Do I need antidepressants. The best online casino: the right criteria for choosing an institution

". For five days, we talk about aggression, hatred, and longing in the city. This material is about the fact that depression and aggression are frequent companions. We found out from a psychologist, psychiatrist and people who took antidepressants how to overcome the illness and become a calm, balanced person.

Ilya Pluzhnikov

associate Professor, Department of Neuro- and Pathopsychology, Moscow State University

Aggression and depression are, of course, related. In some cases, depression is accompanied by aggression, usually when the patient is a 16–20 year old boy. In adolescent patients, we often observe depression that occurs without depressive symptoms - melancholy, tears, stiffness. Their symptoms are characterized by irritability, anger, grumbling against the background of a gloomy mood. The same depressions are observed in the context of brain diseases - traumatic brain injury, epilepsy and others. Patients are angry, prone to explosiveness and aggressive behavior.

People suffering from depression, even if they do not exhibit aggressive behavior, still show an increase in aggressiveness indicators compared to the standard values. We register this when we conduct tests, questionnaires. You understand that moderate aggression is the biological norm. A completely non-aggressive person is not adaptive, cannot withstand the challenges of the environment.

A high level of aggressiveness often precedes the onset of depression. According to psychoanalysis, the open manifestation of aggression is taboo by society and it can be transformed into feelings of guilt, into autoaggression. With high intensity depression, this can lead to suicidal thoughts.

It is important to understand: depression is a disease, it does not exist on its own and usually manifests itself in the framework of other diseases. We note that patients with psychopathy and organic brain damage are more prone to aggressive manifestations than patients with schizophrenia and people with bipolar disorder. When a person comes to a psychologist for help, it is important to adequately assess his condition. If a person does not believe in psychotherapy, meditation, prayer, fitness, but only accepts pharmacology, he can be referred to a psychiatrist who will prescribe mild drugs in moderate doses. Mild depressions can be curable in this way.

denis ivanov

psychiatrist

People go to a psychiatrist of their own free will, when they feel unwell, or on a referral from a neuropsychiatric dispensary or hospital. Almost any doctor can refer to a psychiatrist: a neurologist, a therapist, a cardiologist. Depression is often manifested by a variety of factors - heart pain, sweating, anxiety. If there are no obvious violations in the work of internal organs, the problem may be psychological, it must be solved by a psychotherapist or psychiatrist, he diagnoses and prescribes treatment.

The clinical effect of treatment with antidepressants has been proven many times over, all articles and programs about the dangers of drugs, about the fact that doctors specifically add patients to them are unscientific. The choice of antidepressants is extremely large and very wide. There are tricyclic drugs, the classic and the most powerful, and they were the first to be invented. They have the most side effects... There are drugs of the SSRI group, they are milder, and they have fewer side effects. It must be said that almost any medicine has side effects, which is why it is important to take the drugs under the supervision of a doctor after a thorough examination.

All antidepressants are factory made. The drugs are divided into originals - when the pharmaceutical company itself develops the formula and releases the drug - and generics - when the company buys the finished formula. Of course, it is better to buy a drug that is produced by the company that invented it and first started producing it. It is often more expensive but more effective. According to current legislation, a doctor does not have the right to write a prescription for a specific drug, the prescription always indicates active substance... But he can give you a list of medicines containing this substance. Finding information on which of these drugs is the original is not difficult now.

First story

I started taking antidepressants because I felt bad. So bad that standard advice like “pull yourself together” or “do something nice” didn't help. I broke up with my girlfriend, whom I devoted three years to, ****** [lost] my favorite job, trying to pursue my own project, which died in a bose. I think these were the reasons for my depression. I decided to seek medical help.

The psychiatrist prescribed SSRIs [selective inhibitors reverse capture serotonin] immediately after MAO [monoamine oxidase] inhibitors, which is generally not recommended by all guidelines. As a result, I had random emotions, mostly of the negative spectrum. What does it mean? Well, just imagine that before you come to the cafeteria for lunch you are as excited as before an entrance exam. In addition, for some reason I was stupid and did not drink the prescribed trunks [tranquilizers], because it seemed to me that I should go through everything myself, and not cheat. And he was afraid of getting used to it (irrationally afraid, during those two weeks of the course there would be no addiction).

These two weeks I could only come to work, sit blunt and go home. Average productivity is 10% of my usual. Another thing is that without drugs I would not even get to work. Most of all, I was helped by a rational self-belief that medications should help me and I just need to be patient.

After two and a half weeks, it really became much easier. Then I got better with varying degrees of success over the following months. That is, sometimes it felt bad again, but not for long, and it was not so stressful.
The people around did not notice anything. Relatives got acquainted with the basic course of psychiatry, and I - with the advanced one. Now I can diagnose depression myself, and I'm fucking crazy about how many people live with it and don't know / don't want to be treated.

Second story

The first time I was prescribed antidepressants after my muscles on the right side of my face and my left arm failed on the Moscow-Antalya plane. This was preceded by two years of relationship with an asshole, who monstrously frayed my nerves and suppressed any will to express my own opinion (well, of course, this is my own fault). The last nail in the lid of my coffin was that upon arriving in Antalya, it turned out that my mother's documents were not in order and we were being deported back to Moscow. Mom immediately rushed to faint and distance herself from solving problems, so I first filled out all the documents - that I had no complaints against anyone and I voluntarily fly back, and then I just went limp in the plane and swam.

The doctor was surprised to find that 23-year-old children can have paresis of the facial nerve from stress, and handed me magic pills, from which I was finally released. The face with the hand worked, it was calm and good, the bad man was sent, and life improved.

Then it happened a second time. I had a temperature for almost a year, but nothing hurt. I visited all the doctors, everything was normal, and the therapist advised me to look for the cause in stress at work. I really had a new job related to macroeconomics, which I had not done before, and everything was given to me without the usual ease. In addition, I worked from home, did not communicate with people, it was not very comfortable for me. I was prescribed antidepressants, I took them for several months, but there was no effect. I slept well, changed my job, but the temperature did not go away, but it is unlikely that antidepressants are to blame.

Third story

A couple of years ago, I started some kind of self-sabotage: my motivation, concentration of attention dropped sharply, it became difficult to perform intellectual work, I began to get lost and get stuck on the simplest tasks, experience constant anxiety, dissatisfaction and the desire to hide from the whole world under the blanket. There was a feeling that any movement was like running in water: slowly, difficult, and most importantly, useless. I then had an objectively difficult period in my life, but over time it became clear that this was not an ordinary situational melancholy, but some kind of deep inner shift. And trying to pull yourself together / change the environment / find new inspiration won't work.

Occasionally there were gaps of good health, or even short periods of unreasonable euphoria, but this made it even worse - as soon as you began to believe that everything was in order again, soon the darkness thickened again. For a while, I managed to hide my condition at work and not lose much in efficiency, but over time, the situation began to get out of control. There were outbursts of despair - once I even tried to cut my veins. And I went to the clinic - to a psychotherapist and psychiatrist. I was diagnosed with “bipolar disorder,” and was prescribed an antidepressant, among other drugs. In parallel, I had to go to psychotherapy, but I mastered only a few classes.

