"Imipramine" is the first pharmaceutical product that was used in the composition complex treatment depressive syndrome. His unique action, aimed at improving mood, was identified as a result of studies conducted in the mid-fifties of the twentieth century. The study of the effects of this drug made it possible to create a unique drug group called tricyclic antidepressants. Medicines 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 for.

With depression, a person loses all interest in life, feels overwhelmed and tired all the time, cannot make a single decision

Tricyclic antidepressants got their name from the fact that their structure is based on a triple carbon ring. Today, this category of medicines includes more than three dozen various medicines. Their positive effect on emotional condition the patient is explained by the fact that the main components of medicines contribute to an increase in the synthesis of serotonin and norepinephrine in the body. Also, the use of antidepressants helps to stop the uptake of neurotransmitters, and has positive influence for many internal systems including cholinergic and muscarinic.

In the first years, after its mass distribution, drugs from the AD category (antidepressants) were used to treat the following pathologies:

diseases of the central nervous system, complicated by mental disorders;
somatic diseases;
endogenous disorders;
psychogenic pathologies.

In addition to treatment depressive disorders, panic attacks and anxious illnesses, medicines from this group were used as part of the complex treatment of chronic depressive syndrome. Often, antidepressants are prescribed as prophylactic that prevented the recurrence 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 appearance of a suicidal tendency.

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 a stable result. According to the statistics of that time, the effectiveness of the use of "Amitriptyline" was about sixty percent. The choice of a specific drug that was used in the treatment of pathology depended on clinical manifestations depressive disorder. According to experts of that time, intellectual retardation and disorders motor functions provoked by psychological pathologies and neurological disorders, were easily eliminated with the help of Melipramin. In the case of anxiety personality disorder, Amitriptyline was used.

Depression is dangerous because it can affect the entire body, causing irreversible changes in its individual organs.

Why are antidepressants dangerous and why are they so rarely used today? Approximately 30 percent of first-generation tricyclics have experienced severe side effects. Compared to them, newer drugs cause negative effects in only fifteen percent of cases.

Tricyclics are used in the treatment of depression caused by depressive disorder. Today they are used for the following purposes:

treatment of depressive and anxiety personality disorders;
elimination of panic attacks;
decrease in the severity of involutional melancholy;
therapy of depressive syndrome, which has an organic nature.

In addition, this category of medicines is used as part of the complex treatment of diseases caused by somatogenic factors and the use of potent drugs. neuroleptic drugs. It is allowed to use TCAs in the manic-depressive form of psychosis, as well as in order to prevent depressive syndrome.

Most of the drugs included in this group, in addition to antidepressant effects, are endowed with a sedative effect. Such drugs are used as part of the complex treatment of 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. It is allowed to use this medication in the case of an alcoholic form of depression, which is accompanied by increased lethargy and anxiety.

It is important to pay attention to the fact that antidepressants are not allowed to be used in combination with MAO inhibitors. You can use the latter only a few days after the end of the course of taking TCAs. Among the contraindications to tricyclic antidepressants, one should highlight individual intolerance their composition.

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 the inhibition of the capture of serotonin and norepinephrine. Despite the fact that these drugs show high efficiency in the treatment of depression, they have a negative impact on work. internal organs and systems. Let's look at the most common types of side effects.

First of all, it should be said that the antihistamine effect helps to reduce blood pressure which leads to drowsiness. In addition, many patients experience a rapid increase in body weight. Inhibition of the norepinephrine uptake process provokes the development of tachycardia, and also negatively affects ejaculation and erection. It is important to note that most drugs from the AD category negatively affect the state of libido.

The anticholinergic effect can lead to flatulence and urinary retention. In isolated cases, this process leads to a violation heart rate and causes loss of consciousness. The capture of dopamines and serotonin contributes to the excitation of the nervous system, loss of appetite and the onset of nausea. Negative impact on the CNS may manifest as seizures. It should be noted that long-term use drugs included in the TCA group, has a negative effect on the heart muscle, which is expressed by impaired conduction.

In the situation when human body has an increased instability to this category of medicines, patients have 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 a 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 probability of occurrence. side effects.

Tricyclics inhibit the capture 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 as part of complex therapy various forms depressive disorder. This medication demonstrates high efficiency in the treatment of depressive conditions, which are combined with chronic diseases somatic etiology.

