Antidepressants are increasingly entering the everyday life of many Russian residents. And despite the fact that there is a consensus in the professional community regarding their effectiveness in treating depression, in Russian society the use of antidepressants is not considered something healthy. Many who take these drugs in hopes of improving their mental health are misunderstood by family and friends, who often view their use as a fad or even the result of a conspiracy by pharmaceutical companies. The Village asked science journalist Svetlana Yastrebova to explain how antidepressants actually work, whether we should be concerned about their spread, and why myths about their ineffectiveness arise around them.

Global trends

Since the early 2000s, the use of antidepressants has increased in almost all countries. In 2000, residents of Iceland were the most likely to use these drugs: 71 people out of a thousand admitted to regularly using them, and in 2011 this number increased to 106 people per thousand. In Canada and Australia, the figures are not much better: in 2011, 86 and 89 people out of a thousand, respectively, resorted to using medications against depression. The Scandinavians and other Europeans lagged behind, but not by much. Residents of Eastern European countries avoid taking antidepressants constantly, but often use them once (to be honest, this does not make much sense for health). Women are treated for depression more often than men, and bisexuals are treated more often than homosexuals and heterosexuals. For Russia, alas, there is no exact data.

Chemistry of the process

There is no definitive answer to the question “what causes depression,” and it is unlikely that one will appear soon. There are several theories about the occurrence of depression, and most of them are somehow related to neurotransmitters - substances that transmit a signal from one nerve cell to other nerve or muscle cells. The most popular hypothesis is serotonin. It says that in patients with depression, either the production of serotonin itself or its perception is impaired. Most anti-depression medications are designed to correct this problem. Some of the newest and most frequently used are selective serotonin reuptake inhibitors (SSRIs). They trap serotonin molecules in the gap between two nerve cells, resulting in the effect of the neurotransmitter lasting longer and stronger. SSRIs should not interfere with the functioning of other neurotransmitters.

Previous generations of drugs have more side effects. These are, for example, monoamine oxidase (MAO) inhibitors, an enzyme that destroys serotonin and dopamine. Since these two neurotransmitters act not only on mood, but also on many other processes in the body (for example, serotonin increases intestinal motility and also constricts blood vessels, due to which it controls erection to some extent), MAO inhibitors can have a wide variety of side effects. Therefore, they are used much less frequently than SSRIs, and even then, if possible, in the clinic, under the constant supervision of a doctor.

There is another opinion regarding the causes of depression. It is known that with depression, practically no new connections are formed between nerve cells. This is probably the cause of the disease. Perhaps serotonin does not affect mood at all, but only helps trigger increased formation of connections between neurons. If this is so, then it becomes clear why most antidepressants do not improve your mood immediately after the first dose (like food and alcohol), but only after two weeks, and also why SSRIs sometimes help with anxiety disorders, which are not particularly related to serotonin.

Why shouldn't you choose antidepressants on your own?

Firstly, you don’t know what causes depression specifically in your case. The chemistry of the process as a whole is not fully known, and even more so, it will not be possible to determine by eye which system of neurotransmitters has broken down specifically in your case. In addition, there are many clinical studies and their meta-analyses that show that antidepressants help only if the severity of the disease is above average. Most likely, a person who can really help with antidepressants feels so bad that he is not able to think about any selection of pills.

Psychiatrists determine the severity of depression in several ways. One of them is the so-called Hamilton scale. Most often it is used precisely when studying the effectiveness of individual drugs. It includes 21 questions about the patient's condition. Each answer option gives a certain number of points, and the more points in total, the more severe the depression. The maximum possible number of points is 23, mild depression starts from 8, severe - from 19. The medicine is considered effective if, thanks to it, the patient’s score on the Hamilton scale drops at least three points lower than from “treatment” with a placebo. This decline does not occur in patients with mild to moderate depression.

And finally, like any substance that interferes with brain chemistry, any antidepressant has a wide variety of side effects - from constipation and erection problems to the realized desire to die. Of course, the safest drugs possible are entering the pharmaceutical market, and their direct and side effects have been studied in animals and in the clinic. At the same time, no one has abolished the so-called publication bias: both in medicine and in basic science, positive research results are more often published, while undesirable ones are kept silent. That is, no one lies, but some people do not tell. This is partly due to the way drug regulatory organizations are demanding of antidepressant manufacturers. For example, the US Food and Drug Administration (FDA) in its documents takes into account only those side effects that were observed during the study itself and within 24 hours after its completion. If anything happens to a study participant after this period, it will not be recorded anywhere.

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Use of antidepressants

Antidepressants For many years, they have been widely used in medical practice not only for the treatment of depressive conditions, but also as part of complex therapy for other diseases. Their effect on metabolic processes in the central nervous system is used in psychiatry, neurology and some other areas of medicine. This is partly due to the fact that many antidepressants have quite strong secondary and side effects. Some of them, in addition to their antidepressant effect, cause drowsiness, while others eliminate feelings of anxiety and fear. Of course, the use of drugs with such a wide spectrum of action is possible only as prescribed by specialists.

Indications and contraindications for the use of antidepressants

The main indication for the use of antidepressants, based on their name, is depression of varying severity. All drugs in this group effectively eliminate the symptoms, manifestations, and sometimes the causes of this mental disorder. However, antidepressants are often prescribed for other pathologies associated with mental or nervous activity.

In certain cases, the following diseases may be considered indications for the use of antidepressants:

• some hormonal disorders, etc.

It should be noted that with the above pathologies, not all patients need antidepressants. They can be included in complex therapy by your doctor to eliminate some symptoms. As a rule, the course of treatment in this case is limited to several weeks. Self-administration of antidepressants without a clearly formulated diagnosis often leads to serious complications and numerous side effects.

Since antidepressants have a wide range of side effects and affect, to one degree or another, the functioning of many organs and systems, they have quite a few contraindications. Not all contraindications are listed in the instructions for specific drugs. That is why specialists conduct a thorough diagnosis before prescribing an antidepressant and when selecting the optimal dose. This is necessary to identify associated health problems ( which the patient is sometimes unaware of) and exclude the most serious complications.

Most antidepressants are contraindicated for the following health problems:

• Individual intolerance to the drug. Each person's immune system has its own characteristics. If there is an individual intolerance to certain chemical compounds, the patient may develop an allergic reaction to the prescribed drug. If the patient has already had an allergy to a drug of this group in the past, this may be considered a contraindication to the prescription.
• Glaucoma. Glaucoma is an eye disease in which intraocular pressure increases. A critical increase can lead to damage to the optic nerve and irreversible blindness. Some antidepressants can trigger an attack, so they are not prescribed to patients ( usually elderly) with glaucoma.
• Recovery after myocardial infarction. Some antidepressants may cause heartbeat problems. People who have had a myocardial infarction have weaker heart muscles, and this strain can put their health and life at risk. They try to prescribe antidepressants 4 to 6 months after a heart attack. Such patients require consultation before using them. cardiologist ( sign up) .
• Structural brain damage. Trauma, strokes, and some infections may leave patients with structural damage to nerve tissue in the brain. This will make it much more difficult to predict the effects of antidepressants.
• Intestinal innervation disorders. The smooth muscles of the intestine are responsible for its contractions and partly for the normal digestion of food. Some antidepressants affect the nerves that control smooth muscles. Therefore, problems such as irritable bowel syndrome, chronic constipation or diarrhea may worsen while taking them.
• Urinary disorders. The innervation of the ureters and bladder is also regulated by smooth muscle. Taking antidepressants may cause urinary retention or urinary incontinence. Antidepressants are prescribed to patients with such problems with caution.
• Severe renal or liver failure. The liver and kidneys are vital organs that are responsible for the biochemical transformation and release of many substances, including medications. Severe disruptions to their functioning are a serious contraindication to taking many antidepressants, since the medicine will not be absorbed normally by the body.
• Blood pressure problems. Taking antidepressants may cause periodic increases or decreases in blood pressure ( as a side effect). Patients with hypertension ( high blood pressure) they should be prescribed with caution, under the supervision of specialists.
• Pregnancy and lactation ( for some drugs). For some antidepressants, pregnancy and lactation are an absolute contraindication, as these drugs can cause serious harm to the health of the child.
• Age up to 6 years ( for some drugs). A number of antidepressants are harmful to a growing body. In principle, for serious mental disorders, some drugs in this group can be used for up to 6 years, but only under the supervision of specialists.

