskaya T.G., Golubev V.L., Dyukova G.M. Depression in neurological practice (clinic, diagnosis, treatment). - M .: MIA, 2002.160 p.
3. Gindikin V.Ya. Somatogenic and somatoform mental disorders: a handbook. - M., "Triada-X", 2000. - 256 p.
4. Mosolov S.N. Clinical use of modern antidepressants. -SPb: MIA, 1995 .-- 568 p.
5. Smulevich A.B. Depression in General Medicine: A Guide for Physicians. - M .: MIA, 2001 .-- 256 p.

The word "antidepressants" is alarming. We do not know much about mental disorders, especially if we are not specifically interested in it. Around mental disorders-if not a halo of romanticism and mystery, then frightening stories. There are those who consider antidepressants to be dangerous, personality-changing and addictive drugs with dire consequences. Because of this, sometimes those who need treatment refuse it. After all, what if all these stories are true?

the site understands how everything really is: what antidepressants are and why they are needed, how they are used, whether they cause side effects and addiction, can they be canceled at any time and why to take them if necessary,- fine.

What are antidepressants

Antidepressants are substances that affect the functioning of the central nervous system and, as the name implies, are primarily used in the treatment of depression.

These drugs relieve feelings of melancholy, apathy, anxiety, anxiety, irritability, tension, increase mental activity, normalize appetite and sleep. To understand how antidepressants work, you need to understand how the nervous system works.

How the central nervous system works

The central nervous system (CNS) "leads the parade." It includes the spinal cord and brain, and it is responsible for simple and complex reflexes.-standard reactions to any impact. It all works with nerve signals.-pulses.

The nervous system is made up of many nerve cells-neurons ... For neurons to conduct nerve impulses, they must be connected into a network that will transmit impulses from one cell to another. Introduce the children passing the ball to each other in PE class. Children-nerve cells connected to the system, and the ball-nervous impulse. And here are the hands with which children pass the ball is a synapse , such a place of contact.

At synapses, a nerve impulse is transmitted from one cell to another. This happens with the helpneurotransmitters-these are such intermediary substances. Accordingly, if there are not enough neurotransmitters, then the impulses will pass poorly. This means that the work of the whole organism will be disrupted: after all, the nervous system controls everything.

In addition, there is one more nuance. Neurotransmitters are substances of a different nature, in particular, norepinephrine, serotonin and dopamine are among them. These substances are hormones. Therefore, in addition to transmitting nerve impulses, they perform many more functions as hormones. They affect the work of individual organs and systems, on the processes of contractility of muscles and blood vessels, and partly on mood and internal sensations. And with depression, the level of these neurotransmitter hormones often decreases in a person. Therefore, it is so difficult for patients: feelings of anxiety, apathy and their own worthlessness are caused by a lack of serotonin, dopamine and norepinephrine. And since hormones also affect many functions of the body, this explains the physical manifestations of depression - weakness, fatigue, unstable appetite.

Antidepressants have an effect on the level of these neurotransmitter hormones: they block their breakdown or seizure by neurons. From this, their level rises.

When are antidepressants prescribed and why they may not work

Antidepressants, despite their name, are used for more than just treating depression. They are also used for many other diseases: this is precisely because they affect a variety of processes in the body.

For depression and other mental disorders, antidepressants are also not always used. Scientists still do not know exactly all the features and causes of depression. If it were just a lack of neurotransmitters, then antidepressants would help everyone, which is not the case. In addition, then drugs such as amphetamine or cocaine would help with depression: they affect neurotransmitters and therefore cause a feeling of euphoria. But depression-a much more complex disorder in which different mechanisms are involved.

Therefore, the reaction to antidepressants is individual, but you should not refuse them either. They help to stop serious conditions so that patients can cope with the disease. Antidepressants are usually not used on their own, but are combined with psychotherapy and other therapies. Sometimes you can do without them altogether.-it depends on the condition of the patient. The doctor makes the appointment individually.

Is there a dependence on antidepressants?