"Saroten Retard"- a unique medication used to eliminate signs of depression, sleep problems and anxiety disorders. Specialists prescribe this medication for diseases such as dysphoria, alcoholic, endogenous or reactive form of depressive syndrome.

"Amitriptyline"- a derivative medicine manufactured on the basis of "Imipramine". This tool can be attributed to the first representatives of TCAs. It is used as part of the complex treatment of depression and anxiety disorders.

"Ftoratsizin"- a drug that, in addition to antidepressant effects, has a sedative effect. Despite the increased central and holonolytic activity, this medication reduces the excitation of the nervous system.

"Zoloft"- a drug from the category of tricyclics, which is used for severe depressive disorders. As an active ingredient, this tool uses sertraline, which is one of the most strong antidepressants. Due to the accelerated rate of serotonin uptake, this remedy is one of the best in this category of drugs.

"Lyudiomil"- broad spectrum drug therapeutic impact used to reduce anxiety, relieve lethargy and improve mood. Besides, this drug has the ability to eliminate many somatic symptoms characteristic of the depressive syndrome.

"Lerivon"- the effect of this medication is aimed at blocking alpha-adrenergic receptors. In addition, this medication is endowed with a pronounced sedative effect. It is allowed to use "Lerivon" for both mild and severe forms of depressive syndrome.

"Anafranil"- The uniqueness of this tool lies in a wide range therapeutic impact. This medication is used as part of the complex therapy of masked, neurotic, endogenous, organic and reactive forms depressive disorder.

"Clomiprimin"- a drug from the TCA category, used in the treatment of reactive, masking and neurotic forms of depressive disorder. It is allowed to use "Klomiprimin" as part of the complex therapy of personality disorders and schizophrenia.

Tricyclic antidepressants cause a lot of side effects

Melipramin- used in the treatment of various forms of depressive disorder, which are accompanied by the appearance of anxiety. The use of this drug in the case of bipolar and unipolar personality pathologies is allowed.

"Imizin"- tricyclic, which has antipanic, antidiuretic and antidepressant effect.

"Doxpepin"- a drug that is part of the TCA group, used as part of a complex effect on depressive syndrome. This drug, in addition to analgesic and antidepressant effects, eliminates itching, prevents the development of panic attacks and the appearance of ulcers on the skin.

Also worth mentioning are antidepressants such as Elavel, Saroten and Clofranil, which, in addition to antidepressant effects, are endowed with a sedative effect.

Where can I buy

You can buy tricyclic antidepressants only in pharmacies, with a prescription from your doctor. The need for a medical 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 provoke disturbances in accommodation and the process of urination. One of the main side effects of such drugs is the drying of the mucous membranes.

Many patients taking antidepressants experience abnormal heart rhythms and low blood pressure. Exactly these negative factors, have led to the sale of medicines only with a prescription.

Conclusion

The approximate price of medicines included in the group of tricyclic antidepressants varies from three hundred to a thousand rubles. It should be noted that the independent use of such drugs can lead to the development of negative side effects. In the case of depression, it is more expedient to replace antidepressants with drugs belonging to the category of sedatives.

The course of treatment with antidepressants is recommended to start with a 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 medication in the body. In that case when this indicator rapidly increasing, there high probability development of negative side effects.

Today, depression affects not only adults, but also children and adolescents. This disease and methods of dealing with it are devoted to a lot of research by specialists and a huge number of articles and books. If translated from "scientific" into ordinary language, depression is a loss of strength and desire to live. The 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 (as drugs that work against depression are also called) exist today, what do they have in common and how do they differ from each other, what is the mechanism of their action? These and other questions will be considered in the article brought to your attention.

What are antidepressants?

Which can help relieve symptoms and even prevent depressive states. 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 is significantly reduced: dopamine, norepinephrine or serotonin. Antidepressants of the latest generation, as well as all previous ones, have a regulatory 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 to cope with the symptoms of depression, they are quite often used to get rid of such problems:

various pains of unknown origin;
appetite or sleep disturbances;
severe fatigue or loss of strength;
nervousness or feelings of constant tension;
bouts of nervousness or anxiety;
trouble concentrating or remembering.

