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The site provides reference information solely to familiarize yourself. Diagnosis and treatment of diseases must be under the supervision of a specialist. All drugs have contraindications. Consultation of a specialist is obligatory!

Application of antidepressants

Antidepressants For many years, many years have been widely used in medical practice not only for the treatment of depressive states, but also within the framework of complex therapy of other diseases. Their impact on metabolic processes in the CNS is used in psychiatry, neurology and some other areas of medicine. This is partly due to the fact that many antidepressants have pretty strong secondary and side effects. Some of them, in addition to antidepressive action, cause drowsiness, others - eliminate the feeling of anxiety and fear. Of course, the use of drugs with such a wide range of actions is possible only to appoint specialists.

Indications and contraindications to the appointment of antidepressants

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

In certain cases, the following diseases may be considered to be applied to the use of antidepressants:

• some hormonal disorders, etc.

It should be noted that with the above pathologies, antidepressants are not necessary for all patients. They can be included in the integrated therapy at the attending physician to eliminate some symptoms. As a rule, the course of treatment in this case is limited to several weeks. An independent application of antidepressants without a clearly defined diagnosis often leads to serious complications and the emergence of numerous side Effects.

Since antidepressants have a wide range of side effects and affect in one degree or another, the work of many organs and systems, they have quite a few contraindications. Not all contraindications are indicated in the instructions for specific drugs. That is why specialists before the appointment of antidepressant and during the selection of the optimal dose are thoroughly diagnosed. It is necessary to identify the accompanying health problems ( about which the patient sometimes does not suspect) And eliminate the most serious complications.

Most antidepressants are contraindicated in the following health problems:

• Individual intolerance to the drug. The immune system Every person has its own characteristics. In case of individual intolerance of certain chemical compounds, a patient may develop an allergic reaction to the prescribed drug. If the patient was already in the past allergy to the drug of this group, this can be considered a contraindication to the appointment.
• Glaucoma. Glaucoma is an eye disease, in which intraocular pressure increases. Critical increase can damage spectator nerve and irreversible blindness. Some antidepressants can provoke an attack, so they are not prescribed to patients ( as a rule, the elderly) With glaucoma.
• Restoration after myocardial infarction. Some antidepressants can cause heartbeat problems. People after myocardial infarction, the heart muscle is weak, and such a load can jeopardize their health and life. Antidepressants try to prescribe after 4 - 6 months after the suffered infarction. Before applying, such patients need consultation cardiologist ( sign up) .
• Structural damage to the brain. After injuries, strokes and some infections in patients, patients may remain structural damage to the nerve tissues in the brain. Because of this, it will be much more difficult to predict the effect of antidepressants.
• Innervation disorders. The smooth intestinal musculature is responsible for its cuts and partly for normal digestion. Some antidepressants affect the nerves that regulate the operation of smooth muscles. Therefore, such problems as irritable bowel syndrome, chronic constipation or diarrhea may be aggravated against the background of their reception.
• Urination disorders. The innervation of ureters and bladder is also regulated by a smooth muscles. Reception of antidepressants can cause urine delay or urinary incontinence. Patients with similar problems antidepressants are prescribed with caution.
• Heavy renal or liver failure. Liver and kidneys are vital important organswhich are responsible for biochemical transformation and allocation of many substances, including drugs. Heavy violations of their work are a serious contraindication to the reception of many antidepressants, as the medicine will not be normally absorbed by the body.
• Problems with arterial pressure. Reception of antidepressants can cause a periodic increase or decrease in blood pressure ( as a side effect). Patients with hypertension ( high arterial pressure) They need to be appointed with caution, under the supervision of specialists.
• Pregnancy and lactation ( for some drugs). For some antidepressants, pregnancy and lactation are absolute contraindication, since these drugs can cause serious harm to the child's health.
• Age up to 6 years ( for some drugs). A number of antidepressants are harmful to a growing organism. In principle, with serious mental disorders, some drugs of this group can be applied to 6 years, but only under the supervision of specialists.

There are other diseases and pathological conditions that can exacerbate against antidepressant treatment. If you have serious health problems, you should notify the attending physician in the first consultation.

It should be noted that not all the diseases listed above are absolute contraindication to the treatment of antidepressants. In the case of severe depression, the treatment will still be appointed, just a doctor will pick up exactly that drug, dose and admission mode that will not give serious complications. Also, in the course of the course of treatment, additional advice, analyzes or surveys may be needed.

How and in what doses to apply antidepressants ( instruction)

The overwhelming majority of antidepressants are calculated for long-term use ( months, years), Therefore, one-time reception will not give any visible improvement. As a rule, the drug, a reception scheme and a dose, patient picks up with the attending physician. In addition, each drug is equipped with instructions for use in which optimal doses are necessarily indicated, as well as the maximum dose, excess of which is fraught with poisoning and serious side effects.

The dose and the method of receiving the drug depend on the following factors:

• The severity of depression. In the case of severe protracted depressions, doctors usually prescribe stronger drugs, increase the dose and frequency of reception. This allows you to achieve a higher concentration of blood medication and makes the therapeutic effect more tangible.
• Portability of the drug. Sometimes patients poorly carry the prescribed drug. This can manifest itself in the form of pronounced side effects or allergic reactions. In this case, the doctor may at its discretion reduce the dose or change the drug.
• Risk of development of addiction. Some drugs from the group of antidepressants may eventually cause dependence. To reduce the risk of such a complication, doctors pick up the optimal dose and reception mode. If necessary, they are adjusted during the treatment ( for example, some antidepressants at the end of the course of treatment are not immediately canceled, but by a gradual reduction of the dose).
• Convenience for the patient. This criterion is taken into account in cases where the remaining criteria are already selected. Some people are more convenient to take antidepressants once a day ( and sometimes less often). For them, doctors pick up drugs with long-term ( prolonged) Action at higher doses.

Cancellation syndrome and its symptoms in case of addiction and dependence

Under the abolition syndrome, the totality of symptoms that appear in a patient with a sharp abolition of the drug to which the dependence has developed. Not all antidepressants cause such addictive. Moreover, the reception of drugs in doses prescribed by a specialist rarely gives such a complication. In other words, the risk to be dependent on antidepressant is not so great.

In most cases, addiction occurs in patients undergoing treatment with strong antidepressants for several months. However, this dependence is very different from narcotic. Indeed, with a sharp discontinuation of the drug intake, the nervous system does not have time to rebuilt, and various temporary violations may appear. However, there is no serious risk to health in this case.

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

• general psychological discomfort;
• moderate pain in muscles and joint pain;
• sometimes - nausea and vomiting;
• rarely - sudden pressure drops.

Pronounced symptoms are quite rare. They are usually stronger in people who have concomitant chronic diseases or other health problems. In most cases, any special treatment This state does not require. The patient's condition is normalized within 1 - 2 weeks.

In order to avoid cancellation syndrome, most professionals recommend to finish the course of treatment, gradually reducing the dose of the drug. This allows the body more slowly adapt to new conditions, and no symptoms will arise at all. In rare cases, when the patient is still concerned about the state of health after the end of the course, you should contact a specialist who will definitely determine whether it is about the cancellation syndrome or other health problems.

Overdose and poisoning with antidepressants

Acceptance of an excessive dose of antidepressant may cause very serious disorders in the body, which sometimes put the patient's life. For each drug, the critical dose is somewhat 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 above in children.

Symptoms of overdose and poisoning affect the work of many organs and systems, since the work of the CNS, which controls them is disturbed. The diagnosis is usually put on the basis of existing symptoms and violations. When any atypical organism reactions appear after receiving a large dose of the drug, it is urgent to apply for medical help.

Most often, with serious poisoning with antidepressants, patients appear the following symptoms:

• sudden drowsiness or loss of consciousness ( up to precompose state);
• heart rhythm ( more often with rhythm, tachycardia);
• breath rhythm disorders;
• deterioration of coordination of movements, sometimes cramps;
• the fall arterial pressure (indicates strong poisoning and requires urgent medical care);
• expansion of pupils ( midryaz);
• detection of intestinal work and urine delay.

In severe cases ( especially in children) Symptoms appear quickly and without harbing. The threat of life arises due to severe respiratory and heartbeat disorders. This condition can last from several hours to several days. In the case of repeatedly exceeding therapeutic dose, death is possible from antidepressant poisoning.

Treatment of such poisoning is carried out under resuscitation conditions in the separation of toxicology. First of all, the doctors will take care of maintaining basic vital indicators. Independent reception of vomit in this case is prohibited, since the organs work poorly and may deteriorate the patient's condition ( falling away airways ). In the hospital will be appointed special meanswhich reduce 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 from 6 to 8 percent of children and adolescents also suffer from its various manifestations. In some cases, children can be assigned antidepressants as treatment. It is believed that the minimum age for most drugs of this group is 6 years old, but some of the weakest can be prescribed to children of younger.

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

• Tricyclic antidepressants. because of large number Side Effects The preparations of this group can have a destructive effect on a growing body. They are extremely rare to children, only under the strict observation of doctors.
• Monoaminoxidase inhibitors. These drugs also have a rather strong effect and can lead to a variety of problems in children. They are rarely used.
• Inhibitors of serotonin reverse capture. Preparations of this group have an electoral action, so they do not have such a wide range of side effects. Most professionals are trying to appoint them from children's depressions.
• Preparations of other groups. Preparations are appointed selectively, sometimes in combination with others drugs.

It can be unambiguously to note that the independent use of antidepressants is very dangerous to the parents. Reaction children's body It is very difficult for a particular drug to predict even experienced professionals. Also noted high resistance ( sustainability) Children's body in relation to many antidepressants. Often, even after consulting a psychiatrist, after a while you have to change the dose or drug to get the expected effect.

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

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

In general, the reception of antidepressants during pregnancy is always better to coordinate with the attending physician. It is important to assess the risks from using or refusing the drug and compare them. An independent technique of strong antidepressants often leads to various pregnancy complications, as it represents a threat to a child.

An independent reception of antidepressants during pregnancy can be dangerous for the following reasons:

• The possibility of malformations. Development defects arise in a child in cases where the drug passes a placental barrier between the blood of the mother and the fetus. Some substances suppress the division and growth of certain cells. It is noted, for example, that a number of drugs from the SSRS group ( selective inhibitors of the reverse seizure of serotonin) can lead to disabilities for the development of the respiratory system. Other substances can similarly apply irreparable damage 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 cell composition of the blood, lead to the accumulation of toxic substances. As a result, a woman can exacerbate chronic diseases, a threat of miscarriages or premature births often arises.
• Reducing the 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 in advance, and the doctor assesses the effectiveness of treatment after the start of the course.

The risk of receiving antidepressants during breastfeeding is somewhat lower. Nevertheless, some drugs and their derivatives can stand out with breast milk and fall into the child's body. If possible, women are advised to refrain from the reception of these drugs for breastfeeding period or consult a doctor to choose the most safe medicine and an optimal dose.

Do I need to take any tests or to pass surveys before appointing antidepressants?