No. But it cannot be denied that after the withdrawal of antidepressants, the risk of suicide increases, and the patient feels unwell. This is a withdrawal syndrome that many people mistake for addiction. The fact is that if the artificial support of the level of neurotransmitters is abruptly cut off, then their level will fall - then it seems to the patient that depression has returned, and now he cannot live without pills. This problem is solved by intensified psychotherapy and a slow decrease in the dosage of the drug. Yes, and withdrawal syndrome does not occur in everyone, but most often in patients who took high doses.

How antidepressants help depression

the site asked a girl who went through depression and an eating disorder to tell her story. She shared how she faced a problem, underwent treatment, and then-refused antidepressants and returned to normal life. We publish her story on condition of anonymity.

"When I was a year old, my mother left me. I rarely saw her, my grandmother raised me. Since childhood, I felt unnecessary and was afraid that I would be abandoned. And so it happened when I met a guy: once he just did not come on a date, stopped answering for calls - I could not get in touch with him anymore. I didn’t know the reason, I didn’t understand what was happening. Then I came up with a reason myself: I’m fat. By the way, then I weighed 48 kg with a height of 164 cm. I became a vegetarian, I ate twice day, periodically starved and worked out in the gym until a sweat. I was scared and ran to the gynecologist. She asked me about the diet, and I said that I was eating normally. I was really convinced that I was eating normally, but I overeat because I was weak.

The gynecologist prescribed hormonal. My period went, but when I stopped taking the pills, they stopped again. It was then that I graduated from university and stopped receiving the scholarship. Stress, uncertainty and lack of work plunged into panic: after all, now I did not have money for the gym, and I could put on weight. Even then, the depression began. Once I pasted over all the mirrors in the house so that only the face was visible. I could not see myself and my body. I hated them.

She worked. Then my grandmother died. It was hard and I continued to fast and exercise. Menstruation was out of the question, but I didn't care.

So 4 years passed - and all this time I did not suspect that I had an eating disorder. One day a friend developed the same symptoms and her mother bought her antidepressants. I googled these pills and came across the term "bulimia nervosa" - it exactly matched my condition. At first I wanted to drink antidepressants myself, but could not find one that would be sold without a prescription. Then I decided to turn to a psychotherapist so that he wrote them out for me. By that time, I no longer wanted to live, it became difficult to get up in the morning. I was so disgusted with myself that I wanted to scratch my face and cut my body.

The psychotherapist was not in favor of prescribing me drugs, but I insisted. I was prescribed a small dose: I drank one fourth of the pill. At the same time, I underwent psychotherapy with him and with a psychologist. The effect of the pills was almost immediately: anxiety and self-loathing disappeared, a desire to live appeared. My period has gone. After 7 sessions, I gave up both therapy and pills - I suddenly realized that there was my inner work, which no one would do for me. There were no side effects and no withdrawal syndrome: at some point, I just began to forget to take the pills.

I quit my job and started working remotely. I remembered what I have always loved - to draw. I entered the second degree in design. When I found myself and began to do what I liked, then the problems with food stopped, skipping workouts ceased to be scary. I didn't train all winter because I studied and worked. Now I go to the gym, but only because I like it. I do not limit myself in food, and the breakdowns have stopped. Yes, I have an imperfect body, and now I weigh 57 kg. But none of this matters: I finally began to live. I still have to work on myself: jokes about weight and posts about losing weight work as a trigger and cause bouts of anxiety. I cannot say that I am completely healthy. But I learned to love myself and listen to my body. "

People, especially residents of large cities, began to meet quite often. This is facilitated in many ways by the rapid pace of life along with a disturbed ecology and constant stress. Some people try to treat depression with alcoholic beverages. But this approach, of course, is fundamentally wrong. The problem cannot be solved this way, but it is quite possible to gradually turn into an alcoholic. Depression is a disease and should be treated with medications such as antidepressants. We will consider the side effects of these drugs in the article.