Generations of antidepressants

Before looking at how many generations of drugs for depression have been today, we must remember that antidepressants were discovered only in the middle of the 20th century. To date, depending on the time of invention and the beginning of use in clinical practice, as well as from the action 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 cyclically acting tricyclic thymoleptics (TCAs). These include such drugs: "Amitriptyline" (an antidepressant, the very first of the open ones) 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 of unpleasant side effects, primarily such as sharp rise blood pressure and increased heart rate. The drugs in this group are quite toxic, and the likelihood of 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 medicines that are no longer used today containing irreversible monoamine oxidase inhibitors (MAO) - Iproniazid, Tranylcypromine, Isocarboxazid. Their action is based on the suppression of the activity of 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 more weak impact on neurotransmitters and 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 when they were taken, there were many rather serious side effects, and also because of the interaction with different drugs and unpredictability of exposure, drugs in this group are used extremely rarely. In pharmacies, it is quite difficult to find antidepressants from the group of monoamine reuptake inhibitors. But in some cases they are found under other trade names. So, experts say that the drug "Ludiomil" is the same tablets "Maprotilin", the price, the manufacturer and the country are only different.

third generation

Modern researchers have found that about 30 mediators are involved in the work 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 such most commonly used modern antidepressants as Zoloft, Citalopram, Prozac, Cipralex, Paroxetine, Plizil and many others. These drugs do not block all mediators, but only one - serotonin. In terms of impact, they are inferior to first-generation drugs, but they have significantly fewer side effects than any other predecessors. All drugs of the SSRI group are very effective and should be tolerated by patients in approximately the same way. However, each of us has its own individual characteristics, and it is because of them that the number and strength of the manifestation of side effects will be different in each case. Doctors say the most common backfire third-generation medications are insomnia, dizziness, nausea, and anxiety.

SSRI drugs are quite expensive. So, for a fairly well-known and widely used drug "Citalopram" the price in pharmacies, depending on trademark, under which it is issued, can vary from 870 to 2000 rubles.

Fourth generation antidepressants

These include drugs of the SSRI group (selective serotonin and norepinephrine reuptake inhibitors). These are the latest generation of antidepressants, such as the drugs Simbalta, Milnacipran, Remeron, Effexor, which block the capture 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 unequivocally say 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, drugs 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 nervous system, it must be remembered that all possible - both positive and negative - consequences can be predicted and leveled only by a qualified specialist - a doctor. Taking into account all the individual characteristics and making 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. In the event that any problems arise when taking the prescribed medication, it is the attending physician who will be able to correct or change the treatment regimen. Today, most practitioners recommend drugs from the group of selective serotonin and norepinephrine reuptake inhibitors, the effective effects of which have been tested in practice, to patients with depressive disorders. Drugs such as Milnacipran, Fluxen (Fluoxetine), Duloxetine, Velaxin (Venlafaxine) are the most typical and widely used antidepressants of the latest generation. Consider the most popular thymoleptics in the treatment of depressive disorders.

The drug "Flucosetin"

This drug is one of the first representatives of the SSRI group, it combines both antidepressant and stimulant effects. The drug Fluxen, also known as the antidepressant Fluoxetine, helps reduce anxiety and tension, eliminates fear and improves mood. According to practicing psychotherapists, its use is most effective in cases of asthenic depressive disorders with apathy, as well as depression. varying degrees gravity and obsessive states. This drug is also used in the treatment of bulimia. The antidepressant fluoxetine was first registered in the US in 1974, and in the last decade it has come out on top in the UK, only under a different name. trade name- Prozac. In Russia, this medicine is widely used, and many practitioners confirm that they prescribe it or its generics to patients in various depressive conditions.

The drug "Paroxetine"

It is the most powerful representative of the group of selective serotonin selective uptake inhibitors, widely used in the treatment anxiety states and depression. Today drugs, active substance which is paroxetine, quite a lot. This and Russian drug"Adepress" from "Veropharm", the medicine "Plizil" from the Croatian company Pliva, the Hungarian tablets "Reksetin" from and many others. Regardless of the name of the drug Paroxetine, the reviews about it from both patients and doctors are mostly positive.