There are other diseases and pathological conditions that can worsen during treatment with antidepressants. If you have serious health problems, you should notify your doctor at the first consultation.

It should be noted that not all of the diseases listed above are an absolute contraindication to treatment with antidepressants. In case of severe depression, treatment will still be prescribed, the doctor will simply select exactly the drug, dose and regimen that will not cause serious complications. Also, during the course of treatment, additional consultations, tests or examinations may be needed.

How and in what doses to use antidepressants ( instructions)

The vast majority of antidepressants are designed for long-term use ( months, years), therefore a single dose of the drug will not provide any visible improvement. As a rule, the patient selects the drug, dosage regimen and dose together with the attending physician. In addition, each drug is equipped with instructions for use, which necessarily indicate the optimal doses, as well as the maximum dose, exceeding which can lead to poisoning and serious side effects.

The dose and regimen of the drug depend on the following factors:

• Severity of depression. In cases of severe, prolonged depression, doctors usually prescribe stronger drugs, increase the dose and frequency of administration. This allows you to achieve a higher concentration of the drug in the blood and makes the therapeutic effect more noticeable.
• Tolerability of the drug. Sometimes patients do not tolerate the prescribed drug well. This may manifest itself in the form of severe side effects or allergic reactions. In this case, the doctor may, at his discretion, reduce the dose or change the drug.
• Risk of developing addiction. Some antidepressant medications can cause dependence over time. To reduce the risk of such a complication, doctors select the optimal dose and regimen. If necessary, they are adjusted as treatment progresses ( for example, some antidepressants are not discontinued immediately at the end of the course of treatment, but by gradually reducing the dose).
• Convenience for the patient. This criterion is taken into account in cases where other criteria have already been selected. Some people find it more convenient to take antidepressants once a day ( and sometimes less often). For them, doctors select drugs with long-term ( prolonged) action in higher doses.

Withdrawal syndrome and its symptoms in case of addiction and dependence

Withdrawal syndrome is understood as a set of symptoms that appear in a patient when abruptly withdrawing from a drug to which addiction has developed. Not all antidepressants are so addictive. Moreover, taking drugs in doses prescribed by a specialist rarely causes such a complication. In other words, the risk of becoming dependent on an antidepressant is not that great.

In most cases, addiction occurs in patients undergoing treatment with strong antidepressants for several months. However, such addiction is very different from drug addiction. Indeed, if you abruptly stop taking the drug, the nervous system does not have time to restructure itself, and various temporary disturbances may appear. However, there is still no serious health risk in this case.

Withdrawal syndrome when taking antidepressants may be accompanied by the following symptoms:

• general psychological discomfort;
• moderate muscle pain and joint pain;
• sometimes - nausea and vomiting;
• rarely – sudden changes in pressure.

Severe symptoms are quite rare. They are usually stronger in people who have underlying chronic diseases or other health problems. In most cases, no special treatment is required for this condition. The patient's condition returns to normal within 1 to 2 weeks.

To avoid withdrawal syndrome, most experts recommend completing the course of treatment by gradually reducing the dose of the drug. This allows the body to adapt to new conditions more slowly, and no symptoms will arise at all. In rare cases, when the patient is still concerned about his health after completing the course, he should consult a specialist who will accurately determine whether we are talking about withdrawal syndrome or other health problems.

Overdose and poisoning with antidepressants

Taking an excessive dose of an antidepressant can cause very serious disorders in the body, which sometimes endanger the patient's life. For each drug, the critical dose is slightly different. It is indicated by the manufacturer in the instructions. However, in some cases, when the patient's body is weakened, even a smaller dose can lead to poisoning. Also, the risk of overdose is higher in children.

Symptoms of overdose and poisoning affect the functioning of many organs and systems, as the functioning of the central nervous system, which controls them, is disrupted. The diagnosis is usually made based on existing symptoms and disorders. If any atypical body reactions occur after taking a large dose of the drug, you should immediately seek medical help.

The most common symptoms that occur in patients with serious antidepressant poisoning are:

• sudden drowsiness or loss of consciousness ( up to a precomatose state);
• heart rhythm disturbances ( more often with increased rhythm, tachycardia);
• breathing rhythm disturbances;
• deterioration in coordination of movements, sometimes – convulsions;
• drop in blood pressure ( indicates severe poisoning and requires urgent medical attention);
• pupil dilation ( mydriasis);
• deterioration of bowel function and urinary retention.

In severe cases ( especially in children) symptoms appear quickly and without warning. Life-threatening conditions arise from severe breathing and heart failure. This condition can last from several hours to several days. If the therapeutic dose is exceeded many times, death from antidepressant poisoning is possible.

Treatment of such poisonings is carried out under intensive care conditions in the toxicology department. First of all, doctors will take care of maintaining vital signs. Self-administration of emetics in this case is prohibited, since the organs do not work well and the patient’s condition may worsen ( entry of vomit into the respiratory tract). In the hospital, special agents will be prescribed that will lower the concentration of the drug in the blood and neutralize its toxic effect on the central nervous system.

Is it possible to use antidepressants in children and adolescents?

In principle, depression is not only an adult disease. Psychiatrists note that 6 to 8 percent of children and adolescents also suffer from its various manifestations. In some cases, children may be prescribed antidepressants as treatment. It is believed that the minimum age for most drugs in this group is 6 years, but some of the weaker ones can also be prescribed to younger children.

In the case of treating depression in children, the main groups of antidepressants are prescribed as follows:

• Tricyclic antidepressants. Due to the large number of side effects, drugs in this group can have a detrimental effect on a growing organism. They are prescribed to children extremely rarely, only under the strict supervision of doctors.
• Monoamine oxidase inhibitors. These drugs are also quite strong and can lead to a variety of problems in children. They are rarely used.
• Serotonin reuptake inhibitors. Drugs in this group have a selective effect, so they do not have such a wide range of side effects. Most specialists try to prescribe them for childhood depression.
• Drugs of other groups. The drugs are prescribed selectively, sometimes in combination with other drugs.

The only thing that can be unequivocally noted is that the independent use of antidepressants by parents is very dangerous. The reaction of a child’s body to a specific drug is very difficult to predict, even for experienced specialists. There is also high resistance ( sustainability) of the child's body in relation to many antidepressants. Often, even after consulting a psychiatrist, after some time you have to change the dose or drug to get the expected effect.

Is it safe to use antidepressants during pregnancy and lactation ( breastfeeding)?

Among antidepressants, there is a fairly large selection of drugs that are approved for use during pregnancy and lactation. As a rule, this point is indicated by the manufacturer in a separate column of the instructions. Sometimes there is a trimester of pregnancy in which the use of the drug is especially dangerous.

In general, it is always better to discuss taking antidepressants during pregnancy with your doctor. It is important to assess the risks of using or not using the drug and compare them. Self-administration of strong antidepressants often leads to various pregnancy complications, as it poses a threat to the child.