Antidepressants and the mechanism of their effect on the body

Currently, pharmacies sell a wide variety of antidepressants, which belong to different categories of drugs. But the effect on the body of most of them is the same and is always aimed at changing the amount of certain chemical elements in the brain tissues, which are called neurotransmitters. Their deficiency leads to all kinds of mental disorders and nervous activity, in particular, this causes the development of depression.

As with all medicines, antidepressants also have side effects. More on this below.

The effect of such drugs is that they increase the content of neurotransmitters in the brain or make cells more receptive to these elements. It is customary to prescribe any antidepressants in rather long courses. This is directly related to the fact that they do not show their effect immediately. Most often, the positive effect of the use of such a drug begins to develop only a few weeks after the start of its intake. In those situations where it is required that the action of the drug manifests itself faster, doctors prescribe it in injections. According to reviews, antidepressants are considered to be very effective medications. Their use reliably eliminates such manifestations of depression as a feeling of hopelessness along with a loss of interest in life, apathy, sadness, anxiety and melancholy. But don't forget about the side effects of antidepressants.

Antidepressants do not help, what to do?

You can often hear that it makes no sense to take these medicines because of their ineffectiveness. But more often than not, the lack of results lies in the fact that people buy antidepressants in pharmacies without a medical prescription, and, therefore, without consulting a specialist. In this situation, the medicine may simply not be suitable for the person, or he may take it in the wrong dosage. It is necessary to see a doctor who will prescribe the required treatment.

In addition, do not forget that in order to get a result from therapy, they should be taken for a long time, at least three months. Are there antidepressants without side effects? Many patients are concerned about this issue.

Should you buy cheap drugs?

Often patients refuse treatment with antidepressants because of their high cost. True, in pharmacies, you can almost always buy cheaper analogues that will not be inferior to the main agent in terms of their effectiveness, moreover, quality or safety. Cheap antidepressants, according to patient reviews, affect the body no worse than their counterparts, which are significantly higher in price. But in the event that there are still doubts, then you can always consult on the choice of a medicine with your attending physician.

How long should the treatment last?

As a rule, doctors prescribe antidepressant medication for long courses, which range from several months to one year. You can not independently refuse treatment until the completion of the course, which was recommended by the doctor.

Side effects from antidepressants are much more common in women. In addition to the main reactions, their interest in sex often decreases, it is also difficult to achieve orgasm, lubrication decreases (vaginal dryness appears).

Some drugs, in addition to relieving the symptoms of depression, also have psychostimulating properties. Against the background of their use, patients often have problems falling asleep. But even in this situation, it is impossible to refuse further treatment. It is advisable to contact your doctor with a request to change the therapy regimen. For example, your doctor may recommend taking the required medication at lunchtime and in the morning.

Side effects

Taking any medications, including antidepressants, can lead to side effects. Drugs in this group, according to reviews, can often cause a mild feeling of nausea along with problems with falling asleep. It is extremely rare that they entail violations in the sexual life. As practice shows, all of the listed side effects are observed in the first few days of admission, and then go away on their own, while no additional treatment is required. The attending physician usually advises antidepressants with a minimum of side effects.

Most modern anti-depression medications have little interaction with other medications being taken. But in the event that a person buys antidepressants without a prescription and takes any other drugs, including dietary supplements, then it is imperative to consult with a specialist about the safety of joint administration.

The side effects of the antidepressant Fluoxetine are abundant. It is also known as Prozac. It is important to note that it is highly addictive. "Fluoxetine" has an extremely negative effect on the central nervous system. With prolonged uncontrolled admission, this leads to:

• dizziness and headaches;
• nightmares;
• euphoria;
• anxiety;
• psychomotor agitation;
• neuroses;
• thinking disorder;
• loss of coordination of movements;
• violation of attention;
• lethargy.

In addition, there is a risk of medication overdose.

It is impossible to completely completely exclude any complications even against the background of the use of psychotropic drugs with a sparing effect. The greatest likelihood of side effects as a result of the use of antidepressants occurs among patients suffering from somatic diseases, in addition, in the elderly, who have an increased sensitivity to psychotropic drugs.