The drug "Wellbutrin"

Better known as "Zyban" or "NowSmoke". The active substance of all three drugs is bupropion hydrochloride, which increases the amount of dopamine and norepinephrine in the brain. Medicines with this active ingredient not only relieve the symptoms of depression, but also help overcome the emotional consequences of quitting nicotine. This medicine improves mood and increases efficiency. Reviews of those who got rid of nicotine addiction with the help of drugs such as Wellbutrin, NoSmok and Zyban, they talk about high efficiency these drugs during the period of smoking cessation.

The medicine "Cymbalta"

A drug fourth generation antidepressants, which is an inhibitor of the reuptake of norepinephrine and serotonin, along with a slight uptake of dopamine. This drug, the active substance of which is duloxetine, has a rather high, in comparison with other antidepressants, speed of action. According to the reviews of both doctors and patients, a clear antidepressant effect appears by the end of the first - the beginning of the second week of admission. In addition, this drug is characterized by uniformity of action and 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, the individual characteristics of the flow biochemical reactions quite often lead to the fact that one or another medication prescribed by a doctor may not have the expected result.

How much is?

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, the prices of which are presented in euros. That is why the table below shows 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, and new drugs 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 (SNRIs)	bupropion	Wellbutrin
	venlafaxine	Velaksin
	duloxetine	"Simbalta"

If you look closely 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 large quantity unpleasant side effects and incompatibility with many drugs are practically not used in European countries. In the United States, the medicines Isocarboxazid, Ugenelsin and Tranylcypromine are quite rarely used, and in our country the medicine Nialamide is used. All of the above medicines are available only under the supervision of psychiatric specialists.

This table clearly shows that the price of "classic" tricyclic antidepressants is significantly lower than for newer drugs from the SSRI and SNRI groups. Thus, it is not necessary to talk about the high availability of effective antidepressant drugs for the majority of the population. However, a doctor can help you choose a less expensive drug with similar properties, the so-called generic.

Interaction with other drugs

Antidepressants may interact with other medicines, even those that seem to us absolutely safe and familiar. The most active in this regard are tricyclic thymoanaleptics and monoamine oxidase inhibitors, but the drugs of the SSRI and SNRI groups practically do not interact with other medicines. In any case, if your doctor prescribes you any medications for depression, be sure to find out if you can combine their intake with the use of other medications, dietary supplements, and even teas and herbal teas.

Oddly enough, it sounds, but many people who need to take thymoleptics for various reasons ask the question of how often you can combine the intake of "strong" drinks and anti-depression pills. The answer to this question is quite simple: do you want to risk your mental and physical health, and maybe 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 “mission control center”, that is, the brain, and the organs and systems subordinate to it. Whether or not to combine - the decision is up to you and only you.

Instead of a conclusion

You should not think and "puzzle" over which antidepressants are better and more effective. If you feel that every new day is becoming harder to live than the previous one, you don’t have enough strength even for the simplest and most ordinary things, contact a specialist! The doctor will be able to diagnose your disease and prescribe necessary treatment by choosing the medicines that are most suitable for you. It can be not only antidepressants. The arsenal of today's medicine is quite extensive: different kinds psychotherapy, physical exercise and acupuncture, breathing practices and physiotherapy treatments.

Now I want to talk about what they are.

In general, almost all antidepressants act on the reuptake of serotonin. That is, serotonin is produced in our head, but does not reach where it is needed. The antidepressant "takes him by the hand" and escorts him to his destination. Some drugs also act on dopamine and norepinephrine. The first of them is responsible for some aspirations and vigor (if it is not enough, then you just want to lie down), the second is responsible for pleasure, motivation and learning. I will describe everything very schematically, so please do not scold those who are familiar with science, since now the main thing is for everyone to understand what the pills do, and behind the voluminous scientific descriptions welcome to wikipedia.

I want to draw your attention first of all to two large classes of antidepressants, which are mainly used in the treatment of depression. The rest are no longer so numerous and are represented by a smaller number of drugs.

SSRI antidepressants

SSRI is a selective serotonin reuptake inhibitor. That is, these are narrowly targeted drugs that act only on serotonin. A kind of analogue of a sniper rifle. They are considered one of the most harmless and seem to cause the least side effects.

In fact, this is not the case, and here for the most part it all depends on your individual portability. For example, I can’t stand SSRIs at all, since apathy begins - a well-known phenomenon for everyone when taking this group of drugs. I just need not only serotonin, but other hormones too.