At first, I felt a certain burst of energy, which can rather be explained by self-hypnosis - antidepressants have a cumulative effect and improvements should not appear immediately. This sensation passed rather quickly - and then I did not feel any side effects or noticeable progress. The catch is that it is quite difficult to evaluate the effect of drugs, because you do not know how the disease progresses and how everything would happen without them. Even with the medication, it was painfully difficult for me to do at least something constructive, but perhaps without them I would finally switch to sofa mode. In any case, during the year that I accepted them, at least I was not fired (but here I also owe the patience of the employers), I did not go out the window and even managed to start a new relationship. Not really relying on drugs, I began to improve my health in general: I adjusted the daily routine, started to play sports, changed my diet (reduced the amount of fast carbohydrates).

After a year of such a struggle, an interesting thing happened: I suddenly felt better (literally in a few days), and I returned to my normal state. Perhaps the same cumulative effect worked, or an unexpected remission occurred (this happens with my diagnosis). And perhaps a healthy lifestyle helped me. Since then I have been living without antidepressants for over a year and I feel good for the most part. There are days when it seems to me that it all started again, but so far it turns out to be a false alarm.

Fourth story

My story is like this. At the age of 19, I experienced severe stress, after which I stopped eating. Generally. The body did not accept any food, it was even difficult to pour water into itself. It had nothing to do with either anorexia or my appearance. Just a reaction to the situation. And at that moment I was in another country, without parents, without the right to go home (because of a visa). Two weeks later, when there was no longer the strength to leave the house, I had to solve the issue with the help of a strong drug.

The doctor prescribed me an antipsychotic drug. A very powerful thing. I remember, I took it, immediately passed out for two hours and woke up with an EEREful hunger. I can honestly say that this drug saved me then. I became a very calm and even, as it seemed to me, a happy person. Everything that hurt and tormented, as if carefully cut out. They were mainly interested in sleep and food. Such a happy vegetable existence.

It was necessary to get off this drug very carefully. First it was necessary to switch to a lighter one. Then, under the supervision of a psychotherapist, get away from the pills completely.

Fifth story

My path to antidepressants was a thorny one: a few years ago, my most close personand I realized that I was not coping with my grief. I went to psychotherapy (although before that I considered such phenomena to be quackery and the lot of narcissistic snobs), and my psychotherapist advised me to go to a psychiatrist as well. The psychiatrist diagnosed her with clinical depression and prescribed powerful antidepressants. I remember that they were expensive and had to be ordered separately from the pharmacy - they were waited for several days and sold, of course, only with a prescription. The psychiatrist said that in my case the course should take at least six months. By the way, when taking antidepressants, you should not drink alcohol. We agreed to call once a month and discuss my condition.

The state has changed - I remember that in the first time after the start of taking, I could sleep twenty hours in a row. About a month later I noticed that I began to react to everything much more calmly. Then monstrous problems with the skin of the face began, which, obviously, were caused precisely by the intake of antidepressants. Three months later, I suddenly began to realize that I did not feel myself - instead of joy or sadness, I experienced their miserable likeness. My emotional range was like a toothpick.

I thought a little more and realized that such a life was not for me, and decided to quit taking pills without consulting a psychiatrist about it. This, of course, is irresponsible, but I imagined that she would begin to dissuade me, and living under antidepressants became completely unbearable. I held out on them for about five months and do not plan to return to such conditions anymore.

Sixth story

Five years ago, for the first time, I clearly felt all the symptoms of lingering melancholy: insomnia, loss of appetite and interest in everything that was happening around. A couple of sessions with a psychotherapist ended with a prescription for antidepressants. I started taking them, but the only change in my life was the appearance of short flashes. have a good mood and normalization of sleep. With any attempt to reduce the dose, all the original symptoms returned. There were no complaints about side effects, however.

Three months later, I refused the services of a doctor and taking pills and decided to cope myself. She cut off all ties with fools, through force she began to walk, go on small trips and practice all the other attributes of a happy life. A couple of months later, time and the policy of compulsion to happiness did their job - the seemingly unrestrained blues still faded away. Since then, the consistent elimination of all external stimuli seems to me to be a much more effective measure than taking special drugs.

thank

The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

What are antidepressant medications?

Antidepressants called a group of pharmacological drugs that act on the central nervous system and eliminate the cause and symptoms of depression. In some cases, these drugs are used to treat other diseases, but their effectiveness is significantly reduced.

The main effect of antidepressants is to alter the levels of serotonin, dopamine, and norepinephrine in the cells of the central nervous system. In patients with depression, they eliminate apathy, stimulate interest in physical and intellectual activity, and raise mood in general. It should be noted that people who do not have depression may not feel this effect.

What is the difference between tranquilizers and antidepressants?

Tranquilizers and antidepressants are different pharmacological groups, as these drugs act differently on the central nervous system ( CNS). Almost all tranquilizers have a pronounced sedative ( sedative) action. They can cause drowsiness, apathy, and inhibit physical activity. Their main task is to relieve psychomotor agitation if the patient is overly active or aggressive.

Antidepressants, on the other hand, combine a fairly wide range of therapeutic effects. Only a few drugs in this group give effects more or less similar to the action of tranquilizers. Basically, they relieve symptoms and eliminate the causes of depression - they activate the emotional sphere, raise internal motivation, and give strength ( in a psychological aspect).

In addition, antidepressants and tranquilizers have different chemical structures and interact with different mediators and other substances in the body. For some pathologies, doctors may prescribe the parallel administration of drugs from these two groups.

Can you buy antidepressants at the pharmacy without a prescription and a doctor's prescription?

There are a number of antidepressants that have fewer side effects. Most of these drugs also have a weaker therapeutic effect. In the complex, their action is considered to be "milder", therefore in many states they are allowed to be dispensed in a pharmacy without presenting a prescription from a doctor.

It should be noted that even these drugs, which are, in principle, freely available, should not be used for active self-medication. The problem is not the direct harm from these antidepressants, but rather the unforeseen situations that can occur on rare occasions.

There is a certain risk of self-administration of any antidepressants for the following reasons:

• Possibility of an allergic reaction. Almost any drug can cause an allergic reaction. It depends on the individual characteristics of the patient's body, and no specialist can predict such a complication in advance. If the patient has a predisposition to allergies ( for other substances), it is better to warn the attending physician about this and not take any new drugs on your own.
• Possibility of error in diagnostics. The patient cannot always correctly diagnose the problem. This is especially difficult in the case of mental and emotional disorders. If the diagnosis was initially incorrect, antidepressants may not only fail to provide therapeutic effectbut also exacerbate the problem. That is why it is better to take any drug after consulting a specialist.
• Possibility of drug interactions. As a rule, in the instructions for a specific drug, the manufacturer indicates various unwanted interactions with other drugs. However, each medicine has many brand names, and patients often do not go into details. Because of this, a “harmless” over-the-counter antidepressant can be harmful when combined with another drug the patient is taking. In case of consultation with qualified specialist this risk is minimized.

Which doctor writes a prescription for antidepressants?