Self-administration of antidepressants during pregnancy can be dangerous for the following reasons:

• Possibility of developmental defects. Developmental defects occur in a child in cases where the drug passes the placental barrier between the blood of the mother and the fetus. Some substances inhibit the division and growth of certain cells. It has been noted, for example, that a number of drugs from the SSRI group ( selective serotonin reuptake inhibitors) can lead to developmental disorders of the respiratory system. Other substances may similarly cause irreparable harm to the cardiovascular or nervous system.
• Risk of pregnancy complications. In addition to harm to the fetus, there is a certain risk of complications in a pregnant woman. Changes in metabolism in the body can change the cellular composition of the blood, leading to the accumulation of toxic substances. As a result, a woman’s chronic diseases may worsen, and there is often a threat of miscarriage or premature birth.
• Reduced effectiveness of the drug. Due to hormonal changes in the body, some antidepressants may be less effective for pregnant women than for other patients. It is very difficult to predict this in advance, and the doctor evaluates the effectiveness of treatment after the start of the course.

The risk of taking antidepressants while breastfeeding is slightly lower. However, some drugs and their derivatives can be excreted in breast milk and enter the baby's body. If possible, women are advised to avoid taking these medications while breastfeeding or to consult with their doctor to determine the safest medication and dosage.

Do I need to undergo any tests or examinations before prescribing antidepressants?

In principle, patients undergo tests and examinations to confirm a particular diagnosis and detect various health problems. Based on this information, the specialist decides whether to prescribe a specific drug. Antidepressants are designed to combat depression and a number of other mental problems that can accompany it. In the field of psychiatry, laboratory tests and instrumental examinations are of secondary importance. Mental abnormalities can be observed even in completely healthy people ( based on analysis results) people. In this case, the opinion of a qualified specialist is decisive.

However, if long-term use of antidepressants is necessary, the doctor usually prescribes a number of tests and examinations for patients. Most often this is necessary to detect concomitant diseases ( besides depression). Almost all drugs from the antidepressant group have many side effects associated with the functioning of the heart, gastrointestinal tract or other internal organs. If you do not take into account the presence of chronic pathologies, taking the drug can seriously harm the patient's health.

To detect concomitant diseases, your doctor may order the following tests before starting antidepressants:

• general blood test;
• biochemical blood test;
• electroencephalography;
• allergy tests;
• ultrasound examination of internal organs ( Ultrasound), etc.

Test results help protect the patient and minimize the risk of side effects. A specific list of tests is prescribed by the attending physician at his own discretion. Often, when prescribing weak antidepressants, no tests are required at all.

What are the dangers of self-administering antidepressants at home?

Most strong antidepressants with a pronounced therapeutic effect are available with a prescription from a specialist. This measure is intended to limit self-medication with these drugs, as it may pose a danger to the patient. In general, antidepressants have a very diverse effect on the body. The effect of taking them can affect the functioning of many organs and systems. This explains the possibility of developing serious side effects that the patient is unable to predict.

Self-medication with drugs from the group of antidepressants can be dangerous for the following reasons:

• Incorrect diagnosis. Antidepressants can be prescribed for various diseases, but only a qualified specialist can make an accurate diagnosis. The patient himself cannot accurately classify his condition. Depression can be combined with other mental disorders, and not all of them can be corrected by taking antidepressants. This type of medication in the absence of indications) will not provide a therapeutic effect, and the risk of various complications increases significantly.
• Presence of chronic diseases and contraindications. Many patients do not know all of their health problems. Some pathologies do not appear and can only be detected during special examinations. At the same time, such diseases are often contraindications to taking antidepressants. That is why these drugs should be prescribed by a doctor after a full examination of the patient, and self-medication can be dangerous.
• Possibility of drug interactions with other drugs. Patients often take several drugs in parallel for different diseases. This combination of drugs can have negative consequences. On the one hand, the therapeutic effect may be weakened or enhanced. On the other hand, the risk of side effects and serious complications increases. The instructions for the drug do not indicate the entire list of unwanted drug interactions. To rule out a dangerous combination of medications, it is better to consult a doctor.
• Wrong dose selection. Calculation of the dose required to treat a patient and the regimen of taking the drug depends on many factors. When prescribing a particular medicine, a doctor is guided by the results of a preliminary examination. Patients themselves, trying to quickly achieve a therapeutic effect, can significantly exceed the permissible dose.
• Lack of specialist supervision. Most antidepressants must be taken under the supervision of a specialist ( in hospital or at periodic consultations). This will allow you to evaluate the therapeutic effect, notice the appearance of side effects in time and more accurately calculate the required dose of the drug. Self-administration without the supervision of a specialist is fraught with delaying treatment, a high risk of side effects and the development of drug dependence.

Thus, the risk of self-medication significantly outweighs the possible benefits. It is especially dangerous to use these drugs yourself for other purposes ( for example, for weight loss). In these cases, a thorough preliminary examination and accurate dose calculation are required.

It should be noted that antidepressants, which can be purchased at a pharmacy without a doctor's prescription, do not pose such a serious threat to the patient. However, their use without prior consultation can in some cases lead to serious consequences. For example, when taken simultaneously with some other psychoactive drugs, their effect on the body may increase, and the patient will have an overdose.

How long does antidepressant treatment last?

The duration of treatment with antidepressants is determined by the disease that caused them to be prescribed. In most cases, the drug is prescribed for several weeks, after which the doctor evaluates its effect on the body, tolerability and effectiveness. If the patient does not experience side effects and there is a tendency to improve, antidepressants may be prescribed for several months. For each individual drug, the duration of treatment may vary. As a rule, drugs of this group are taken for at least 2–3 weeks ( and more often - several months). Otherwise, it will be difficult to assess their effectiveness.

The duration of treatment with antidepressants depends on the following factors:

• established diagnosis;
• the patient's condition while taking the drug ( there must be positive dynamics);
• presence of side effects;
• presence of contraindications ( chronic diseases);
• treatment conditions ( in hospital or at home);
• the possibility of regular consultations with a specialized specialist.

For patients with severe mental disorders, strong antidepressants can be prescribed for a long period of time ( several months or more). As a rule, this occurs under the supervision of doctors in a hospital setting. The main danger of long-term treatment is addiction to most antidepressants. If a patient needs to take antidepressants for a long time to recover, the doctor may change medications during treatment to avoid dependence.

Does long-term use of antidepressants harm the body?

Taking antidepressants almost always involves a long course of treatment, which can be associated with some complications. The most serious of them is the development of drug dependence. It may appear when taking certain medications for several months. After completing the course of treatment, certain difficulties will arise with complete withdrawal of the drug ( withdrawal syndrome and its symptoms).

Other complications are rarely associated with long-term use. As a rule, problems with the digestive, nervous or cardiovascular system occur within a few weeks after the start of treatment. They are associated with the individual sensitivity of the body to a particular drug.

How long after taking antidepressants can you drink alcohol?

In principle, there is no consensus among experts regarding the compatibility of alcohol and antidepressants. It is believed that some drugs can be combined with alcohol in small doses, but this small dose varies widely for each patient. It depends on the individual characteristics of the body, the type of alcohol and other factors. It is almost impossible to foresee them all in advance and predict exactly what effect the combination of alcohol and antidepressants will have.

In general, the effect on the body of alcohol and antidepressants is almost the opposite. Despite the similar effect ( alcohol at the first stage liberates and lifts your spirits), the processes occurring in the central nervous system are very different. Pharmacological drugs have a selective effect on a specific system and, even in the presence of side effects, have a more stable and targeted effect. Alcohol affects many organs and systems. For example, inhibition of liver function leads to a deterioration in metabolism necessary for the nervous system. In addition, the circulation of water in the body is disrupted. This partly explains the appearance of insomnia after prolonged drinking.

