MEDICINES FOR THE TREATMENT OF DEPRESSION (ANTIDEPRESSANTS)

According to the modern classification, antidepressants are divided into irreversible monoamine oxidase inhibitors (nialamide), reversible monoamine oxidase inhibitors (befol, inkazan, moclobemide, pyrazidol, sidnofen, tetrindol), non-selective neuronal uptake inhibitors (azafen, amitriptyline, imipramine, maprotiline, damylene maleate, fluorocyzine) , selective neuronal uptake inhibitors (trazodone, fluoxetine), antidepressants of various groups (cephedrine).

Azaphen (Azaphenum)

Synonyms: Pipofezin hydrochloride, Pipofezin, Azaksazin, Disafen.

Pharmachologic effect. Azafen is a tricyclic antidepressant. Pharmacological properties are close to imipramine. It does not have an inhibitory effect on MAO (monoamine oxidase). Thymoleptic (improving mood) action is combined with sedative activity (calming effect on the central nervous system).

Indications for use. Azafen has found wide application in the treatment of various depressions (depressed state).

Azafen is prescribed for astheno- and anxiety-depressive states, the depressive stage of manic-depressive psychosis (psychosis with alternating excitement and mood depression), involutional melancholy (senile depression), depressions of organic genesis (origin), somatogenically caused depressions, reactive depressions, depressive states , developing during long-term treatment with neuroleptics (drugs that have an inhibitory effect on the central nervous system and do not cause a hypnotic effect in normal doses), as well as in astheno-depressive states (weakness, depression) of a neurotic nature. It can be used as a "aftercare" agent after treatment with other drugs.

The drug is especially effective in mild to moderate depression; with deep depression can be used in combination with other tricyclic antidepressants. Azafen, if necessary, can be prescribed in combination with antipsychotics.

Due to its good tolerability, rather strong antidepressant (improving mood) activity and sedative effect, azafen is widely used in diseases accompanied by depressive and neurotic conditions. There is evidence of the effectiveness of Azafen for the treatment of depression in patients with coronary heart disease.

Azafen is successfully used for the treatment of shallow alcoholic depressions, occurring both with anxiety and with lethargy.

Method of application and dose. Azafen is prescribed orally (after eating) at a dose of 0.025-0.05 g (25-50 mg). Then the dose is gradually increased by 25-50 mg per day (in 3-4 doses). Usually the therapeutic dose is 0.15-0.2 g per day. If necessary, increase the daily dose to 0.4 g. The course of treatment lasts 1-1.5 months. Upon reaching the therapeutic effect, the doses are gradually reduced and switched to maintenance therapy (25-75 mg per day).

Azafen is usually well tolerated. Unlike imipramine, it does not exacerbate psychotic symptoms (delusions, hallucinations) in patients with schizophrenia, and does not increase anxiety and fear. The drug does not cause sleep disturbances, and patients can take it in the evening; as a rule, taking azafen improves sleep. The drug does not have cardiotoxic (heart-damaging) properties. The absence of pronounced side effects allows the drug to be prescribed to patients with somatic diseases (diseases of internal organs) and the elderly.

Due to the lack of an anticholinergic effect, azafen can be prescribed to patients with glaucoma (increased intraocular pressure) and other diseases in which the use of drugs with anticholinergic activity is contraindicated.

Because of its good tolerability, azafen is more convenient than imipramine and other antidepressants for outpatient (non-hospital) use.

Side effect. In some cases, when taking Azafen, dizziness, nausea, vomiting are possible; when the dose is reduced, these phenomena quickly disappear.

Contraindications. Azafen, like other tricyclic antidepressants, should not be administered in conjunction with MAO inhibitors. After the use of these drugs, Azafen can be prescribed after 1-2 weeks.

Release form. Tablets of 0.025 g (25 mg) in a package of 250 pieces.

Storage conditions. List B. In a dry, dark place.

Amitriptyline (Amitriptylinum)

Synonyms: Teperin, Tryptisol, Adepril, Adepress, Atriptal, Damilen, Daprimen, Elatral, Lantron, Laroxal, Novotriptin, Redomex, Saroten, Sarotex, Triptil, Triptanol, Elavil, Amiprin, Laroxil, Lentizol, Proheptadiene, Tryptopol, etc.

Pharmachologic effect. Amitriptyline, like imipramine, is one of the main representatives of tricyclic antidepressants. It is an inhibitor of neuronal reuptake of mediator monoamines, including norepinephrine, dopamine, serotonin, etc. Does not cause MAO (monoamine oxidase) inhibition. Significant anticholinergic activity is characteristic. The thymoleptic (improving mood) effect is combined in amitriptyline with a pronounced sedative effect (calming effect on the central nervous system).

Indications for use. Used mainly for endogenous depression (depressed mood). Especially effective in anxiety-depressive conditions; reduces anxiety, agitation (motor excitation against the background of anxiety and fear) and actually depressive manifestations (a state of depression).

Does not cause exacerbation of delirium, hallucinations and other productive symptoms, which is possible with the use of stimulant antidepressants (imipramine, etc.).

Method of application and dose. Assign inside, intramuscularly or in a vein. Inside take (after meals), starting with 0.05-0.075 g (50-75 mg) per day, then gradually increase the dose by 0.025-0.05 g until the desired antidepressant (improving mood) effect is obtained. The average daily dose is 0.15-0.25 g (150-250 mg) for 3-4 doses (during the day and at bedtime). Upon reaching a stable effect, the dose is gradually reduced. In severe depression, up to 300 mg (or more) per day is prescribed.

Indications for use. Depressive (podapennye) states of various etiologies (causes), especially those occurring with lethargy.

Method of application and dose. Assign usually inside (after eating), starting with 0.75-0.1 g per day, then gradually increase the dose (daily by 0.025 g) and bring it up to 0.2-0.25 g per day. With the onset of an antidepressant effect, it is not recommended to increase the dose. In some resistant (resistant) cases and in the absence of side effects, up to 0.3 tons per day are used. The duration of treatment is an average of 4-6 weeks, then the dose is gradually reduced (by 0.025 g every 2-3 days) and switched to maintenance therapy (usually 0.025 g 1-4 times a day).

In case of severe depression in a hospital (hospital), combination therapy can be used - intramuscular injections and oral administration of the drug. Start with intramuscular injections of 0.025 g (2 ml of 1.25% solution) 1-2-3 times a day; by the 6th day, the daily dose is adjusted to 0.15-0.2 g. Then the injection dose is reduced and the drug is prescribed orally, with each 25 mg of the drug for injection being replaced, respectively, with 50 mg of the drug in the form of a dragee. Gradually, they switch to taking the drug only inside and then to maintenance therapy.

Doses of imipramine should be lower for children and the elderly. Children are prescribed inside, starting with 0.01 g 1 time per day; gradually, over 10 days, increase the dose for children aged 1 to 7 years to 0.02 g, from 8 to 14 years old - up to 0.02-0.05 g, over 14 years old - up to 0.05 g and more per day. Elderly people are also prescribed, starting with 0.01 g 1 time per day, gradually increasing the dose to 0.03-0.05 g or more (within 10 days) - up to the optimal dose for this patient.

Side effect. Dizziness, sweating, palpitations, dry mouth, disturbance of accommodation (impaired visual perception), eosinophilia (increase in the number of eosinophils in the blood), leukocytosis (increase in the number of leukocytes in the blood); in case of overdose, agitation and insomnia.

Contraindications. Diseases of the liver, kidneys, hematopoietic organs, diabetes, severe atherosclerosis, glaucoma (increased intraocular pressure), hypertrophy (increase in volume) of the prostate gland, atony (loss of tone) of the bladder, pregnancy (first 3 months). The drug can not be combined with MAO inhibitors.

Release form. Tablets of 0.025 g in a package of 50 pieces; ampoules of 2 ml of 1.25% solution in a package of 10 pieces.

Storage conditions.

FLUOROCIZIN (Phtoracizinum)

Synonyms: Fluacizin.

Pharmachologic effect. Fluoracizine has an antidepressant effect, combined with a sedative effect (calming effect on the central nervous system). It has strong central and peripheral anticholinergic activity.

Indications for use. It is used as an antidepressant (drug that improves mood) in anxiety-depressive (suppressed) states within the framework of manic-depressive psychosis (psychosis with alternating excitement and depression of mood), in schizophrenia, if the clinical picture is characterized by severe affective disorders (fear, anxiety, emotional stress), with reactive (depressed mood in response to a conflict situation) and neurotic states accompanied by depression, as well as with depression caused by the use of neuroleptic drugs (drugs that have an inhibitory effect on the central nervous system and do not cause a hypnotic effect in normal doses ). In depressive states with lethargy, in atypical depressions in patients with diencephalic disorders (dysfunction of the medulla oblongata) and in involutional melancholia (senile depression / depressed mood /), the drug is not effective enough.

Fluoracizine can be combined with other (tricyclic) antidepressants, neuroleptics, psychostimulants.

Method of application and dose. Assign inside (after eating) and intramuscularly. When taken orally, start with 0.05-0.07 g (50-70 mg) per day (in 2-3 doses), then gradually increase the dose. The average therapeutic dose is 0.1-0.2 g (up to 0.3 g) per day 0.025 g (2 ml of a 1.25% solution) is administered intramuscularly 1-2 times a day, then the dose is gradually increased, and when therapeutic effect is gradually replaced by injections by taking the drug orally.

Due to the central anticholinergic effect, fluorocyzine can be used as a corrector for

extrapyramidal disorders (impaired coordination of movements with a decrease in their volume and trembling) that occur during the period of treatment with neuroleptics. Assign 0.01-0.06 g (10-60 mg) 1-2 times a day orally or 0.01-0.04 g (10-40 mg) per day intramuscularly.

Side effect. In the treatment of fluorocyzine, a decrease in blood pressure, weakness, nausea, and pain in the extremities are possible. Relatively often observed dry mouth, disturbance of accommodation (impaired visual perception), difficulty urinating.

Contraindications. The drug is contraindicated in violation of the functions of the liver and kidneys, gastric ulcer, glaucoma (increased intraocular pressure), hypertrophy (increase in volume) of the prostate gland, atony (loss of tone) of the bladder. It is impossible to prescribe fluorocyzine simultaneously with MAO inhibitors.

Release form. Film-coated tablets of 0.01 and 0.025 g (yellow or green, respectively), in a package of 50 pieces; 1.25% solution in ampoules of 1 ml in a package of 10 ampoules.

Storage conditions. List B. In a cool, dark place.

Tricyclic antidepressants are used to treat depressive and stressful conditions, the list of drugs will help you choose the most appropriate medicine. These drugs are effective for treating depression of any severity.

Tricyclic antidepressants (TCAs) are powerful drugs whose action is aimed at activating the brain's production of neurotransmitters such as norepinephrine (norepinephrine) and serotonin (the happiness hormone). This group of drugs got its name (tricyclic) due to the fact that their basis is a triple carbon ring. The intervention of TCAs in neurotransmitter metabolism causes the possibility of side effects. Among them:

• drowsiness;
• constipation;
• cardiopalmus;
• decreased sex drive.

The use of TCAs can cause autonomic disorders such as weakness, fainting, dizziness. The risk of these effects is especially high in patients with diseases of the cardiovascular system. Among the most frequent disorders in this group of patients are tremor, muscle twitching, extrapyramidal disorders.

Incorrectly selected doses of tricyclic antidepressants and their use for a long period can lead to a cardiotoxic effect, expressed in disruption of the conduction system of the heart. This can cause arrhythmias and other pathologies of the cardiovascular system. Therefore, the treatment of such patients requires ECG monitoring.

Treatment of TCA is very long: 4-6 months.

Positive results of the action of antidepressants are observed within a few days after the start of their use. In the event that there is no pronounced effect of treatment after 1-2 weeks, doctors do not recommend interrupting therapy and increasing the dosage. You need to be patient and wait for the results. There are no TCAs that work the same for all people. Medicines in this group have a gradual therapeutic effect.

Tricyclic antidepressants do not belong to the group of tranquilizers, therefore they do not cause drug dependence. The use of TCAs does not require a special diet. Tricyclic antidepressants are able to eliminate the symptoms of severe and moderate depressive states.

List of drugs

Azafen is prescribed for astheno- and anxiety-depressive states, psychoses, pathologies of a neurotic nature (depression, apathy, anxiety). Azafen is most effective in the treatment of mild to moderate depression. It can be prescribed in combination with more powerful TCAs, acting as a "treatment" drug.

This drug is well tolerated and does not exacerbate psychotic symptoms. Suitable for the treatment of alcohol withdrawal. Azafen does not have a cardiotoxic effect. It can be used in the treatment of patients with gastrointestinal diseases and glaucoma.