In principle, analyzes and examination patients are held to confirm one or another diagnosis and detecting various health problems. Already on the basis of this information, the specialist decides whether to prescribe a specific drug. Antidepressants are designed to fight depression and a few other mental problemswhich can accompany it. In the field of psychiatry, laboratory tests and instrumental surveys are secondary importance. Mental deviations can even be observed in completely healthy ( according to the results of the analyzes) of people. A qualified specialist is crucial in this case.

However, if necessary, a long-term reception of antidepressants, a doctor usually assigns a number of analyzes and surveys to patients. Most often it is necessary to detect concomitant diseases ( in addition to depression). Almost all drugs from the antidepressant group have many side effects associated with the work of the heart, gastrointestinal tract or other internal organs. If you do not take into account the presence of chronic pathologies, the reception of the drug can seriously damage the patient's health.

To detect accompanying diseases, the doctor may assign the following tests before receiving antidepressants:

• general blood analysis ;
• biochemical analysis blood;
• electroencephalography;
• allergic samples;
• ultrasound examination of internal organs ( Ultrasound) and etc.

The results of the analyzes help secure the patient and minimize the risk of side effects. A specific list of analyzes is prescribed by the attending physician at its discretion. Often, when appointing weak antidepressants, it is not necessary to pass any tests at all.

What is dangerous to the independent use of antidepressants at home?

Most strong antidepressants with severe therapeutic effect are released by the recipe of a specialist. This measure is designed to limit self-treatment with these drugs, as it may be dangerous to the patient. In general, antidepressants have a very diverse effect on the body. The effect of their reception can be reflected in the work of many organs and systems. This explains the possibility of developing serious side effects that the patient is not able to predict.

Self-treatment drugs from the antidepressant group may be dangerous for the following reasons:

• Invalid diagnosis. Antidepressants can be assigned to various diseasesBut only a qualified specialist can put an accurate diagnosis. The patient itself cannot accurately classify its condition. Depression can be combined with other mental violations, and not all of them can be adjusted by taking antidepressants. Such a reception of drugs ( in the absence of indications) It will not give the healing effect, and the risk of various complications increases significantly.
• The presence of chronic diseases and contraindications. Many patients do not know all their health problems. Some pathologies do not manifest and can be identified only during special surveys. At the same time, such diseases are often contraindications for receiving antidepressants. That is why these drugs must prescribe a doctor after a complete survey of the patient, and self-treatment can be dangerous.
• The possibility of drug interaction with other drugs. Often, patients are taken parallel to several drugs from different diseases. A similar combination of drugs may have negative consequences. On the one hand, the healing effect may be weakened or strengthened. On the other hand, the risk of side effects and serious complications increases. In the instructions for the drug do not indicate the entire list of unwanted drug interactions. To exclude a dangerous combination of drugs, it is better to consult with your doctor.
• Erroneous selection of dose. The calculation of the dose required for the treatment of the patient and the treatment regimen depends on many factors. The doctor, appointed this or that medicine, is guided by the results of the preliminary examination. Patients themselves seeking to achieve the healing effect faster, can significantly exceed the permissible dose.
• Lack of specialist control. Most antidepressants must be taken under the control of a specialist ( in hospital or periodic consultations). This will allow to evaluate the therapeutic effect, in time to notice the appearance of side effects and more accurately calculate the necessary dose of the drug. An independent welcome without controlling a specialist is fraught with tightening treatment, a high risk of side effects and the development of drug addiction.

Thus, the risk from self-medication is significantly higher than possible. It is especially dangerous to independently use these drugs not as appointment ( for example, for weight loss). In these cases, a thorough preliminary examination is required and the accurate calculation of the dose.

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

How long does the course of treatment with antidepressants?

The duration of treatment with antidepressants is determined by the disease that caused their destination. In most cases, the drug is prescribed for several weeks, after which the doctor assesses its impact on the body, tolerability and efficiency. If the patient does not have side effects and there is a trend towards improving state, antidepressants can be assigned for several months. In the case of each individual preparation, the duration of the course of treatment may be different. As a rule, drugs of this group drink at least 2 - 3 weeks ( and more often - a few months). Otherwise, it will be difficult to assess their effectiveness.

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

• established diagnosis;
• patient condition against the preparation background ( there must be a positive dynamics);
• the presence of side effects;
• the presence of contraindications ( chronic diseases);
• conditions of treatment ( in hospital or at home);
• the possibility of regular consultations from the profile specialist.

Patients with severe mental violations strong antidepressants may assign for a long time ( several months and more). As a rule, this occurs under the supervision of doctors in the hospital. The main danger of long-term treatment is addictive to most antidepressants. If the patient needs to receive antidepressants for recovery for a long timeThe doctor may change drugs along the treatment to avoid dependence.

Does the body harm the long-lasting taking antidepressants?

Reception of antidepressants almost always implies a long course of treatment, which can be conjugate with some complications. The most serious of them is the development of drug addiction. It may appear when taking some drugs for several months. After the end of the course of treatment, there will be certain difficulties with complete cancellation of the drug ( cancellation syndrome and his symptoms).

The remaining complications are rarely connected with a long admission. As a rule, problems with the digestive, nervous or cardiovascular system occur in a few weeks after the start of treatment. They are connected with the individual sensitivity of the body to a specific drug.

After how much after receiving antidepressants you can drink alcohol?

In principle, there is no single opinion of specialists regarding the compatibility of alcohol and antidepressants yet. It is believed that some drugs in small doses can be combined with alcohol, but for each patient, this small dose varies in large limits. It depends on the individual characteristics of the organism, the type of alcohol and other factors. Provide them all in advance and predict exactly what effect will give a combination of alcohol with antidepressants, it is almost impossible.

In general, the effect on the body of alcohol and antidepressants is almost the opposite. Despite the similar effect ( alcohol at the first stage opens and raises the mood), the processes occurring in the CNS are very different. Pharmacological preparations have a selective action on a certain system and even with side effects have a more stable and directional effect. Alcohol affects many organs and systems. For example, the oppression of liver functions leads to a deterioration in the metabolism required for nervous system. In addition, water circulation in the body is disturbed. This partly explains the appearance of insomnia after a long use of alcohol.

Thus, the simultaneous use of antidepressants and alcohol will most often give negative consequences. For example, an antidepressant will not be due to enzymes, while the risk of side effects will increase. More serious consequences are also possible associated with pronounced violations in the work of the central nervous system. In severe cases, patients can quickly appear with heartbeat, breathing. Also high risk of psychosis, neuroses and other sharp psycho emotional disorders. In this regard, it is considered to be most safe to drink alcohol a few days after the end of the course of treatment with antidepressants ( a more accurate term can suggest a doctor). Abuse with alcohol drinks during the course of receipt of the drug simply negates the benefit of its reception.

How many antidepressants act after use?

The tangible effect of receiving most antidepressants occurs no earlier than a few weeks after the start of the course of treatment. Sometimes this period can last several months. Such a belated therapeutic effect is explained by the features of the action of these drugs. In most cases, one-time reception is not felt, as in the blood and nerves there has not yet accumulated a sufficient concentration of antidepressant. Over time, with proper and regular use, a "restructuring" of the nervous system occurs. From this point on, the patient begins to feel the improvement of the state. Therapeutic effect lasts throughout the course of treatment, while the patient continues to take medicine.

After graduating and stopping the reception, there may be several options:

• Full recovery. With easy depressions, the properly selected drug can lead to complete recovery in a few weeks or months. After the end of the reception, the patient no longer faces this problem and leads a normal life.
• Long remission. This treatment result is the most common. After the end of the treatment, the patient's nervous system is still functioning normally for a long time. The period is without depression and is called remission. It can last from several months to several years. Unfortunately, many patients sooner or later ( usually on the background of stress or under the action of other factors) severe depression develops again, and the course of treatment has to be repeated.
• Return of depression. Unfortunately, such an outcome is found quite often. With serious mental disorders, in principle, it is very difficult to achieve complete recovery. Heavy depressions may return, and their elimination will need a new course of treatment. Some patients are forced to take antidepressants for years to maintain a normal state.

What antidepressants do not cause addiction and cancellation syndrome?

The development of dependence on any antidepressant is not an inevitable complication of treatment. A strong addiction to the drug occurs under the condition of long-term reception, a certain dose and some individual predisposition of the body. In addition, doctors, assigning one or another drug, always try to choose a treatment regimen that will minimize the risk of addiction.

In general, severe addictive causes not so much antidepressants. At the legislative level, their distribution is limited. In other words, almost all antidepressants who are sold in pharmacies for the prescription, in certain conditions can be addictive. Lighter preparations that can be purchased independently, such properties do not have. If they help well with depression, then the addiction can rather be psychological, and after stopping the reception in the patient there will be no cancellation syndrome.

You can clarify the risk of addiction to a particular drug at the attending physician. This is especially important for people who suffered in the past from severe dependence ( drug addiction, alcoholism, etc.). For them, before starting accepting antidepressants, in any case, consult with psychiatrist ( sign up) or narcologist ( sign up) .

How do antidepressants affect libido?

Some antidepressants can lower libido ( sexual attraction) And dull emotions in general. Such a side effect is characteristic, first of all for selective inhibitors Reverse seizure of serotonin ( SSRS). It is usually indicated in the instructions for a specific drug. Also, the risk of the emergence of such problems is warned by a doctor before appointing the drug. In the case of long-term use of antidepressants, this effect may remain even after the use of the drug itself. Some experts even distinguish such a disorder called post-soulospix sexual disorder.

The side effect in the form of a decrease in the libido should not stop doctors and patients if the patient really needs a course of antidepressants. Just the patient should be informed, and in case such problems appear to contact a specialist.

What could be the consequences of taking antidepressants?

In rare cases, the effects of antidepressants may be felt quite a long time after the end of the course of treatment. This is due to the fact that during the reception of the CNS drugs in a certain way "rebuilt" and "accustomed" to regular admission active substances from outside.

The most tangible the following consequences Antidepressant reception:

• Development of drug addiction. Dependence is developing gradually due to artificial stimulation or braking of certain departments of the nervous system. Sometimes to get rid of this dependence may require special medical care.
• Problems with certain organs and systems. Side effects of some antidepressants can be associated with the work of the heart, liver, kidneys, gastrointestinal tract. After the cessation of the course of treatment, some patients may have problems with heartbeat, diarrhea or constipation, abdominal pain and other symptoms. As a rule, these violations are not for too long ( no more than 2 - 3 weeks), after which the work of the organs returns to the norm. With pronounced symptoms and substantial discomfort, it is better to seek medical help, and not wait until the problems go about themselves.
• Return of depression. Sometimes the course of treatment does not give a stable result, and the patient after stopping the reception of antidepressants will soon be returned to the depressive state. In this case, you must contact the psychiatrist. The doctor will objectively appreciate the patient's condition and find out why the treatment was not effective. Sometimes the course of treatment is prolonged ( with changing the drug or without), and sometimes just give the nervous system a little time to return to normal. Of course, the patient is observed by a doctor to complete recovery.

It should be noted that the correct reception of antidepressants during the course of treatment ( compliance with the regime and dosage) Practically excludes any serious consequences of their reception. Problems may arise when retreat from the treatment regimen prescribed by the attending physician.

At what diseases and problems are antidepressants appoint?