The most common side effects of tricyclic antidepressants include anticholinergic disorders along with dysfunctions of the nervous system. Plus, there may be malfunctions in the work of the heart and blood vessels, in addition, sometimes there are complications in the organs of hematopoiesis, as well as metabolic and endocrine changes associated with an increase in body weight and allergic reactions.

Side effects and complications from antidepressants usually manifest themselves in the initial stages of administration in the first couple of weeks. They sometimes persist for one month of therapy, after which they undergo a reverse development. Against the background of persistent and at the same time overly pronounced disorders, it is advisable to reduce the dose, and if necessary, complete cessation and refusal of therapy is required. So, among the main side effects that can develop with the use of antidepressants, the following conditions are most often observed in patients:

• The appearance of nausea.
• Feeling of dry mouth.
• Decreased or complete lack of appetite.
• The presence of vomiting.
• Development of diarrhea or constipation.
• Frequent dizziness.
• Insomnia along with headaches.
• Increased feelings of anxiety.
• The appearance of nervousness along with a feeling of inner tension.

Under the supervision of a doctor, it is possible to choose an antidepressant without side effects for your body.

Myths

Many people are very wary of antidepressant treatment, as they believe that these drugs can rob them of all human emotions, thereby turning them into soulless robots. In fact, this is exactly the case. According to reviews, antidepressants minimize feelings of fear, longing, and anxiety. They have absolutely no effect on any other emotions.

Another equally common myth about antidepressants is that once you start treatment with these drugs, you will have to continue using them for the rest of your life. In fact, antidepressants do not cause any physical addiction, let alone mental dependence. Just for the effectiveness of treatment, it is necessary to prescribe them to patients in long courses.

Antidepressants with minimal side effects

Available for purchase without a prescription, have fewer side effects:

• The tetracyclic group is Maprotiline (Ladiomil).
• Tricyclic group - "Paxil" ("Adepress", "Plizil", "Sirestill", "Plizil").
• Selective inhibitors - Prozac (Prodel, Fluoxetine, Profluzac).
• If you need to quit long-term bad habits, for example, smoking - "Zyban" ("KnowSmok", "Wellbutrin").
• Herbal preparations - "Persen", "Deprim", "Novo-Passit".

Antidepressants and exercise

Against the background of sports training, the human body begins to intensively produce hormones of joy, which are scientifically called endorphins. They do an excellent job of reducing the severity of depression by improving mood. For this reason, regular sports activities are ideally combined with antidepressant therapy, shortening the duration of the courses and reducing the dosage of the drugs used.

Therefore, if you have mild depression, it is best to head to the pool or gym instead of buying antidepressants from the pharmacy without a prescription. So a person will be able not only to improve his condition without the use of medications, but it will also bring a lot of benefits to the whole body as a whole.

End of antidepressant therapy

In the event that a person began a course of antidepressant treatment, then it should never be stopped independently without the permission of a doctor. This is because any withdrawal from antidepressant use must be done slowly and gradually. Against the background of a sharp refusal from further therapy, depressive symptoms will return almost immediately. In addition, symptoms may become even worse than they were before starting treatment. That is why the abolition of antidepressants should take place strictly according to the indicated scheme, which was recommended by the attending physician.

Now let's find out what ordinary people who have had a chance to undergo treatment with these drugs think about the use of antidepressants.

Responses to side effects of antidepressants

People have different opinions about antidepressants, but overall they are happy with the effect that they can achieve with their use. In particular, it is reported that taking these drugs actually helps to change your life for the better when depression sets in and it begins to seem that everything is so bad that you don't even want to live.

Almost all the comments that people leave on the Internet about certain antidepressants are accompanied by words and phrases such as "helps", "rescues", "manages to get through" and so on.

There is a wide variety of information about the speed of obtaining a result. So, some write that they were able to notice the effect after the first few days of admission, while others report the result obtained only after one month.