Amitriptyline is one of the main representatives of TCAs. It has a pronounced sedative effect, thymoleptic effect (raises emotional tone), reduces anxiety and motor excitation caused by it, does not cause productive symptoms in patients with schizophrenia. It is indicated for anxiety-depressive states of any etiology.

It has a wide list of contraindications: diabetes, glaucoma, first trimester of pregnancy, atherosclerosis, bladder and prostate pathologies. Among the side effects are dizziness, sweating, an increase in the number of leukocytes in the blood, impaired visual perception.

Fluorocyzine has a pronounced sedative (calming) effect, is effective in anxiety-depressive states, psychoses with alternating excitement and depression, in neuroses and neurosis-like states. Fluorocyzine can be combined with other TCAs, antipsychotics and psychostimulants. This drug does not cause drowsiness or lethargy. Produced in the form of tablets and solution in ampoules.

Desipramine. This TCA is indicated for endogenous and psychogenic depressions, psychasthenia, psychoneuroses, psychopathic conditions accompanied by lethargy. It helps to increase physical activity, activate psychomotor, improves mood, stabilizes the psycho-emotional state.

The drug is produced in the form of dragees, which are taken in the morning. Elderly patients are advised to reduce the dose. With a sharp refusal of the drug, manifestations of the withdrawal syndrome are possible. During the period of treatment, blood control, liver and kidney function are necessary.

doxepin and clomipramine

An effective antidepressant, the action of which is aimed at blocking the reuptake of norepinephrine. Rapidly absorbed from the gastrointestinal tract and distributed throughout the tissues. Doxepin is found in the heart, liver, and brain.

The drug eliminates most of the symptoms of depression: apathy, depression, obsessive experiences. It improves mood, normalizes adrenergic and serotonergic transmission disturbed in depressive states. It has an analgesic effect. Possible side effects include blurred vision, drowsiness, depersonalization, restlessness.

Clomipramine is indicated for obsessive-compulsive disorders, depressive episodes, post-schizophrenic depression, phobias, panic disorders, neurotic forms of depression. Clomipramine has adrenoblocking antihistamine activity, has a psychostimulating and sedative effect.

It is quickly absorbed and well excreted from the body with urine. Side effects: taste perversion, increased blood pressure, lacrimation, vestibular disorders, emotional lability. During treatment, blood pressure control is necessary.

When using tricyclic antidepressants, you should be aware that nicotine and some other components of cigarette smoke can reduce the concentration of tricyclic antidepressants in blood plasma. For smokers, it is 2 times lower than for non-smokers. Therefore, during the period of treatment with antidepressants of this group, it is recommended to stop smoking. This will allow you to get faster and more stable results of therapy.

Benefits and harms of antidepressants. Lists of over-the-counter drugs for children, weight loss, smoking cessation, cheap, strong.

Man is born for a joyful life. Only in such a mood is he able to create and create.

The truth of modernity is the world's number one problem called "depression". It turns out that her symptoms can be leveled, muffled for some time, but few people succeed in completely curing her.

The pharmaceutical industry is "generous" with offers of a "magic" pill for depression. And consumers successfully buy it and take it for a long period of time, if not a lifetime.

However, are antidepressants really harmless? How much do their benefits outweigh their long list of side effects? Let's talk about these and related points in more detail.

What are antidepressants and how do they work?

different antidepressants in bowls on the table

Antidepressants are pharmaceutical products designed to alleviate the symptoms of depression.

They are designed to regulate the number of mediators. These are substances responsible for the connections between neurons. There are many mediators in the human brain. There were about thirty discovered by scientists. Those affected by antidepressants:

• norepinephrine
• serotonin
• dopamine

In a normal person, neurons are arranged in such a way that a space is preserved between them - a synapse. In a state of depression, it disappears because it is filled with other neurons, so the connection of mediators is broken. And antidepressants just eliminate this moment.

scheme of action of antidepressants on human nerve cells

According to the nature of the action, the drugs in question are divided into 2 large groups:

• Timiretics.
  Their purpose is to excite, stimulate the work of the nervous system. Effective for the treatment of conditions with signs of depression, depression.
• Thymoleptics.
  They calm the excessive excitement that occurs with depression.

Classification of antidepressants in the table.

classification of antidepressants, table

What antidepressants can be bought without a doctor's prescription?

pills and capsules of antidepressants laid out on a white sheet

Note that you will definitely not be able to purchase potent drugs without a doctor's prescription. Causes - a large number or severity of side effects.

And yet available for purchase without a prescription are:

• tetracyclic group - Maprotiline (Ladiomil)
• tricyclic group - Paxil (adepress, plizil, reksetin, sirestill, plizil)
• selective inhibitors - Prozac (prodel, fluoxetine, fluval, profluzac)
• when giving up long-term bad habits, for example, smoking - Zyban (Nousmoke, Wellbutrin)
• herbal preparations - Deprim, Persen, Novo-Passit
• ready-made herbs

Tricyclic antidepressants, new generation: list and names of drugs

a handful of different antidepressants scattered on the table

To date, 4 generations of tricyclic antidepressants are known. The most common drugs are the third, namely:

• Citalopram
• fluoxetine
• Paroxetine
• Sertraline
• Fluvoxamine

However, we also note the representatives of the fourth generation, as they are gradually conquering their segment of consumers:

• Duloxetine
• Mirtazapine
• Venlafaxine
• Milnacipram

Good modern, light antidepressant pills for depression, nerves, apathy, tearfulness, anxiety and stress: a list

a girl holds an antidepressant pill in her hand to take it from tearfulness

This type of drugs refers to those that are free to buy at a pharmacy without a special purpose.

We list the most common mild antidepressants:

• Prozac
• Maprotiline (Ladiomil)
• Rexetin
• Adepress
• Aktapark-setin
• Plizil
• Paroxetine hydrochloride hemihydrad
• Cyrestill
• Deprim
• Gelarium hypericum
• Doppelhertz Nervotonik
• Persen
• Mianserin
• Amitriptyline
• Amizol
• Valerian
• Paxil
• Doxepin
• Tianeptine
• Herbion Hypericum
• Negrustin

Antidepressants for children: a list

teenage girl sitting at the table with a handful of antidepressants

As it is not regrettable, however, today's children are also subject to stress. As a result, their behavior and psychological health are seriously changing.

Below is a list of some antidepressants for the youngest group of patients:

• Paxil
• Amitriptyline
• Fluoxetine (Prozac)
• Sertraline (Zoloft) - from 12 years old
• Paroxetine (Adepress) - for teenagers only
• Fluvoxamine (Fevarin) - from 8 years old
• Glycine - from 3 years
• Deprim (St. John's wort, Gelarium Hypericum, Life 600) - from 6 years old
• Novo-Passit - from 12 years old

Antidepressants for smoking cessation: a list

a mountain of different pills and capsules of antidepressants for quitting smoking next to a stack of cigarettes

• Zyban (Bupropion)
• Champix (Varenicline)
• Nortriptyline

Strong antidepressants: a list of drugs without a doctor's prescription

several capsules of antidepressants on the table

• Venlafaxine (Venlaxor, Velaxin, Efevelon)
• Azona

Antidepressants are cheap: a list of drugs without a doctor's prescription

• Azafen
• Adepress
• Amitriptyline
• Velaksin
• Venlaxor
• Deprim
• Melipramine
• Paxil
• Paroxetine
• pyrazidol
• Rexetin
• Stimuloton
• Cipramil
• fluoxetine

Antidepressants for alcoholism without a prescription: a list

man is about to take antidepressants as he is coming out of alcohol addiction

• Azafen
• Amitriptyline
• Phenibut
• Tiapride
• Mianserin
• Mirtazapine
• Pirlindol - Pyrazidol, Tianeptine
• Adenosylmethionine - Heptral
• Mexidol

Antidepressants for menopause without a prescription: a list

a handful of antidepressant pills on a newspaper

• Paroxetine
• fluoxetine
• Fluvoxamine
• Sonapax
• Etaperazine
• Depakine
• Finlepsin
• Coaxil (Tianeptine)
• Efevelon
• Velaksin
• Velafax
• fluoxetine
• Profluzak
• Prozac
• Fluval
• Poroxetine
• Actaparoxetine
• Adepress
• Paxil
• Rexetin
• Plizil

Antidepressants for weight loss without a doctor's prescription: a list

a sad girl sits at a table in front of open jars of antidepressants while losing weight

• Bupropion
• Zoloft
• fluoxitine
• Maprolitin
• Prozac
• Paxil
• Deprim
• Azafen

Antidepressant - Fluoxetine, Fevarin, Amitriptyline, Lenuxin, Afobazole, Zoloft: can I buy without a doctor's prescription, how to take it?

several antidepressants in tablets and capsules are scattered on the table

Fluoxetine is available for free purchase at a pharmacy without a prescription. It is received like this:

• 20 mg once a day for a couple of weeks.
  Then increase the dose by adding the same amount of the drug in the evening.
• Elderly people start taking the drug with 60 mg.
• The maximum daily dose is 80 mg.
• The duration of the course is 1-4 weeks.

Fevarin can be bought at a pharmacy only with a prescription.
His:

• Take from a minimum dose of 1 tablet in the evening and bring to the optimum - 2 tablets per day.
• Drink a small amount of pure water.
• The maximum duration of admission is 70 days.

Amitriptyline is available for purchase without a prescription.
Features of its reception:

• starting daily dose is 25-50 mg
• within 6 days increases to 200 mg, subject to hospital treatment
• the duration of the course varies between 3-6 months
• elderly patients increase the dose only under the supervision of a doctor
• the best time to take it is in the evening, as the drug has a sedative effect on the body

Lenuxin is also available without a prescription for depression sufferers. Take it like this:

• at any convenient time of the day
• repeating course 2-4 weeks for 6 months
• minimum dose of 10 mg once a day

Afobazole is a group of mild antidepressants available for purchase at a pharmacy without a prescription.
Features of its reception:

• only after meals
• 10mg thrice a day
• maximum daily dose - 60 mg
• course 2-4 weeks
• if necessary, extend the course up to 90 days

Zoloft can be bought at a pharmacy without a prescription. Features of its application:

• once a day after meals
• minimum starting dose 25 mg
• maximum 50 mg possible one week after the start of the drug
• course duration from 4 weeks to 3 months

Herbal natural antidepressants, antidepressant products without side effects: a list, the best fruit antidepressant

fruits and vegetables are laid out on the table, which help to cope with depression

Among herbal antidepressants available for purchase at a pharmacy or self-harvesting, we note:

• St. John's wort is the most powerful herbal representative. A number of antidepressant drugs are made on its basis.
• Infusions of lemongrass, maral root, rosea rhodiola, immortelle, ginseng.
• Leuzea extract on alcohol.
• Zamaniha.
• Infusion of red clover, blue honeysuckle, oregano, motherwort.
• Chamomile, dill, cumin.
• Valerian, peppermint, hops, lemon balm.
• Hawthorn.
• Angelica medicinal.
• Calendula.

Depressed people often crave food. The latter are able to alleviate it and even level it in the early stages.

Among the products with antidepressant qualities, we note:

• Rich in omega-3 fatty acids.
  These are fish, for example, salmon, cod, herring, mackerel, sardine, salmon, as well as avocados, seeds, nuts, unrefined vegetable oil.
• Seaweed.
• Lean meats such as turkey, chicken, pork, beef.
• Egg white.
• Bright fruits - bananas, oranges, persimmons, tangerines.
• Bitter chocolate.
• Oatmeal, buckwheat.
• Vegetables and greens - tomatoes, cauliflower, beets, chili and sweet peppers, celery, broccoli, lettuce, eggplant, carrots.

The best fruit antidepressant is one that has a bright color. Since people are different in their taste preferences, one will be pleased, for example, with a banana, and the second with a persimmon.

By trial and error, you will find the best fruit for your mood.

Tranquilizers and antidepressants: what's the difference?

an open jar of tranquilizers lies on the table

The first are substances that eliminate feelings of fear, anxiety, excessive arousal, internal emotional tension by stimulating a special area of ​​the human brain. The latter is a kind of brake for such processes.

Benefits of using tranquilizers:

• preservation of memory and thinking
• muscle relaxation
• elimination of spasms
• normalization of the work of the autonomic nervous system, heart rate, blood circulation of the brain
• lowering blood pressure

These drugs are effective for the treatment of:

• distinct episodes of anxiety
• insomnia
• epilepsy
• neurotic and neurosis-like states

A significant disadvantage of long-term use of tranquilizers is addiction. It triggers reverse processes in the body, leading to a significant deterioration in health.

Antidepressants have a much broader spectrum and mechanism of action.