Currently, the spectrum of the application of antidepressants in medical practice is very wide. They are used not only for the treatment of depression proprieties, but also under a number of other mental diseases, syndromes and disorders. This is due to complex disorders in the work of the central nervous system, which accompany many pathology. Almost every antidepressant has its advantages and disadvantages. A qualified specialist can combine these drugs with other medicines to achieve a good healing effect.

Most often antidepressants ( independently or within the framework of integrated therapy) prescribe under the following diseases:

• depression;
• neurosis;
• panic attacks;
• schizophrenia;
• various psychosis.

It should be noted that in each case there is a specific drug. That's why independent treatment These pathologies, even weak antidepressants can lead to unpredictable consequences.

Depression

Is it possible to treat depression without antidepressants?

Vegeth-vascular dystonia ( VD)

Vegeth-vascular dystonia is not considered by many specialists as a separate disease, since its manifestations can be very diverse, and it is difficult to classify them. The disease is usually reduced to the nervous disorder, at which there are more often observed changes in blood pressure, periodic pain, urination disorders, a sudden change in heart rate and respiration, strong sweating. A sharp attack can provoke a panic attack in a patient. Currently, many neurologists are recommended to prescribe patients with similar antidepressants as one of the main drugs within comprehensive therapy.

The most effective for ITRs the following groups of antidepressants:

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

The course of treatment lasts from a few weeks to several months. The patient must regularly visit a specialist who will evaluate the effectiveness of the prescribed drug. With cardiovascular ( cardiovascular) The form of the VDC is the risk of temporary deterioration of the state due to the side effects of the drug. In this regard, take antidepressants for treatment of VD It is impossible. The drug and dose chooses a qualified specialist.

Polynereropathy

Pinsaineuropathy is a very serious problem in which peripheral nerves are affected by patients for one or another reasons. It may be accompanied by quite strong pools, sensitivity disorders, and in severe cases - and motor disorders ( motor function). Treatment of this disease should be integrated, aimed at eliminating the cause of the disease, and to combat its manifestations.

Some antidepressants are widely used as symptomatic treatment In diabetic polyneuropathy. In particular, amitriptyline and venlafaxine remove pain more efficiently than many traditional painkillers ( non-steroidal anti-inflammatory means).

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

• betting pain occurs at the level of the nervous system;
• the severe condition of patients with launched diabetes is often accompanied by a depressed mood and depression ( which are also removed by antidepressants);
• eliminate the root cause ( actually damage to nerves) When diabetes is almost impossible, and with pain you need to fight constantly, and antidepressants are just designed for long-term use.

Thus, the use of antidepressants in the treatment of polyneuropathy is justified and effectively. Before starting treatment, the choice of the drug and dose is better to discuss with their share professionals ( neuropathologist, Therapist, Endocrinologist).

Neurosis

Panic attacks

Panic attacks are sharp nervous disorders that can manifest themselves in different ways. Currently it is believed to relieve ( elimination of sharp symptoms) Panic disorder can be successfully carried out using antidepressants. As a rule, this initial stage of treatment lasts a few weeks. During the finalization of the result, antidepressants are combined with other drugs and psychotherapy, and a 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 occur, for example, against the background of various phobias. For full-fledged treatment, the patient must consult a psychiatrist and neurologist, which will exclude objective reasons for disorders and refine the diagnosis. In some cases, antidepressants will be appointed in combination with other drugs.

In treating panic attacks The most commonly use drugs of the following groups:

• tricyclic antidepressants ( clomipramine, desipramine, norriptyline, amitriptyline, etc.);
• selective inhibitors of serotonin reverse capture ( fluoksetin, Escitalopram, etc.);
• mao inhibitors ( monoaminoxidase) reversible and irreversible action ( porlindol, Fenelzine, etc.).

In some cases, patients also prescribe powerful benzodiazepine tranquilizers. All of the above preparations that effectively eliminate panic symptoms may have a lot of side effects. They should be taken only on the recipe of a specialist after a thorough examination.

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

Many antidepressants have a comprehensive effect on the CNS, and they can be used not only for treating depression. Among the drugs of this group there are those that have a pronounced anxiolytic effect ( remove the alarm, unreasonable fear, anxiety). They are quite widely used for disturbing neurosis and similar pathological conditions in psychiatry.

Most often, patients are prescribed the following antidepressants with anti-high effects:

• maprotilin;
• azapane;
• mianserin;
• mirtazapine.

In efficiency, these drugs are inferior to traditional anxolitams ( tranquilizers), but can be used within the framework of complex therapy, or in patients who do not respond to more traditional treatment schemes.

Do antidepressants help with insomnia?

Depressive states may be accompanied by various violations in the work of the CNS. Quite often, patients have sleep disorders ( drowsiness or insomnia). In the case of insomnia, the patient's condition deteriorates greatly due to the fact that the nervous system is depleted. With such states, antidepressants are applied, possessing sedative effect. Their use is quite quickly soothing the patient and gives a sleeping pill effect. W. different drugs This group, this effect is expressed in different ways.

In general, antidepressants with a sedative effect ( amitriptyline, imipramine, northriptyline) Pretty widely applied to the treatment of insomnia. The effect of their application appears after a few weeks after the beginning of the course of treatment. However, all patients react to treatment in different ways, and to achieve the best effect to select the drug and a dose of a qualified specialist.

Does antidepressants help when climax ( menopause)?

Menopause normally comes in women from 40 to 50 years. It is characterized by a hormonal restructuring of the body, as a result of which the menstrual cycle is not only stopped, but also a number of concomitant disorders and disorders arise. Many of them are associated with the emotional state as a whole and possible mental disorders ( in some cases). Medical assistance during this period includes a fairly wide range of drugs, among which there are antidepressants.

The use of antidepressants is possible throughout the entire climax. Some women have this period stretching from 3 to 10 - 15 years. To maintain a stable emotional background with antidepressants, it is better to contact a specialist ( gynecologist, psychiatrist). They will help to choose the optimal dose of the drug. As a rule, in these cases, light antidepressants are prescribed, which have fewer side effects and facilitate the emerging symptoms. The purpose of stronger drugs is necessary only in the case of the development of severe mental disorders.

Clearing antidepressants help eliminate the following symptoms:

• sharp mood differences ( emotional lability);
• sleep disorders;
• lack of motivation;
• fast fatiguability ;

Do antidepressants prescribe with postpartum mental disorders?

Postpartum mental disorders are a relatively common problem. Changes in hormonal background and lifestyle can cause severe stress in a woman. This is especially true for women whose pregnancy passed with various complications. As a result, after childbirth, certain psycho-emotional problems may be observed ( depression, irritability, etc.). Sometimes antidepressants are prescribed for the correction of such disorders.

For postpartum depressions Antidepressants usually have a good therapeutic effect. The drug and the dose appoints the attending physician ( usually - Psychiatre). The main condition is the safety of the selected medication during the breastfeeding period. Long-term courses of treatment more strong drugs May be needed to patients who have a pregnancy led to the exacerbation of had siche disorders.

Is it possible to drink antidepressants for weight loss?

Antidepressants as a group pharmaceutical preparations Have a wide range of action on various organism systems. One of possible effects From the reception of these drugs is a decrease in appetite and a peculiar "motivation" of a person to a more active way of life. In this regard, many people use antidepressants to combat overweight. Moreover, some obesity combined clinics include some drugs of this group in their treatment programs.

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

• Side effects. Antidepressants have quite a lot of serious side effects that may even appear when proper reception Preparation according to the scheme appointed by the specialist. Take these drugs to combat obesity is dangerous, since the main task is still the impact on the central nervous system. It is noted that healthy peopleWith direct readings for receiving antidepressants, convulsions, diarrhea, heart rate problems, problems with sleep and even suicidal inclinations can appear.
• The presence of alternative treatment schemes. In most cases, patients to get rid of excess weight You can choose a safer treatment scheme. Dietary doctors can help with this. In some cases, the weight set may be an endocrinological problem. Accordingly, the patient will need normalization of the hormonal background under the direction of endocrinologist ( sign up) . Antidepressants are needed only to the patients who began to gain weight against the background of emotional or mental disorders.
• The ability to reverse effect. As practice shows, treatment of obesity by antidepressants is not universal. In some patients, such treatment gives a tangible effect only at the beginning of the course. At the later stages of the patient may begin to gain weight again. To avoid this, it is better to develop a treatment scheme using several methods that complement each other and not rely only on antidepressants.

Nevertheless, in many cases, antidepressants really have tangible assistance in the fight against overweight. It is reasonable to use them in the initial stages to assist sustained patients or patients with concomitant behavioral disorders. Properly selected drug and dose will be a good impetus, which, on the one hand, will reduce appetite ( acting on the nervous system), and on the other, the patient motivates for a more active lifestyle ( sports, achieving the goal, visits to specialized programs for people with obesity). It should be noted that before the start of reception of antidepressants, in any case, it is better to consult with a specialist. An independent reception of a random drug may not only do not give the desired effect, but also to jeopardize the patient's health.

Can antidepressants help with headaches?

Chronic headaches may be associated with various diseases and violations in the body. Sometimes they accompany depressive states. In these cases, pain is in part "mental", and ordinary painkillers may be ineffective. So for proper treatment Head pain is important to establish the reason for their appearance.

It is proved that some antidepressants can relax or completely eliminate headaches not related to specific structural damage. In other words, in injuries, tumors or an increase in blood pressure, they will not give any effect. But if a patient has chronic stress or have mental disorders identified earlier, antidepressants are sometimes the optimal output.

Independently take these drugs with any headache, of course, it is impossible. In some cases, this can only aggravate the problem. It is better to consult with a specialist ( therapist, neurologist, etc.), which will appoint the necessary surveys. It will be able to recommend the drug that will be most effective in this particular case.

Is it possible to take antidepressants after a stroke?

In principle, antidepressants are recommended after a stroke of many patients within the framework of complex rehabilitation therapy. Quite often, the stroke is accompanied by the disability of the patient, since certain parts of the brain dies or temporarily do not cope with their functions. According to modern research, some drugs from the group of antidepressants accelerate the "adaptation" of the brain to the new conditions and accelerate the return of lost skills. This group includes mainly selective inhibitors of serotonin reverse seizure ( SSRS) - Escitalopram and cipralex. In addition, many patients after the suffered stroke suffer from depression. To eliminate this problem, they can be appointed antidepressants treatment from other groups.

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

What if appointed funds do not help?

Almost all drugs that belong to the group of antidepressants have their own features of use. Even qualified specialists are not always possible to choose the preparation from the first time, which will help a specific patient. As a rule, the doctor warns the patient about such an opportunity and pre-stipulates the time of re-consultation with him. The patient itself does not always correctly appreciate the effect of the use of medication.

In the event that the patient within a few weeks does not feel the improvement of the state, you should consult a doctor who assigned a course of treatment. Sometimes the desired drug that works well on a particular patient, it is possible to choose only with the second or third attempt. In severe cases, a combination of several drugs will be able to strengthen the therapeutic effect.