Among the dissatisfied reviews, there is often a statement that antidepressant withdrawal syndrome is extremely difficult for patients. On this basis, apathy and depression overwhelm a person in full. In addition, they talk about the emergence of uncontrollable anger. Therefore, many claim that they began to feel even worse than before taking the medication. As part of the commentary on such reviews, it should be recalled that antidepressants, with the least side effects, including, are not a toy at all, and they should be taken solely as directed by a doctor.

It is not uncommon for people to talk about such a side effect as insomnia. On top of that, for some, taking the pill is accompanied by a decrease in libido. Some say that they did not tolerate the course of admission in general, and that antidepressants increase blood pressure.

People are also unhappy with the fact that it takes too long to take such pills in order to achieve and maintain a positive effect. Quite often there are complaints about the cost of antidepressants, which for some drugs can go up to two thousand rubles per package.

So, in conclusion, let's name the main advantages that people who used antidepressants talk about:

• Drugs change lives for the better, helping to get out of difficult situations.
• Eliminate feelings of depression, tearfulness, anxiety, irritability, and so on.

The following disadvantages are given as disadvantages:

• High price.
• Development of side effects. Most often it is insomnia and decreased libido.
• The need for long-term use.
• For some, depression worsens.
• Withdrawal syndrome.

Thus, today antidepressants are a good solution in the case of depression. In most reviews of antidepressants and side effects, people report their effectiveness. But it is extremely important to undergo a course of treatment with these drugs only in accordance with medical recommendations, since otherwise, with self-therapy, your condition can only worsen.

The side effects are very similar. But the main difference is that the former are addictive while the latter are not.

Sooner or later, a modern person is faced with the need to purchase antidepressant drugs used in the complex treatment of a depressed emotional state. Antidepressants are "called" to the service of a person to raise mood, create a positive emotional background, and ultimately.

When do you need a doctor's prescription for antidepressants?

The dosage, daily regimen of medication is prescribed, of course, by the doctor. Only a qualified specialist will be able to assess the true state of your psyche, accurately calculate and schedule the doses of drugs. Adherence to a recipe for depression treatment is one of the ingredients for success in dealing with depression.

A prescription for the purchase of antidepressant drugs is required only in the following cases:

• exacerbation of the disease;
• treating the most severe forms of depression;
• with an atypical form of the course of the disease.

The doctor in this situation prescribes monoamine oxidase inhibitors (MAOIs). These are potent antidepressant drugs that are used in case of ineffectiveness of other types or with strong side effects.

Moclobemide, phenelzine, isocarboxazid and tranylcypromine are most effective in the treatment of severe forms of depression.

Fenelzine, isocarboxazid and tranylcypromine are time-tested drugs that have been used since the 1950s and have many side effects. Moclobemide is a new generation drug with faster effects and fewer associated negative reactions.

New generation light antidepressants. What is special?

A mild form of depression can be "corrected" with drugs for which pharmacies do not ask for a prescription. New generation antidepressants are generally not as harmful to the body as drugs produced in the last century. Modern "OTC" antidepressants are fundamentally different from heavy drugs and drugs of the old generation.

Benefits of modern antidepressants:

1. faster effect on the body and elimination of the depressive state;
2. fewer side effects;
3. the possibility of simultaneous administration with many other drugs;
4. lack of significant addiction to the action of the drug.

According to the effect of drugs on the mental state of a person, antidepressants are distinguished by stimulating and sedative properties.

It is very important to accurately determine the nature of the disease and the subsequent correct choice of antidepressant drugs (to excite or inhibit the central nervous system). The time and effectiveness of treatment largely depends on this.

List of mild antidepressants over the counter (15 remedies)

Over-the-counter antidepressants are divided into different groups according to the degree and type of their effect. Let's list the main groups and the drugs included in them. Let's start the list by listing stimulant antidepressants.

1. Maprotilin (Maprotilin)

Drug name: Maprotiline

Analogues: Ludiomil, Ladiomil, Flexyx.

Indications: endogenous, involutional, psychogenic and neurotic depression, exhaustion, somatogenic, latent, climacteric depression.