Antidepressants treat or cripple: the harm of antidepressants, side effects, is it worth taking?

a picture with the inscription "is there any benefit from taking antidepressants?"

It is impossible to answer this question unambiguously. Because there really are people who are really sick, requiring treatment with these drugs and specialist supervision.

Due to the lack of a high-quality experimental base, a specific drug has a lot of side effects after the fact before it enters the market. Their constant list, noted in the insert of any drug, makes you think. By the way, they range from mild - stool disorder, to lethal - suicide.

It is beneficial for manufacturers to record only positive reactions of sick people and not to get involved with those who suffer from deep depression.

The most common side effects of antidepressants are:

• diarrhea
• nausea
• dizziness
• dry mouth
• constipation
• sexual disorders up to the complete suppression of the desire for sex
• lethargy
• drowsiness
• difficulty urinating
• vision disorders
• cardiopalmus
• skin rashes
• increased sweating
• tremor
• delayed and reduced orgasm, weight gain
• dry eyes
• fluctuations in blood pressure
• sleep disorder
• difficulty achieving sexual orgasm
• swelling of the ankles and fingers
• blurred vision of objects in the field of vision
• nervousness
• excitement
• insomnia
• headache
• hypotension
• excitation

Antidepressants and alcohol: consequences of co-administration

on the table are a lot of various pharmaceutical preparations and antidepressants in blisters

Let's start with the fact that these substances are incompatible. Therefore, the consequences of their simultaneous intake are unlikely to please and relieve the manifestations of depression.

The picture below shows the mechanism of their influence on a person.

scheme of the effects of alcohol and antidepressants on humans

In addition to the most undesirable consequences - the death of a person, the following are possible:

• severe headaches
• insomnia or drowsiness
• arrhythmia
• vasospasm
• disorders of the cardiovascular and nervous systems, kidneys
• hypertension to dangerous levels
• liver dysfunction
• organism intoxication
• lack of energy and interest in life
• ear congestion
• problems with coordination of movements
• inhibition of body reactions

Which doctor prescribes antidepressants?

psychiatrist writes a prescription for antidepressants to a patient

These drugs are prescribed:

• psychiatrist
• psychotherapist
• senior psychiatric nurse

Is it possible to take antidepressants during pregnancy, breastfeeding?

a pregnant girl holds a handful of antidepressants in blisters on her palm

The answer depends on the initial data in each specific situation.

If a mother is annoyed by depression that cannot be treated with folk methods, then pills cannot be dispensed with.

The information that you find on the Internet lulls vigilance. It is clear that the studies were carried out by companies that were not interested in completely abandoning antidepressants.

And yet they recorded a small percentage of children developing in utero with health deviations such as:

• umbilical hernia
• problems in the work of the right ventricle of the heart
• irritability
• temperature instability

In this case, antidepressants are completely transmitted through the placenta or amniotic fluid to the baby. That is, their dose is equal to the maternal.

When a mother takes these drugs during breastfeeding, they enter the body of the crumbs in a lower concentration.

If you include a sound approach to planning pregnancy and breastfeeding, then antidepressants should be abandoned in advance. Every baby has the right to the best possible health at birth and during infancy.

Can you take antidepressants for the rest of your life?

capsules of the antidepressant Prozac close-up

The answer is yes, if your disease is serious and requires constant correction. And also you understand that by such actions you bring yourself more benefit than the harm done.

Be especially careful about:

• liver protection
• the regularity of medical examinations of the state of one's health
• drug dosages
• consultations with experts

Remember, long-term use of antidepressants will leave their side effects. Be ready for them.

So, we examined the features of taking antidepressants when getting rid of bad habits, menopause, during pregnancy and lactation. Compiled lists of drugs for different cases, including for children.

Take care of yourself and be healthy and happy!

Video: depression and antidepressants

Drugs for the treatment of depression, used in modern medicine, reflect the current understanding of the role and place of the so-called neurotransmitters - chemicals that ensure the transmission of nerve impulses between brain neurons. Since more than one neurotransmitter is involved in the “work” of the nervous system, various medications are used to restore their functions.

What drugs to take for depression?

The main group of drugs in the treatment of depressive disorders are antidepressants. Under the influence of the substances included in their composition, the mood is corrected to the inherent individual norm, the emotional background is stabilized, anxiety and anxiety are reduced, inhibition is eliminated, motor and mental activity is increased. The whole range of achieved effects is conditionally called "thymoleptic action". Today, there are several groups of antidepressants, different in composition and mechanism of action (stimulating and calming).

Antidepressants for depression- exactly those life-saving drugs that can alleviate, eliminate and prevent the disease. Before the discovery of drugs in this group, drugs with an exciting effect were actively used to treat disorders, which can cause a state of euphoria in the "melancholic". Such stimulants were opium and other opiates, caffeine, ginseng. Along with them, to reduce excitability and relieve anxiety, bromine salts, valerian, lemon balm, and motherwort were used.

The discovery of antidepressants in the 1950s was a real revolution in psychopharmacology. And for more than half a century, these drugs have been the "authoritative" effective drugs for depression. The first cure for depression was “discovered” quite by accident, when isoproniazid, a drug used in the complex treatment of tuberculosis, had an unusual side effect. Patients who took isoproniazid noted unusually high spirits, a state of lightness and bliss. Soon this medication began to be used to treat depressive disorders. At about the same time, in the course of experiments with various substances, a German doctor discovered imipramine, which also improved mood and relieved the blues. Unlike isoproniazid, imipramine is still on the WHO list of official drugs and has recently been the most sought-after and best-selling antidepressant.

How do pills "save" depression?

The purpose of antidepressants is to correct disturbances in the functioning of individual mechanisms of the brain. To date, 30 chemical mediators have been identified - mediators, whose tasks include the transfer of information from one neuron to another. Three mediators, biogenic amines, are directly related to depressive disorders: norepinephrine, dopamine and serotonin. Pills against depression regulate the required level of concentration of one or more mediators, thereby correcting the mechanisms of the brain that are disturbed as a result of the disease.

Are depression medications dangerous?

In the post-Soviet environment, there is an opinion that anti-depression pills are harmful and addictive. The answer is unequivocal: antidepressants used today in psychopharmacology are not addictive, regardless of the duration of their use. Their task is to help the body restore the mechanisms disturbed by depression. Drugs for depression are able to "reconstruct" the inner world broken by the disease and return a person to his characteristic activity and vigor.

When do depression and stress medications start to work?

The effect of antidepressants does not appear immediately. As a rule, at least two weeks pass between the time they start taking them and the appearance of a positive effect, although some patients report positive changes in mood as early as one week.

What pills help with depression?

An important point in choosing a drug is the name of the antidepressant. For example: the same drug in the domestic market can be represented by a dozen pharmaceutical companies. That is, a drug with the same active ingredient is sold under 10 different names. The cheapest are domestic drugs for depression and stress and pills produced in countries with cheap labor. Their disadvantage is that they often have a large number of side effects. Medicines produced by Western pharmaceutical companies are more expensive, but their therapeutic effect is better, and side effects are much less pronounced.

How to take drugs?

Antidepressants should be taken daily, preferably at a specific time. The number of doses and time depend on the effect of the drug. So, antidepressants with a hypnotic effect are recommended to be taken before bedtime. Tablets aimed at increasing activity are taken in the morning.

What antidepressants are used for depression?

Tricyclic antidepressants (TCAs)- the very first developments of pharmacists. The drugs of this group increase the content of noradrenaline and serotonin in the brain due to a decrease in the uptake of neurotransmitters by neurons. The action of drugs from this group can be both sedative and stimulating. A true antidepressant effect occurs on average 3 weeks after the start of their intake, and stable results are achieved only after a few months of treatment. Since these antidepressants also block other mediators, they provoke a significant range of negative side effects. It should be borne in mind that an overdose of drugs of this group can lead to serious consequences, including death. Currently, psychiatrists are trying to reduce the appointment of these "representatives" of the past generation.

As a rule, MAOIs are prescribed for those patients who have not improved after a course of treatment with tricyclic antidepressants. These drugs are used for atypical depression, which is a condition in which some of the symptoms differ from those of typical depression. Since MAOIs do not have a calming, but a pronounced stimulating effect, they are recommended for the treatment of minor depression - dysthymia. The drugs block the action of the enzyme monoamine oxidase, which is contained in the nerve endings. This substance destroys norepinephrine and serotonin, which affect mood.

- a later class of drugs that has become in demand due to the minimum number of side effects, significantly less than that of the antidepressants of the previous two groups. The action of SSRIs is based on stimulating the supply of the brain with serotonin, which regulates mood. Inhibitors block the reuptake of serotonin in the synapse, thereby increasing the concentration of the mediator. The drugs are easy to use and do not lead to overdose. SSRIs are not only used to treat depressive disorders. They are designed to deal with other unpleasant problems, for example: overeating. SSRIs should not be given to patients , because they can cause manic states. The drugs are not recommended for patients with liver diseases, since it is in this organ that biochemical transformations of inhibitors occur. You also need to remember that drugs in this group can adversely affect erectile function.

There are also antidepressants that are not included in any of the three previous groups, as they differ both in their mechanism of action and in their chemical composition.

– the latest achievement of psychopharmacological science. To date, the only drug of this class on the Russian market is Agomelatine (Melitor). The tool is able to influence simultaneously 3 types of receptors that are responsible in the body for the regulation of biological rhythms. The drug after 7 days of therapy normalizes sleep and daytime activity, reduces anxiety, restores efficiency.

Treatment of depression with antidepressants: selection criteria

The choice of the drug is the most important part of the treatment. It should only be done by a doctor. When prescribing an antidepressant, it is necessary to take into account: the age of the patient, individual sensitivity to psychopharmacological drugs, the severity of depression, the effects of previous treatment, the concomitant somatic condition, the medications taken.

Medications for depression: a list of antidepressants

Tricyclic antidepressants

• Azafen
• Amitriptyline
• Clomipramine (anafranil),
• Imipramine (melipramine, tofranil),
• Trimipramine (Gerfonal)
• doxepin,
• Dothiepin (dosulepin).
• Coaxil
• Fluorocyzine

Monoamine oxidase inhibitors (MAOIs)

• befol
• Inkazan
• Melipramine
• Moclobemide
• pyrazidol
• Sidnofen
• Tetrindol

Selective serotonin reuptake inhibitors (SSRIs)

• fluoxetine
• Citalopram
• Paroxetine
• Sertraline
• Fluvoxamine
• Escitalopram

Other antidepressants

• Mianserin
• Trazodone
• Mirtazapine
• Bupropion
• Tianeptine
• Venlafaxine
• Milnaciparin
• Duloxetine
• Nefazodon

Melatoninergic antidepressants

• Agomelatine (Melitor)

What drugs are used additionally?

Other groups of drugs are prescribed on an individual basis, depending on the medical indications of each individual patient. Supportive therapies include:

A group of tranquilizers. They have five components of pharmacodynamic activity: anxiolytic, muscle relaxant, hypnotic, sedative and anticonvulsant. Eliminate fear and anxiety, relieve emotional stress. They have a pronounced calming effect, normalize sleep. The action of the drugs is aimed at inhibiting the areas of the brain responsible for the emotional sphere: the limbic system, the hypothalamus, the reticular formation of the brain stem, the thalamic nuclei.

Pills for depression: a list of tranquilizers

benzodiazepine derivatives

• Phenazepam
• Diazepam
• Chlordiazepoxide
• Medazepam
• Oxazepam
• Midazolam
• Lorazepam
• Alprazolam
• Tofisopam

Diphenylmethane derivatives

• Hydroxyzine

Carbamates

• Meprobamate
• Emilcamat
• Mebutamat

Other anxiolytics

• Benzoctamine
• Buspirone
• Mefenoxalone
• Hedocarnyl
• Etifoxine
• Mebicar

Normotymic group. Smooth out circular disorders of the affective sphere. Prevent the development of depressive and manic symptoms, i.e. mood swings. Used to prevent relapse. Abrupt discontinuation of this group of drugs can provoke a resumption of affective fluctuations. Use drugs:

• Valproic acid
• lithium carbonate
• Lithium oxybate
• Carbamazepine
• Valpromide

group of neuroleptics. They have a multifaceted effect on the body, have powerful antipsychotic properties. Antipsychotics used for depression have a disinhibitory, activating effect. At the same time, they suppress the feeling of fear, weaken tension. Achieved various effects of drugs explained with their impact on the occurrence of excitation in different parts of the CNS. As a rule, neuroleptics are prescribed:

• Clozapine
• Risperidone
• Olanzapine
• Quetiapine
• Amisulpride
• Ziprasidone
• Aripiprazole

group of nootropics. They have a powerful positive effect on brain function. Increase resistance to various harmful factors. Reduce neurological deficit and improve corticosubcortical connections. They increase the level of mental activity, improve cognitive functions, memory and attention. Nootropics are used:

• Nootropil
• Pantocalcin
• Phenotropil
• Noopept
• Cereton
• Glycine
• encephabol

A group of sleeping pills. Eliminate sleep disorders, improve its quality. Use drugs for depression: a list of sleeping pills

• Andante
• Bromisoval
• Donormil
• Ivadal
• Melaxen
• notta
• sunmil
• Tripsidan
• flunitrazepam
• eunoctin

B group vitamins. They have a general strengthening effect on the central nervous system. They take part in the synthesis of neurotransmitters. Positive effect on intellectual abilities. Increase performance, endurance. Replenish "energy deficit".