In principle, the main specialized doctors who often prescribe antidepressants in their practice are psychiatrists ( sign up) and neurologists ( sign up) ... It is these specialists who are most closely associated with disorders in the work of the central nervous system ( both structural and functional). In addition, other doctors usually refer patients with depression or related disorders.

If necessary, antidepressants can be prescribed by other professionals. Usually they are emergency doctors, therapists ( sign up) , family doctors, etc. It should be noted that they usually prescribe weaker drugs, which do not require a prescription. However, legally, any doctor with a valid license has the right to prescribe a patient's prescription for a more potent drug. At the same time, he takes responsibility for familiarizing the patient with the admission rules and for the possible consequences.

What are "prohibited" and "allowed" ( non-prescription) antidepressants?

Antidepressants, like everyone else medical drugs, in principle, can be divided into two large groups... These are "allowed" drugs that anyone can freely purchase at the pharmacy, and conditionally "prohibited" drugs that are sold by prescription.
In each country, the list of approved and prohibited drugs is slightly different. It depends on the health policy, the current legislation, the prevalence of narcotic and semi-narcotic drugs.

Over-the-counter antidepressants are generally less effective. They do not have such a wide range of side effects and practically cannot seriously harm the patient's health. However, the effectiveness of these drugs in severe depression is very low.

OTC antidepressants in most countries include the following drugs:

• prozac;
• zyban;
• maprotiline;
• deprim, etc.

There are also a number of tools on the free market vegetable origin (valerian, St. John's wort, etc.), which have an antidepressant effect.

Conventionally "prohibited" antidepressants are called so because their distribution is restricted by law. This is partly done for the safety of the patients themselves. These drugs have many side effects, and they independent application can seriously harm your health. Also, some drugs in this group can be equated with drugs and addictive. In this regard, a prescription for them is written by a specialist who, before that, will make sure that the patient really needs this medicine.

"Banned" antidepressants with a stronger effect include the following drugs:

• imipramine;
• maprotiline;
• anafranil, etc.

It should be noted that as a result of changes in the WHO recommendations ( world health organization) and with reforms at the national level, the list of “permitted” and “prohibited” antidepressants changes periodically.

Classification of antidepressants

The classification of antidepressants is a very difficult task, since various criteria can be taken as a basis ( chemical structure, mechanism of action, etc.). It is now accepted to distinguish between two main groups of these drugs. The first affects the capture of neurotransmitters between the membranes of nerve cells. The second neutralizes the action of an enzyme that releases receptors. In practice, drugs of these two groups are used almost equally. It should also be noted that such a division is very arbitrary, since each representative of any of these groups has its own characteristics. That is why the vast majority of antidepressants are prescribed by a specialist who is familiar with the intricacies of the action of each drug.

Chemical and pharmacological groups of antidepressants

From a practical point of view, the most convenient classification of antidepressants is based on the chemical structure of the drug in combination with the mechanism of action. In most countries, experts are guided by these criteria. They allow, if necessary, to replace an intolerable or ineffective drug with another that is closest in action.

The following groups of antidepressants are distinguished according to their chemical structure:

• Tricyclic. In the chemical structure of tricyclic antidepressants, there are so-called "rings" or "cycles". These are groups of atoms united in a closed chain, which largely determine the properties of the drug.
• Tetracyclic. There are four cycles in the structure of tetracyclic antidepressants. There are significantly fewer drugs in this group than in the tricyclic one.
• Another structure. For convenience, this group includes substances that do not have cycles in their chemical structure ( rings), but with a similar effect on the central nervous system.

According to the mechanism of action, antidepressants are usually subdivided according to the enzymes and mediators with which they interact in the central nervous system.

Tricyclic antidepressants

Tricyclic antidepressants are the first generation of antidepressants and have been used in medical practice for several decades. In the chemical structure of these substances, three interconnected "rings" or cycles are common. The drugs of this group are non-selective inhibitors of the reuptake of a number of substances in the central nervous system. Their reception eliminates anxiety, fear or depression, and also causes a general "uplift" of mood. Currently, tricyclic antidepressants are still widely used for many mental disorders. The main disadvantage of this group is the large number of side effects. This is due precisely to the indiscriminate effect on various processes in the brain.

The most common representatives of the group of tricyclic antidepressants are:

• amitriptyline;
• imipramine;
• clomipramine;
• trimipramine;
• nortriptyline, etc.

Tetracyclic antidepressants ( first generation antidepressants)

This group is represented by substances that have four "rings" of atoms in the molecule. In medical practice, they are used much less frequently than tricyclic antidepressants.

The most common tetracyclic antidepressants are:

• mianserin;
• mirtazapine;
• pirlindol, etc.

Selective serotonin reuptake inhibitors ( SSRI)

SSRIs are one of the most widespread and demanded groups of antidepressants in modern medical practice. The mechanism of action of these drugs is reduced to the selective blocking of certain enzymes in the central nervous system ( CNS). This allows you to achieve the desired therapeutic effect with greater precision. The risk of various side effects from the use of drugs is also reduced. This group includes serotonin reuptake inhibitors, but, in principle, for each neurotransmitter ( substance - transmitter) in the nervous system found their own drugs. The medicine is selected by a specialist who can accurately diagnose and determine violations in the central nervous system.

The following reuptake inhibitors are available for various neurotransmitters:

• Serotonin - cipralex, fluvoxamine, etc.
• Norepinephrine - nortriptyline, maprotiline, etc.
• Dopamine - diclofenzin.

There are also a number of drugs that block the reuptake of both norepinephrine and serotonin. These include amitriptyline, imipramine, and other tricyclic antidepressants. They are called non-selective.

What is the difference between different groups of antidepressants?

Antidepressants, like most other drugs, are divided into pharmacological groups, which have some characteristic differences. This is necessary for the convenience of the practical use of drugs in treatment. The chemical structure of molecules in this case is most often of secondary importance. The main criterion is the mechanism of action of the drug.

Antidepressants of different groups have the following differences:

• Mechanism of action. Each group of antidepressants has a different mechanism of action. Drugs from different groups interact with different substances in the central nervous system, which ultimately leads to a similar effect from taking the drug. That is, the action of drugs is similar, but the chain of biochemical reactions that occur in the body is very different.
• The strength of the drug. The strength of the drug is determined by how effective it is to block enzymes in the central nervous system. There are more powerful antidepressants that have a pronounced and stable effect. They are usually available with a prescription due to the risk of severe side effects. Medications with a weaker effect can be purchased at the pharmacy yourself.
• Transformation of the drug in the body. The set of chemical transformations that a drug molecule undergoes in the body is called pharmacodynamics or drug metabolism. In this regard, almost every drug has its own characteristics. For example, the duration of blocking of an enzyme may vary. Accordingly, the effect of one drug will last for a long time ( up to a day), while the other took only a few hours. This determines the reception mode. There is also a time of elimination of the drug from the body after ingestion. Some substances are quickly eliminated naturally, while others can accumulate during the course of treatment. This should be considered when choosing a medicine. The mechanism of drug elimination is also important. If the substance is eventually excreted in the urine through the kidneys, and the patient has renal failure ( difficult filtration of blood and urine formation), then the drug will accumulate in the body, and the risk of serious complications increases greatly.
• Side effects. Depending on the characteristics of the action of a particular antidepressant on the body, it can cause various side effects. It is important for specialists to know them in order to notice their symptoms in time and take the necessary measures.
• Interaction with other drugs. Drugs in the human body interact with various substances. Taking several medicines at the same time can increase or decrease their effect, and sometimes give other, unpredictable effects. In the instructions for each of the antidepressants, manufacturers usually indicate with which drugs a given substance can interact.
• The possibility of developing an allergic reaction. Each antidepressant has its own chemical structure. An allergic reaction in a patient can be almost any drug ( with varying probability). If you are allergic to one drug, you need to consult a doctor and change it to another drug that differs in chemical structure, but has a similar therapeutic effect.
• The chemical structure of the molecule. The chemical structure of the molecule determines the properties of any drug. It is because of this that each antidepressant has its own advantages and disadvantages. In addition, the characteristics of the chemical structure underlie the classification of antidepressants.