Modern "rabid" rhythm of life, an endless flow of information that needs a person to process daily, as well as many others, in most of its negative factors, lead to the fact that the body and the psyche cannot be held. Insomnia and stress, impairment and communication, often ignored, and most often drunk by drugs or other potent substances, as a result lead to such complex diseases as syndrome chronic fatigue (SHU) and various depressed. According to forecasts of medical analysts, depressed by the 20th of this century will be ahead of the number of patients with the leaders of the twentieth century - infectious diseases and disease of cardio-vascular system. The fight against depressive disorders uses various drugs created both on the basis of natural and synthetic components.

Antidepressants - what is it? What are they and can these medicines cure depression or only make it easier for her symptoms? What are the advantages and disadvantages of such drugs? In this article, we will try to answer these and other questions about antidepressants, the effect of their application and the consequences of the reception.

What it is?

As follows from the name, antidepressants (also called thymoleptics) are psychotropic drugs working against the symptoms of depression. Thanks to these drugs, increased anxiety and excessive emotional stress, apathetic and lethargy, insomnia decrease significantly and even completely disappear. The drugs attributable to this group are different both by the chemical structure and composition and the mechanism of impact.

How it works?

Let's figure it out, antidepressants - what it is: the destruction of the body or the help of the exhausted human psyche. Let's look at how these drugs work. Human brain It consists of a plurality of neurons - nerve cells that constantly carry out the informational exchange among themselves. To implement such information transmission, special intermediary substances are needed - neurotransmitters penetrating through synaptic slits in space between neurons. Modern researchers allocate more than 30 different mediators, but the development and flow of depression have "direct" attitude only three of them: serotonin, norepinephrine (norepinephrine) and dopamine. According to research data, depression occurs when in places of interaction of neurons there is a significant quantitative decrease in neurotransmitters. The effect of antidepressants is directed to an increase in the number of necessary mediators and normalization of the biochemical brain balance.

A bit of history

Before proceeding with the consideration of modern groups and types of antidepressants, we briefly tell about the history of their discovery.

Until the middle of the twentieth century of depression and various neurotic states with similar symptoms were treated through various vegetable preparations. For "raising mood", various exciting compositions were used in which caffeine, ginseng or opiate representatives. "Soothe" nervous excitement tried in bromine salts or drugs based on Valerian medicinal. Also used different kinds Gymnastics and physiotherapy procedures, the effectiveness of which was rather insignificant.

In the early 50s of the twentieth century, the preparation of "Promethazin" was created, originally used for anesthesia at surgical operations. Pharmacologists tried to strengthen the braking and overwhelming effect of this medication, as a result of which by 1951 was obtained "chlorpromazine", which was widely applied in the medical practice of treating depression. Today, this drug is known as "aminazine".

In the late 60s of the last century, Swiss doctors treated with tuberculosis, was noted a rather unusual side effect of such a drug as "IProniazid". Patients who received it were distinguished by increased mood. Gradually began to be used in psychiatric practice, since he helped against tuberculosis very weakly. At about the same time, the German researcher Ronald Kun opened the "imipramine" preparation.

The opening of the first thymoleptics led to the rapid development of pharmacological studies in this area and the creation of new medicines aimed at combating symptoms and the causes of depressive disorders.

Modern classification

Depending on which effects the use of antidepressants on the patient depressed, they are subdivided as follows:

Group	Basic action	Preparations
Sedative	Removing psycho-emotional voltage without sleeping effect	"Herfon", "Amitriptyline"
Balanced action	Take which is possible only for the purpose and under the supervision of the attending physician, since when taking large doses, a stimulating effect occurs, but the average doses act soothing	"Lyubomil" "Pyrazidol"
Stimulating	Used in the process of treating depressive states with symptoms of lethargy and apathy	"Aurorix" "Meliprammin" "Anafranil"

In addition, there is a classification based on how the effect of antidepressants affects the flow of biochemical processes in the human body:

• TCCs - tricyclic TimoNaleptics.
• IMAO - monoaminoxidase inhibitors:

Irreversible ("tralylsipromine", "phenlay");

Reversible ("Pyrazidol", "Moklobemoid").

• IIPS - serotonin selective absorption inhibitors;
• Izsin - inhibitors of the inverse seizure of serotonin and norepinephrine;
• Nassas - Noradreengic and specific serotonergic antidepressants.

There are also a number of antidepressive drugs that cannot be attributed to any of the named groups.

TCC: What is it?

The drugs of the tricyclic group, such as "Northriptyline", "imipramine" and "amyltryptilin", received their name with a triple carbon ring lying on them. These antidepressant drugs contribute to increasing the amount in the brain of such neurotransmitters as norepinephrine (norepinephrine) and serotonin (hormone of happiness). This is achieved due to the reduction of their consumption of nerve cells - neurons.

Due to the fact that when taking these drugs, not only the necessary neurotransmitters are blocked, many different side effects occur. The reception of antidepressants of the tricyclic group can cause the following side effects:

• lethargy;
• drowsiness;
• subtaching;
• dry mouth;
• weakness;
• dizziness;
• the frequency of heart rate - pulse;
• constipation;
• reduced potency and libido;
• anxiety or anxiety.

Such medicines are usually appointed by doctors first of all, as they are most studied and the consequences of their use are well known.

IMAO - monoaminoxidase inhibitors

The preparation "IProniazid", open one of the first, as well as other medicines of this group, such as "isocarboxesid", "tralylsipromin", suppress the enzyme reaction of monoaminoxidase contained in the nerve endings. Due to this, neurotransmitters responsible for our mood, such as serotonin, thiramine and norepinephrine, are not destroyed, and gradually accumulate in the brain.

The most often antidepressants of the IMAO are prescribed with or in the case when the drugs of the tricyclic group did not fit and did not provide the necessary effect. The advantage of medicines of this group is that they do not have an overwhelming effect, but, on the contrary, stimulate mental processes.

Just like tricyclic drugs, IMAO does not have an instant effect on the human condition - the effect of antidepressants occurs in a few weeks after the start of their reception.

Due to the fact that they have many side effects (and besides, it is easily engaged in interaction with cough and colds and are able to provoke a life-threatening increase in blood pressure), as well as because of a rather rigid diet, they are prescribed Preparations are quite rare, when other treatment methods did not help.

Serotonin's selective absorption inhibitors

The treats and IMAO groups considered by us are mostly open and well-studied drugs. But the "old" generations of antidepressants are gradually displaced by more modern drugs, the action of which blocks not all mediators, but only one-sole - serotonin, preventing it from the reverse absorption of neurons. Due to this, its concentration increases and the healing effect turns out. The IIPS includes such modern drugs like "Fluoksetin", "Sertraulin", "Zolofext", "Paroksetin" and others. The drugs of this group have a smaller number of side effects, and they do not affect the human body.

Inhibitors of the reverse seizure of serotonin and norepinephrine

These are rather new drugs that are already attributed to the third generation of antidepressants. They began to be produced in the mid-90s of the twentieth century.

Such drugs like "Cymbalt", "Effembor" block reverse seizure not only serotonin, but also noripinephrine, but such drugs, as "Velbutrin" and "Ziban" impede the return of norepinephrine and dopamine.

The side effects of the medicines of this group are significantly less than that of others, and they are quite weak. After taking antidepressants created on the basis of inhibitors such as Duloxetin and Bupropion, weight gain and small dysfunctions in the sexual sphere may be observed.

Noradrenergic and specific serotonergic antidepressants - Nassas

Another of the modern groups of antidepressive drugs are NASS, which slow down or at all cease to capture norepinensine synapses of nerve cells, thereby increasing its concentration. Such medicines like "Remeron", "Lerivon", "Serzoron" carry out the blocking of serotonin receptors.

When taking drugs of this group, such poorly discharged unpleasant side effects, like drowsiness, dry mouth, increased appetite and the associated weight increase is observed. Canceling antidepressants of this group proceeds without any serious problems.

In addition to the above major groups of antidepressants, there are a number of medicines that cannot be attributed to any of them. They differ as chemical compositionand the mechanism of impact. This, for example, drugs such as "bupropion", "Hypericin", "Tianeptin", "Nefazodon" and many others.

Alternative methods

Today, foreign specialists are increasingly used for the treatment of depressive states, affecting non-neurotransmitters and neurotransmitters, but on the state of such organs endocrine systemlike adrenal glands, hypothalamus and pituitary gland. Some of these drugs, such as "aminogllutetimide" and "ketoconazole", block the synthesis of cortisol hormone adrenal glands, but they have a set of side effects and have a negative impact on the endocrine system.

To the second group it is customary to attribute antagonists of Antalammin receptors, uniting positive traitswhich possess tranquilizers and antidepressants.

In addition to drug treatment of depressive states, such methods are increasingly used as periodic norvo-fluid hypoxia and plasmferresis, therapy with light, as well as many other, contributing to a decrease in manifestations and weakening symptoms.

Pros and cons

Most of those who accepted antidepressants agree that these are very effective drugs, especially if they are accepted simultaneously with a specialist course of therapy. It should be remembered that these drugs, as well as their dosage, can only be prescribed by a doctor under the control of which and necessary to take them. You should not expect instant improvement. As a rule, the feeling of hopelessness and loss of interest in life, as well as lethargy, apathy and sadness pass 3-4 weeks after the start of systematic reception.

One of the largest minuses of these drugs is the abolition of antidepressant syndrome, manifested with a sharp and uncontrolled cessation of their reception.

How to apply?

1. If you have diagnosed heart disease, kidneys or liver. Be sure to inform the doctor.

2. Antidepressants act individually, so the specialist will select the drug suitable for you.

3. In some cases, one medicine is not enough, the doctor may appoint simultaneous reception Several (tranquilizers and antidepressants, neuroleptics and any anticonvulsant drugs). Based on the diagnosis and controlling your somatic state, the specialist will select drugs that can add each other and will not have a negative impact on the human body.

4. It is impossible to stop the reception of antidepressive drugs suddenly and without consultation with a specialist, as this may aggravate the flow of depression and cause various unpleasant physiological reactions.

5. Many ask whether it is possible to drink together. In all the instructions for drugs it is stated that it is categorically unacceptable, as it can lead to serious damage to the nervous system, up to death.

Cancellation syndrome or addiction?

In the event that you have taken antidepressants for a long time, and then for any reason, there is sharply discontinued, there may be unpleasant sensations, such as emotionally unstable behavior, increased fatigue, muscle pain, dizziness. All these symptoms are known as the abolition syndrome of antidepressants.

That is why doctors recommend gradually reduce the adopted dose of drugs and do it under the supervision of specialists. Only professionals will help relieve unpleasant sensations, choosing the necessary norms and drugs based on plants. If the drug was taken uncontrollably, and then his reception was discontinued, such a cancellation of antidepressants could lead to sleep disorders, increased anxiety, as well as problems from the cardiovascular system. In addition, the following symptoms may occur:

• caught fears;
• flu-like symptoms;
• nausea, vomiting;
• spasms and pain in the gastrointestinal tract;
• loss of coordination and dizziness;
• nightmares;
• tremor limbs.

Instead of imprisonment

Of all the above, it is possible to conclude how strong such drugs are rather dangerous, which antidepressants are, that these are modern drugs that can cope with depression. However, before starting their acceptance, be sure to consult with a specialist - a psychiatrist or a psychoneurologist who can find out what form of the disease you are and what medicines will help to cope with it.