In the 50s of the 20th century, a doctor from Switzerland began to prescribe to his patients, while he noticed that people's mood levels increased markedly. After some time, scientists determined that with the help of this drug, depression can be relieved.

It was in this way, randomly, that tricyclic antidepressants (TCAs or tricyclics) were discovered. This name was given to them in connection with their structure, which is based on a triple carbon ring. Today, there are many drugs in this group.

TCAs are able to increase and promote the transmission of norepinephrine and serotonin. Such antidepressants, along with stopping the capture of these neurotransmitters, have an effect on other systems - muscarinic, cholinergic, and others.

Previously, the list of indications for the use of this group of antidepressants was very wide:

• psychogenic disorders;
• endogenous;
• somatic disorders;
• CNS disease along with mental disorders.

Along with the treatment of depression and panic attacks, doctors prescribed drugs for long-term use in case of prolonged persistent depression, and as a preventive measure so that the disease would not recur.

Some of the foreign scientists suggest that tricyclic antidepressants are most effectively used for the treatment of severe stages of depression and suicidal tendencies.

30 years after the discovery of this group of drugs, it was believed that with the treatment of TCAs, for example, in patients with endogenous depression, an improvement could be seen in 60% of all cases.

For scientists and doctors, the main requirement in choosing a particular drug was the clinical picture of the patient's depression.

Previously, scientists believed that inhibited intellectual and motor functions against the background of neurological and psychological disorders can be treated with, but - Amitriptyline.

However, it has been observed that when taking tricyclic antidepressants, 30% of people had pronounced side effects, due to which they were forced to refuse treatment. In cases of people who were prescribed newer generations of antidepressants, only 15% stopped taking the drugs.

Indications and contraindications for use

Tricyclics have found their use in the treatment of depression, or depression. They are prescribed for:

Some drugs with normal tolerance and a strong antidepressant effect, as well as a sedative effect, can very often be used to treat diseases that occur along with neurotic disorders and depression.

So, in the treatment with Azafen, in patients with depressive disorders and heart disease, good results were observed. Also, the drug is actively used in the treatment of mild alcoholic depression, which can occur with anxiety and lethargy.

The negative effect of TCA on the body

Tricyclics inhibit the capture of norepinephrine, serotonin, and the manifestation of anticholinergic and antihistamine effects. Their great variety spills out in a huge number of undesirable effects that often begin to appear during treatment with this group of antidepressants:

• antihistaminic action manifests itself in a rapid increase in body weight, a drowsiness develops, low blood pressure;
• anticholinergic effect it is expressed by the appearance of constipation, urinary retention occurs, the heartbeat quickens, even loss of consciousness is possible;
• inhibition of norepinephrine tachycardia, muscle twitching may appear, sexual functions may be unstable, erectile dysfunction and ejaculation;
• due to dopamine uptake a person has motor excitation;
• in serotonin uptake the patient may have a decrease in appetite, possible manifestations of nausea, dyspepsia, weak erection and ejaculation;
• due to effects on the central nervous system, seizures may occur;
• also when using tricyclic antidepressants the heart is heavily loaded, conduction disturbance is possible.

With all this, if the human body is too unstable to these drugs, there may be violations of the skin, liver and blood.

Our TOP 15 best TCAs

We analyzed tricyclic antidepressants available on the Russian market and compiled our TOP-15 - a list of the most effective, safe and popular drugs:

Is it possible to buy without a prescription?

Tricyclic antidepressants cause a lot of side effects. Almost all drugs from the list have a holonolytic effect on the body:

• the mucous membranes of the body dry up;
• accommodation is disturbed;
• tachycardia appears;
• the process of urination is disturbed;
• glaucoma develops.

These drugs have a strong effect on the heart, very often they can cause a decrease in pressure, tachycardia. Due to these factors, tricyclic antidepressants cannot be purchased without a doctor's prescription. This is clearly a plus, because experimenting on yourself is not the best idea. It is more reasonable to listen to the opinion of an experienced specialist.

Issue price

Prices for tricyclic antidepressants:

Prices for all other drugs in the group, on average, are in the range of 300-500 rubles.

Never buy tricyclic antidepressants without a prescription, even if it is available somewhere. It is necessary to take this type of drug strictly according to the dosages prescribed by the doctor.

It is necessary to start treatment with small doses and gradually increase them, with the help of this tactic, the risk of side effects is reduced. When using tricyclic antidepressants, it is necessary to constantly donate blood for analysis in order to control the percentage of the active substance of the drug in the body. Its uncontrolled increase is very dangerous for health.

Antidepressants have a therapeutic effect in depressive disorder, but do not cause an immediate increase in mood, as occurs with the use of amphetamines. Two groups of drugs have been reported to have antidepressant properties. One of them is represented by tricyclic antidepressants and related related compounds. The first of these drugs, imipramine, was clinically tested by Kuhn (1957). Another group consists of monoamine oxidase inhibitors; despite years of use, their antidepressant effects continue to be debated. This chapter first describes tricyclics and related compounds, then monoamine oxidase inhibitors, and finally L-tryptophan, a compound with very uncertain antidepressant properties.

TRICYCLIC AND TETRACYCLIC ANTIDEPRESSANTS

Pharmacology

Tricyclic antidepressants are so named because their chemical formula contains three linked rings to which a side chain is attached. Their antidepressant properties depend on the mid-ring structure, and the potency and sedative properties are due to differences in the side chain. If a fourth ring is added, the drug is called tetracyclic. The clinician may consider tetracyclic drugs not as a separate group, but rather as a variant of tricyclic drugs. Many varieties of tricyclic and tetracyclic drugs have been produced, mostly for commercial reasons. They differ slightly in their therapeutic effect, although differences in their side effects should be taken into account by the clinician. It was believed that the therapeutic effect of these drugs is due to their general property to increase the flow of norepinephrine or serotonin to the receptors of postsynaptic neurons by blocking the reuptake of these neurotransmitters in presynaptic nerve endings. However, for some antidepressants (for example, iprindole and mianserin), this effect is not very strong, and in any case it occurs earlier and faster than the therapeutic effect (which appears after two weeks or more). It is known that antidepressants have other pharmacological effects, in addition to inhibition of the reuptake of neurotransmitters from the synaptic cleft. These effects are characterized by a decrease in the sensitivity of alpha-2-adrenergic autoreceptors (stimulation of these receptors reduces the release of norepinephrine into the synaptic cleft, and blockade increases it), a decrease in postsynaptic beta-adrenergic sensitivity, and an increase in serotonergic function. The integral action of these effects is difficult to determine. Thus, the therapeutic effect, despite many years of research, cannot be fully explained. (See Heninger et al. 1983a for a review.)

Available drugs

The many available compounds can be divided into tricyclic, tetracyclic, and others. Tricyclic compounds, in turn, are divided into derivatives of aminobenzyl, dibenzylcycloheptane and aminostilbene. But the clinician is primarily interested in pharmacological differences, not structural ones. Meanwhile, no matter what the manufacturers claim, there is no convincing evidence that any drug acts faster than the others.

"Standard" antidepressants

Amitriptyline has a pronounced sedative effect, as well as antidepressant properties. Therefore, it is suitable for the treatment of depressive symptoms associated with anxiety or agitation. There is also a sustained-release drug (lentizol) that can be taken once a day, but amitriptyline itself is long-acting and can be given once a day. Therefore, it is not recommended to use prolonged forms of the drug. Imipramine(melipramine) is used to treat inhibited depression due to its less sedative effect compared to amitriptyline.

Other antidepressants

These include dotepine, doxepin, iprindol, lofepramine, mianserin, fluoxetine, trazodone, and trimipramine. Of these, mianserin has a less pronounced anticholinergic effect and less cardiotoxic effect. Therefore, it is more suitable for the treatment of depression in patients with heart disease, although it has not been established that its antidepressant effect is as pronounced as that of amitriptyline. Iprindole, lofepramine, trazodone, and doxepin appear to be less cardiotoxic than imipramine. Fluvoxamine and fluoxetine are selective serotonin reuptake blockers. They may be less cardiotoxic (and less sedative) than standard antidepressants, but may cause nausea, anxiety, and anorexia. Fluvoxamine has been associated with convulsions and should therefore be avoided in epileptics. drugs, less sedative than standard antidepressants - desipramine, maprotiline, lofepramine and nortriptyline.

Clomipramine (anafranil), which has a strong effect on the reuptake of serotonin, according to some reports, has a specific therapeutic effect on the symptoms of obsession, but this is not completely certain. The drug was administered intravenously, but this practice is not recommended due to the risk of cardiac arrhythmias.

PHARMACOKINETICS

Antidepressants are rapidly absorbed and extensively metabolized by the liver. They are long lasting and should be given once a day. Patients differ sharply from each other in the intensity of absorption and metabolism of antidepressants. It was reported that when prescribing the same dose of nortriptyline in different patients, a tenfold difference in its concentration in the blood was observed. Therefore, the dose should be set individually depending on the clinical efficacy and adverse reactions. Measurements of drug concentration in the blood may be of value in the absence of a response to the usual dose. When using nortriptyline, there is evidence that both too high and too low a dose, the clinical effect is insufficient (Asberg et al 1971). However, this “therapeutic window” has not been confirmed for amitriptyline (Coppen et al. 1978) and may not be seen with other drugs at all. Concentrations of antidepressants in mother's milk correspond to plasma concentrations.

ADVERSE EFFECTS

They are numerous and significant (Table 17.7). They can be divided into five groups. Vegetative effects: dry mouth, impaired accommodation, difficulty urinating leading to urinary retention, constipation, occasionally leading to ileus, postural hypotension, tachycardia, increased sweating. Of these, urinary retention, especially in older men with prostatic hypertrophy, and exacerbation of glaucoma are the most serious; the most common symptoms include dry mouth and disturbed accommodation. Iprindol and mianserin have the least anticholinergic side effects. Mental side effects: fatigue and drowsiness when taking amitriptyline and other drugs with a strong sedative effect; insomnia when using imipramine; acute organic syndromes; in patients with a bipolar type of affective disorder, mania may be provoked.

Table 17.7. Some unwanted side effects of tricyclic antidepressants

Vegetative(except cardiovascular)

Dry mouth

Disturbed accommodation

Difficulty urinating

sweating

Cordially-vascular

Tachycardia

hypotension

ECG changes

Ventricular arrhythmias

neurological

Fine tremor

Coordination disorders

Headache

muscle twitches

epileptic seizures

Peripheral neuropathy

Other

Skin rashes

cholestatic jaundice

Agranulocytosis

Cardiovascular effects- tachycardia and hypotension - almost always develop. The electrocardiogram often shows an increase in the intervals of PR and QT, oppression of the ST segments and flattening of the T waves. Ventricular arrhythmia sometimes develops, more often in patients with heart disease. These symptoms appear to be less pronounced with mianserin and trazodone. Neurological effects: fine tremor, coordination disorders, headache, muscle twitching, epileptic seizures in predisposed patients, occasionally peripheral neuropathy. Other effects: allergic skin rashes, mild cholestatic jaundice, occasionally - agranulocytosis. With the use of mianserin, leukopenia was noted, although very rarely (Committee on the Safety of Medicines 1981), which is why the manufacturers of the drug recommend regularly checking the number of leukocytes in the blood when using it. A teratogenic effect has not been noted in women, but nevertheless, during pregnancy, especially in its first third, antidepressants should be prescribed with caution.

Cancel antidepressants gradually. Abrupt withdrawal may cause nausea, anxiety, excessive sweating and insomnia.