Thus, the simultaneous use of antidepressants and alcohol will most often have negative consequences. For example, an antidepressant will not have the desired effect on enzymes, while the risk of side effects will increase. More serious consequences associated with pronounced disturbances in the functioning of the central nervous system are also possible. In severe cases, patients may quickly develop problems with heartbeat and breathing. There is also a high risk of psychosis, neuroses and other acute psycho-emotional disorders. In this regard, it is considered safest to drink alcohol a few days after finishing a course of antidepressant treatment ( The attending physician can advise you on a more precise date.). Abuse of alcoholic beverages during the course of taking the drug simply negates the benefits of taking it.

How long do antidepressants last after use?

The noticeable effect of taking most antidepressants does not occur earlier than a few weeks after the start of treatment. Sometimes this period can last several months. This delayed therapeutic effect is explained by the peculiarities of the action of these drugs. In most cases, a single dose of medication is not felt, since a sufficient concentration of the antidepressant has not yet accumulated in the blood and nerves. Over time, with proper and regular use, a “restructuring” of the nervous system occurs. From this moment the patient begins to feel an improvement in his condition. The therapeutic effect lasts throughout the entire course of treatment as long as the patient continues to take the medicine.

After completing the course and stopping treatment, there may be several options:

• Full recovery. For mild depression, the right drug can lead to complete recovery in a few weeks or months. After the end of treatment, the patient no longer faces this problem and leads a normal life.
• Long-term remission. This treatment outcome is the most common. After completion of treatment, the patient’s nervous system functions normally for a long time. The period without depression is called remission. It can last from several months to several years. Unfortunately, many patients sooner or later ( usually due to stress or other factors) severe depression develops again, and the course of treatment has to be repeated.
• Return of depression. Unfortunately, this outcome occurs quite often. With serious mental disorders, it is, in principle, very difficult to achieve complete recovery. Severe depression may return and will require a new course of treatment to resolve it. Some patients are forced to take antidepressants for years to maintain normal conditions.

Which antidepressants do not cause addiction or withdrawal symptoms?

The development of dependence on any antidepressant is not an inevitable complication of treatment. Strong addiction to the drug occurs subject to long-term use, a certain dose and some individual predisposition of the body. In addition, when doctors prescribe a particular drug, they always try to choose a treatment regimen that will minimize the risk of addiction.

In general, not many antidepressants are highly addictive. At the legislative level, their distribution is limited. In other words, almost all antidepressants that are sold in pharmacies with a prescription can be addictive under certain conditions. Lighter drugs that can be purchased independently do not have this property. If they help well with depression, then the dependence may be more likely psychological, and after stopping the use the patient will not have a withdrawal syndrome.

You can check with your doctor about the risk of addiction to a particular drug. This is especially important for people who have suffered from severe addiction in the past ( drug addiction, alcoholism, etc.). Before starting antidepressants, they should always consult with psychiatrist ( sign up) or narcologist ( sign up) .

How do antidepressants affect libido?

Some antidepressants may decrease libido ( sexual attraction) and dull emotions in general. This side effect is characteristic primarily of selective serotonin reuptake inhibitors ( SSRIs). It is usually indicated in the instructions for a specific drug. The doctor also warns about the risk of such problems before prescribing the drug. In the case of long-term use of antidepressants, this effect may remain even after stopping the use of the medication itself. Some experts even identify this disorder as post-SSRI sexual disorder.

The side effect of decreased libido should not stop doctors and patients if the patient really needs a course of antidepressants. The patient just needs to be informed, and if such problems arise, contact a specialist.

What can be the consequences of taking antidepressants?

In rare cases, the effects of taking antidepressants can be felt for quite a long time after the end of treatment. This is explained by the fact that during the period of taking medications, the central nervous system “rebuilt” in a certain way and “got used to” the regular supply of active substances from the outside.

The most noticeable effects of taking antidepressants are:

• Development of drug dependence. Addiction develops gradually due to artificial stimulation or inhibition of certain parts of the nervous system. Sometimes special medical help may be required to overcome this addiction.
• Problems with certain organs and systems. Side effects of some antidepressants may be associated with the functioning of the heart, liver, kidneys, and gastrointestinal tract. After stopping treatment, some patients may experience heart palpitations, diarrhea or constipation, abdominal pain, and other symptoms. As a rule, these disorders do not last too long ( no more than 2 – 3 weeks), after which organ function returns to normal. If symptoms are severe and there is significant discomfort, it is better to seek medical help rather than wait until the problems go away on their own.
• Return of depression. Sometimes the course of treatment does not give a stable result, and the patient, after stopping taking antidepressants, soon returns to a depressed state. In this case, you should definitely contact a psychiatrist. The doctor will objectively assess the patient’s condition and find out why the treatment was not effective. Sometimes the course of treatment is extended ( with or without drug change), and sometimes they simply give the nervous system a little time to return to normal. Of course, the patient is observed by a doctor until complete recovery.

It should be noted that the correct use of antidepressants during the course of treatment ( compliance with the regimen and dosage) virtually eliminates any serious consequences of taking them. Problems may arise when you deviate from the treatment regimen prescribed by your doctor.

For what diseases and problems are antidepressants prescribed?

Currently, the range of use of antidepressants in medical practice is very wide. They are used not only to treat depression itself, but also for a number of other mental illnesses, syndromes and disorders. This is explained by complex disturbances in the functioning of the central nervous system that accompany many pathologies. Almost every antidepressant has its own advantages and disadvantages. A qualified specialist can combine these drugs with other medications to achieve a good therapeutic effect.

The most common antidepressants ( alone or as part of complex therapy) is prescribed for the following diseases:

• depression;
• neuroses;
• panic attacks;
• schizophrenia;
• various psychoses.

It should be noted that in each individual case a specific drug is used. That is why self-treatment of these pathologies even with weak antidepressants can lead to unpredictable consequences.

Depression

Is it possible to treat depression without antidepressants?

Vegetative-vascular dystonia ( VSD)

Vegetative-vascular dystonia is not considered by many experts as a separate disease, since its manifestations can be very diverse and difficult to classify. The disease usually comes down to a nervous disorder, in which sudden changes in blood pressure, periodic pain, urination problems, sudden changes in heart rate and breathing, and severe sweating are most often observed. A sudden attack can trigger a panic attack in the patient. Currently, many neurologists recommend prescribing antidepressants to patients with similar problems as one of the main medications as part of complex therapy.

The following groups of antidepressants are most effective for VSD:

• SSRIs);
• some tricyclic antidepressants;
• tetracyclic antidepressants.

The course of treatment lasts from several weeks to several months. The patient must regularly visit a specialist who will evaluate the effectiveness of the prescribed drug. With cardiovascular ( cardiovascular) form of VSD there is a risk of temporary deterioration of the condition due to the side effects of the drug. In this regard, you cannot take antidepressants to treat VSD on your own. The drug and dose are selected by a qualified specialist.

Polyneuropathy

Polyneuropathy is a very serious problem in which patients' peripheral nerves are affected for one reason or another. This can be accompanied by very severe pain, sensory disturbances, and in severe cases, motor disorders ( motor function). Treatment of this disease should be comprehensive, aimed at both eliminating the cause of the disease and combating its manifestations.

Some antidepressants are widely used as symptomatic treatment for diabetic polyneuropathy. In particular, amitriptyline and venlafaxine relieve pain more effectively than many traditional painkillers ( nonsteroidal anti-inflammatory drugs).

The effectiveness of antidepressants for polyneuropathy is explained by the following mechanisms:

• dulling of pain occurs at the level of the nervous system;
• the serious condition of patients with advanced diabetes mellitus is often accompanied by depressed mood and depression ( which are also relieved by antidepressants);
• eliminate the root cause ( actual nerve damage) with diabetes is almost impossible, and pain must be dealt with constantly, and antidepressants are designed for long-term use.