The current standard for SSRIs is escitalopram, which is marketed with a drug such as cipralex. It costs like a car, but it really acts very gently. If you have never taken antidepressants before, it is best to start with it. He has one problem - he does not work on all depressions. That is, in some cases it will be weak.

Also well known paroxetine, or paxil. He is already much stronger than escitalopram, so he is also prescribed quite often. It is famous for its severe withdrawal syndrome, in which everyone is quite strongly sausage. However, the effect is very good.

Also have fluoxetine(Prozac) sertraline(zoloft), fluvoxamine(fevarin), citalopram(Cipramil) and so on.

Most common side effects of SSRIs

Drowsiness. Get ready to sleep on the go in the first days. Passes away with time.

Apathy. Already mentioned it above. SSRIs don't give us norepinephrine and dopamine, so some turn into vegetables. Like me, for example. A happy and contented vegetable that forgets to eat, wash and clean up.

Anxiety. If you have anxiety and panic disorder, then at the beginning of the reception they can become aggravated. It is treated by "rollback" to a lower initial dosage or by adding a tranquilizer to the treatment regimen.

Malfunctions in the digestive tract. It does not manifest itself in everyone, but it greatly interferes with life. At the beginning of the reception, there may be nausea and abdominal pain, then constipation often occurs. Not the most pleasant, so you need to watch your intestines, use fiber. And the opposite can happen, that is, diarrhea.

There are a bunch of other side effects - for example, on all SSRIs, my jaw is constantly reflexively clenched. Many are afraid to get better on antidepressants, but I can say that it will only be possible to get better on Paxil, but Prozac, on the contrary, will make you anorexic. Personally, I lose a lot of weight on all SSRIs (because I forget to eat, and I don’t feel like it). Also, many note a decrease in sexual desire and difficulty with orgasm. I confirm that it is.

Tricyclic antidepressants (TCAs)

Second big group.

Tricyclics are the case when sparrows are fired from a cannon. They stimulate those receptors that they can reach, and since the striking ability of the gun is much higher than that of a sniper rifle (SSRI), then the effect of it is greater. True, tricyclics at the same time shy away not only at sparrows, but also at those birds that happened to be here by chance and fell under the distribution. This type of antidepressant stimulates the production of serotonin, norepinephrine, and dopamine. Whether you need it or not - don't care, get it and sign it.

Tricyclic antidepressants are a rather old type of drug that many doctors prefer not to mess with. Well, just if there are SSRIs, then we don’t need much. But the trouble is, some people either do not wait for the effect of SSRIs, or their side effects greatly interfere with their lives. In this case, the good old tricyclics appear on the scene.

Amitriptyline called the gold standard of TCAs. It is also so budgetary that you simply wonder how these “five kopecks per bucket” pills can somehow help you. But, nevertheless, amitriptyline has more than once pulled me out of quite serious condition. Other well-known tricyclics are − clomipramine(anafranil), imipramil(melipramil), Azafen(purely Russian, but at the same time a good development). By the way, the latter, in my opinion, and in the opinion of many doctors, has the best tolerance among all TCAs.

By the way, many tricyclics have the ability to deal with chronic pain - all these ulcers, gastritis, migraines, intestinal pain, even back pain - they can easily remove all this.

Side effects of tricyclic antidepressants

Remember the sparrows and the cannon? This is where it shows up main disadvantage TCA - a large number of side effects. They are good not only with a powerful action, but also with powerful side effects. Moreover, side effects can only be at the beginning of treatment, then they pass, but not everyone has the patience to wait for the effect - many people simply stop taking TCAs.

The main one is drowsiness and terrible dullness. The TCAs are so overwhelming that they are often prescribed as sleeping pills (in low doses). Exit to high dosages not everyone can, and for some reason our doctors avoid them. They only prescribe adequate doses in hospitals, and then you walk around the wards like zombies and drool. No, in fact, everything is not so 🙂 You stupidly sleep all day long, and this is actually very useful - in a dream, the body recovers and gains strength.