TOXIC EFFECTS

When overdosed, tricyclic antidepressants cause many side effects, sometimes very serious. In such cases, urgent help from specialists in a general hospital is needed, but the psychiatrist must be aware of the main signs of an overdose. They can be stated as follows. Cardiovascular effects include ventricular fibrillation, conduction disturbance, and low blood pressure. The pulse rate can be increased or decreased, which to a certain extent depends on the violation of conduction. Respiratory failure leading to respiratory failure. The resulting hypoxia increases the possibility of cardiac complications. Aspiration pneumonia may develop. Complications from central nervous system these are: agitation, muscle twitching, convulsions, hallucinations, delirium, coma. Pyramidal and extrapyramidal symptoms may develop. Parasympathetic symptoms- this is dry mouth, dilated pupils, blurred vision, urinary retention, pyrexia. Most patients need only observation and care, but monitoring of cardiac activity is especially important, and in case of arrhythmia, urgent help from a specialist in the intensive care unit is necessary. Tricyclic antidepressants delay gastric emptying, so in case of an overdose, it must be washed out within a few hours after taking an excessive dose of the drug. Irrigation should be carried out with extreme caution to prevent the possibility of aspiration of gastric contents. If necessary, an endotracheal tube with an inflatable cuff is inserted into the trachea before flushing.

ANTIDEPRESSANTS AND HEART DISEASE

The cardiovascular side effects of tricyclic antidepressants previously described, combined with their cardiotoxic effects in overdose, have suggested that tricyclic antidepressants may be dangerous in patients with heart disease. Evidence is conflicting: The British drug monitoring system links some cardiac deaths to amitriptyline (Coull et al. 1970), but the same system in the United States does not support this link (Boston Collaborative Drug Surveillance Program 1972). Tricyclic antidepressants have anticholinergic and quinidine-like effects and weaken the contractile function of the myocardium. These medicines, therefore, can interfere with cardiac activity. However, Veith et al. (1982) found no effect of tricyclic antidepressants on left ventricular function (both at rest and after) in depressed patients with chronic heart disease.

As already noted, it is possible that antidepressants without a pronounced anticholinergic effect (such as mianserin or trazodone) are safer than other antidepressants, but this has not been proven. Orme (1984) concluded that all antidepressants are generally safe in patients with mild heart disease, but in severe heart disease (eg, myocardial infarction, heart failure, electrocardiographically confirmed His bundle block or heart block), tricyclic antidepressants can only be used with very great care.

INTERACTIONS WITH OTHER DRUGS

Metabolism of tricyclic antidepressants is competitively inhibited by phenothiazine derivatives and enhanced by barbiturates (but not benzodiazepines). Tricyclic antidepressants enhance the pressor effect of norepinephrine, epinephrine, and phenylephrine by inhibiting their reuptake (Boakes et al. 1973), and this may complicate the use of local anesthesia in dental or other surgical procedures. Tricyclic antidepressants also interfere with the action of the antihypertensive drugs betanidine, clonidine, debrisoquine, and guanethidine. But they do not interact with beta-blockers used to treat hypertension. Alternatively, mianserin can be used to treat depressed patients who also have hypertension, as it only interacts with clonidine. The interaction of tricyclic antidepressants with monoamine oxidase inhibitors is discussed below.

CONTRAINDICATIONS

Contraindications include agranulocytosis, severe liver damage, glaucoma, and prostatic hypertrophy. These drugs should be given very carefully to epileptics, the elderly, and patients after coronary thrombosis.

APPLICATION

The clinician should be familiar with the two "standard" drugs, one of which has a more pronounced sedative effect. Amitriptyline (more sedative) and imipramine (less sedative) meet these requirements and have been extensively studied in many clinical trials. The clinician should also know a drug that has few anticholinergic side effects and is less cardiotoxic than others; mianserin, for example, can be chosen, although it is not yet certain that its antidepressant effect is as strong as that of amitriptyline. It makes no sense to change one tricyclic drug to another in the hope of obtaining a therapeutic effect, if one of them has not already given such an effect; there is also no point in prescribing two or more of these drugs at the same time (the combination of tricyclic antidepressants and monoamine oxidase inhibitors is discussed below). Do not give benefits and drugs containing a combination of an antidepressant and an antipsychotic - a derivative of phenothiazine. Agitation is usually just as well controlled with a sedative antidepressant. If it is necessary to support its action with a phenothiazine derivative, then it is better to give these drugs separately in order to establish adequate doses of each of the drugs independently.

If a depressed patient needs an antihypertensive drug, it is better if a diuretic, an appropriate beta-blocker (such as propranolol), or a combination of these two drugs is used for this purpose. If this is not possible, blood pressure should be carefully measured at least once a week, since other antihypertensive drugs may interact with tricyclic drugs, as discussed earlier. If necessary, the dose of the antihypertensive agent is adjusted. It is also important to continue to monitor blood pressure and be prepared to re-evaluate the antihypertensive drug dose when the antidepressant is discontinued.

Having chosen the appropriate antidepressant, it is very important to explain to the patient that the therapeutic effect may not occur immediately, but after two to three weeks, although sleep will probably improve earlier. It should also be reported that side effects (dry mouth, disturbances of accommodation, constipation) will appear before the therapeutic effect. An older person should be alerted to the possibility of postural hypotension. The patient should be reassured that most of these phenomena will gradually disappear with continued use of the drug. Since the patient's well-being may worsen due to side effects before the onset of a therapeutic effect, the doctor should revisit him in a week (severely depressed patients - even earlier), establish which side effects have arisen, and explain the origin of those that were not previously reported. it was said. He must encourage the patient, convince him to continue taking the medicine, while assessing the depth of depression.

The starting dose should be moderate (eg, amitriptyline 75 to 100 mg daily). If necessary, this dose is increased after about a week, when the severity of side effects can already be clarified. The entire dose of an antidepressant is usually given at night, so the sedative effect of the drug may improve sleep, and side effects peak at night and are likely not to be noticed by the patient. Doses should be lower in elderly patients, in those with heart disease, prostatic hypertrophy or other conditions that may be exacerbated by tricyclic antidepressants, and in patients with liver and kidney disease.

If after two or three weeks the depressive state does not alleviate, you should not change one medicine for another. Instead, the doctor should try to find out why the therapeutic effect was not achieved: whether the patient took the medicine at the prescribed dose; is the diagnosis correct? what social factors play a role in maintaining a disease state. Negative attitude of the patient to taking antidepressants is a common phenomenon. It is associated with the gloomy confidence of the depressed patient that nothing can help him, the unwillingness to endure unpleasant side effects and the fear that once he starts taking the medicine, he will never be able to refuse it.

If a therapeutic effect is achieved, the drug should be continued at the full dose for another six weeks. Then treatment should be continued at a reduced dose for the next six months (Mindham et al. 1973). If an exacerbation occurs when the dose is reduced, the previous dose should be restored for at least three months, and only then can you try to reduce the dose again. (There is another tactic: stopping therapy immediately after the end of the depressive phase. - Ed.)

Recently, the number of people suffering from depression has increased significantly. This is largely facilitated by the frantic rhythm of modern life, the increased level of stress. Added to this are also economic and social problems. All this cannot affect the mental and mental health of people.

People feel changes in the psyche when they are reflected in their performance and social relationships. They turn to a doctor for advice, and often he diagnoses them with depression.

First of all, it should be noted that one should not be afraid of this diagnosis. The disease does not indicate that the person suffering from it is mentally or mentally handicapped. It does not affect the cognitive functions of the brain, and in most cases it can be cured.

However, depression is not just a bad mood or sadness that can roll over healthy people from time to time. With depression, a person loses all interest in life, feels overwhelmed and tired all the time, and cannot make a single decision.

Depression is dangerous because it can affect the entire body, causing irreversible changes in its individual organs. In addition, with depression, relationships with others deteriorate, work becomes impossible, thoughts of suicide appear, which can sometimes be carried out.

Depression is not actually the result of a person's weak will, his insufficient efforts to correct the situation. In most cases, it is a biochemical disease caused by a metabolic disorder and a decrease in the amount of certain hormones in the brain, primarily serotonin, norepinephrine and endorphin, which act as neurotransmitters.

Therefore, as a rule, depression is not always possible to cure non-drug means. It is well known that a change of scenery, relaxation techniques and auto-training, etc., can help a person with a depressed mood. but all these methods require considerable effort on the part of the patient, his will, desire and energy. And with depression, they just don’t exist. It turns out a vicious circle. And it is often impossible to break it without the help of drugs that change the biochemical processes in the brain.

Classification of antidepressants according to the principle of action on the body

There are several options for classifying antidepressants. One of them is based on what kind of clinical effect the drugs have on the nervous system. In total, three types of such actions are distinguished:

• Sedative
• Balanced
• Activating

Sedative antidepressants have a calming effect on the psyche, relieving anxiety and at the same time increasing the activity of nervous processes. Activating drugs fight well with such manifestations of depression as apathy and lethargy. Balanced drugs have a universal effect. As a rule, the sedative or stimulating effect of drugs begins to be felt from the very beginning of the intake.

Classification of antidepressants according to the principle of biochemical action

This classification is considered traditional. It is based on what chemicals are included in the drug and how they affect the biochemical processes in the nervous system.

Tricyclic antidepressants (TCAs)

A large and diverse group of drugs. TCAs have long been used in the treatment of depression and have a solid evidence base. The effectiveness of some drugs of the group allows us to consider them a benchmark for antidepressants.

Tricyclic drugs are able to increase the activity of neurotransmitters - norepinephrine and serotonin, thereby reducing the causes of depression. The name of the group was given by biochemists. It is associated with the appearance of the molecules of substances of this group, consisting of three carbon rings connected together.

TCAs are effective drugs, but have many side effects. They are observed in approximately 30% of patients.

The main drugs of the group include:

• Amitriptyline
• Imipramine
• Maprotiline
• Clomipramine
• Mianserin

Amitriptyline Tricyclic antidepressant. It has both antidepressant and mild analgesic effects Composition: 10 or 25 mg amitriptyline hydrochloride Dosage form: dragee or tablets Indications: depression, sleep disorders, behavioral disorders, mixed emotional disorders, chronic pain syndrome, migraine, enuresis. Side effects: agitation, hallucinations, visual disturbances, tachycardia, pressure fluctuations, tachycardia, indigestion Contraindications: heart attack, individual intolerance, lactation, intoxication with alcohol and psychotropic drugs, conduction disorders of the heart muscle. Application: immediately after meals. The initial dose is 25-50 mg at night. Gradually, the daily dose increases to 200 mg in three divided doses.

Monoamine oxidase inhibitors (MAO inhibitors)

These are first generation antidepressants.

Monoamine oxidase is an enzyme that destroys various hormones, including neurotransmitters. MAO inhibitors interfere with this process, due to which the number of neurotransmitters in the nervous system increases, which in turn leads to the activation of mental processes.

MAO inhibitors are quite effective and cheap antidepressants, but they have a large number of side effects. These include:

• hypotension
• hallucinations
• Insomnia
• Agitation
• constipation
• Headache
• Dizziness
• sexual dysfunction
• visual impairment

When taking certain drugs, you should also follow a special diet to avoid the ingestion of potentially dangerous enzymes that are metabolized with the help of MAO.

The most modern antidepressants of this class have the ability to inhibit only one of two types of the enzyme - MAO-A or MAO-B. These antidepressants have fewer side effects and are called selective inhibitors. Non-selective inhibitors are currently rarely used. Their main advantage is their low price.

The main selective MAO inhibitors:

• Moclobemide
• Pirlindol (pyrazidol)
• befol
• Metralindol
• Garmalin
• Selegiline
• Rasagiline

Selective serotonin reuptake inhibitors (SSRIs)

These drugs belong to the third generation of antidepressants. They are relatively easily tolerated by patients and have fewer contraindications and side effects compared to TCAs and MAO inhibitors. Their overdose is not so dangerous as compared to other groups of drugs. The main indication for drug treatment is major depressive disorder.

The principle of operation of the drugs is based on the fact that the neurotransmitter serotonin, which is used to transmit impulses between neuron contacts, when exposed to SSRIs, does not return back to the cell that transmits the nerve impulse, but is transferred to another cell. Thus, antidepressants such as SSRIs increase the activity of serotonin in the neural circuit, which has a beneficial effect on brain cells affected by depression.

As a rule, drugs of this group are especially effective in severe depression. In depressive disorders of minor and moderate severity, the effect of drugs is not so noticeable. However, a number of doctors have a different opinion, which is that in severe forms of depression, it is preferable to use proven TCAs.

The therapeutic effect of SSRIs does not appear immediately, usually after 2-5 weeks of use.