Thus, the use of antidepressants in the treatment of polyneuropathy is justified and effective. Before starting treatment, it is better to discuss the choice of drug and dose with specialized specialists ( neurologist, therapist, endocrinologist).

Neurosis

Panic attacks

Panic attacks are acute nervous disorders that can manifest in different ways. It is currently believed that cupping ( relief of acute symptoms) panic disorder can be successfully treated with antidepressants. Typically, this initial stage of treatment lasts several weeks. During the period of consolidation of the result, antidepressants are combined with other drugs and psychotherapy, and the full course of treatment can last more than a year.

It should be noted that panic attacks are often combined with other mental disorders. They can arise, for example, against the background of various phobias. For full treatment, the patient must undergo a consultation with a psychiatrist and neurologist, who will rule out objective causes of the disorders and clarify the diagnosis. In some cases, antidepressants will be prescribed in combination with other medications.

In the treatment of panic attacks, the following groups of drugs are most often used:

• tricyclic antidepressants ( clomipramine, desipramine, nortriptyline, amitriptyline, etc.);
• selective serotonin reuptake inhibitors ( fluoxetine, escitalopram, etc.);
• MAO inhibitors ( monoamine oxidases) reversible and irreversible action ( pirlindole, phenelzine, etc.).

In some cases, patients are also prescribed powerful benzodiazepine tranquilizers. All of the above drugs, which effectively eliminate panic symptoms, can have many side effects. They should only be taken with a prescription from a specialist after a thorough examination.

Do antidepressants help with anxiety and fear ( anti-anxiety effect)?

Many antidepressants have a complex effect on the central nervous system, and they can be used not only for the treatment of depression. Among the drugs in this group there are also those that have a pronounced anxiolytic effect ( relieve anxiety, unreasonable fear, worry). They are quite widely used for anxiety neuroses and similar pathological conditions in psychiatry.

Most often, patients are prescribed the following antidepressants with anti-anxiety effect:

• maprotiline;
• azafen;
• mianserin;
• Mirtazapine.

In terms of effectiveness, these drugs are inferior to traditional anxiolytics ( tranquilizers), but can be used as part of complex therapy, or in patients who do not respond to more traditional treatment regimens.

Do antidepressants help with insomnia?

Depressive states can be accompanied by a variety of disorders in the functioning of the central nervous system. Quite often, patients have sleep disorders ( drowsiness or insomnia). In the case of insomnia, the patient's condition greatly worsens due to the depletion of the nervous system. For such conditions, antidepressants that have a sedative effect are used. Their use quickly calms the patient and gives a hypnotic effect. This effect is expressed differently in different drugs in this group.

In general, antidepressants with sedative effects ( amitriptyline, imipramine, nortriptyline) are quite widely used to treat insomnia. The effect of their use appears within a few weeks after the start of treatment. However, all patients respond to treatment differently, and to achieve the best effect, it is better to select the drug and dose from a qualified specialist.

Do antidepressants help with menopause ( menopause)?

Menopause normally occurs in women between 40 and 50 years of age. It is characterized by hormonal changes in the body, as a result of which not only the menstrual cycle stops, but also a number of associated disorders and disorders arise. Many of them are associated with the emotional state in general and possible mental disorders ( in some cases). Drug assistance during this period includes a fairly wide range of drugs, including antidepressants.

The use of antidepressants is possible throughout menopause. For some women, this period stretches from 3 to 10 – 15 years. To maintain a stable emotional background with the help of antidepressants, it is better to consult a specialist ( gynecologist, psychiatrist). They will help you choose the optimal dose of the drug. As a rule, in these cases, mild antidepressants are prescribed, which have fewer side effects and alleviate the symptoms that arise. Prescription of stronger drugs is necessary only in the case of the development of severe mental disorders.

Antidepressants for menopause help eliminate the following symptoms:

• sudden mood swings ( emotional lability);
• sleep disorders;
• lack of motivation;
• fatigue;

Are antidepressants prescribed for postpartum mental disorders?

Postpartum mental disorders are a relatively common problem. Changes in hormonal levels and lifestyle can cause severe stress in a woman. This is especially true for women whose pregnancy was accompanied by various complications. As a result, after childbirth, certain psycho-emotional problems may be observed for a long time ( depression, irritability, etc.). Sometimes antidepressants are prescribed to correct such disorders.

For postpartum depression, antidepressants usually have a good therapeutic effect. The drug and dose are prescribed by the attending physician ( usually a psychiatrist). The main condition is the safety of the chosen medication during breastfeeding. Long courses of treatment with stronger drugs may be necessary for patients in whom pregnancy has led to an exacerbation of existing psychiatric disorders.

Is it possible to take antidepressants for weight loss?

Antidepressants as a group of pharmaceutical drugs have a wide spectrum of action on various body systems. One of the possible effects of taking these drugs is a decrease in appetite and a kind of “motivation” of a person to a more active lifestyle. In this regard, many people use antidepressants to combat excess weight. Moreover, some clinics involved in the fight against obesity include some drugs of this group in their treatment programs.

It is very difficult to decide unequivocally whether it is possible to take antidepressants for weight loss. The fact is that each drug has its own characteristics, and only a qualified specialist can predict its effect on a particular patient.

• Side effects. Antidepressants have many serious side effects that can occur even if the drug is taken correctly according to the regimen prescribed by a specialist. Taking these drugs to combat obesity is dangerous, since their main task is still to affect the central nervous system. It has been noted that healthy people who do not have direct indications for taking antidepressants may experience seizures, diarrhea, heart rhythm problems, sleep problems and even suicidal tendencies.
• Availability of alternative treatment regimens. In most cases, patients can choose a safer treatment regimen to lose excess weight. Dietitians can help with this. In some cases, weight gain may be an endocrinological problem. Accordingly, the patient will need to normalize hormonal levels under the guidance of endocrinologist ( sign up) . Antidepressants are needed only for those patients who have begun to gain weight due to emotional or mental disorders.
• Possibility of reverse effect. As practice shows, treatment of obesity with antidepressants is not universal. In some patients, such treatment gives a noticeable effect only at the beginning of the course. In later stages, the patient may begin to gain weight again. To avoid this, it is better to develop a treatment regimen using several methods that complement each other, and not rely only on antidepressants.

However, in many cases, antidepressants do provide significant assistance in the fight against excess weight. It is reasonable to use them in the initial stages to help complex patients or patients with concomitant behavioral disorders. A correctly selected drug and dose will be a good boost, which, on the one hand, will reduce appetite ( acting on the nervous system), and on the other hand, motivates the patient for a more active lifestyle ( playing sports, achieving a goal, attending specialized programs for people with obesity). It should be noted that before starting to take antidepressants, in any case, it is better to consult a specialist. Self-administration of a random drug may not only not give the desired effect, but also jeopardize the patient’s health.

Can antidepressants help with headaches?

Chronic headaches can be associated with a variety of diseases and disorders in the body. Sometimes they accompany depression. In these cases, the pain is partly “mental” and conventional painkillers may not be effective. Thus, to properly treat headaches, it is important to determine the cause of their occurrence.

Some antidepressants have been shown to reduce or eliminate headaches that are not associated with specific structural damage. In other words, for injuries, tumors or high blood pressure, they will not have any effect. But if the patient has chronic stress or has previously identified mental disorders, antidepressants are sometimes the best solution.

Of course, you cannot take these medications on your own for any headache. In some cases, this can only make the problem worse. It is better to consult a specialist ( therapist, neurologist, etc.), who will prescribe the necessary examinations. He will also be able to recommend a drug that will be most effective in this particular case.

Can I take antidepressants after a stroke?