Are there natural antidepressants ( natural herbs)?

There are not many recipes in traditional medicine that could provide real help in the fight against depression. This is largely due to the complexity of the processes that take place in the central nervous system. If antidepressants act selectively, affecting certain substances ( neurotransmitters, enzymes, etc.), then their natural analogues do not possess such selectivity. Their effect will be much weaker, and the likelihood of side effects increases ( neither decoctions nor infusions allow isolating only the active substance from a particular plant). That is why, with severe depression and other serious psychiatric diseases, it is recommended, first of all, to contact a specialist, and, with his consent, start taking folk remedies. Most often, they will have to be combined with certain pharmacological drugs.

The following herbs have a weak effect similar to that of antidepressants:

• The rhizome of the enticement. The crushed rhizome is poured with medical alcohol ( 70% solution ethyl alcohol ) in a ratio of 1 to 10 and insist for several hours. The infusion is taken 1 teaspoon 2 times a day.
• Chamomile aster flowers. For 1 tablespoon of dried flowers, 200 ml of boiling water is needed. Infusion lasts at least 4 hours. The resulting product is taken 1 tablespoon 3 times a day.
• Bird Highlander. 3 - 5 grams of dried mountaineer is poured with 2 cups of boiled water and insisted until the water cools independently to room temperature. The infusion is drunk half a glass before meals ( 3 times a day).
• Aralia Manchu. The crushed roots of aralia are poured with medical alcohol in a ratio of 1 to 5 and insisted for 24 hours. The resulting tincture is taken 10 drops 2 - 3 times a day, diluted in boiled water.
• Ginseng root. Dried ginseng root is crushed and poured alcohol solution (50 – 60% ) in a ratio of 1 to 10. The mixture is infused for 2 - 3 days in a closed vessel. The resulting tincture is drunk 10-15 drops 2 times a day.

Properties and action of antidepressants

Antidepressants, as a separate pharmacological group, have certain general properties... First of all, this concerns the predominant effect on the central nervous system. Any antidepressant affects the transmission of nerve impulses in the brain, and its effect on other organs and systems will be of secondary importance. Otherwise, most drugs in this group have their own characteristics. So, for example, from antidepressants, drugs can be distinguished that give a hypnotic or, conversely, an invigorating effect. Side effects can affect almost any organ or system. This is due to the fact that the brain, one way or another, regulates the vital activity of the whole organism, and any changes in its work will inevitably affect the organism as a whole.

The mechanism of action of antidepressants

To better understand the mechanism of action of antidepressants, it is necessary to understand in general terms how the central nervous system of a person works. The brain consists of many nerve cells, neurons, that perform the most important functions. Neurons have a large number of different processes that connect to other nerve cells. As a result, a kind of network of cell contacts is formed. The impulses entering the brain are distributed in this network in a certain way, and the brain reacts to the information received. Each part of the brain is responsible for regulating certain processes in the body. Depression, as well as various nervous and mental disorders, are, first of all, a consequence of the excitation of certain parts of the brain. Antidepressants affect the junction of nerve cells, speeding up or slowing down the transmission of nerve impulses in various ways ( depends on the specific drug).

The transmission of a nerve impulse in the brain occurs as follows:

• The impulse is formed in a nerve cell as a result of chemical interactions and goes along one of the processes to the junction with another nerve cell.
• The junction of two nerve cells is called a synapse. Here, at a very close distance, there are two cell membranes. The gap between them is called the synaptic cleft.
• The nerve impulse reaches the presynaptic membrane ( the cell that transmits the impulse). There are bubbles with a special substance - a neurotransmitter.
• As a result of excitation, enzymes are activated, which lead to the release of the mediator from the vesicles and its entry into the synaptic cleft.
• In the synaptic cleft, neurotransmitter molecules interact with receptors on the postsynaptic membrane ( the membrane of the cell "receiving" the impulse). As a result, a chemical reaction occurs, and a nerve impulse arises that is transmitted through the cell.
• The mediator molecules, which carried out the transmission of impulses between cells, are captured back by special receptors and are concentrated in vesicles or destroyed in the synaptic cleft.

Thus, a number of different substances are involved in the propagation of nerve impulses in the central nervous system. There are also enzymes that interfere with the propagation of the pulse. That is, both excitation and inhibition can occur between cells.

Antidepressant molecules interact with specific receptors, mediators or enzymes, and affect the overall transmission of impulses. Thus, the excitation or inhibition of processes in various parts of the brain occurs.

What side effects do antidepressants have?

The vast majority of antidepressants have a fairly wide range of side effects that severely limit the use of these drugs. Most often, such phenomena occur due to the parallel effect of the drug on receptors in the peripheral nervous system. This affects the work of many internal organs. However, there are other mechanisms for the development of side effects.

Side effects from taking antidepressants can be divided into the following groups:

• Dose dependent. This group of side effects includes problems that arise when the therapeutic ( curative) dose. All medicines, without exception, have them. Many of these side effects can be interpreted as signs of overdose. In the case of tricyclic antidepressants, for example, this may be a hypotensive effect ( lowering blood pressure). As a rule, all such effects disappear when the dose is reduced.
• Dose independent. This group of side effects usually appears during long-term treatment. A drug with a similar structure and action affects the work of certain cells or tissues, which, sooner or later, may cause various problems. For example, when using tricyclic antidepressants, leukopenia is possible ( low leukocyte count and weakened immunity), and in the treatment of serotonergic antidepressants - inflammation and pain in the joints ( arthropathy). In such cases, lowering the dose will not solve the problem. It is recommended to stop treatment and prescribe the patient drugs from another pharmacological group... This gives the body time to recover a little.
• Pseudo-allergic. This group of side effects resembles common allergic reactions ( urticaria, etc.). Such problems are quite rare, mainly while taking serotonergic antidepressants.

In general, the spectrum of side effects that can occur while taking antidepressants is very wide. Disruptions in the work of various organs and systems are possible. Patients often not only develop any symptoms and complaints, but also abnormalities are observed in various studies ( for example, in a blood test).