Antidepressants are faster in everyday life of many residents of Russia. And despite the fact that in the professional community there is a consensus on their effectiveness in the treatment of depression, in Russian society, the use of antidepressants is not considered to be something healthy. Many of those who take these drugs hoping to improve their mental condition, face misunderstanding from relatives and friends who often consider them a reception to priest or even the result of a conspiracy of pharmaceutical companies. The Village asked the scientific journalist Svetlana Yastreb to explain how antidepressants actually work, whether their distribution is worthwhile and why the myths about inefficiency are born around them.

Global trends

Since the beginning of the 2000s, the frequency of applying antidepressants has grown in almost all countries. In 2000, Most often these drugs were used by residents of Iceland: 71 people from a thousand were recognized that they regularly apply them, and in 2011 this number increased to 106 people per thousand. In Canada and Australia, the indicators are not much better: in 2011, 86 and 89 people from a thousand, respectively, were resorted to the help of drugs against depression. Scandinavians and other Europeans lagged behind, but not much. Residents of Eastern European countries avoid a permanent reception of antidepressants, but they often enjoy one of them (frankly, it does not have a special meaning to health). Women treat depression more often men, and bisexuals - more often homo- and heterosexuals. In Russia, alas, there is no accurate data.

Process chemistry

Definitely faithful answer to the question "What Causes Depression" is not, and it is unlikely that he will soon appear. There are several theories of the emergence of depression, and most of them are somehow tied to neurotransmitters - substances transmitting a signal from one nervous cell to other nervous or muscle cells. The most popular hypothesis is serotoninic. She says that sick depression is either violated by the production of serotonin, or his perception. Most drugs against depression are designed to eliminate this problem. Some of the newest and frequently used - selective inhibitors of serotonin reverse seizure (SSRS). They delay serotonin molecules in the slot between two nerve cells, as a result of which the neurotransmitter effect is manifested longer and stronger. There should be no act to work on other neurotransmitters.

The means of previous generations have more side effects. This, for example, monoaminoxidase inhibitors (Mao) - enzyme, destroying serotonin and dopamine. Since the two of these neurotransmitters act not only for mood, but also for many other processes in the body (for example, serotonin enhances the intestinal peristalsis, and also narrows the vessels, due to which to some extent it controls the erection), MAO inhibitors can give a wide variety of side effects. Therefore, they are applied much less often SIRES, and even then if possible in the clinic, under the permanent supervision of the doctor.

There is another opinion regarding the reasons for depression. It is known that when depressed is practically no new links between nerve cells. Probably, this is the cause of the disease. Maybe serotonin does not affect the mood at all, and only helps to run the enhanced formation of contacts between neurons. If this is so, it becomes clear why most antidepressants raise the mood not immediately after the first reception (like food and alcohol), but only in two weeks, and why the SIRES is sometimes helping with disturbing disorders that are not particularly connected with serotonin.

Why don't you choose antidepressants yourself?

First, you do not know what caused by depression specifically in your case. The chemistry of the process is generally known not to the end, and even more so determine on the eye, which system of neurotransmitters broke specifically in your case, will not come out. In addition, there are many clinical studies And their metaanalyzes that show: antidepressants help only if the severity of the disease is higher than the average. Most likely, a person who is actually able to help antidepressants, feels so bad that it is not capable of thinking about any kind of pill selection.

The severity of the depression of psychiatrists is determined in several ways. One of them is the so-called Hamilton scale. It is most often used in the study of the effectiveness of individual drugs. It includes 21 patient status. Each version of the answer gives a certain amount of points, and what they are total more, the harder depression. The maximum possible number of points - 23, light depression begins from 8, heavy - from 19. The medicine is considered effective if thanks to him the patient's account on the Hamilton scale will fall at least three points lower than from the "treatment" with the help of placebo. This fall does not occur in patients with depression easy and moderate severity.

Well, finally, like any substance that interferes in brain chemicals, any antidepressant has a lot of a variety of side effects - ranging from constipation and erection problems and ending with a realized desire to go away. Of course, the safest drugs from possible, and their direct and side effects investigated on animals and in the clinic. At the same time, no one canceled the so-called Publication Bias: in medicine, and in fundamental science, positive research results are more often published, and unwanted is silent. That is, no one lies, but someone does not heal. This is partly due to how the requirements of drug control organizations are heard to antidepressant manufacturers. For example, the Office of Food Control and Drug Administrations (FDA) in its documents takes into account only those side effects that were observed during the study and within 24 hours after its end. If anything happens to the study participant later this period, it will not be fixed anywhere.

Are there any ways to quickly find the right medicine?

Catad_Tema Depression - Articles

Depressed in general student practice (clinic, diagnosis, drug therapy)

Methodical manual for doctors
2006

Authors: Professor of the Department of Psychiatry, Narcology and PPK psychotherapy and PPS, D.M. PB Zotov, M.S. Umansky
Reviewer: head. Department of Medical Psychology and Psychotherapy Tyumen GMA, D.M. B.Yu. Adience

FGOU VPO "Tyumen Medical Academy of Roszdrava" Faculty of advanced training and PPS

The methodological manual considers the main issues of diagnosis, clinical features and dosage therapy of depression in general student practice.

Introduction

Depression- mental disorder, characterized by pathologically reduced mood with a negative, pessimistic assessment itself, its position in the surrounding reality, of its past and the future.

Depressive change in the mood, along with a distortion of cognitive processes, is accompanied by motor braking, a decrease in motivation to activities, somato-vegetative dysfunctions [Smlevich AB, 2001].

The importance of identifying and treating depression Related to the fact that it is:
- reduces the adaptive capabilities of the individual;
- worsens the course or provokes a somatic disease;
- increases the risk of complications and mortality in somatic pathology;
- violates the microsococial functioning of the individual (in the family, collective);
- reduces the quality of life;
- increases the risk of suicide;
- can lead to a decrease in social status and loss of work; Increases the risk of disabled.

Prevalence of depression In the overall population ranges from 3 to 6%, and among patients with clinically disconnected, typical forms of depression are detected for help, typical forms of depression are detected at least 12-25% of cases [Spelevich AB, 2001]. Among women, depression frequency ranges from 18 to 25%, among men - 7-12%, while the average duration of untreated emotional disorders is up to 6-8 months. Most often, depression is present in patients undergoing strokes, patients of cardiological and oncological clinics.

Prevalence of depression (%)

The diagnosis of typical depression forms in most cases does not represent difficulties, however, the low indicators of their detectability may be due to a number of reasons:
- Low doctor's awareness common practice about the depression clinic;
- "displacement" of diagnosis solely on identifying a somatic disease;
- Use of diagnoses: neuro-circulatory dystonia, diancephal syndrome, astheno-vegetative disorders, etc.
- prejudice of the patient and / or doctor against the statement of mental disorder

Clinic Depression

In the classic version clinical manifestations Depressed includes the following symptom groups:
- Limit of time, a duty officer of the general practice for a patient examination.

Factors affecting the development of depressionmay have different nature.

Among them can be allocated:
1. Psychodias - stress factors (conflicts in the family, at work, social).
2. Somatic diseases - may themselves determine the development of depression, to be their consequence or proceed independently of each other. Depression worsen the course of a somatic disease and at the same time, complicating the clinical picture, lead to an increase in the frequency of appeals for medical care and a significant number of unnecessary research.
3. Reception of medicines [Vane A.M., 2002]:
- hypotensive remedies - reserpine and its derivatives, clonidine, methyldop, beta-adrenoblastors - Obizant, propranolol, calcium channel blockers - nimotop, nymodipine;
- heart rate - cardiac glycosides from a group of drugs of vicecrowders, procanamide;
- hormonal agents - corticosteroids, anabolic steroids, oral contraceptives, progesterone, estrogens;
- drugs with anti-cultural effect - clonidine, barbiturates;
- analgesics and non-steroidal anti-inflammatory agents -Indetacin, fenacetin, butadion;
- antibiotics - cyclosporine, griseofullvin, nodium acid;
- anti-tuberculosis means - ethionamide, isoniazide.
4. Endogenous factors (violation of the metabolism of serotonin, norepinephrine, ACTH, cortisol, endorphins, etc.)
5. Organic CNS diseases (brain vessel damage during atherosclerosis, hypertensive disease, consequences of stroke, cranial and brain injuries, etc.).
6. Features of nutrition.

1. Reducing the mood, obvious compared to the inherent norm of the norm prevailing almost daily and most day. In this case, the state of low mood is little subject to change during the day. The decline in mood is often combined with anxiety. May also be observed:
- reduction / loss of interests and ability to enjoy (Angedonia);
- understated self-esteem and self-confidence;
- gloomy, pessimistic vision of the future;
- ideas of guilt and self-esteem;
- suicidal ideas, attempts;
- reduction of the ability to concentrate attention;

2. Somato-vegetative violations:
- increased fatigue;
- dizziness;
- violation of cardiac rhythm;
- dry mouth;
- constipation;
- decrease in appetite;
- reduction of sexual potency or frigidity;
- Violation menstrual cycle and etc.

3. Sleep disorders:
- fallback disorders;
- surface sleep with frequent awakening;
- nightmares;
- Losing sense of satisfaction from sleep.

In general practice, there are various options for depressive disorders, among which depressed depresses are prevailing with alarming violations. According to severity, light shapes are more common.

Typical version of simple depression It is characterized by the moderate severity of symptoms and the predominance of oppressed mood (sadness, despondency, sadness). Past, present and future perceived by patients in gloomy light. There are sleep disorders, a decrease in appetite, constipation. Patients complain of lethargy, fatigue. For the successful therapy of these states, the appointment of amitriptyline, azapane, fluoxetine, recrete, zipralex, pyrazidol, and other antidepressants in moderate doses (see Table 1) is sufficiently sufficient.

Anxiety-depressive version - The predominance of anxiety, obscure concern, insecurity in the future. Patients can not stop in one place for a long time, crossed with their fingers, bite nails. With a rather pronounced disturbing component of depression, psychosomatic symptoms are associated with more sharp vegetative dysfunction and predominance of sympathetic: tachycardia, sternum pain, shortness of breath (tachipne), sensation of air shortage, expansion of pupils, tremor, hyperhydrosis, pallor of skin, dry mouth, nausea, Diarrhea, a decrease in appetite, a feeling of heat or cold, insomnia (mainly difficulty in falling asleep), Niccountura, an increase in blood pressure and blood glucose.

ASTEN-Depressive Option It is characterized by the predominance of asthenic complaints, sensory hyperesthesia, emotional lability, a special type of asthenic thinking, in which a fast depletion is noted, the understanding of the complex relationship between phenomena, and common lethargy, weakness, fast fatigue, i.e. Elements of physical asthenia, but most important in the morning. Irritability easily replaces tears. The mood is reduced, motility and speech are somewhat slowed down, but its intellectual impotence is experiencing the most painful patients. When choosing preparations, preference should be given to antidepressants with a stimulating effect (imipramine, fluoxetine, anatherapy, cipralex).

Apato-depressive version - The forefronts of the lack of or reducing the level of motivation (motivation), interest in the surrounding, emotional response to the events, indifference, anellium or insufficiency of volitional impulses with the inability to overcome themselves, to make an effort on themselves, take a certain decision. In this embodiment, antidepressants with a stimulating effect are also preferred.