In principle, antidepressants are recommended after a stroke for many patients as part of complex rehabilitation therapy. Quite often, a stroke is accompanied by disability of the patient, since certain areas of the brain die or temporarily fail to cope with their functions. According to modern research, some drugs from the group of antidepressants accelerate the “adaptation” of the brain to new conditions and accelerate the return of lost skills. This group includes mainly selective serotonin reuptake inhibitors ( SSRIs) - escitalopram and cipralex. In addition, many stroke patients suffer from depression. To eliminate this problem, they may be prescribed a course of treatment with antidepressants from other groups.

It should be noted that antidepressants in these cases are prescribed by the attending physician only some time after the stroke ( at a certain stage of recovery). Their immediate use in the first days or weeks may be dangerous due to possible side effects.

What to do if the prescribed remedies do not help?

Almost all drugs that are classified as antidepressants have their own characteristics of use. Even qualified specialists are not always able to select the drug that will help a particular patient the first time. As a rule, the doctor warns the patient about this possibility and negotiates with him in advance the time for a second consultation. The patient himself cannot always correctly assess the effect of using the medicine.

If the patient does not feel any improvement within several weeks, you should contact the doctor who prescribed the course of treatment. Sometimes the right drug that works well for a particular patient can only be found on the second or third try. In severe cases, a combination of several drugs is possible that will enhance the therapeutic effect.

Antidepressants are used in the treatment of depression, a list of which can be seen below. Antidepressants are drugs that selectively affect a person’s depressive state. These drugs and antipsychotics for depression can be used to relieve affective-delusional syndromes in children and adults.

The most common mild antidepressants are:

• Moclobemide;
• Bethol;
• Toloxatone;
• Pyrazidol;
• Imipramine;
• Amitriptyline;
• Anafranil;
• Pertofran;
• Trimipramine;
• Azafen;
• Maprotiline;
• Mianserin;
• Fluoxetine;
• Fevarin;
• Citalopram;
• Sertraline;
• Paroxetine;
• Cymbalta.

This is only some of the antidepressants used to combat nervous disorders and depression. All of them are divided into several classifications.

Calming

Anti-depressants are a classification of the most common drugs used to combat depression.

Amitriptyline belongs to the classic type of mild antidepressants with a tricyclic structure. It is distinguished from Imipramine by its rather strong sedative effect. It is used to get rid of depression of anxious and agitated types, which can manifest themselves with “vitality”. This drug is available in the form of tablets and injections.

Another domestic antidepressant is Azafen, or Hypophysin. It is used to combat the symptoms of “minor” depressive disorders of the cyclothymic register. The drug has moderate sedative and thymoanaleptic effects.

Mianserin, or Lerivon, is a drug that has a strong sedative effect when used in small doses. Due to this effect, it can be used to treat cyclothymia in combination with insomnia. It is capable of curing depression with major episodes.

Stimulating

Moclobemide, or Aurorix, is a selective MAO inhibitor. The drug has a powerful stimulating effect on people suffering from inhibited types of depression. It is prescribed for somatized types of depression. But the drug is strictly prohibited for use in anxiety depression.

Imipramine, or Melipramine, is the first fully studied tricyclic antidepressant. It is used in the treatment of severe depression with a high prevalence of sadness and lethargy, and with suicidal thoughts. The drug is available both in the form of tablets and as intramuscular injections.

Fluoxetine is a drug that has a thymoanaleptic effect. Its second name is Prozac. The drug is effective during the treatment of depression with obsessive-phobic symptoms.

This type of medication is called a selective serotonin reuptake inhibitor (SSRI). The drug is devoid of some effects of clinical tricyclic antidepressants:

• antihistamine;
• adrenolytic;
• cholinolytic.

Pertofran is a more powerful version of Imipramine (desmethylated). It has a brighter activating effect. The drug is used to combat depression combined with depersonalization.

Balanced drugs

The second name of Pyrazidol is Pirlindol. The drug is produced in Russia. It is a reversible inhibitor of MAO type A, like Moclobemide. This drug is used to prevent and treat depression of the inhibited type, as well as depressive disorders with pronounced anxiety manifestations. The advantages of the drug are that it can be taken for glaucoma, prostatitis and heart pathologies.

Another powerful drug created as a result of the synthesis and introduction of a chlorine atom into the imipramine molecule is Anafranil. It is used to treat resistant depression and to relieve the affective phases of severe depression.

Maprotiline, or Ludiomil, is an antidepressant with a tetracyclic structure. It has a fairly powerful thymoanaleptic effect when interacting with anxiolytic and sedative components. It can be used for circular depression in combination with ideas of self-blame. The drug is used for involutional melancholia. Maprotiline is produced in the form of oral medications and injections.

Reversible monoamine oxidase inhibitors and selective reuptake inhibitors

Befol is one of the domestic drugs that are prescribed for depressive disorders of asthenic and anergic types. It is used to treat the depressive phase of cyclothymia.

Fevarin and Fluoxetine belong to the classification of drugs with thymoanaleptic action. The drugs have a vegetative stabilizing effect.

Citalopram and Tsipramil are other names for thymoanaleptic antidepressants that can be used to treat depression. They belong to the group of sedating serotonin reuptake inhibitors (SSRIs).

Afobazole is an over-the-counter antidepressant. It is used to combat somatic diseases with adaptation disorders, anxiety, neurasthenia and oncological and dermatological diseases.

The drug has a good effect in treating sleep disorders and relieving PMS symptoms. But it is worth considering that it is contraindicated for children and women during pregnancy and lactation.

Tricyclic

Trimipramine, or Gerfonal, is used in the treatment of depression with increased anxiety. This is one of the most powerful drugs of this kind. Its psychotropic activity is similar to Amitriptyline. When carrying out treatment, it is worth considering the list of contraindications of this antidepressant:

• dry mouth;
• orthostatic hypotension;
• problems with urination.

New generation antidepressants

Sertraline and Zoloft are names of antidepressants with a strong thymoanaleptic effect and a weak stimulating effect. Moreover, the drugs do not have anticholinergic or cardiotoxic properties.

They achieve maximum effect when fighting somatized atypical depression with some manifestations of bulimia.

Paroxetine is a derivative of piperidine. It has a rather complex bicyclic structure. The main properties of Paroxetine are thymoanaleptic and anxiolytic. They appear when there is stimulation.

The drug shows itself well in the fight against endogenous and neurotic depression, their melancholy or inhibited variants.

Venlafaxine is an antidepressant used for depression associated with severe mental disorders such as schizophrenia, etc.

Opipramol is used to treat somatized and alcoholic depression. It is able to prevent vomiting, convulsions and generally stabilize the autonomic nervous system.

Toloxatone, or Humoril, is similar in its effect on the human body to Moclobemide. The drug does not have anticholinergic or cardiotoxic properties. But it copes well with treating depression with pronounced inhibition.

Cymbalta or Duloxetine are used to combat depression with panic attacks.

Side effects

Most antidepressants have a fair number of side effects. Their list is quite long:

• hypotension;
• arrhythmia;
• sinus tachycardia;
• violation of intracardiac conduction;
• suppression of bone marrow functions;
• agranulocytosis;
• thrombocytopenia;
• hemolytic anemia;
• dry mucous membranes;
• violation of accommodation;
• intestinal hypotension;
• problems with urination;
• increased appetite;
• increase in body weight.

Such side effects occur quite often due to the use of tricyclic antidepressants. In contrast, antidepressants that are serotonin reuptake inhibitors have less pronounced side effects. But it could be:

• frequent headaches;
• insomnia;
• anxiety states;
• depotentiating effects.

If combination therapy is used for treatment, that is, drugs of both types are used simultaneously, then serotonin syndrome may occur, characterized by an increase in temperature, signs of intoxication of the body, and disturbances in the functioning of the heart and blood vessels.

Any antidepressants for depression should be taken only after a complete medical examination and an accurate and complete diagnosis.