Possible Side Effects of Taking Antidepressants

Affected organs or systems	Complaints and violations	Possible ways solving the problem
The cardiovascular system		Reducing the dose of antidepressant. If impossible - drugs to eliminate symptoms ( at the discretion of the cardiologist).
	Heart rhythm disorders ( on the electrocardiogram)
	Enhancement blood pressure (sometimes sharp)
	A strong change in blood pressure with a change in body position ( orthostatic hypotension)
Digestive system		Reducing the dose of the drug. Changing the receive mode ( more often, but in smaller doses), a gradual increase in the dose at the beginning of treatment. If jaundice develops, it is recommended to stop treatment or change the drug.
	Bitter taste in the mouth
Blood and hematopoietic system	An increase or decrease in the level of leukocytes ( respectively leukocytosis or leukopenia), low platelet count ( thrombocytopenia), elevated level eosinophils ( eosinophilia). These violations are detected when general analysis blood	Termination of treatment, change of the drug.
central nervous system	Lethargy and drowsiness ( in severe cases and confusion)	At the discretion of the attending physician ( psychiatrist or neurologist), you can reduce the dose, stop taking the drug, or prescribe symptomatic treatment in parallel ( lithium salts, antipsychotics, phenobarbital, beta-blockers - depending on the symptoms).
	Nervous excitement, increased activity
	Irritability
	Hives
Swelling and joint pain
A sharp increase in blood pressure (hypertensive crisis)
	Nausea and vomiting
General disorders and symptoms	Decreased sex drive
	Hormonal disorders
	Hearing impairment

In principle, if, against the background of a single or long-term use of antidepressants, the patient begins to develop any unusual symptoms, you should seek the advice of your doctor. Many of the above side effects indicate poor drug tolerance. If you do not stop treatment, the patient may develop very serious damage to organs or systems, which will require additional treatment.

Also, the side effects of many antidepressants can be attributed to addiction, and, as a result, withdrawal syndrome that occurs after stopping treatment. In these cases, the tactics of treatment may be different. Treatment is prescribed by a specialist who takes care of the patient.

Are there antidepressants without side effects?

In principle, any pharmacological drug can potentially cause certain side effects. Among antidepressants with a very broad spectrum of action, there are no drugs that would be ideal for all patients. This is due to the characteristics of the underlying disease ( antidepressants are prescribed not only for depression) and the individual characteristics of the organism.

To reduce the likelihood of side effects when choosing a drug, you should pay attention to the following points. First, newer drugs ( "new generation") have a narrowly targeted effect on the body and usually have fewer side effects. Second, over-the-counter antidepressants have a weaker effect on the body as a whole. That is why they are commercially available. As a rule, serious side effects occur much less often when taken.

Ideally, the selection of the drug is carried out by the attending physician. To avoid serious side effects, he conducts a series of tests and better understands the characteristics of the body of a particular patient ( concomitant diseases, accurate diagnosis, etc.). Of course, in this case there is no one hundred percent guarantee either. However, under the supervision of a physician, it is always possible to replace the drug or select an effective symptomatic treatment that will eliminate the complaints and allow the continuation of the course of treatment.

Compatibility of antidepressants with other drugs ( antipsychotics, hypnotics, sedatives, psychotropic, etc.)

The simultaneous administration of several drugs in medicine is a very urgent problem. In the case of antidepressants, it should be noted that they are often used as part of complex therapy... This is necessary to achieve a more complete and rapid effect in a number of mental disorders.

The following combinations of antidepressants are very relevant in psychiatry:

• Tranquilizers - with neuroses, psychopathies, reactive psychosis.
• Lithium salts or carbamazepine - with affective psychosis.
• Antipsychotics - with schizophrenia.

According to statistics, almost 80% of patients in psychiatric wards receive such combinations. However, in this case, therapy is prescribed by a specialist, and the patient is always under the supervision of doctors - in a hospital.

In general, the combination of antidepressants with many other pharmacological drugs often gives negative consequences. There may be unexpected side effects or a decrease in the effectiveness of a drug ( there is no expected therapeutic effect). There are several mechanisms behind this.

Negative combinations of antidepressants with a number medicines can be dangerous for the following reasons:

• Pharmacodynamic interactions. In this case, we are talking about the difficulty in the assimilation of medicinal substances. After taking an antidepressant ( in pill form) the active substance should be normally absorbed in the intestine, enter the liver, and combine with blood proteins. Taking other pharmacological drugs can break this chain at any of the stages. For example, many drugs are converted in one way or another in the liver. Taking several drugs that interact with the same enzymes can weaken the effect of each one individually or cause some complications from the liver itself. To avoid such complications, the doctor prescribes drugs taking into account the time of their assimilation, specifying the regimen.
• Pharmacokinetic interactions. In this case, we are talking about the effect of several drugs on the same body system ( the same target cells or enzymes). Antidepressants work at the level of nerve connections in the central nervous system. Taking other drugs that affect the nervous system can enhance their effect or, conversely, neutralize it. In both cases, the expected therapeutic effect will not be obtained, and the risk of side effects will greatly increase.

That is why, during the course of treatment with antidepressants, one should be very careful and not take even familiar and familiar drugs that are sold in pharmacies without a prescription without a doctor's prescription. In some cases, improper drug combinations can seriously damage the patient's health or even endanger his life. If you need to take any drug, it is advisable to consult with your doctor or pharmacist. On most drugs ( in instructions) often indicate the most dangerous drug combinations for a particular drug.

Do antidepressants have a stimulating effect?

In principle, most antidepressants have a stimulating effect on the central nervous system to one degree or another. Depression itself is accompanied by a state of depression. The patient is passive because he has no desire to do anything. The right antidepressant medication restores the desire to do something and thus gives strength.

However, the stimulating effect of antidepressants should not be confused with the effect of energy drinks or certain drugs. The stimulating effect is manifested more in the emotional and mental sphere. Physical fatigue decreases due to the removal of a certain "psychological block". The drugs promote motivation and interest in various activities.

The greatest stimulating effect in this regard is possessed by MAO inhibitors ( monoamine oxidase). However, this effect develops in them gradually, as the corresponding enzymes and mediators accumulate in the body. You can feel the changes in 1 - 2 weeks after you start taking the drug ( provided that it is correctly selected and taken in the required dose).

There are also antidepressants that have hypnotic and sedative effects. They stimulate mental and emotional activity, but the physical condition of a person changes little. These include, for example, amitriptyline, azafen, pyrazidol. Thus, the patient may not get the expected result. In order not to be mistaken, it is better to consult in advance with a specialist who will be able to explain in detail what effect he expects from treatment with this or that drug.

Do antidepressants have pain relief?

The main effect of antidepressants is to get rid of the patient's symptoms and signs of depression, including drowsiness, passivity, lack of motivation, mental and emotional depression. None of the drugs in this group has a pronounced analgesic effect in the conventional sense. In other words, given the obvious source acute pain (inflammation, trauma, etc.) taking antidepressants will not alleviate the patient's condition.

However, some antidepressant drugs have been used successfully for chronic pain. The fact is that chronic pain often accompanies long-term depression. Mental disorders are not the only source of pain, but they may well increase it and, thereby, greatly worsen the patient's condition. Experts have noticed that a number of antidepressants can relieve chronic pain like this. In this case, it is more about a reduction in pain perception than an analgesic effect.