Options somatized depression

I. With violation of the function of the internal organs:

1. Cardiovascular and respiratory disorders - Most often found in somatic practice and qualified therapists as vegetual-vascular or neurocirculators of dystonia.

Patients impose complaints of dizziness, weakness, sweating, gulp headaches, compression / burning in the heart of the heart, tilt of heat, cooling limbs, lack of air.

Condition periodically can interrupt with raptuses with functional impaired cardiovascular and respiratory systems (pulse lability and blood pressure, arrhythmia, tachycardia, shifts for ECG, respiratory rhythm disorders), similar to attacks of angina, myocardial infarction, stroke, bronchial asthma, and accompanied by death .

2. Masks in the form of the pathology of the gastrointestinal tract. At the same time, patients presented mainly complaints about dyspeptic disorders (dry mouth, nausea, vomiting, meteorism, constipation or diarrhea) and pain in the abdomen. Functional disorders are usually found in the form of various discsion (spasms of pharynx and esophagus, dyskinesia of the biliary tract, thin and large intestines), spastic or atonic phenomena (spastic colitis, athony of a large intestine, etc.).

3. Disorders gOOD SYSTEM - Student urination, urinary for urination at night, impotence in men, frigidity in women, reduced libido.

Clinically clearly designed depressive disorders do not pose problems to identify general practitioners. Typically, difficulties occur in the diagnosis of so-called somatized, masked or licorived depression options characterized by dominance in clinical picture somatic and / or vegetative symptoms. With these states, patients with characteristic depressive symptoms are present in erased form or absent at all. Masked depressions can range from 10 to 30% of all chronically patients with general media practices (Mosolov S.N., 1995).

II. Allogical option- Complaints of pain manifestations of various localization dominate:
- Head and facial pains;
- toothache;
- back pain and spine;
- intercostal neuralgia;
- Lumbago et al.

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

Various paresthesias, neurological and muscle pain with sufficiently clear localization ("syndrome restless legs", Different ticks, muscle twitching, blefarospasm, etc.).

IV. Depression with the predominance of sleep disordersit is mainly in the outpatient practice. Patients presented complaints predominantly on sleep disorder, loss of feeling sleep and drowsiness during the day. At the same time, the fear may not fall asleep may acquire obsessive character. This option is often found at the beginning of the development of depression and in the future can be replaced by the appearance of more typical symptoms. In the therapeutic terms, doxyepin, Mianserin, Trazodon are well helped in dissenters.

Diagnosis of depression

Diagnosis of depression is largely based on the right collection and analysis of patient complaints, the abstract data of the disease and anamnesis of life.

Clinical interview with potentially depressive patients difficult processrequiring a certain patience and skill. This is due to the fact that many patients deny, do not realize or do not want to talk about their psychological problems and mental experiences and therefore directly questions about reducing mood, longing or alarm are usually negative. In addition, patients are often hampered to verbally state their mental state and use more familiar somatic terminology, i.e. Describe pain or senthenetics sensations of various modalities and almost always emphasize their unusual and communications with an emotional state (most often anxious or dreary experiences).

Therefore, the first question after listening to the patient's complaints should be the question of the impact of these symptoms on its daily life (whether they prevent his professional activities, study, family life, leisure). Here you can clarify whether the pleasure of entertainment gets.

The next task of the doctor is to clarify the characteristics of the patient's personality in order to exclude hysterical disorders or installation behavior (simulation). Then you can ask whether there are sleep disorders, appetite (there is no decrease in body weight), sexual sphere, mood oscillations during the day. And finally, it is necessary to specifyly clarify whether the circle of interests of the patient narrowed, how pessimistic he evaluates his situation (as well as the future and the past), did the development of symptoms of any unpleasant (stressful) events, etc. were preceded by the development of symptoms. Complaints in a complex with answers to these questions in most cases allow the doctor to determine the presence or absence of depression in the patient.

In order to develop further treatment tactics, it is important to understand the relationship of affective disorders with the main somatic pathology. In this case, the following options can be distinguished:
1) a somatic disease was directly caused by depression (for example, hypothyroidism often causes depressive symptoms);
2) Somatic disease accelerates the development of depression in predisposed personalities (for example, Cushing's disease contributes to the emergence of a depressed depressive episode):
3) Depression develops as a reactive state to a severe somatic disease (for example, under cancerous diseases, myocardial infarction, etc.);
4) Somatic disease and depression are not related to each other.

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

Improving the condition or complete cure of the somatic disease does not always lead to the disappearance of depressive symptoms. In 60% of patients with complete reduction of depressive symptoms, the forecast of the course of somatic pathology does not occur in the persistence of depression significantly deteriorates. Therefore, in the absence of an effect from adequate somatic therapy for a sufficient period of time or if the patient has an incurable chronic illness (Diabetes, rheumatoid polyarthritis, cancer), under medical control, and the persistence of depression should begin to conduct an appropriate thymoyless and psychotherapeutic effect.

Preferred selection of antidepressant depending on the nature of depression

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

This group of medicines is customary to divide on 3 main categories:
1) antidepressants with a stimulating effect (preferred in depression with asthenic, apathetic components);
2) antidepressants of a balanced action (have a wide polyvalent spectrum of action);
3) antidepressants with a sedative effect (preferable to depression with an alarm affect and dysphoria).

Somogenic depression can be divided into organic, developing due to morphological changes in the brain, and symptomatic, accompanying non-metropralic somatic diseases or resulting from the effects of any substances (drugs, narcotic, etc.).

Clinical classification Antidepressant
[S.N. Molos. 1995] *

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

Antidepressants - Sedatika
Amitriptyline (tripotisol)
Mianserin (Lerivon, Tollon)
Azapane (Pipophhesin)
Alprazolam (Ksanaks, Cassadan)
Flouquamine (Fevarin, Phloxifral, MIRINSIM)
Femoksian (Malexyl)
OPIPRAMOL (Insidol, Pramalon)
Medifoxamine (Kreedil, Gerdaxil)
Medazopan (serzon)

Antidepressants of a balanced action
Venlafaxin (Effekt)
Maprotilin (Ludiomil)
Nonoxiptilin (Agnedal, Nijell, Dibenzoxin)
Dibenzepine (Ekatarl, Novyl)
Tianeptine (older, coaxil)
Midalcipram (Milnacipram, Ixel)
Propiispin (Vagran)
SERTRALIN (COLORF)
PAROKSETHIN (Rexetin, Paroksetin, Paksil)
Klomipramine (Anafranil, Gidifen)

Antidepressants - stimulants
S-adenosylmethionine (heptral)
Iprindol (Galatur, Prondel)
Inasan (metraldol)
Imipramine (melipramine)
Northriptyline (Northrilene)
Prodriptaline (Concordin, Vivactile)
Citalopram
Fluoksetin (Prozak, has done)
Indostan
Synophen
Niiamid (Nuderal)
IPRONIZID (IPRAZID)

A. Symptomatic depressed

Depression for Ischemic Heart Disease Most often occurs in patients who have undergone myocardial infarction (up to 65%). These depressions are prone to protracted flow and, as a rule, continue at least a year. At the same time, compared with the usual flow of the post-infarction period, these patients have a higher level of disability, suicidal attempts and mortality. For these patients, it is characterized by fixing on anxious and pain, the development of cardophobia and expectation anxiety.

With a masked depression, painful syndrome rarely wears an approaches and does not depend on the physical voltage. Such patients are more often preferred to stop pain with validol or valokardine, and not nitroglycerin, which is poorly transferred and does not bring the desired relief.

The main rules for the use of antidepressants in cardiological practice are not different from those in the treatment of depression and mooring disorders. When choosing a drug, first of all, it is necessary to be guided by the correspondence of the spectrum of its action by the psychopathological structure of depression, i.e. With the predominance of fear, anxiety, concerns, phobic education, apply sedative antidepressants (amitriptyline, azapane), and with the predominance of longing and other nuclear hypothic manifestations (sad, depressed mood, Angedonia) - preparations with balanced properties and a distinct thimoanalestic action (recreteen, fluoxetine, Fluvoxamine et al.) And, finally, with the predominance of apathetic, asthenic and adamic manifestations of depression - antidepressants with a stimulating component of action (imipramine, fluoxetine, cipralex).

The best effect of antidepressants is observed when the stress angina. In the process of therapy, in addition to the relief of the actual depressive and alarming-phobic manifestations, the severity of pain syndrome decreases (decrease in the duration and intensity of pain in the heart of the heart) and a decrease in the number of angina attacks.

The course of antidepressant therapy is 1-2 months, but with a good effect (decrease in the severity of depressive symptoms and angina, as well as the absence of side effects) treatment in a complex with anginal therapy should be continued for several months. Reducing the dose and discontinuation of antidepressants should be carried out gradually in order to avoid pinshegetative manifestations of cancellation syndrome.

With hypertension Typical depressive syndromes with decorated adhects of longing, anxiety or the distiliac character of the affect are developing. Often joined the alarming-phobic (including panic), obsessive-phobic and hypochondriac disorders. In remote stages of the flow of hypertensive disease, dysphoric affective disorders associated with emerging psycho-organic syndrome can act on the fore.

The choice of antidepressant in hypertension is determined by three main factors:
1) the phenomenology of depression in accordance with common principles Timanalented therapy;
2) the severity of the hypotensive effect of the drug;
3) interactions with various hypotensive means.

In order not to strengthen the action of basic therapy, it is desirable to choose drugs with minimal hypotensive properties of the type of selective inhibitors of the presynaptic seizure of serotonin (fluoxetine, fluvoxamine, rexetin, sertraline, cipralex, etc.), Mianserin (Lerivon, Miancan), Pyrazidol, Docepina, etc.

With ulcer of stomach and duodenal gut Depressive symptoms are detected in the form of shallow disturbing and alarming-phobic (including carcercphobic) or anxious and hypochondriatic experiences with characteristic dentalalgic manifestations (burning, pressure, stupid pain). In some patients, hypochondriacification on their sensations reaches a superssense level. The presence of depression significantly complicates the course of ulcerative disease. Almost constantly observed nausea, vomiting, constant burning in the abdomen, not to the effects of ordinary anti-sized drugs. In this case, the severity of clinical symptoms often does not correspond to (exceeding) the actual changes found in the gastrointestinal tract, for example, when endoscopic study. Therefore, the correction of mental disorders is essential for the success of the whole treatment in general. The main role among psychotropic drugs in the complex therapy of patients ulcerative disease It belongs to tranquilizers (diazepams, phenases) and neuroleptics (eglonyl, phrenolone, etc.). However, with the appearance of distinct depressive, anxious-phobic or hypochondriac symptoms, the accession of antidepressants is also important. A good effect is observed when applying antidepressants with a sedative effect (trimipramine, doxypin, azapane, amitriptyline) and preparations of a balanced action (Rexetin, Anafranil, Tsipralex, people and others).

When appropriating antidepressants, during gastroenterological diseases, it is necessary to choose preparations with minimal side effects (especially gastrointestinal) and the absence of drug interactions with anti-sized means.