Action: reduction of apathy, improvement of mood, removal of psychomotor retardation.

Side effects: headache, lethargy, drowsiness, hearing loss, hallucinations, tachycardia, arrhythmia, vomiting, nausea, dry mouth, urticaria, edema, weight gain, sexual dysfunction, stomatitis.

Contraindications: epileptic disease, kidney disease, liver disease, pregnancy.

2. Prozac

Drug name: Prozac

Analogues: Fluoxetine, Prodel, Profluzak, Fluval.

Indications: depression, bulimia nervosa, obsessive-compulsive disorder (obsessive thoughts and actions).

Action:

• relieve emotional overload, obsessive thoughts;
• alleviate anorexia nervosa;
• eliminate premenstrual disorders;
• will reduce anxiety and panic.

Side effects: at the beginning of treatment and with increasing doses - anxiety, drowsiness, headache, nausea. Rarely - convulsions. Skin rashes, pain in muscles, joints, fever may occur

Contraindications: hypersensitivity, pregnancy, lactation.

3. Paxil

Drug name: Paxil.

Analogues: Reksetin, Adepress, Aktaparok-setin, Plizil, Paroxetine hydrochloride hemihydrad, Sirestill.

Indications: depression of all types in adults and in children 7-17 years old.

Action: in the first weeks of admission, symptoms of depression decrease, suicidal thoughts are eliminated. Prevents relapses of the depressive state.

Side effects: drowsiness, insomnia, loss of appetite, tachycardia, nausea, constipation, seizures, sweating.

Contraindications: hypersensitivity to paroxetine and drug components. Pregnancy, lactation.

Drug name: Deprim.

Analogues: Gelarium Hypericum, Doppel-Hertz Nervotonik.

Indications: chronic fatigue syndrome, depression, emotional exhaustion, decreased ability to work.

Action: increased efficiency, mental and physical activity, normalization of sleep.

Side effects: dry mouth, changes in the work of the gastrointestinal tract, fatigue.

Contraindications: children under 6 years old. Individual intolerance. Take with extreme caution during pregnancy and lactation.

Along with medications of chemical origin, herbal preparations can be taken to fight depression. Herbal antidepressants are herbal infusions that can be purchased over the counter or prepared at home.

5. Leuzea extract

Drug name: Leuzea extract (safflower raponticum).

Indications: as a complex therapy.

Action: general tonic effect, increased efficiency, improved mood, increased appetite .

Side effects: headache, irritability, increased blood pressure, allergic reaction, insomnia.

Contraindications: hypersensitivity, epilepsy, chronic sleep disorders, acute period of infectious diseases.

6. Tincture of ginseng

Drug name: Ginseng tincture.

Indications: hypotension, increased fatigue, overwork.

Action: increased efficiency, reduced fatigue, increased blood pressure.

Side effects: insomnia, headache, diarrhea, nausea, nosebleeds.

Contraindications: hypertension, children under 16, thyroid hyperfunction.

7. Lemongrass tincture

Drug name: Lemongrass tincture.

Indications: hypotonic illness, neurasthenia, depression.

Action: stimulating the central nervous system, increasing blood pressure, improving visual acuity.

Side effects: overexcitation of the central nervous and cardiovascular systems.

Contraindications: insomnia, high blood pressure, acute infectious diseases.

Let's take a closer look at the class of sedative antidepressants.

8. Azafen

Drug name: Azafen.

Indications: asthenodepressive syndrome, anxiety-depressive state, alcoholic depression, endogenous depression, exogenous depression, depressive states in chronic somatic diseases.

Action: elimination of anxiety-depressive state, manifestations of senile depression, smoothing of the negative state caused by prolonged use of antipsychotics.

Side effects: nausea, vomiting, headache, dizziness.

Contraindications: hypersensitivity, myocardial infarction, coronary heart disease, diabetes mellitus, pregnancy, acute infectious diseases.

9. Persen

Drug name: Persen.