The following antidepressants can be used to treat chronic pain syndromes:

• venlafaxine;
• amitriptyline;
• clomipramine;
• desipramine.

Of course, you shouldn't start taking antidepressants on your own if you have chronic pain. First, this group of drugs has a wide range of side effects, and the patient may have other problems. Secondly, having eliminated the pain syndrome, the patient runs the risk of “masking” the problem. After all, back pain, muscle pain or headaches do not always accompany depression. Most often they have a very specific reason that should be eliminated. That is why patients need to consult a specialist for the correct diagnosis. Only when depression is confirmed in combination with chronic pain, the use of the above antidepressants will be justified and rational. Before use, you must consult a specialist.

Antidepressants are medications used along with other therapies to treat depression of various kinds... When we deal with antidepressants, it is rather difficult to assess how effective a particular drug is for a given patient, since these drugs begin to work some time after the start of therapy. In most cases, you need to take the drug for four to six weeks before it starts working. When the antidepressant starts to work, you may notice some side effects, and after a while, you will appear. positive action drug: you will feel a surge of strength and energy and will look more positively at life. If the prescribed antidepressant does not work or cause too many side effects, the doctor may change the drug and adjust the treatment plan. Today, doctors most often prescribe as antidepressants selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SSRIs), selective norepinephrine and dopamine reuptake inhibitors (SSRIs and D), and tricyclic drugs antidepressants. Your healthcare provider will monitor whether the prescribed treatment regimen is working for you and will recommend alternative treatments based on your condition.

Attention: the information in this article is for informational purposes only. Before using any drugs consult your doctor.

Steps

Identify signs that your treatment is effective

Be patient. Be prepared in advance that it will take time to find antidepressants (or a combination of drugs) that will work for you. It is often necessary to change several drugs until you can find the right one. In addition, you need to take the drugs for a long time (from four to six weeks), so that they begin to have a noticeable effect on the person's condition.

Watch your condition improve. Keep a journal to describe your symptoms daily. If before starting treatment you felt that the future was bleak and hopeless, try to pay attention to how your attitude towards the future has changed two weeks after starting a course of antidepressants. If you have a feeling that you are doing everything slowly and have difficulty concentrating on tasks, check to see if these symptoms have changed with the influence of treatment.

Pay attention to the positive changes. If you start feeling more energetic during the day or less pessimistic about life, this is an indicator that your antidepressants are taking effect. If you notice an improvement in your well-being two to six weeks after starting treatment, this is a very good sign.

Pay attention to side effects. Antidepressants work to reduce the symptoms of depression, however, like any other medication, they have side effects. Therefore, you need to pay attention to both the improvement of your condition and the side effects that may arise from taking the drug. Although new generation antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SSRIs N) have far fewer side effects than previous generation drugs, various undesirable symptoms occur quite often during treatment. Side effects include decreased sex drive, dry mouth, nausea, sleep disturbance, anxiety and anxiety, weight gain, drowsiness, and constipation and diarrhea. In most cases, side effects appear before the therapeutic effect develops from taking the drug. Thus, if you notice the appearance of unpleasant symptoms, this may be a signal that the drug is starting to work. However, you need to tell your doctor that you have any side effects.

Look for signs that antidepressants are not having the desired therapeutic effect. It is extremely important to monitor your condition in order to notice in time that the prescribed treatment is ineffective. There are quite a few signs to help you determine if the prescribed antidepressant is not right for you. Particular attention should be paid to abrupt, unreasonable changes in mood, the appearance of suicidal thoughts, as well as an increase in the general level of energy, accompanied by a depressed emotional state. Below are some of the symptoms that indicate that the prescribed treatment regimen is not right for you.

Record your mood in the CBT Self-Help Guide app. it mobile app for keeping a diary, where you can keep track of how you perceive events occurring during the day and react to them. You need to write in a diary information about events in your life, associated mood and intensity of emotions. This will help you track symptoms of depression while you are taking antidepressants. If you start using this app before starting your treatment, you can use it to assess whether your mood has improved since starting medication. Unfortunately, this app is currently only available in English.

Install the MoodKit app (in English). This app will help you track your mood and learn about various activities to improve your mood. This application will be useful for people with mild depression, but it is unlikely to help with moderate to severe forms of the disease. In this case, this application can be used as an additional tool for tracking mood, which you will use in conjunction with other therapeutic methods. You can also use a similar application in Russian "Diary - Mood Tracker".

Use the free T2 Mood Tracker app (in English). This app helps you keep track of your emotional condition at different points in time, and its functionality includes the ability to present information in a graphical form. This will allow you to monitor the manifestations of depression, so you can more reliably communicate this information to your doctor. By carefully and accurately entering information into the app and discussing dynamics with your doctor, you can reliably determine how well your antidepressants are working.

Imipramine is the first pharmaceutical product to be used in complex treatment depressive syndrome. Its unique mood-enhancing effects have been identified through research in the mid-fifties and twentieth century. The study of the effect of this drug made it possible to create a unique drug group, called "tricyclic antidepressants". Medicines included in this group are often designated using the term "tricyclics" or the abbreviation "TCA". In this article, we propose to discuss what antidepressants are and what they are for.

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

Tricyclic antidepressants get their name from the fact that their structure is based on a triple carbon ring. Today, this category of medicines includes more than three dozen different medicines. Their positive effect on the patient's emotional state is explained by the fact that the main components of medications increase the synthesis of serotonin and norepinephrine in the body. Also, the use of antidepressants helps to stop the seizure of neurotransmitters, and has a positive effect on many internal systems, including cholinergic and muscarinic.

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

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

In addition to treating depressive disorders, panic attacks and anxiety ailments, medicines from this group were used as part of the complex treatment of chronic depressive syndrome. Often, antidepressants were prescribed as prophylactic agents that prevent the disorder from recurring.

According to many Western researchers, tricyclic antidepressants are one of the better means to eliminate a severe form of depressive disorder, which is accompanied by the appearance of a suicidal tendency.

In the nineties of the last century, scientists believed that the use of TCAs as part of a comprehensive treatment for endogenous depression can achieve a lasting result. According to the statistics of that time, the effectiveness of the use of "Amitriptyline" was about sixty percent. The choice of a particular drug that was used in the treatment of pathology depended on clinical manifestations depressive disorder. According to experts of that time, intellectual inhibition and impaired motor functions, provoked by psychological pathologies and neurological disorders, were easily eliminated with the help of "Melipramine". In the case of anxiety disorder of personality, "Amitriptyline" was used.

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

Why are antidepressants dangerous and why are they so rarely used today? In about thirty percent of first-generation tricyclitics use, severe side effects have occurred. In comparison, newer drugs cause negative effects only fifteen percent of the time.

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

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

In addition, this category of medicines is used in the complex treatment of diseases caused by somatogenic factors and the use of potent antipsychotics. It is allowed to use TCAs in manic-depressive psychosis, as well as for the prevention of depressive syndrome.