Anticholinergic side effects. If you have ever been injected with atropine, then you will understand me. Pupils dilated, dry mouth, heart pounding. You look like an old drug addict. Plus, it can hit the allocation systems - no shit, sorry, normal, no piss. The body keeps natural waste in itself and does not want to give it away. However, this side effect is useful for those who suffer from diarrhea - TCAs will perfectly fix you and at the same time calm that revolution in the stomach that happens with irritable bowel syndrome or colitis.

Action on the heart. Immediately upon taking TCAs, you will surely feel that your motor has begun to work clearly more actively, such a good tachycardia occurs. If you take these antidepressants for a long time and in high doses, then the heart may begin to act up. So when taking TCAs, you need to regularly do a cardiogram.

Weight gain. Here everything is more clear than with SSRIs - you will probably gain weight. Especially if you eat TCAs in high doses. I just want carbs wildly, to the point of shaking. If at the same time there is also an antidepressant effect, then you will simply not care about weight, you will not notice anything and enjoy life until you stop walking through the door.

There are other types of antidepressants, which I will discuss briefly.

MAO inhibitors(iproniazid, pyrazidol) - a terrible thing (but effective), reacting with everything that is possible. They try not to name them. Unless everyone has already tried, and nothing works.

Heterocyclic antidepressants- maprotinil (ludiomil), mirtazapine (remeron), mianserin (lerivon). Similar to TCAs, but easier to tolerate.

SNRIs(selective serotonin and norepinephrine reuptake inhibitors) - as the name implies, they also act on norepinephrine. If you have apathy from SSRIs, then you can try SNRIs - it may well be that you will feel better from them. Typical representatives are venlafaxine (Velaxin), duloxetine (Cymbalta), milnacipran (Ixel). They are weaker than tricyclics and much easier to tolerate than both TCAs and SSRIs.

SNRIs(selective norepinephrine and dopamine reuptake inhibitors) are well tolerated and work well. But some particularly nervous individuals may experience anxiety. So far, there is only one SNRI antidepressant, and that is bupropion (wellbutrin).

SSA(specific serotonergic antidepressants) - not only add serotonin, but also cut off the flow of “anxious” hormones into the blood. Therefore, they act more or less well, but at the same time they are also normally tolerated. Well, except that they sedate strongly. A typical representative is trazodone (trittiko).

Well, the last one - agomethalin (Valdoxan) - is incredibly expensive. melatonergic antidepressant. It normalizes sleep, but only a very weak one will eliminate depression. But it transfers just fine.

I hope you don't have dazzling eyes from medical terms. I’ll try to summarize - you need to start treating depression with SSRIs, if it doesn’t help, then you can either turn to TCAs, and if they are poorly tolerated, then to other types of antidepressants. You have to try and try and try. It is rare when the first time it turns out to pick up a drug, since everyone has different organisms, and everyone reacts to pills in different ways. For example, I tolerate TCAs well and SSRIs very poorly. And how it will be for you - you will not know until you try. Despite the large number of side effects I have described, this does not mean that you will experience all of them. I want to apologize right away if I scared you with them. However, remember that depression itself is much more destructive than pills.

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

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

SSRI and SNRI may have the following side effects:

hypoglycemia or low level blood sugar
low sodium
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 younger than 18, may have suicidal thoughts, especially when they first start using.

Tricyclic antidepressants (TCAs)

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

Tricyclic antidepressants may have the following side effects:

seizures
insomnia
anxiety
arrhythmias or abnormal heart rhythms
hypertension
nausea and vomiting
cramps in the abdomen
weight loss
constipation
urinary retention
increased pressure on the eye
sexual dysfunction

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

Monoamine oxidase inhibitors

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

It inhibits the action of monoamine oxidase, a brain enzyme. Monoamine oxidase promotes the degradation of neurotransmitters such as serotonin.

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

Doctors now use MAOIs if SSRIs don't work. MAOIs are usually used when other antidepressants do not work because MAOIs interact 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 MAOIs 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? You need to find one that works so you can enjoy life again.