With bronchial asthma Often develop various degrees of depression, mainly with typical alarming-phobic or hypochondriac symptoms. At the later stages of the development of the disease can be joined by obsessions. It is important to note that, in contrast to the widely recommended in such cases to relocate the alarm of tranquilizers (phenases, Sedudxen, etc.), which oppress the respiratory center and worsen the pulmonary function during obstructive state, heterocyclic antidepressants (amitriptyline, people, azapane, etc.) are capable Improve the respiratory function and reduce the phenomena of bronchospasm. In patients with a distinct agoraphobic component, a good effect is observed when appointible anatherapy, recrete, fluoxetine, set-up, ciprax, etc. in standard doses.

For sugar diabetes Depressed depressions are 2 times more often than with other somatic diseases. Moreover, the prevalence of depression is the same among patients with insulin-dependent and with an insulin-dependent form of diabetes; more often found in women. Diabet depression is prolonged and have a tendency to recurrence. On the early stages Diabetes are more likely astere-depressive and disturbing depressions, and at remote stages, hypochondriac and obsessive-phobic depressive states are observed. The focus during the diagnosis of depression should be given to identifying its cardinal symptoms (reduced mood, annemonium, longing, anxiety, ideas of low value, an unpromising vision of the future, etc.).

In diabetes, it is better to use selective inhibitors of serotonin reverse seizure, since they have better physiological tolerance (recrete, Ixel, Cipraleks, etc.). A good effect is observed when applying reversible inhibitors of Mao (pyrazidol, moklobemoid, etc.).

In the oncological clinic Various degrees of severity are psychogenic depressive violations are found practically in all patients at the diagnosis setup. The symptoms lasting for 1-2 weeks after the detection of the disease should be considered as an adaptation reaction, and the main method of assistance in most patients is psychotherapy. In the event of a pronounced depressive violations, the question of the appointment of antidepressants is individually solved.

In the subsequent period, special methods of antitumor treatment (operation, chemo-treatment), tumor intoxication, pain syndrome, factors of social disadvantage can have special methods for the development or maintenance of depression. These patients are distinguished by not so much hypothic affect, how much is a dysphoric mood, feeling of helplessness and hopelessness, reduced self-esteem and desire to die. In these patients, there is a good effect when prescribing heterocyclic antidepressants (amitriptyline, imipramine, azapane, anatherapy, etc.) and brocators of the inverse seizure of serotonin (recreteen, cipralex, and ixel, etc.).

It should be noted that the indication for the use of antidepressants during oncological pathology may be painful syndrome, since most of the anidepressants, acting on the central mechanisms of pain, themselves cause an anti-solid effect, as well as can potentiate the effect of central analgesics.

In chronic pain syndromesantinocyptive effect of antidepressants can be implemented in three main mechanisms:
1) reduction of depression;
2) the potentiation of exogenous or endogenous analgesic substances (opiate peptides, etc.);
3) own analgesic effect.

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

Analgesic effect is observed when applying tricyclic antidepressants (amitriptyline, anatherapy), noradereginic drugs (desipramine, people) and selective inhibitors of serotonin reverse seizure (recreteen, cipralex, ixel, etc.).

B. Organic Depression

Under cerebral stroke or infarction Depression is observed up to 40% of cases and last an average of about 1 year. In the pathogenesis of these depressions, depending on the localization of the cerebral catastrophe, the proportion of psychogenic and organic components is different. Of psychotropic drugs, with these violations, mainly drugs of neurometabolic action (nootropics) and tranquilizers are used. Antidepressants are more effective in distant stages of the disease, if depression persists, despite the objective improvement in the impaired motor and cognitive functions. In these cases, it is usually sufficient to assign antidepressants with a balanced or sedative effect (recrete, azapane, etc.).

A number of patients in the post-duty period develops "pathological crying syndrome" - sudden attacks of crying, provoked by the slightest occurrence, which are accompanied by specific facial paroxysms and may unexpectedly replace the uncontrolled laugh. This phenomenon is experiencing patients. A good therapeutic effect in these patients can be achieved when appointing small doses (50-75 mg / day) amitriptyline and fluoxetine and cytital (in standard dosages).

Depression for Alzheimer's Disease It is noted in 30-40% of patients. In the early stages of the course of the disease in the genesis of depression, reactive components are involved, which in subsequent periods can even disappear. Most often there are alarming, anxious and hypochondriac and complex depressive-delusional states. In these cases, along with specific therapy, antidepressants with selective action (fluoxetine, recreteen, cytitalopram, etc.) can be used.

Depression for epilepsy It is observed in 19-31% of patients who are characterized by short (from 2 to 6 weeks) depressive episodes with a dysphoric color. The use of antidepressants is mainly aimed at the correction of dysphorous, especially with the asthenic forms that are accompanied by the depression of mood, irritability, sometimes more distinct longing or anxiety, as well as dental-ipochondriac inclusions and vegetative symptoms. Among the antidepressants are preferred amitriptyline and doxypin, applied against the background of anti-epileptic therapy.

Characteristic of some antidepressants
[S.N. Mosolov, 1995]

Azapane (pipophhesin) - antidepressant of the tricyclic group, has a distinct antiserotonin -ergic effect; Holinolithic activity is practically absent.

Azapane refers to "small" antidepressants and combines moderate thimoanaleptic and sedative (tranquilizing) effects.

The main target of Azapane is the states flowing with a decrease in the mood in combination with asthenic and other negros-like symptoms - affective violations in the form of irritability, emotional lability, tendency to mood fluctuations in different ranges - from light emotional instability to quick-temperedness, exposiveness, incontinence.

Patients whom asthenic and depressive phenomena are also sensitive to the azapane, with infringement, lethargy, adamicacy, reduced energy potential. It is also used to treat symptomatic depresses in alcoholism and correction of sleep disorders during outpatient depressions, since the drug has a soft hypnotic effect. The drug is used in vascular, somatogenic, reactive depressions, neurotic asthome-depressive states, depressive states of climacteric age.

Azaphen is prescribed inside with a gradual increase of up to 75-200 mg / day (the initial dose is 25-50 mg). The dose is evenly distributed to a three-time reception. The presence of a tranquilizing effect allows you to prescribe a drug in the evening. After reaching therapeutic effect The dose is reduced gradually up to 75 mg / day, which is often preserved with outpatient therapy as supportive therapy.

The drug is well tolerated by patients and only in rare cases causes side effects (dizziness, nausea, vomiting), which quickly disappear when the dose is reduced. Azapane does not have cardiotoxic and cholinolitical effects. Due to this, the drug was widely used, first of all, in outpatient practice, as well as in elderly and somatic weakened patients.

Azapane can be combined with neuroleptics, tranquilizers and other antidepressants, with the exception of irreversible Mao inhibitors.

Ixel (Milnacipran) - a new antidepressant, selectively inhibiting the inverse seizure of serotonin and norepinephrine (SOSIRSH) without direct influence on postsynaptic receptors, which increases its effectiveness relative to antidepressants, affecting the serotonergic system (SSRS).

Ixel has a balanced action, is an antidepressant of choice for therapy of all types of depression, including depressive disorders with the predominance of anxiety and high risk of suicide, as well as depressive disorders in socially active patients with the predominance of psychomotor inhibition and adamis.

The selective mechanism of action contributes to the earlier attack of the Timoyanalente effect than traditional antidepressants, and the best tolerance profile - Ixel does not cause sexual disorders, does not negatively affect the cognitive functions and the activities of the cardiovascular system. Ixel does not interact with the cytochrome P450 system, therefore it can be combined with most of the drugs most often used in psychiatry and during therapy of somatic diseases. Ixel does not strengthen the sedative effect of alcohol.

When evaluating the Hamilton and MadRS scales in the process of treatment with Ixel, it was shown that the drug significantly reduces the severity of suicidal trends: the actual number of successful suicides in patients receiving Ixel is approximately 3 times less than in the placebo group.

Ixel has a high degree of security in overdose: during clinical trials there were cases of intentional overdose of a drug exceeding 2800 mg (i.e., 28 times more than the recommended daily dose). None of these cases became fatal and did not lead to violations of heart rhythm or coma.

Currently, there is no data on a possible teratogenic or fetotoxic action of Ixel. Its use is not recommended for pregnancy and during lactation. With caution should be used by Ixel at an increased risk of developing dizuriya; It is contraindicated in the hyperplasia of the prostate gland and the presence of dysuria.

You can not apply simultaneously with MAO inhibitors. Ixel can be prescribed no earlier than 14 days after the abolition of Mao inhibitors. In addition, from the moment of cancellation of the drug Ixel before the start of therapy inhibitors, MAO should pass at least 7 days.

Dosing mode: Starting dose - 7-8 days 50 mg per day (1 caps 25 mg 2 times a day during meals). Subsequent reception 100 mg per day (1 caps 50 mg or 2 caps 25 mg 2 times a day).

Form release: capsules 25 mg No. 56; Capsules 50 mg No. 56.

Rexetin (Paroksetin, Paxil, Aropax) is the most specific and most specific brocade of serotonin inverse selection among selective serotonergic antidepressants and introduced into clinical practice during recent years. Like other drugs of a group of selective inhibitors, it affects the main receptor systems, with the exception of muscarinic, and, therefore, has a moderate cholinolitical action.

The main components of the profile of the psychotropic activity of the drug are Timanalenic and anxiolytic effect with a rather distinct stimulating effect. The drug is equally effective both in classical endogenous and neurotic and reactive depressions. Unlike other antidepressants of the new generation, recreteen can be successfully used in severe cases (both with dreary and under the inhibited versions), not inferior by imipramine efficiency and even ahead of it in the speed of action (1-2 week of treatment). The reduction of symptoms gradually increases for several weeks and even months. Moreover, the drug is often effective in patients resistant to tricyclic antidepressants.

The drug has good effect With anxious states with depressive symptoms and does not cause hyperstimulation, enhancing agitation or sleep disorders. Rexetin significantly reduces suicidal thoughts; It is capable of improving the sleep of depressive patients already in the early stages of treatment, without causing daylights or inhibition. The positive effect of rexetin is also detected in the pain in patients with diabetic neuropathy.

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

Applied doses range from 10 to 40 mg / day. The most optimal dose providing almost complete absence side phenomena and high therapeutic efficacy, it is considered 20 mg / day (reception with food in the morning of 1 tablets 1 time per day). If this dose is exceeded, more often than other side effects are nausea, dry mouth, constipation and other dyspeptic disorders, drowsiness, sleep disorders, sweating, acceleration disorders.

The combined use of recreteen with Mao inhibitors, as well as in patients with phenomena of renal and hepatic insufficiency and increased sensitivity to the drug. The drug is not recommended to be used during pregnancy and lactation.

Preparations of other groups

Mexidol (3-Oxy-6-methyl-2-ethylpyridine succinate) is a modern domestic drug belonging to the group of antihypoxants and direct-action antioxidants. The drug passed clinical trials under the conditions of the Farmacology of the RAMS, the Research Institute of Neurology of the RAMS, SSC of Social and Judicial Psychiatry, the Narcology Research Institute and separation of the Herontological Psychiatry of the National Institute of RAMS with a proven soft tranquilizing effect.