Most drugs in this group, in addition to antidepressant effects, are endowed with sedative effect... Such drugs are used in the complex treatment of disorders of the functionality of the nervous system. "Azafen" is one of the most effective means in this group, it is often used for pathologies in cardiac activity arising against the background of a depressive disorder. It is allowed to use this medication in the case of an alcoholic form of depression, which is accompanied by increased lethargy and anxiety.

It is important to note that antidepressants should not be used in combination with MAO inhibitors. The latter can be used only a few days later, after the end of the TCA course. Among the contraindications to tricyclic antidepressants, one should highlight the individual intolerance of their composition.

TCAs can increase and promote the transmission of norepinephrine and serotonin

Side effects of drugs

The principle of action of tricyclic antidepressants is based on inhibition of the seizure of serotonin and norepinephrine. Despite the fact that these drugs show high efficiency in the treatment of depression, they have a negative effect on the functioning of internal organs and systems. Let's take a look at the most common types of side effects.

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

The anticholinergic effect can lead to flatulence and delayed urine output. In isolated cases, this process leads to a violation of the heart rhythm and provokes loss of consciousness. The uptake of dopamines and serotonin contributes to arousal of the nervous system, loss of appetite and the appearance of nausea. A negative effect on the central nervous system can manifest itself in the form of seizures. It should be noted that long-term use of drugs included in the TCA group has a negative effect on the heart muscle, which is expressed by conduction disturbances.

In a situation where human body has an increased instability to this category of medicines, patients have liver dysfunction, metabolic disorders and the development of other dangerous pathologies. It is important to note that antidepressants without side effects and addiction do not exist today.

The best drugs in the TCA category

On the Russian pharmaceutical market, more than several dozen different drugs are available from the category of tricyclic antidepressants. In the list below, we have collected the most common pharmacological products with high efficacy and low likelihood of occurrence. side effects.

Tricyclics inhibit the seizure of norepinephrine, serotonin, and the manifestation of anticholinergic and antihistamine effects

Tricyclic antidepressants, list of drugs:

"Azafen" - a drug from the group of tricyclic antidepressants, which is used as part of complex therapy different forms depressive disorder. This medication demonstrates high efficiency in the treatment of depressive conditions, which are combined with chronic diseases somatic etiology.

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

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

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

"Zoloft" - a drug from the tricyclic category, which is used for severe depressive disorder. Sertraline is used as an active ingredient in this product, which is one of the most powerful antidepressants. Due to the accelerated rate of uptake of serotonin, this drug is one of the best in this category of drugs.

"Lyudiomil" - a medication with a wide range of therapeutic effects, used to reduce anxiety, relieve lethargy and improve mood. In addition, this drug has the ability to eliminate many of the somatic symptoms characteristic of depressive syndrome.

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

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

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

Tricyclic antidepressants cause many side effects

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

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

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

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

Where could I buy

You can buy tricyclic antidepressants exclusively at pharmacies, with a prescription from your doctor. The need for a medical prescription is explained by the fact that drugs from the TCA category are harmful to the body. Their long-term use leads to the development of glaucoma and tachycardia, and also provokes violations of accommodation and urination. One of the main side effects of such remedies is the drying of the mucous membranes.

Many patients taking antidepressants have abnormal heart rhythms and low blood pressure. It is these negative factors that led to the sale of drugs only with a prescription.

Conclusion

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

It is recommended to start the course of treatment with antidepressants with a minimum dosage. This approach to medication significantly reduces the risk of side effects. Experts recommend regularly taking a blood test throughout the course of treatment in order to be able to take control of the percentage of active components of the drug in the body. In the case when this indicator is rapidly increasing, there is a high likelihood of developing negative side effects.

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

People feel changes in their psyche when they are reflected in their performance and social relationships. They go to their doctor for advice, and often they are diagnosed 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 function of the brain and can be cured in most cases.

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

Depression is dangerous because it can affect the entire body, causing irreversible changes in some of its 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 really 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 metabolic disorders 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, it is not always possible to cure depression with non-drug means. It is well known that in a depressed mood a person can be helped by a change of environment, relaxation and auto-training methods, etc. but all these methods require significant effort on the part of the patient, his will, desire and energy. And with depression, they just do not. It turns out vicious circle... And it is often impossible to break it without the help of drugs that alter 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 drugs have on the nervous system. In total, three types of such actions have been identified:

• Sedative
• Balanced
• Activating

Sedative antidepressants have a calming effect on the psyche, relieving anxiety and increasing the activity of nervous processes. Activating drugs work well with such manifestations of depression as apathy and lethargy. Balanced preparations 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 chemical substances 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 as the standard 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 in this group, consisting of three carbon rings connected together.

TCA - effective drugsbut have many side effects. They are observed in about 30% of patients.

The main drugs of the group include:

• Amitriptyline
• Imipramine
• Maprotiline
• Clomipramine
• Mianserin

Amitriptyline Tricyclic antidepressant. Provides both antidepressant and mild analgesic effects Ingredients: 10 or 25 mg amitriptyline hydrochloride Dosage form: pills or tablets Indications: depression, sleep disturbances, behavioral disturbances, 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, alcohol and psychotropic drug intoxication, cardiac muscle conduction disorders. Application: immediately after meals. The initial dose is 25-50 mg at night. Gradually, the daily dose is increased to 200 mg in three 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 lot of side effects. These include:

• Hypotension
• Hallucinations
• Insomnia
• Agitation
• Constipation
• Headache
• Dizziness
• Sexual dysfunction
• Visual impairment

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

The most modern antidepressants of this class have the ability to inhibit only one of the 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 rarely used at the moment. Their main advantage is their low cost.

The main selective MAO inhibitors:

• Moclobemide
• Pirindol (pyrazidol)
• Bethol
• Metralindol
• Harmaline
• Selegiline
• Razagiline

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 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 neurons by contacts, does not return to the cell transmitting the nerve impulse when exposed to SSRI, but is transmitted to another cell. Thus, antidepressants such as SSRIs increase the activity of serotonin in the neural chain, which has a beneficial effect on brain cells affected by depression.

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

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

This 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: Tablets 10 mg Indications: depression of various origins, obsessive-compulsive disorder, bulimia nervosa Contraindications: epilepsy, tendency to seizures, severe renal or hepatic failure, glaucoma, adenoma, suicidal tendencies, taking MAO inhibitors Side effects: hyperhidrosis, chills, serotonin intoxication, indigestion Application: regardless of food intake. The usual regimen is once a day, in the morning, 20 mg. After three weeks, the dose may be doubled. Fluoxetine analogs: 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 such drugs are Bupropion (Zyban), Maprotiline, Reboxetine, Mirtazapine, Trazadone, Agomelatine. All this good antidepressants, proven in practice tools.

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, concomitant 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, tremors, tachycardia are also observed. Application: the medicine should be taken once a day, in the morning. Typical dose is 150 mg, maximum daily dose is 300 mg.