And for children they are prescribed with extreme caution. Be sure to do this under the supervision of a doctor so as not to harm the body.

20.10.2018

In the pharmacy you can find antidepressants without prescriptions that help normalize sleep, relieve depression and relieve anxiety. Such new drugs affect the exchange of mediators in the brain (norepinephrine and serotonin).

The use of such drugs stimulates the human psyche. But what strong antidepressants to choose? Below we will offer a list of drugs that you can take without fear of side effects.

Antidepressants available to everyone

You can only buy light pills without a doctor's prescription, which can also have a positive effect on your mood. Here are the names of the medicines, tablets of which can be purchased over the counter. What products are these, and why you don’t need a prescription to buy them.

Maprotiline (Lyudiomil)

When choosing the best antidepressant, pay attention to this tetracyclic drug. With its help, you can lift your mood, eliminate apathy, anxiety, and stabilize psychomotor retardation. Speaking about side effects, this drug should not be taken during pregnancy, liver dysfunction, or kidney disease.

Prozac (Fluval, Prodep, Profluzac, Fluoxetine)

These over-the-counter antidepressants belong to the group of selective serotonin inhibitors (SSRIs). Such names are often used by neurologists and therapists. The effect of the drugs is achieved in the treatment of menstrual disorders, elimination of anxiety and panic conditions, improves mood, and can be used to get rid of obsessive thoughts. If you take such medications regularly, you can achieve a balanced psyche and improve your mood.

Zyban (Nousmoke, Wellbutrin)

Paxil (Sirestill, Rexetine, Plizil, Adepress)

Taking tricyclic antidepressants brings good effects; such drugs are often prescribed to be taken in the doctor's office. You can take medications such as antidepressants and anti-anxiety medications. If we talk about side effects and consequences, then it does not affect the functioning of the heart and psychomotor functions. Can be taken to correct heart function. It is recommended to drink in stressful situations, depression, and various types of phobias.

Deprim

Taking antidepressants of this type improves mood and performance. Such medicines contain St. John's wort, which has a good effect.

Persen

When choosing treatment with antidepressants, you can opt for Persen. The drug provides a high effect and contains natural ingredients (peppermint, valerian, lemon balm). Lifts your mood and fights stress.

Novo-Passit

The action of antidepressants of this type has a pronounced sedative effect. Such medicines contain passionflower, hops, guaifenesin, lemon balm, elderberry, St. John's wort and hawthorn. You can take medications when you need to relieve anxiety, tension, headaches, and alleviate premenstrual and climatic syndromes.

Herbal antidepressants

New generation antidepressants may contain drugs; they have a good effect and almost no side effects. It is recommended to drink such remedies when you need to cope with depression and anxiety that appears against the background of worries and stress.

• Infusions of immortelle, rhodiola rosea, maralia root, lemongrass - these remedies eliminate the feeling of overwork. The drugs should be taken before meals, 150 grams;
• Alcohol extract of Leuzea - ​​such drugs stimulate human psychometric functions, improve mood, increase performance;
• Ginseng tincture can have an effect in the form of stimulation of the immune system. It treats symptoms of depression and increases the body's resistance to stress. Side effects include increased sensitivity to the sun. It is not recommended to go to the solarium if you decide to drink ginseng tincture;
• Zamanikha - can be used to increase performance, improves mood, normalizes sleep;
• Motherwort, oregano, blue honeysuckle, meadow clover. Such remedies allow you to get rid of depression;
• Hawthorn produces a calming effect;
• Hops, peppermint, valerian are excellent herbal antidepressants that do not have any special side effects;
• Medicinal angelica works great against insomnia;
• You can drink calendula to relieve fatigue and tension.

These herbal medicines can be used exclusively for moderate and mild severity of the disease. They have an effect on sleep disorders, restlessness, and anxiety.

Another indication for treatment with herbal remedies is various psychovegetative disorders. This is a series of conditions in which the pathology of internal organs is not detected during examinations, and the manifestations themselves are formed as consequences of disturbances in the functioning of the nervous autonomic system. They include:

• A feeling of lack of air;
• Head pain and dizziness;
• Pain in the abdomen and heart;
• Rapid heartbeat;
• Disorders of bowel movement and urination.

Antidepressants based on St. John's wort have virtually no side effects and can be used without a doctor's prescription. But in the case of more severe depressive conditions, such remedies will not bring effective results. In such conditions, the assistance of the attending physician and the prescription of antidepressants of a different category are necessary.

Security measures

Many people have various mental disorders. Unfortunately, people who are constantly in stressful situations, at work, at home and even on vacation, are familiar with the problems of sleep disturbances and irritability. Women usually, at the first signs of depression, try to take medications without thinking about the consequences; men “kill their nerves.”

You should not shy away from the help of a psychiatrist. Such over-the-counter medications may not help if there are factors causing the pathology. Only after it is determined can you start taking medications. In other cases, the disease will develop into a chronic form with intervals of remissions and exacerbations.

Before you try to purchase new generation antidepressants in the public domain, think about the side effects. Can you distinguish neurosis from depression?

It may be better to visit a professional doctor who can rule out the negative effects of medications on your body.

Even herbal preparations have a number of side effects if used incorrectly.

Medical statistics say that the majority of modern people who buy a variety of sedatives do not suffer from mental problems. Such patients create a mindset of depression within themselves and try to recover from the imaginary condition.

Today, depression affects not only adults, but also children and adolescents. A lot of research by specialists and a huge number of articles and books are devoted to this disease and methods of combating it. If translated from “scientific” into ordinary language, depression is a loss of strength and desire to live. Symptoms of this disease are apathy and constant anxiety and fatigue, lethargy and gloom.

Modern pharmacology offers the latest generation of antidepressants to combat this disease. How many generations of thymoleptics (also called drugs that work against depression) exist today, what do they have in common and how do they differ from each other, what is their mechanism of action? These and other questions will be discussed in the article presented to your attention.

What are antidepressants?

Thanks to which you can relieve symptoms and even prevent depressive conditions. The main mechanism of their action is aimed at adjusting the biochemical activity of the human brain. its components constantly interact with each other through special substances - neurotransmitters. According to one theory, depressive disorders occur when in the brain, for various reasons, the level of any neurotransmitter or biogenic amine: dopamine, norepinephrine or serotonin is significantly reduced. Antidepressants of the latest generation, like all previous ones, have a regulating and corrective effect on the biochemical processes of the brain by changing the concentration of one or another biogenic amine.

What are they for?

In addition to the fact that modern antidepressants help cope with the symptoms of depression, they are often used to get rid of the following problems:

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

Generations of antidepressants

Before considering how many generations of drugs against depression have been created to date, we need to remember that antidepressants were discovered only in the middle of the 20th century. Today, depending on the time of invention and the beginning of use in clinical practice, as well as on the effect of antidepressants, it is customary to distinguish four generations of these drugs.

First generation drugs

The first generation, discovered in the 50s of the last century, is represented by cyclic tricyclic thymoleptics (TCAs). These include the following drugs: Amitriptyline (an antidepressant, the very first one discovered) and its derivatives, as well as the drugs Nefazodone, Anafranil and Melipramine. These compounds block the reuptake of norepinephrine, thereby increasing its concentration. However, TCAs blocked not only norepinephrine (norepinephrine), but also all other neurotransmitters that came their way, which led to a large number of unpleasant side effects, primarily such as a sharp increase in blood pressure and an increase in heart rate. Drugs in this group are quite toxic, and the likelihood of an overdose when using them is very high, which is why they are so little used in the treatment of depressive disorders today.

In addition, the first generation includes drugs that are no longer used today and contain irreversible monoamine oxidase inhibitors (MAOIs) - Iproniazid, Tranylcypromine, Isocarboxazid. Their action is based on suppressing the activity of the nerve endings of brain neurons, resulting in an increase in the concentration of serotonin and norepinephrine.