The class includes substances such as:

• fluoxetine
• Paroxetine
• Citalopram
• Sertraline
• Fluvoxamine
• Escitalopram

fluoxetine Antidepressant, selective serotonin reuptake inhibitor. Has an antidepressant effect, relieves feelings of depression Release form: 10 mg tablets Indications: depression of various origins, obsessive-compulsive disorder, bulimia nervosa Contraindications: epilepsy, convulsive tendencies, severe renal or hepatic insufficiency, glaucoma, adenoma, suicidal tendencies, taking MAO inhibitors Side effects: hyperhidrosis, chills, serotonin intoxication, indigestion Application: regardless of the meal. The usual scheme is once a day, in the morning, 20 mg. After three weeks, the dose can be doubled. Fluoxetine analogues: Deprex, Prodep, Prozac

Other types of drugs

There are also other groups of drugs, for example, norepinephrine reuptake inhibitors, selective norepinephrine reuptake inhibitors, noradrenergic and specific serotonergic drugs, melatonergic antidepressants. Among these drugs are Bupropion (Zyban), Maprotiline, Reboxetine, Mirtazapine, Trazadone, Agomelatine. All of these are good antidepressants, proven in practice.

Bupropion (Zyban) Antidepressant, selective norepinephrine and dopamine reuptake inhibitor. Antagonist of nicotinic receptors, due to which it is widely used in the treatment of nicotine addiction. Release form: Tablets 150 and 300 mg. Indications: depression, social phobia, nicotine addiction, seasonal affective disorders. Contraindications: allergy to components, age up to 18 years, simultaneous use with MAO inhibitors, anorexia nervosa, convulsive disorders. Side effects: an overdose of the drug is extremely dangerous, which can cause epileptic seizures (2% of patients at a dose of 600 mg). Urticaria, anorexia or lack of appetite, tremor, tachycardia are also observed. Application: the medicine should be taken once a day, in the morning. The typical dose is 150 mg, with a maximum daily dose of 300 mg.

Next generation antidepressants

These are new drugs, which mainly include antidepressants of the SSRI class. Among drugs synthesized relatively recently, drugs have shown themselves well:

• Sertraline
• fluoxetine
• Fluvoxamine
• Mirtazalin
• Escitalopram

The difference between antidepressants and tranquilizers

Many believe that tranquilizers are a good remedy for depression. But in fact, this is not the case, although tranquilizers are often used to treat depression.

What is the difference between these drug classes? Antidepressants are drugs that generally have a stimulating effect, improve mood and relieve mental problems associated with a lack of certain neurotransmitters. This class of drugs works for a long time and does not affect people with a healthy nervous system.

Tranquilizers, as a rule, are fast-acting drugs. They can be used to fight depression, but mostly as ancillary drugs. The essence of their impact on the human psyche is not in the correction of his emotional background in the long term, as in drugs for depression, but in the suppression of manifestations of negative emotions. They can be used as a means to reduce fear, anxiety, agitation, panic attacks, etc. Thus, they are more of an anti-anxiety and sedative than an antidepressant. In addition, during the course of treatment, most tranquilizers, especially diazepine drugs, are addictive and addictive.

Can you buy antidepressants without a prescription?

According to the rules for dispensing medicines in Russia, in order to obtain psychotropic drugs in pharmacies, a doctor's prescription is required, that is, a prescription. And antidepressants are no exception. Therefore, theoretically strong antidepressants cannot be bought without prescriptions. In practice, of course, pharmacists can sometimes turn a blind eye to the rules in pursuit of profit, but this phenomenon cannot be taken for granted. And if you are given a medicine without a prescription in one pharmacy, this does not mean that the situation will be the same in another.

You can buy without a doctor's prescription only drugs for the treatment of mild depressive disorders such as Afobazol, "daytime" tranquilizers and herbal preparations. But in most cases, it is difficult to attribute them to real antidepressants. It would be more correct to classify them as sedative drugs.

Afobazole Russian-made anti-anxiety, anxiolytic and mild antidepressant without side effects. OTC drug. Release form: Tablets 5 and 10 mg Indications: anxiety disorders and conditions of various origins, sleep disorders, neurocirculatory dystonia, alcohol withdrawal. Side effects: Side effects while taking the drug are extremely rare. These can be allergic reactions, disorders of the gastrointestinal tract, headaches. Application: It is advisable to take the drug after meals. A single dose is 10 mg, daily - 30 mg. The course of treatment is 2-4 weeks. Contraindications: hypersensitivity to the components of the tablets, age up to 18 years, pregnancy and lactation

Why is self-treatment of depression dangerous?

There are many factors to consider when treating depression. This is the state of health of the patient, the physiological parameters of his body, the type of disease, and other drugs he takes. Not every patient can independently analyze all the factors and choose the medicine and its dosage in such a way that it would be useful and would not bring harm. Only specialists - psychotherapists and neuropathologists with extensive practical experience, will be able to solve this problem and say which antidepressants are better to use for a particular patient. After all, the same medicine used by different people will lead in one case to a complete cure, in another it will not have any effect, in the third it may even aggravate the situation.

Almost all depression medications, even the mildest and safest, can cause side effects. And strong drugs without side effects simply do not exist. Especially dangerous is prolonged uncontrolled use of drugs or excess dosage. In this case, intoxication of the body with serotonin (serotonin syndrome) can occur, which can lead to death.

How to get a prescription for the drug?

If you think that you have depression, it is recommended to consult a psychotherapist or neurologist. Only he can carefully examine your symptoms and prescribe the appropriate remedy for your case.

Herbal remedies for depression

The most popular herbal preparations for raising the mood today contain extracts of mint, chamomile, valerian, motherwort. But preparations containing St. John's wort showed the greatest effectiveness in depression.

The mechanism of the therapeutic action of St. John's wort has not yet been clearly elucidated, but scientists believe that the enzyme hypericin contained in it is able to accelerate the synthesis of norepinephrine from dopamine. St. John's wort also contains other substances that have a beneficial effect on the nervous system and other body systems - flavonoids, tannins, essential oils.

Hypericum preparations are mild antidepressants. They will not help with any depression, especially with its severe forms. However, the effectiveness of St. John's wort in mild to moderate depression has been proven by serious clinical studies in which it has shown itself to be no worse, and in some respects even better than the popular tricyclic drugs for depression and SSRIs. In addition, St. John's wort preparations have a relatively small number of side effects. They can be taken by children from the age of 12. Among the negative effects of taking St.

St. John's wort-based medicines are sold without a prescription. So if you're looking for over-the-counter depression remedies, this class of drugs may be your best bet.

Some preparations based on St. John's wort:

• Negrustin
• Deprim
• Gelarium Hypericum
• Neuroplant

Negrustin Antidepressant and anti-anxiety agent based on St. John's wort extract Release form: there are two release forms - capsules containing 425 mg of St. John's wort extract and a solution for internal administration, poured into 50 and 100 ml bottles. Indications: mild and moderate depression, hypochondriacal depression, anxiety, manic-depressive states, chronic fatigue syndrome. Contraindications: photodermatitis, endogenous depression, pregnancy and lactation, simultaneous use of MAO inhibitors, cyclosporine, digoxin and some other drugs. Side effects: eczema, urticaria, increased allergic reactions, gastrointestinal disorders, headaches, iron deficiency anemia. Application: three times a day is taken in a capsule of Negrustin or 1 ml of solution. Children under 16 are prescribed 1-2 capsules per day. The maximum daily dose is 6 capsules or 6 ml of solution.

List of popular drugs alphabetically

Name	Active substance	A type	Special properties
Amitriptyline		TCA
Agomelatine		melatonergic antidepressant
Ademetionine		mild atypical antidepressant	hepatoprotector
Adepress	Paroxetine
Azafen	Pipofezin
Azilect	Rasagiline
Aleval	Sertraline
Amizol	Amitriptyline
Anafranil	Clomipramine
Asentra	Sertraline
Aurorix	Moclobemide
Afobazole		anxiolytic and anti-anxiety drug	can be used for mild depression, OTC
befol
Bupropion		atypical antidepressant	used in the treatment of nicotine addiction
Valdoxan	Agomelatine
Wellbutrin	Bupropion
Venflaxin
Herbion Hypericum	hypericin
Heptor	Ademetionine
Hypericin		atypical antidepressant	herbal preparation, non-prescription
Deprex	fluoxetine
Default	sertraline
Deprim	hypericin
Doxepin		TCA
Zyban	Bupropion
Zoloft	sertraline
Ixel	Milnacipran
Imipramine		TCA
Calixta	Mirtazapine
Clomipramine		TCA
Coaxil	Tianeptine
Lenuxin	Escitalopram
Lerivon	Mianserin
Maprotiline		tetracyclic antidepressant, selective norepinephrine reuptake inhibitor
Melipramine	Imipramine
Metralindol		reversible selective MAO inhibitor type A
Miansan		Mianserin
Mianserin		TCA
Miaser		Mianserin
Milnacipran		selective serotonin and norepinephrine reuptake inhibitor
Miracitol	Escitalopram
Mirtazapine		noradrenergic and specific serotonergic antidepressant	new generation drug
Moclobemide		selective MAO inhibitor type A
Negrustin	hypericin
Neuroplant	hypericin
Newwelong	Venflaxin
Paroxetine		SSRIs
Paxil	paroxetine
Pipofezin		TCA
pyrazidol	Pirlindol
Pirlindol		reversible selective MAO inhibitor type A
Plizil	paroxetine
Prodep	fluoxetine
Prozac	fluoxetine
Rasagiline
Reboxetine		selective norepinephrine reuptake inhibitor
Rexetin	Paroxetine
Remeron	Mirtazapine
Selegiline		selective MAO inhibitor type B
selectra	Escitalopram
Serenata	Sertraline
Sirlift	Sertraline
Sertraline		SSRIs	new generation drug
Siozam	Citalopram
Stimuloton	Sertraline
Tianeptine		atypical TCA
Trazadone		serotonin reuptake antagonist/inhibitor
Trittico	Trazadone
Thorin	Sertraline
Fevarin	Fluvoxamine
Fluvoxamine		SSRIs	new generation drug
fluoxetine		SSRIs
Cipralex	Escitalopram
Cipramil	Citalopram
Citalon	Citalopram
Citalopram		SSRIs
acepi	Escitalopram
Elycea	Escitalopram
Escitalopram		SSRIs

List of antidepressants produced in Russia and Ukraine:

Azafen	MAKIZ Pharma
Adepress	Veropharm
Amitriptyline	ALSI Pharma, Moscow Endocrin Plant, Alvivls, Veropharm
Afobazole	Pharmstandard
Heptor	Veropharm
Clomipramine	Vector Pharm
Melipramine	Egis Rus
Miaser	Pharma Start
Ixel	Sotex
Paroxetine	Berezovsky Pharmaceutical Plant, Alvils
pyrazidol	Pharmstandard, Lugansk Chemical Plant
Siozam	VeroPharm
Stimuloton	Egis Rus
Thorin	Veropharm
Trittico	CSC Ltd
fluoxetine	Vector Medica, Medisorb, Production of Medicines, Valeant, Ozone, Biocom, Russian Cardiology Research and Production Complex, Vector Pharm
Citalopram	ALSI Pharma
acepi	VeroPharm
Escitalopram	Berezovsky Pharmaceutical Plant

Approximate price of drugs

Name	Price from
Adepress	595 rub.
Azafen	25 rub.
Amitriptyline	25 rub.
Anafranil	331 rub.
Asentra	732 rub.
Afobazole	358 rub.
Valdoxan	925 rub.
Heptor	979 rub.
Deprim	226 rub.
Zoloft	489 rub.
Ixel	1623 rub.
Calixta	1102 rub.
Clomipramine	224 rub.
Lenuxin	613 rub.
Lerivon	1060 rub.
Melipramine	380 rub.
Miratazapine	619 rub.
Paxil	728 rub.
Paroxetine	347 rub.
pyrazidol	171 rub.
Plizil	397 rub.
Rasagiline	5793 rub.
Rexetin	789 rub.
Remeron	1364 rub.
selectra	953 rub.
Serenata	1127 rub.
Sirlift	572 rub.
Siozam	364 rub.
Stimuloton	422 rub.
Thorin	597 rub.
Trittico	666 rub.
Fevarin	761 rub.
fluoxetine	31 rub.
Cipramil	1910 rub.
Cipralex	1048 rub.
Citalopram	386 rub.
acepi	439 rub.
Elycea	597 rub.
Escitalopram	307 rub.

Tricyclic antidepressants are medicines consisting of 3 rings in a molecule and radicals attached to them. Different substances can be radicals. In the classification of antidepressants, this group is referred to as non-selective neuronal reuptake blockers of monoamines.

Mechanism of action

The main mechanism is blocking the reuptake of the acting neurotransmitter; they act on the presynaptic membrane. This leads to their accumulation in the synaptic cleft and activation of synaptic transmission.

Neurotransmitters blocked by TCAs include:

• serotonin;
• norepinephrine;
• dopamine;
• phenethylamine.