Indications: poor sleep, irritability, increased nervous irritability.

Action: sedative and antispasmodic action.

Side effects: allergic reaction. With prolonged use - constipation.

Contraindications: hypersensitivity to the components of the drug, arterial hypotension. Children under 3 years old (tablets), children under 12 years old (capsules)

10. Mianserin

Drug name: Mianserin (Mianserin).

Indications: Depression of various origins.

Action: improvement of sleep, reduction of nervous excitability.

Side effects: drowsiness, hypokinesia, convulsions.

Contraindications: manic syndrome, pregnancy, lactation, children's age (up to 18 years). Hepatic and renal failure.

11. Amitriptyline

Drug name: Amitriptyline.

Indications: manic-depressive psychosis, nervous bulimia, infantile enuresis.

Action: sedative effect, antidiuretic effect during bedwetting, analgesic effect.

Side effects: drowsiness, disorientation, excitability, hallucinations, fatigue, tachycardia, nausea, vomiting, weight gain.

Contraindications: epilepsy, intestinal obstruction, angle-closure glaucoma, pregnancy, breastfeeding.

12. Mirtazapine

Drug name: Mirtazapine

Indications: depressive conditions, early awakening from sleep, loss of interest, anxiety depression.

Action: restoration of the ability to have pleasure, adjustment of sleep, elimination of suicidal thoughts.

Side effects: drowsiness, dizziness, unusual dreams, tachycardia, nausea, diarrhea, decreased libido, dry mouth, increased appetite.

Contraindications: hypersensitivity to the components of the drug, epilepsy, organic brain damage.

13. Novo-passite

Drug name: Novo-passite.

Indications: neurasthenia, manager syndrome, migraine, eczema of psychological etiology.

Action: sedative, removal of nervous excitability of the premenstrual and climacteric periods, elimination of anxiety.

Side effects: allergic reactions, dizziness, drowsiness, slight decrease in muscle tone.

Contraindications: hypersensitivity to the components of the drug, children's age (up to 12 years), alcoholism, epilepsy, diseases, brain trauma.

14. Tincture of hawthorn

Drug name: Hawthorn tincture.

Indications: nervousness, cardiovascular diseases, menopause, high cholesterol levels.

Action: calming effect on the nervous system, normalizing heart activity, reducing excitability during menopause.

Side effects: allergic reactions, itching, urticaria.

Contraindications: pregnancy, lactation, individual intolerance, children under 12 years of age.

15. Valerian tincture

Drug name: Valerian tincture.

Indications: insomnia, migraine, hysteria, irritability, smooth muscle spasms.

Action: calming, antispasmodic, choleretic, normalizing effect for the digestive tract.

Side effects: decreased performance, drowsiness, depression.

Contraindications: individual intolerance.

Contraindications for over-the-counter antidepressants

Over-the-counter antidepressants have a beneficial effect on the elimination of neuroses of various etiologies. But this does not mean at all that these drugs can be taken for a very long time and without negative consequences.

Many antidepressant drugs that are freely available in pharmacies may have a number of contraindications.

These "bans" apply to almost all antidepressants:

• individual intolerance to the components of the drug;
• pregnancy;
• lactation period;
• children under 18 years of age.

It must be said that each antidepressant drug, along with the above contraindications, may have its own, inherent only to this drug.

If you are in doubt about taking antidepressants or not, watch a video that will educate you and destroy a number of invented myths about drugs of this kind:

Constant stressful situations, a very fast pace of modern life lead to the fact that many people become overly irritable, nervous, prone to different types of phobias. Depressive states, unfortunately, have ceased to be something unique and isolated.

Nowadays, even young children are familiar with the term "depression".

The chemical composition and clinical uses of these drugs vary. The search for new pharmacological compounds to combat depression in medical science continues.

The first drugs to combat depression began to be prescribed to patients in the 1950s. The drug "iproniazid" is at the origins of antidepressants. Currently, there are about 125 drugs with antidepressant action in pharmacology. Be careful when choosing antidepressants!