New generation antidepressants

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

• Sertraline
• Fluoxetine
• Fluvoxamine
• Mirtazalin
• Escitalopram

Difference between antidepressants and tranquilizers

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

What is the difference between these classes of drugs? Antidepressants are drugs that generally have a stimulating effect, normalize 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 quick-acting remedies. They can be used to combat depression, but mostly as adjuvants. The essence of their effect 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 anti-anxiety and anti-anxiety drugs than antidepressants. 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 force in Russia, obtaining psychotropic drugs in pharmacies requires a doctor's prescription, that is, a prescription. And antidepressants are no exception. Therefore, in theory, 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 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 Afobazole, "daytime" tranquilizers and herbal preparations. But in most cases, they are difficult to classify as real antidepressants. It would be more correct to classify them as sedatives.

Afobazol Anti-anxiety, anxiolytic and mild antidepressant drug of Russian production without side effects. Non-prescription drug. Method of release: Tablets 5 and 10 mg Indications: anxiety disorders and states 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, a daily dose is 30 mg. The course of treatment is 2-4 weeks. Contraindications: hypersensitivity to the components of tablets, age up to 18 years, pregnancy and lactation

Why self-treatment for depression is dangerous

There are many factors to consider when treating depression. This is the patient's state of health, the physiological parameters of his body, a type of disease, and other drugs he takes. Not every patient will be able to independently analyze all the factors and choose a medicine and its dosage in such a way that it would be useful and would not cause harm. Only specialists - psychotherapists and neuropathologists with extensive practical experience will be able to solve this problem and say which better antidepressants use for a specific 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 drugs for depression, even the lightest and safest, can cause side effects. And there are no strong drugs without side effects. Especially dangerous is prolonged uncontrolled use of drugs or excess dosage. In this case, intoxication of the body with serotonin (serotonin syndrome) may occur, which can be fatal.

How do I get a prescription for a drug?

If you think you are depressed, it is recommended that you see a psychotherapist or neurologist. Only he can carefully examine your symptoms and prescribe the appropriate drug in your case.

Herbal remedies for depression

Most Popular Today herbal preparations to raise the mood contain extracts of mint, chamomile, valerian, motherwort. But the drugs containing St. John's wort have shown the greatest effectiveness in depression.

Mechanism therapeutic action St. John's wort has not yet been clarified for sure, but scientists believe that the enzyme hypericin contained in it can 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.

St. John's wort preparations are mild antidepressants. They will not help with all depression, especially with its severe forms. However, the effectiveness of St. John's wort in mild to moderate depression has been proven to be serious. clinical research, in which it showed itself not worse, and in some parameters 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. John's wort preparations, the phenomenon of photosensitization should be noted, which consists in the fact that when the skin is exposed to sunlight during the course of treatment with the drug, rashes and burns may appear on it.

St. John's wort medicines are sold without a prescription. So if you're looking for an over-the-counter anti-depression remedy, then this class of drugs might 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 forms of release - capsules containing 425 mg of St. John's wort extract and a solution for internal administration, poured into bottles of 50 and 100 ml. Indications: mild to moderate depression, depression of the hypochondriacal type, anxiety, manic-depressive states, chronic fatigue syndrome. Contraindications: photodermatitis, endogenous depression, pregnancy and lactation, concomitant use of MAO inhibitors, cyclosporine, digoxin and some other drugs. Side effects: eczema, hives, increased allergic reactions, gastrointestinal disorders, headaches, iron deficiency anemia. Application: three times a day, take a capsule of Negrustin or 1 ml of solution. Children under 16 are prescribed 1-2 capsules a 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
Azilekt	Razagiline
Aleval	Sertraline
Amisole	Amitriptyline
Anafranil	Clomipramine
Asentra	Sertraline
Aurorix	Moclobemide
Afobazol		anxiolytic and anti-anxiety drug	can be used for mild depression, OTC
Bethol
Bupropion		atypical antidepressant	used in the treatment of nicotine addiction
Valdoxan	Agomelatine
Wellbutrin	Bupropion
Venflaxin
Gerbion Hypericum	hypericin
Heptor	Ademetionine
Hypericin		atypical antidepressant	herbal preparation, over-the-counter
Deprex	Fluoxetine
Deprefault	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
Newvelong	Venflaxin
Paroxetine		SSRI
Paxil	paroxetine
Pipofezin		TCA
Pyrazidol	Pirlindol
Pirlindol		reversible selective MAO inhibitor type A
Plizil	paroxetine
Prodep	fluoxetine
Prozac	fluoxetine
Razagiline
Reboxetine		selective norepinephrine reuptake inhibitor
Reksetin	Paroxetine
Remeron	Mirtazapine
Selegiline		selective MAO inhibitor type B
Selectra	Escitalopram
Serenata	Sertraline
Surlift	Sertraline
Sertraline		SSRI	new generation drug
Siozam	Citalopram
Stimuloton	Sertraline
Tianeptine		atypical TCA
Trazadone		serotonin reuptake antagonist / inhibitor
Trittico	Trazadone
Thorin	Sertraline
Fevarin	Fluvoxamine
Fluvoxamine		SSRI	new generation drug
Fluoxetine		SSRI
Tsipralex	Escitalopram
Tsipramil	Citalopram
Zitalon	Citalopram
Citalopram		SSRI
Acipe	Escitalopram
Elicea	Escitalopram
Escitalopram		SSRI

List of antidepressants produced in Russia and Ukraine:

Azafen	MAKIZ Pharma
Adepress	Veropharm
Amitriptyline	ALSI Pharma, Moscow Endocrine Plant, Alvivls, Veropharm
Afobazol	Pharmstandard
Heptor	Veropharm
Clomipramine	Vector Farm
Melipramine	Egis Rus
Miaser	Pharma Start
Ixel	Sotex
Paroxetine	Berezovsky pharmaceutical plant, Alvils
Pyrazidol	Pharmstandard, Lugansk KhFZ
Siozam	VeroFarm
Stimuloton	Egis Rus
Thorin	Veropharm
Trittico	CS Si Ltd
Fluoxetine	Vector Medica, Medisorb, Production of Medicines, Valeant, Ozone, Biocom, Russian Cardiological Research and Production Complex, Vector Pharm
Citalopram	ALSI Pharma
Acipe	VeroFarm
Escitalopram	Berezovsky pharmaceutical plant

Approximate price of drugs

Name	Price from
Adepress	595 RUB
Azafen	RUB 25
Amitriptyline	RUB 25
Anafranil	331 r
Asentra	732 RUB
Afobazol	358 r
Valdoxan	RUB 925
Heptor	979 r
Deprim	226 r
Zoloft	489 r
Ixel	1623 RUB
Calixta	1102 RUB
Clomipramine	224 r
Lenuxin	RUB 613
Lerivon	1060 RUB
Melipramine	RUB 380
Miratazapine	RUB 619
Paxil	728 RUB
Paroxetine	347 r
Pyrazidol	171 r
Plizil	397 r
Razagiline	5793 RUB
Reksetin	RUB 789
Remeron	1364 RUB
Selectra	953 r
Serenata	1127 RUB
Surlift	572 r
Siozam	364 RUB
Stimuloton	422 r
Thorin	597 r
Trittico	666 RUB
Fevarin	761 RUB
Fluoxetine	RUB 31
Tsipramil	1910 RUB
Tsipralex	1048 RUB
Citalopram	386 r
Acipe	439 r
Elicea	597 r
Escitalopram	307 r