Antidepressants block the breakdown of monoamines (neurotransmitters), act on monoamine oxidase, preventing reverse synthesis. They act as activators of the onset of depressive and affective states, which manifests itself when there is insufficient intake of monoamines in the synaptic cleft.

Within the class they are divided into:

1. Tertiary amines. TCAs of this group are distinguished by a balanced effect on the reuptake of monoamines (norepinephrine, serotonin). They are characterized by sedative and anti-anxiety, antidepressant activity and, in accordance with this, many side effects.
2. secondary amines. TCAs have a lesser effect compared to tertiary amines, but a greater stimulating effect. They are distinguished by an imbalance in the capture of monamines, mainly norepinephrine. Side effects are expressed to a lesser extent.
3. Atypical tricyclic antidepressants. The structure of their molecule corresponds to TCA, but the mechanism of action is different or similar to classical TCA. This is a large group of drugs that have targeted use in clinical practice.
4. heterocyclic antidepressants. Chemical structure, four-cyclic formula, mechanism of action corresponds to tricyclics.

The main features of this group are:

1. Thymoleptic effect, which is expressed in a decrease in the severity of the violation of the patient's affective sphere. Reception improves the mood, psychological state of the patient.
2. Psychomotor and somatic effects.
3. Analgesic action.
4. Anticonvulsant action.
5. They have a nootropic effect on the cognitive sphere.
6. Stimulating effect.
7. Antihistamine effect.

Adaptive changes when taking drugs occurs after the accumulation of neurotransmitters. The therapeutic effect occurs regardless of the method of taking the drugs (orally or parenterally), 3-10 days are enough for the onset of the effect.

Indications for appointment

Violations of the psychosomatic sphere of a person and the occurrence of conditions that contribute to the development of diseases as complications of these conditions. The most common diseases are:

1. Depressive states of various etiologies. Sometimes they occur as a result of treatment with neuroleptics or other psychotropic drugs.
2. Neuroses and neurotic states of a reactive nature.
3. Organic disorders in the work of the central nervous system. These include disorders such as Alzheimer's disease, which develops as a result of the deposition of amyloid plaques in the vessels of the central nervous system. Tricyclics reduce the rate of their formation and have a nootropic effect.
4. Anxiety in schizophrenia and severe depression.

The use of antidepressants requires a careful history of comorbidities. This pharmacological group has a wide range of side effects.

List of tricyclic antidepressants

The group of antidepressants includes 2466 drugs, of which only 16 are tricyclic. They are classified according to the active substance.

The most common are new generation antidepressants:

• Trazadone;
• fluoxetine;
• Fluxonil;
• Sertalin.

Medicines and over-the-counter products available for purchase:

• Deprim;
• Novo-passit;
• Persen and others.

Prices in pharmacies for drugs of this pharmaceutical group depend on the manufacturer, the quality of the drug, its properties and the characteristics of dispensing from the pharmacy. Some drugs contain narcotic substances and are sold by prescription.

Side effects

The use of drugs as a result of long-term use can lead to such disorders:

• cardiotoxic effect - arrhythmia, conduction, etc.;
• teratogenic effect;
• vegetative disorders (dry mouth, dizziness, disturbance of accommodation, etc.);
• changes in the blood formula (eosinophilia, leukocytosis);
• violation of ejaculation, urination, etc.

This group of antidepressants includes the very first drugs with an antidepressant effect, which were synthesized in the 50s of the last century. They got the name "tricyclic" because of their structure, which is based on a triple carbon ring. These include imipramine, amitriptyline nortriptyline. Tricyclic antidepressants increase the concentration of neurotransmitters such as serotonin and norepinephrine in our brain by reducing their uptake by neurons. The action of drugs in this group is different: for example, amitriptyline has a calming effect, and imipramine, on the contrary, has a stimulating effect.

TCAs act faster than other groups, and in some cases, positive mood changes can be observed as early as a few days after the start of administration, although all individually and sometimes stable results are observed only after a few months of administration. Since these drugs also block other mediators, they cause a number of unwanted side effects. The most common of these are lethargy, drowsiness, dry mouth (in 85%), constipation (in 30%). There is also increased sweating (25%), dizziness (20%), increased heart rate, decreased potency, weakness, nausea, and difficulty urinating. There may be feelings of anxiety and anxiety. When taking TCAs, problems may arise in those who suffer from cardiovascular diseases, as well as in contact lens wearers (usually there is a feeling of "sand in the eyes").

These drugs are low cost. An overdose of TCAs can be fatal. Often this drug is used for suicidal purposes.

Monoamine oxidase inhibitors (MAOIs).

MAOIs interfere with the action of the enzyme monoamine oxidase contained in the nerve endings. This enzyme breaks down neurotransmitters such as serotonin and norepinephrine that affect our mood. Usually, MAOIs are prescribed for those who have not improved after the appointment of tricyclic antidepressants. They are also often prescribed for atypical depression - a disorder, some of the symptoms of which are the opposite of typical depression (a person sleeps and eats a lot, feels worse not in the mornings, but in the evenings). In addition, because MAOIs have a stimulant rather than a calming effect, they are preferred over TCAs for the treatment of dysthymia, a minor depression. A positive effect occurs after a few weeks. The most common side effects are dizziness, fluctuations in blood pressure, weight gain, sleep disturbance, decreased potency, increased heart rate, and swelling of the fingers.

The difference between MAOIs and other drugs is that certain foods should not be consumed while taking them. This is a rather unusual list: aged cheeses, sour cream, cream, kefir, yeast, coffee, smoked meats, marinades, fish and soy products, red wine, beer, legumes, sauerkraut and pickled cabbage, ripe figs, chocolate, liver. There are also a number of drugs that do not combine with MAOIs. In this regard, this class of antidepressants should be prescribed with extreme caution. Also, therapy with other antidepressants should begin no earlier than two weeks after the abolition of MAO.

Nialamide (Nuredal). MAO inhibitor of irreversible action. Rarely used at the moment. "Small" antidepressant with a pronounced stimulating effect. It is used for shallow depressions with lethargy, fatigue, anhedonia, lethargy. Due to the presence of an analgesic effect, it is also used to treat pain syndromes with neuralgia.

Pirlindol (pyrazidol). Moclobemide (Aurorix).

Antidepressants - SSRIs.

This is the name of a class of antidepressants that has become popular due to fewer side effects compared to the drugs of the other two previous groups. But SSRIs have a drawback - a high price.

The action of these drugs is based on an increase in the supply of the brain with a mediator - serotonin, which regulates our mood. SIZOS got its name in connection with the mechanism of action - they block the reuptake of serotonin in the synapse, as a result of which the concentration of this mediator increases. Inhibitors act on serotonin without affecting other mediators, and therefore almost do not cause side effects. This group includes fluoxetine, paroxetine, fluvoxamine and sertraline (zoloft). When taking SSRIs, people, on the contrary, lose some weight. Therefore, they are prescribed for overeating, obsessive states. They are not recommended for bipolar depression, as they can cause manic states, as well as for people with a diseased liver, since biochemical transformations of SSRIs occur in the liver.

Side effects: anxiety, insomnia, headaches, nausea, diarrhea.

There are other antidepressants. These are bupropion (wellbutrin), trazodone and venlafaxine, remeron.

Anxiolytics (tranquilizers) and sleeping pills.

Anxiolytics are an extensive group of drugs whose main pharmacological effect is the ability to eliminate anxiety.

Other effects:

Ø Sedative

Ø Sleeping pills

Ø Muscle relaxant

Ø Antiphobic

Ø Vegetostabilizing

Ø Anticonvulsant.

In this connection, they are used for sleep disorders, addictions to psychoactive substances, epilepsy and other convulsive conditions, a number of neurological diseases, as well as many somatic and psychosomatic disorders, especially coronary heart disease, hypertension, peptic ulcer, bronchial asthma and many others. In addition, they are used by surgeons as a means for premedication.

According to the chemical structure, anxiolytics are divided into two large groups:

v Benzodiazepines , which include most of the tranquilizers used today in medical practice;

v Non-benzodiazepine derivatives - bushpiron, oxidine, phenibut, etc.

According to their strength, that is, the severity of the sedative and anti-anxiety effects, these drugs are conditionally divided into:

§ Xi flax which include, in particular, clonazepam, alprozolam, phenazepam, triazolam, estazolam.

§ medium strength - eg diazepam, tranxen, lorazepam, chlordiazepoxide.

§ Weak - for example, oxazepam, medazepam, oxylidine and others.

Finally, another very important characteristic of this group of drugs is the average half-life, in connection with which they are divided into:

Short-lived or drugs with a short half-life (conditional limit of 24 hours or less), - for example, alprazolam, triazolam, estazolam, lorazepam, grandaxin, medazepam, phenazepam, oxazepam.

Long-lived, or drugs with a long half-life - for example, clonazepam, clorazepate, diazepam, nitrazepam, etc.

Rules for the appointment of tranquilizers:

1. Treatment begins with as low doses as possible with a gradual increase, doses should be reduced just as gradually at the end of therapy; the patient should be warned in advance about side effects, especially in the first days of admission (muscle relaxation, lethargy, slow reaction, difficulty concentrating).

2. To avoid the risk of addiction formation, the prescription should be written for a small amount of the drug and the doctor should examine the patient at least once every 2 weeks.

3. If a long course (2-3 months or more) is needed, for example, with GAD, drugs and their doses must change, monotonous administration of the drug in a consistently high dose for more than 3-4 weeks is unacceptable; drugs with a long half-life are preferred.

4. Constant monitoring is important so as not to miss the first signs of the development of abuse and dependence on the drug.

5. Always remember that tranquilizers are by no means a panacea, but only one of the methods for treating anxiety disorders and use only where non-drug treatments have failed.

Antidepressants

The main indication for the appointment of antidepressants is a persistent decrease in mood (depression) of various etiologies. This group includes agents that differ significantly both in chemical structure and in mechanisms of action (Table 15.3). In psychopharmacological studies, the action of antidepressants is associated with the potentiation of monoamine mediator systems (mainly norepinephrine and serotonin). However, perhaps the effect

Table 15.3. Main classes of antidepressants

due to a deeper adaptive restructuring of receptor systems, since the effect of any antidepressant develops relatively slowly (not earlier than 10-15 days after the start of treatment). Some psychostimulants (phenamine, sydnofen) and L-tryptophan (a precursor of serotonin) also have a short-term antidepressant effect.

Tricyclic antidepressants (TCAs) are currently the most commonly used treatment for depression. They are similar in chemical structure to phenothiazines. The most potent drugs are amitriptyline and imipramine (melipramine). The antidepressant effect of these drugs develops relatively slowly, an increase in mood and the disappearance of ideas of self-blame are observed after about 10-14 days from the start of treatment. In the first days after administration, additional effects are more pronounced. In particular, amitriptyline is characterized by a pronounced sedative, anti-anxiety, hypnotic, and for melipramine - an activating, disinhibitory effect (Table 15.4). At the same time, an M-anticholinergic effect develops, manifested by dry mouth, sometimes accommodation disorders, constipation, and urinary retention. Often there is an increase in body weight, a decrease or increase in blood pressure. Dangerous complications in the use of TCAs are cardiac arrhythmias, sudden cardiac arrest. These side effects limit their intake to people over 40 years of age (especially with coronary heart disease, angle-closure glaucoma, prostate adenoma). The exceptions are azafen and gerfonal, the use of which is considered quite safe at any age. A great similarity of the clinical effect with the action of TCAs is found in ludiomil (maprotiline) and the sedative antidepressant mianserin (lerivon). In cases of resistance to TCAs, they may be more effective.

Table 15.4. The severity of sedative and psychostimulant effects in drugs with antidepressant action

Sedatives

Balanced

Stimulants

Fluorocyzine

Ludiomil

irreversible inhibitors

Gerfonal

Doxepin

Amitriptyline

Sidnofen

Mianserin

pyrazidol

Aurorix

Amoxapine

Clomipramine

Wellbutrin

Venlafaxine

fluoxetine

Trazodone

Desipramine

Nortriptyline

Opipramol

Melipramine Cephedrine Befol Inkazan Heptral

Non-selective irreversible MAO inhibitors were discovered in connection with the synthesis of anti-tuberculosis drugs from the ftivazide group. In Russia, only nialamide (well-redal) is used. The drug has a strong activating effect. The antidepressant effect is comparable in strength to tricyclic antidepressants, but develops somewhat faster. The use of the drug is limited due to significant toxicity caused by inhibition of detoxifying liver enzymes, as well as incompatibility with most psychotropic drugs (tricyclic antidepressants, reserpine, adrenaline, psychostimulants, some antipsychotics) and foods containing tyramine (cheese, legumes, smoked meats, chocolate and etc.). Incompatibility persists up to 2 weeks after the abolition of nialamide and is manifested by bouts of hypertension, accompanied by fear, sometimes a heart rhythm disorder.