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

So don't give up. There are many antidepressants out there and chances are you will find one that works well for you. Sometimes a combination of drugs can be 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 help you, your doctor may have:

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 works slightly like a sleeping pill may be a good option.
Possible side effects. The side effects of antidepressants vary from drug to drug and from 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 an antidepressant helped a parent or sister, it may also work well for you. Also, if an antidepressant has been effective for your past depression, it may help again.
Interaction with other drugs. Some antidepressants can cause dangerous reactions when using other medicines.
Pregnancy or breast-feeding. The decision to use antidepressants during pregnancy and lactation is based on a balance of risks and benefits. Typically, the risk of birth defects and other problems in mothers taking antidepressants during pregnancy is low. However, some antidepressants, such as paroxetine, can be misleading 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 may help treat other physical or mental states 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 restlessness, but this will depend on the type of medication used, as mentioned above.

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

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

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

Suicidal thoughts. There are several reports of a higher risk of suicidal ideation when first taking antidepressants.

This may be due to medications or other factors, such as the timing of medication or possibly undiagnosed bipolar disorder, which may require a different treatment approach.

These drugs are used not only to treat depression, but also for other conditions.

The main or approved use of antidepressants are:

excitement
obsessive-compulsive disorder (OCD)
children's 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, an antidepressant is used without indications.

How long does the treatment last?

5 to 6 people out of 10 will see 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 the 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 will help you evaluate the pros and cons of taking antidepressants during pregnancy.
The use of SSRIs during pregnancy is associated with more high risk fetal loss, premature birth, low weight at birth and birth defects development.

Possible problems at birth include excessive bleeding at mother.

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

Pregnancy studies show that use of SNRIs or TCAs during pregnancy may increase the risk of pregnancy-induced hypertension or high blood pressure. 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 abstinence syndrome. Symptoms include sleep disturbance, tremors, and high-pitched crying. In some cases, the symptoms are severe.

A lab study showed that rodents that were exposed to citalopram, an SSRI antidepressant, just before and after birth, showed significant brain abnormalities and behaviors.

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

Alternative substitutes for antidepressants

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

St. John's wort

St. John's wort appears to help some people with depression. It is available without a prescription as a supplement. It is often taken in the form of a tea. It should not be taken with antidepressants!

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

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

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

It may reduce the effectiveness of some prescription drugs, including birth control pills, some heart medicines, warfarin, and some HIV and cancer treatments.

It is important to tell your doctor or pharmacist if you plan 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 with stress, depression and stomach cramps. The active ingredients in these herbs cause a number of good effects on the body, making it an easy and safe alternative.

Diet and exercise

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

depression is serious illness, which may require medical treatment. Anyone experiencing symptoms of depression should seek medical attention.

Moclobemide(Aurorix) is a selective MAO inhibitor type A. It is characterized by a distinct stimulating effect in inhibited depression. Shown at . Recommended doses are from 300-600 mg / day, it takes two to three weeks to develop a thymoanaleptic effect. Contraindicated in anxiety depression.

befol- original domestic with an activating effect of action (asthenic, anergic depressions). It is used in the depressive phase. Average therapeutic doses are 100-500 mg/day.

Toloxatone(humoril) is close in action to moclobemide, devoid of anticholinergic and cardiotoxic properties. Effective in depression with severe lethargy in doses of 600-1000 mg / day.

pyrazidol(Pirlindol) is an effective domestic antidepressant, a reversible inhibitor of MAO type A. It is used to treat both inhibited melancholy depressions and depressions with anxiety manifestations. It has no contraindications in the presence of glaucoma and prostatitis. The dosage of the drug is 200-400 mg / day. Cholinolytic effects are not manifested, which allows the drug to be prescribed for cardiovascular pathology.

Imipramine(melipramine) is the first studied tricyclic antidepressant. It is used to treat "major depressions with a predominance of sadness, lethargy, the presence of suicidal thoughts. With oral doses of 25-50 to 300-350 mg / day, it is possible parenteral administration(into a muscle, into a vein), one ampoule contains 25 mg of melipramine, daily dose at intramuscular injection 100-150 mg.

Amitriptyline It is also a "classic" antidepressant of the tricyclic structure, differs from a in a powerful sedative effect, therefore it is indicated in the treatment of anxiety, with the presence of manifestations of "vitality". In tablets, up to 350 mg / day is prescribed, parenterally up to 150 mg with intramuscular injection and up to 100 mg with intravenous administration.