Mexidol has a wide range of pharmacological activity, has a neuroprotective, antihypoxic, antioxidant and anti-storage effect. The drug increases the organism resistance to the effects of various stress factors (hypoxia, ischemia, reperfusion, inflammation, shock, intoxication, including various drugs). Mexidol is effective under different types of hypoxia, protects the nerve cells from the death caused by ischemia, normalizing the metabolism of cerebral tissue, improves the absorption of oxygen in the brain tissue, enhances the aerobic glycoliz in the brain, increases the resistance of the body to oxygen-dependent pathological processes, increases the threshold of the sacriveness of the brain, improves Functions, reduces the toxic effects of alcohol.

At the same time, mexidol has a property to stabilize the membranes inherent in all 3-oxypyridine and, in contrast to all exogenous acid preparations, facilitates the penetration of the molecule into the cell and the use of the residue of pyridine and succinate as energy substrates. It is shown that in the presence of mexidol there is an activation of the succinoxidase oxidation path, which, under the conditions of limiting over-dependent oxidation in the early stages of hypoxia, it allows you to maintain a certain level of oxidative phosphorylation in mitochondria. The activation of the succinoxygenase oxidation route for hypoxia helps to increase the resistance of brain cells, myocardium, liver to the oxygen deficiency and determines the mechanism of the antihypoxic effect of succinate-containing oxypyridine derivatives. Mexidol inhibits peroxidation oxidation due to an increase in the backup capabilities of the antioxidant protection system, favorably affects the lipid blood spectrum and the aggregation activity of platelets, reduces increased hemostatic activity by increasing the deformability of red blood cells, reducing blood viscosity. It has anxiolytic, anti-storage, nootropic, anti-alcohol, cerebroprotective, anti-cell, anti-parkinsonic and vegetative effect.

Mexidol action mechanism, in addition to inhibiting the free radical oxidation of membrane lipids, is associated with an improvement in the energy exchange of the cell, activating the energy-sensing functions of mitochondria, the effect on the content of biogenic amines and the improvement of the synaptic transmission. The key elements of the drug action also include the modulation of the receptor complexes of the brain membrane - benzodiazepine, GAB-Ergic, acetylcholine receptors, strengthening their ability to bind.

Mexidol possessing a distinctly pronounced tranquilizing effect, contributes to the rapid reduction of emotional stress, anxiety, asthenic and vegetative disorders, as well as provides the therapeutic effect in the disorders of the premunity, post -ssing and, especially, intransicious nature, increases the coefficients of social adaptation. This allows the drug in the treatment of various emotional disorders, alcoholic withdrawal syndrome with somato-neurological and mental signs, encephalopathy of various genes (diabetic, post-traumatic, etc.).

Mexidol has the ability to have a potentiary effect on the effects of other neuropsychotropic drugs. Under its influence, the action of antidepressive, translissal, neuroleptic, sleeping pills, anticonvulsive and analgesic agents is enhanced, which reduces their doses and thus reduce side effects. The use of mexidol in comprehensive depression therapy allows to overcome the pharmacological resistance of depressions.

In the border psychiatry testimony to the use of mexidol are:
alarming disorders in neurotic and neurosis-like states;
light cognitive disorders of etterosclerotic genesis;
intoxication of ethyl alcohol and the relief of alcohol abstineent syndrome;
acute intoxication by antipsychotic means (neuroleptics);
exogenous organic diseases of the brain (as a result of previously transferred neuroinfections, cranial and brain injury, etc.).

Mode of application: Mexidol is prescribed intravenously (inkjet or drip), intramuscularly and inside. In the intravenous method of administration, the drug is bred by water for injection or isotonic solution of sodium chloride. Intravenously embedded mexidol introduces 1.5-2 minutes, intravenously drip - at a speed of 80-120 drops per minute.

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

With neurotic and neurosis-like states. Mexidol is used by 100-200 mg (2-4 ml) intravenously inkjet 10-16 ml of 0.9% NaCl solution, daily - 10 days. It is possible intramuscular administration of a drug of 200 mg (4 ml), daily, 15 days. After injections, it is advisable to appoint a tablet forms of 0.25-0.50 g per day. The daily dose of the drug is rheaforized by 2-3 receptions. The course of treatment is 26 weeks. Currency therapy finishes in this case gradually, reducing the dose of the drug within 2-3 days.

With alcohol abstinence syndrome. Dosing mode: 4-400 mg (4-8 ml) intravenously, dividing into two receptions, by 16.0 ml of 0.9% NaCl solution, daily, within 10-15 days. Further, it is possible to transition to intramuscular administration of the drug at a dose of 200 mg (4 ml), daily, within 10 days, followed by a transition to a tableted form of 0.125-0.250 g two or three times a day, 4-6 weeks.

With cognitive disorders of atherosclerotic genesis

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

Contraindications for the use of mexidol: acute disorders of the liver and kidney function; Increased sensitivity or intolerance to the drug.

The interaction of the drug with other drugs is installed. Mexidol will potentiate the effect of tranquilizers, analgesics, anticonvulsant and anti-parkinsonic agents, reduces the toxic effects of ethyl alcohol.

Release form: a solution for injection of 5% in ampoules in 2 ml No. 10; Tablets covered with shell 125 mg number 30.

Bibliography:
1. Alexandrovsky Yu.A. Border Mental Disorders: Tutorial. - M.: M, 2000. - 496 p.
2. Vane A.M., Voznesenskaya T.G., Golubev V.L., Dyukova G.M. Depression in neurological practice (clinic, diagnosis, treatment). - M.: Mia, 2002. -160 p.
3. Gyindikin V.Ya. Somatogenic and somatoformous mentally disorders: directory. - M., "Triada X", 2000. - 256 p.
4. Mosolov S.N. Clinical application of modern antidepressants. -PB: Mia, 1995. - 568 p.
5. Spelevich A. B. Depression in general medicine: guide for doctors. - M.: Mia, 2001. - 256 p.

Moklobmeoid (Aurorix) - a selective inhibitor of Mao type A. is characterized by a distinct stimulating effect when depressed depressions. Shown at. Doses of from 300-600 mg / day are recommended, for the development of the TimoNaleletic effect it is necessary for two or three weeks. Contraindicated in disturbing depressions.

Befol. - original domestic with an activating effect (asthenic, aell depression). Used in the depressive phase. Middle therapeutic doses 100-200 mg / day.

Toloksaton (Humoril) is close in action to mocknesside, deprived of cholinolitic and cardiotoxic properties. Effective with depression with pronounced injector in doses of 600-1000 mg / day.

Pyrazidol (Porlindol) - an effective domestic antidepressant, a reversible inhibitor of the Mao type A. is used to treat both the inhibited daily depressions and depression with disturbing manifestations have no contraindications in the presence of glaucoma and prostatitis. Dosage preparations are 200-400 mg / day. Cholinolytic effects do not manifest itself, which allows you to prescribe a drug with cardiovascular pathology.

Imipramine (Melipramine) is the first studied antidepressant tricyclic structure. It is used to treat "large depresses with the predominance of sadness, inhibition, the presence of suicidal thoughts. When orally receiving a dose of 25-50 to 300-350 mg / day, parenteral administration (in the muscle, to vein) is possible, in one ampule contains 25 mg of melipraline, the daily dose at intramuscular administration 100-150 mg.

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

Anafranil - Powerful antidepressant obtained as a result of a directional synthesis and administration of the chlorine atom in the imipramine molecule. It is used for the treatment of resistant depression (psychotic options) in dosages up to 150-200 mg / day during oral administration, 100-125 mg / day for administration intravenously in cases of severe depression to relieve affective phases.

Perptuffran. - Dismetected imipramine, has a more powerful activating effect compared to it, is used in the treatment of depressions with depostelation. Dosage - up to 300 mg / day (in tablets).

Trimipramine (Herbon) is the most powerful antidepressant anti-exploitation action. Profile of psychotropic activity is close to. Average daily doses range from 150 to 300 mg. The drug, as well as, causes cholinolic effects (dry mouth, urination disorders, ortostatic hypotension) What to take into account when conducting coursework treatment.

Azapane (Pipofezin) - a domestic antidepressant, which is shown to treat small depressions of a cycloctimical register. It combines moderate tyrimaleletic and sedative effects. Maximum dosage of 300-400 mg / day with oral use.

Maprotilin (Ludiomil) - an antidepressant of the tetracyclic structure, has a powerful TimoNaleptic effect with an anxiolytic and sedative component. It is shown in typical circular depression with the ideas of self-evidence, it is used successfully for involutionary melancholy. Dosage - up to 200-250 mg / day with oral use. The drug is intravenously injected with resistant depressions to 100-150 mg / day (60 drops per minute per 300 ml of isotonic solution). Typically make 10-15 injections.

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

Fluoxetine (Prose) It has a distinct tyrimalenial effect with a predominantly stimulating component, especially effective in the presence of obsessive-phobic symptoms in the structure. Refers to a group of selective inhibitors of serotonin inverse seizure (SSRS), completely devoid of antihistamine, cholinolitic and adrenolytic effects of classical tricyclic. It has a very long half-life (60 h). It is convenient when treating the fact that it is assigned once a day at 20 mg along with the reception of writing a permissible dose - 80 mg / day. Course treatment at least 1-2 months.

Fevarin It has a moderately pronounced tyrimalenial effect, but the growing stabilizing effect is manifested. Applied doses - from 100 to 200 mg / day, assigned once a day in the evening.

Citalopram (Zipramil) has moderate thymotone properties with a stimulating component, refers to the SSRS group is prescribed once a day at a dose of 20-60 mg during oral administration.

Seraralin (Heal) does not possess cholinolitical and cardiotoxic properties, gives a distinct thimoanaleptic effect with: a weak stimulating effect. Especially effective with somatizable, atypical depressions with phenomena. Assign at a dose of 50-100 mg once a day, the effect is observed 10-14 days after the start of therapy.

Parksetin (Rexetin, Paksil) - Piperidine derivative has a complex bicyclic structure. The main properties of the psychotropic activity of the Paroksetin - TimoNaleptic and anxiolytic effect in the presence of stimulation manifestations. Effective both in classical endogenous and neurotic depressions. It has a positive effect both with dreary and under the inhibited versions, while not inferior in the activity of imipramine. Detected: the prophylactic effect of the paxyl with unipolar depressive phases. It is assigned once a day at a dose of 20-40 mg / day.

Sybalt (Duloxetine) is used to treat depressions with the presence, is appointed in capsules of 60-120 mg once a day.

Side effects

The side effect of these drugs is manifested by hypotension, sinus tachycardia, arrhythmia, intracardiac conductivity impaired, a number of signs of oppression of bone marrow functions (agranulocytosis, thrombocytopenia, hemolytic anemia and etc.). Other vegetative symptoms include dryness of mucous membranes, accommodation violation, intestinal hypotension, urination delay. This is most often noted when using tricyclic antidepressants. The use of tricyclic drugs is also accompanied by an increase in appetite, an increase in body weight. Preparations - inhibitors of the inverse seizure of seroton are characterized by greater safety, but can also cause headaches, insomnia, anxiety, depotentizing effects. With a combination of these agents with preparations of tricyclic rows, there may be phenomena of serotonin syndrome with an increase in body temperature, signs of intoxication, violations in the cardiovascular sphere.

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