Tetracyclic antidepressants (pyrazidol) and other selective MAO inhibitors (befol) are safe antidepressants with a minimum number of side effects and a successful (psychoharmonizing) combination of anti-anxiety and activating effects. Combined with any psychotropic drugs, used in patients of any age. However, their antidepressant activity is significantly lower than that of tricyclic antidepressants.

Selective serotonin reuptake inhibitors (fluoxetine, sertraline, paxil) are relatively new drugs. Their effectiveness is comparable to the action of tricyclic antidepressants: the disappearance of signs of depression begins 2-3 weeks after the start of treatment. Side effects are limited to dry mouth, sometimes nausea, dizziness. Used in patients of any age. Specific effects include appetite suppression (used in the treatment of obesity). Important advantages of this group of drugs are ease of use (in most cases, a single dose of 1 or 2 tablets per day is sufficient for maximum effect) and surprisingly low toxicity (cases of taking a 100-fold dose of the drug without risk to life are known). Incompatible with irreversible MAO inhibitors.

In recent years, antidepressants have been increasingly used to treat obsessive fears and panic attacks. Selective serotonin reuptake inhibitors and clomipramine (anafranil) are especially effective against anxiety attacks.

The use of drugs with a pronounced stimulant effect for the treatment of depression can lead to increased anxiety and an increased risk of suicide. The use of antidepressants in patients with hallucinatory-delusional symptoms is associated with the risk of exacerbation of psychosis and therefore should be carried out carefully, in combination with the use of neuroleptics.

Tranquilizers (anxiolytics)

The tranquilizing (anxiolytic) effect is understood as the ability of this group of drugs to effectively relieve anxiety, internal tension, anxiety. Although this effect may facilitate falling asleep, however, it should not be considered as a synonym for hypnotic action, since calming patients is not always accompanied by drowsiness - sometimes, on the contrary, activity increases.

The point of application of tranquilizers is currently considered to be the chloride ion receptor complex, which consists of a GABA receptor, a benzodiazepine receptor, and a chloride channel. Although the main representatives of tranquilizers are benzodiazepines, any drugs that act on the chlorine ion complex (GABAergic, barbiturates, and others) can be considered as tranquilizers. The highly selective tropism of tranquilizers for benzodiazepine receptors determines, on the one hand, a small number of side effects, and, on the other hand, a rather narrow spectrum of psychotropic activity. Tranquilizers as the main means can be used only for the mildest neurotic disorders. They are widely used by healthy people in the event of situational excitement and tension. For the relief of acute psychosis (for example, in schizophrenia), tranquilizers are ineffective - the appointment of antipsychotics is preferable.

Although in practice it is necessary to take into account some features of the spectrum of action of each of the drugs (Table 15.5), the effects of various tranquilizers are characterized by considerable similarity, and in most cases the replacement of one drug with another in an adequate dose does not lead to a significant change in the state.

When prescribing an anxiolytic agent, it is often necessary to take into account its pharmacokinetic features (absorption rate, half-life, lipophilicity). The effect of most drugs develops quickly (with intravenous administration immediately, with oral administration after 30-40 minutes), you can speed up the effect of the drug by dissolving it in warm water or taking a tablet under the tongue. Keto-substituted drugs have the longest duration of action.

benzodiazepines (Table 15.6) - radedorm, elenium, sibazon, flurazepam. After their use, patients may experience drowsiness, lethargy, dizziness, ataxia, and memory impairment for a long time. In elderly patients, there is usually a slowdown in the excretion of benzodiazepines from the body, and accumulation phenomena may occur. In this case, hydroxy-substituted benzodiazepines (oxazepam, lorazepam) are more easily tolerated. Triazole derivatives (alprazolam, triazolam) and the new hypnotic imovan have an even faster and short-term effect. The use of strong tranquilizers in the daytime is associated with a deterioration in performance, therefore, a group of "daytime" is distinguished.

Table 15.5. The main classes of tranquilizers

Table 15.6. Chemical structure of benzodiazepines

derivatives

Z-Hydroxy-

derivatives

Triazole and

imidazole

derivatives

Chlordiazepoxide

Oxazepam

Alprazolam

Diazepam

Lorazepam

Triazolam

flurazepam

temazepam

Estazolam

Nitrazepam

Brotizolam

Rohypnol

Midazolam

Phenazepam

Clorazepate

tranquilizers, the sedative effect of which is much less pronounced (nozepam, clorazepate, mebicar) or even combined with a slight activating effect (mezapam, trioxazine, grandaxin). With severe anxiety, you should choose the most powerful drugs (alprazolam, phenazepam, lorazepam, diazepam).

Tranquilizers are low toxic, go well with most drugs, their side effects are few. The muscle relaxant effect is especially pronounced in the elderly, and therefore the dosage should be the lower, the older the patient. In myasthenia, benzodiazepines are not prescribed. On the other hand, the muscle relaxant effect can be used for painful muscle spasms (osteochondrosis, headaches). The use of any tranquilizer worsens the severity of the reaction and is unacceptable when driving. With prolonged (more than 2 months) use of tranquilizers, addiction may form (especially with the use of diazepam, phenazepam, nitrazepam).

Many benzodiazepines have anticonvulsant activity (nitrazepam, phenazepam, diazepam), but the pronounced sedative effect of these drugs prevents their widespread use for the treatment of epilepsy. For effective and safe prevention of epileptic seizures, drugs with a long-term effect, devoid of a pronounced sedative effect (clonazepam, clorazepate, clobazam) are more often used.

The tranquilizing effect is found in many drugs used in somatic medicine and acting on other mediator systems - in antihypertensive drugs (oxylidine), antihistamines (atarax, diphenhydramine, donormil), some M-cholinolytic drugs (amizil). Buspirone is the first representative of a new class of tranquilizers, the action of which is probably associated with serotonergic receptors. Its effect develops gradually (1-3 weeks after the appointment), there is no muscle relaxant and euphoric effect, it does not cause dependence.

Psychostimulants

This group includes agents of various chemical structures that cause activation, increase efficiency, more often due to the release of mediators present in the depot. Phenamine (amphetamine) was the first drug introduced into practice, but due to its pronounced tendency to cause dependence, phenamine was included in the drug list in Russia (see section 18.2.4). Currently, sidnocarb is most often used, other drugs in this group are sidnofen, caffeine. In psychiatry, psychostimulants are used extremely limitedly. Indications are mild depressive states and apathetic-abulic states in schizophrenia. The antidepressant effect of psychostimulants is short-lived. After each use of the drug, a good rest is required to restore strength - otherwise, tolerance increases with the subsequent formation of dependence. Psychostimulants (phenamin, fepranone) reduce appetite. Side effects include insomnia, increased anxiety and restlessness, exacerbation of psychosis in patients with delusions and hallucinations.

29. Normotimics and antimanic drugs.

The most important property of this group of drugs is the ability to smooth out, eliminate and prevent pathological mood swings (normothymic action), as well as to stop the states of hypomania and mania, in connection with which these drugs are used to prevent the phases of bipolar disorder and schizoaffective disorder, as well as to treat manic states. . For the appearance of the preventive effect of these drugs, they must be taken for a long time - 1-1.5 years or more.

This group includes lithium carbonate and other salts, as well as carbamazepine, valproic acid preparations, lamotrigine, etc.

lithium carbonate. It has a pronounced anti-manic effect, as well as a distinct preventive effect in phasic affective and schizoaffective psychoses. The half-life is on average 22-32 hours.

Method of treatment and dose: 300-600 mg per day in 2-3 doses. Then the content of lithium in the blood plasma is determined and, depending on the result, a further dose is selected. When stopping manic states, the concentration of lithium in plasma should be 0.6-1.2 mmol / l - higher concentrations are toxic and dangerous, and at a dose below 0.4 there is no therapeutic effect. The doses required for this are 600-900-1200 mg per day. The determination at the beginning of therapy with increasing doses is repeated 1-2 times a week, when the desired concentration is reached - weekly, and subsequently - 1 time per month. It is necessary to periodically check kidney function (twice a year, a general analysis of urine and the content of urea in the blood).

Side effects: mild tremor, polyuria, polydipsia, some weight gain, lethargy, especially at the beginning of therapy. The appearance of vomiting, drowsiness, muscle weakness, large-scale tremor indicates intoxication and requires cessation of therapy.

Carbamazepine (finlepsin, tegretol). A well-known antiepileptic drug. In addition to anticonvulsant activity, it also has anti-manic and prophylactic effects, and therefore is used for the relief of mania and for maintenance treatment of affective and schizoaffective disorders. The anti-manic effect develops after 7-10 days from the start of treatment. It has a preventive effect in about 70-80% of cases. It has no antidepressant effect.

Doses: when stopping mania, the initial dose is 400 mg, the average is 600-800 mg orally per day in 2-3 doses after meals; in prophylactic therapy, start with 200 mg per day, then increase the dose by 100 mg every 4-5 days to a daily dose of 400 to 1000 mg per day in 3 divided doses, depending on tolerance. The most common dose for maintenance treatment is 400-600 mg per day. The criterion that the correct dose has been reached is the occurrence of very slight drowsiness in the patient, muscle relaxation for short periods after taking the drug, if this is more pronounced, then the dose of the drug should be reduced.

Side effects: drowsiness, lethargy, difficulty concentrating, muscle weakness, nausea, dizziness, uncertainty when walking, occasionally hepatitis and changes in the blood picture.

Depakin (depakin-chrono, convulsofin, covulex). Valproic acid or its salts - sodium valproate, calcium valproate, etc. When ingested in the small intestine, valproic acid is formed from valproates, which is the active substance. The anti-manic effect develops after 5-7 days from the start of administration. It has no direct antidepressant effect.

Doses: is prescribed after meals, starting with 150-300 mg per day in 2 or 3 doses with a gradual increase in dose by 150-300 mg every 2-3 days. Usual doses for prevention are 600 to 1200 mg per day, doses for the treatment of mania are slightly higher (800-1800 mg per day).

Side effects: nausea, vomiting, occasionally hair loss, thrombocytopenia. Drowsiness, muscle weakness usually do not cause.

Lamotrigine (lamiktal). The mechanism of action is associated with blocking the sodium and calcium channels of neurons and inhibition of excessive amounts of glutamate. It is used in the prophylactic treatment of bipolar disorder, especially when depressive phases predominate.

Side effects: drowsiness, headache, tremor, skin rash.

Doses: from 100 to 300-400 mg per day in 1 or 2 doses, depending on the preventive effect.

Until recently, this group included only lithium salts (carbonate or hydroxybutyrate). Initially proposed for the treatment of mania, lithium salts are increasingly being used to prevent both manic and depressive phases in MDP and schizophrenia. The disadvantage of these funds is a small therapeutic latitude. With an overdose, polyuria, hand tremor, dyspepsia, an unpleasant taste in the mouth, drowsiness, headaches, and dysfunction of the thyroid gland develop rapidly. Therefore, the dose of lithium should be monitored weekly by determining its content in the blood plasma. Usually, 0.6-0.9 mmol / l is sufficient for the prevention of affective phases. For the treatment of acute mania, the concentration can be increased to 1.2 mmol / l, however, neuroleptics (hapoperidol) have been increasingly used to treat mania in recent years. When taking lithium, you should strictly monitor the intake of salt and fluid, as well as diuresis, in order to avoid unwanted fluctuations in the concentration of the drug.

An action similar to that of lithium was found several years ago in some anticonvulsant drugs - carbamazepine (tegretol, finlepsin) and valproic acid salts (depakine, convulex). These drugs have a greater therapeutic breadth, have a sedative effect, but their effectiveness compared to lithium is debated.

Nootropics.

Nootropics (synonym: neurometabolic stimulants, cerebroprotectors) are a group of drugs that improve brain metabolism, higher brain functions (memory, learning, thinking) and increase the resistance of the nervous system to aggressive environmental factors (shock, intoxication, trauma, infection).

Under the influence of therapy with these drugs, memory improves, working capacity increases, learning processes accelerate, the level of wakefulness increases, mental and physical asthenia decreases, extrapyramidal and neurological symptoms weaken.

They are used in the treatment of many organic and symptomatic mental disorders of the brain of a traumatic, vascular, infectious and toxic nature.

Contraindications and complications of treatment there are practically no drugs for this group. There may be irritability, sleep disturbances, dyspeptic disorders (nausea, epigastric pain, diarrhea in people who use piracetam for a long time.