Anafranil- a powerful antidepressant obtained as a result of targeted synthesis and the introduction of a chlorine atom into the imipramine molecule. It is used to treat resistant depressions (psychotic variants) in dosages up to 150-200 mg / day when administered orally, 100-125 mg / day for intravenous administration in cases of severe depression to relieve affective phases with.

Pertofran- demethylated imipramine, has a more powerful activating effect compared to it, is used in the treatment of depression with depersonalization. Dosage - up to 300 mg / day (in tablets).

Trimipramine(Gerfonal) is the most powerful antidepressant with anti-anxiety action. The psychotropic activity profile is close to . Average daily doses range from 150 to 300 mg. The drug, as well as, causes anticholinergic effects (dry mouth, urination disorders, orthostatic hypotension), which must be taken into account when conducting a course of treatment.

Azafen(pipofezin) is a domestic antidepressant, which is indicated for the treatment of "small" depressions of the cyclothymic register. It combines moderate thymoanaleptic and sedative effects. The maximum dosage is 300-400 mg / day when taken orally.

Maprotiline(Ludiomil) is an antidepressant of a tetracyclic structure, has a powerful thymoanaleptic effect with an anxiolytic and sedative component. Indicated in typical circular depression with ideas of self-blame, used successfully in involutional melancholia. Dosage - up to 200-250 mg / day when taken orally. Intravenously, the drug is administered intravenously with resistant depression up to 100-150 mg / day (60 drops per minute per 300 ml of isotonic solution). Usually do 10-15 infusions.

Mianserin(lerivon) has a mild sedative effect in small doses, which allows it to be used in the treatment of cyclothymia with insomnia. When prescribing the drug in dosages of 120-150 mg / day, the phenomena of a major depressive episode are stopped orally.

Fluoxetine (Prozac) has a distinct thymoanaleptic effect with a predominantly stimulating component, it is especially effective in the presence of obsessive-phobic symptoms in the structure of depression. It belongs to the group of selective serotonin reuptake inhibitors (SSRIs), completely devoid of the antihistamine, anticholinergic and adrenolytic effects of classic tricyclic ones. Has a very a long period half-life (60 hours). It is convenient for treatment by the fact that it is prescribed once a day for 20 mg along with the intake of food. The permissible dose is 80 mg / day. The course of treatment is at least 1-2 months.

Fevarin has a moderately pronounced thymoanaleptic effect, but at the same time a vegetostabilizing effect is manifested. Applied doses - from 100 to 200 mg / day, is prescribed once a day in the evening.

Citalopram(Cipramil) has moderate thymoanaleptic properties with a stimulating component, belongs to the group of SSRIs, is prescribed once a day at a dose of 20-60 mg orally.

Sertraline(zoloft) does not have anticholinergic and cardiotoxic properties, gives a distinct thymoanaleptic effect with: a weak stimulating effect. It is especially effective in somatized, atypical depressions with symptoms. Assign at a dose of 50-100 mg once a day, the effect is observed 10-14 days after the start of therapy.

Paroxetine(Rexetin, Paxil) - a derivative of piperidine has a complex bicyclic structure. The main properties of the psychotropic activity of paroxetine are thymoanaleptic and anxiolytic effects in the presence of manifestations of stimulation. It is effective both in classical endogenous and in neurotic depressions. It has a positive effect both in dreary and inhibited variants, while it is not inferior in activity to imipramine. Found: preventive effect of paxil in unipolar depressive phases. It is prescribed once a day at a dose of 20-40 mg / day.

simbalta(duloxetine) is used to treat depression with the presence, is prescribed in capsules of 60-120 mg once a day.

Side effects

Side effects of these drugs include hypotension, sinus tachycardia, arrhythmia, impaired intracardiac conduction, a number of signs of inhibition of functions bone marrow(agranulocytosis, thrombocytopenia, hemolytic anemia and etc.). Other vegetative symptoms include dry mucous membranes, accommodation disorders, intestinal hypotension, and urinary retention. This is most often noted with the use of tricyclic antidepressants. The use of tricyclic drugs is also accompanied by an increase in appetite, an increase in body weight. Seroton reuptake inhibitor drugs are safer, but can also cause headaches, insomnia, anxiety, and depotent effects. When these drugs are combined with tricyclic drugs, serotonin syndrome phenomena can be observed with an increase in body temperature, signs of intoxication, and disorders in the cardiovascular sphere.

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