Second generation drugs

The second generation, unlike the first, has a more selective, but also weaker effect on neurotransmitters and the neurons themselves. It includes tetracyclic irreversible (MAO-B) and reversible (MAO-A) monoamine reuptake inhibitors, represented by drugs such as Lerivon, Ludiomil, Pyrazidol and a number of others. Due to the fact that many quite serious side effects occurred when taking them, as well as due to interactions with various drugs and the unpredictability of the effects, drugs in this group are used extremely rarely. It is quite difficult to find antidepressants from the group of monoamine reuptake inhibitors in pharmacies. But in some cases they are found under other trade names. So, experts say that the drug “Lyudiomil” is the same tablets “Maprotiline”, the price, manufacturer and country are just different.

Third generation

Modern researchers have found that about 30 mediators are involved in the functioning of the brain and nervous system, but only three of them are “involved” in depression: serotonin, dopamine and norepinephrine (norepinephrine). The third generation includes selective serotonin reuptake inhibitors (SSRIs), represented by the most commonly used modern antidepressants such as Zoloft, Citalopram, Prozac, Cipralex, Paroxetine, Plizil and many others. These medications do not block all mediators, but only one - serotonin. In terms of the strength of their effect, they are inferior to first-generation drugs, but they have significantly fewer side effects than any other predecessors. All SSRI drugs are very effective and should be tolerated approximately equally by patients. However, each of us has its own individual characteristics, and it is because of them that the number and severity of side effects will vary in each specific case. Doctors say the most common side effects of taking third-generation drugs are insomnia, dizziness, nausea and anxiety.

SSRI drugs are quite expensive. Thus, for the fairly well-known and widely used drug “Citalopram”, the price in pharmacies, depending on the brand under which it is released, can vary from 870 to 2000 rubles.

Fourth generation antidepressants

These usually include drugs from the SSRI group (selective serotonin and norepinephrine reuptake inhibitors). These are the latest generation antidepressants, such as Cymbalta, Milnacipran, Remeron, Effexor, which block the uptake of both norepinephrine and serotonin. The drugs Zyban and Wellbutrin do not interact with serotonin, but retain dopamine and norepinephrine. The development of drugs belonging to this group began only in the mid-90s of the last century, and every year more and more new drugs appear.

Doctors cannot say unequivocally that this particular group contains the best antidepressant; this is basically impossible, since for the treatment of various types of depressive disorders, medications are selected individually, taking into account the health characteristics of each patient.

Popular modern thymoleptics

Knowing about the serious impact of drugs in this group on the nervous system, it is necessary to remember that all possible - both positive and negative - consequences can only be predicted and mitigated by a qualified specialist - a doctor. Taking into account all the individual characteristics and having made a diagnosis, it is the doctor who will be able to prescribe exactly those antidepressants that can best help in your particular case, with minimal side effects. If any problems arise while taking the prescribed medication, it is the attending physician who will be able to adjust or change the treatment regimen. Today, most practitioners recommend drugs from the group of selective serotonin and norepinephrine reuptake inhibitors to patients with depressive disorders, the effective effects of which have been tested in practice. Medicines such as Milnacipran, Fluxen (Fluoxetine), Duloxetine, Velaxin (Venlafaxine) are the most typical and widely used antidepressants of the latest generation. Let's consider the most popular thymoleptics in the treatment of depressive disorders.

Medicine "Flucosetine"

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

The drug "Paroxetine"

This is the most powerful representative of the group of selective inhibitors of selective serotonin uptake, widely used in the treatment of anxiety and depression. Today there are quite a lot of medications whose active ingredient is paroxetine. This includes the Russian drug “Adepress” from Veropharm, the drug “Plizil” from the Croatian company Pliva, the Hungarian tablets “Rexetine” from and many others. Regardless of the name of the drug "Paroxetine", reviews of it from both patients and doctors are mostly positive.

The drug "Wellbutrin"

Better known as "Zyban" or "NoSmoke". The active ingredient in all three drugs is bupropion hydrochloride, which increases the amount of dopamine and norepinephrine in the brain. Medicines containing this active ingredient not only relieve symptoms of depression, but also help overcome the emotional consequences of quitting nicotine. This medication improves mood and increases performance. Reviews from those who got rid of nicotine addiction with the help of drugs such as Wellbutrin, KnowSmoke and Zyban indicate the high effectiveness of these drugs during the period of smoking cessation.

Medicine "Cymbalta"

A drug of the fourth generation of antidepressants, which is an inhibitor of the reuptake of norepinephrine and serotonin, simultaneously carrying out a slight uptake of dopamine. This drug, the active ingredient of which is duloxetine, has a rather high speed of action compared to other antidepressants. According to reviews from both doctors and patients, a clear antidepressant effect appears by the end of the first - beginning of the second week of use. In addition, this drug is characterized by uniform action throughout the entire time of its use. However, there is a group of patients, according to whose reviews the effect of this medicine, if it occurs, is very weak. As already mentioned, individual characteristics of the course of biochemical reactions quite often lead to the fact that one or another medication prescribed by a doctor may not have the expected result.

What is the price?

Today it is quite difficult to talk about prices for medicines. This is due to the fact that the foreign exchange market is extremely unstable, and new antidepressants for the most part come to us from foreign manufacturers, whose prices are presented in euros. That is why the table below presents the minimum and maximum prices in rubles, since it is simply impossible to average them. Some of the drugs received earlier are still sold at the old prices, while new ones are much more expensive.

Group	Active ingredient	Trade name	in rubles
Tricyclic antidepressants	amitriptyline	"Elavel"
	imipramine	"Imizin"
	clomipramine	"Anafranil"
	maprotiline	"Lyudiomil"
Selective serotonin reuptake inhibitors (SSRIs)	sertraline	Zoloft
	paroxetine	"Paxil"
	fluvoxamine	"Fevarin"
	fluoxetine	"Prozac"
	citalopram	"Cipramil"
	escitalopram	"Lenuxin"
Serotonin and norepinephrine reuptake inhibitors (SSRIs)	bupropion	"Wellbutrin"
	venlafaxine	"Velaxin"
	duloxetine	"Cymbalta"

If you carefully look at the table, you will notice that it does not contain second-generation drugs, namely MAOIs (monoamine reuptake inhibitors). This is not a mistake. The thing is that these antidepressants, which have a large number of unpleasant side effects and are incompatible with many drugs, are practically not used in European countries. In the USA, the medications “Isocarboxazid”, “Ugenelzin” and “Tranylcypromine” are used quite rarely, and in our country the drug “Nialamide” is used. All of the above medications are available only under the supervision of psychiatrists.

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

Interaction with other drugs

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

Strange as it may sound, many people who need to take thymoleptics for various reasons ask the question of how often they can combine taking “hot” drinks and pills for depression. The answer to this question is quite simple: if you want to risk your mental and physical health, and maybe your life, try it! The fact is that both alcohol and antidepressants have a serious effect on the central nervous system and the brain, and such double pressure can negatively affect both the “flight control center” itself, that is, the brain, and the organs and systems subordinate to it. Whether or not it is worth combining is a decision that you and only you can make.

Instead of a conclusion

You shouldn’t think and rack your brains about which antidepressants are better and more effective. If you feel that each new day is becoming more difficult to live than the previous one, that you don’t have enough strength even for the simplest and most mundane things, contact a specialist! The doctor will be able to diagnose your disease and prescribe the necessary treatment, choosing the most suitable medications for you. These may not only be antidepressants. The arsenal of today's medicine is quite extensive: various types of psychotherapy, physical activity and acupuncture, breathing practices and physiotherapeutic procedures.