Antidepressants are one of the most difficult groups of drugs for pharmaceutical consultation. Often associated with very specific disorders and sold strictly by prescription, they are shrouded in many secrets and speculation. Some patients are afraid of antidepressants, others have too high hopes for them. But both the former and the latter have many questions about how these medications will affect their lives. They ask these questions not only to the attending physician, but also to another person in a white coat - the head of the pharmacy. We have collected answers to the most popular of them in this material to help our readers, if necessary, build a capacious and correct consultation.
Explain in simple terms - how do antidepressants work?
Antidepressants are a group of psychotropic medications that affect the levels of neurotransmitters (they transmit nerve impulses between cells in the human brain), thereby helping to treat depression. We are talking about three hormones: serotonin, dopamine and norepinephrine. According to the prevailing point of view in scientific circles, with depression their concentration noticeably decreases, which is why the interaction between neurons is disrupted. Modern antidepressants help reverse this process, returning the brain to normal functioning. Thanks to this, patients experience the following improvements: improved mood, improved vitality, decreased anxiety and apathy, and normalized sleep and appetite.
When are antidepressants prescribed and why they may not be effective
Antidepressants, despite their name, are used not only to treat depression. They are also used for many other diseases: this is precisely explained by the fact that they affect a variety of processes in the body.
For depression and other mental disorders, antidepressants are also not always used. Scientists still do not know exactly all the features and causes of depression. If it were just a matter of a lack of neurotransmitters, then antidepressants would help everyone, but this is not the case. In addition, then drugs like amphetamine or cocaine would help with depression: they affect neurotransmitters and therefore cause a feeling of euphoria. But depression is a much more complex disorder in which different mechanisms are involved.
Therefore, the reaction to antidepressants is individual, but you should not refuse them. They help relieve severe conditions so that patients can cope with the disease. Antidepressants are usually not used on their own, but in combination with psychotherapy and other treatment methods. Sometimes you can do without them altogether - it depends on the patient’s condition. The doctor makes an appointment for each person individually.
What happens if during treatment the patient stops taking the prescribed drug?
It all depends on the situation. If the withdrawal is abrupt, there is a high risk that the body will not have time to adapt to the new regime, and the side effects will increase exponentially. This is called withdrawal syndrome and can be expressed in different ways. Most often, patients complain of dizziness, headaches, sleep disorders, spasms and tremors in the limbs. There is also a rebound syndrome, in which untimely withdrawal from the drug provokes the return of all the negative symptoms of depression. With gradual withdrawal, such consequences do not occur, so it is extremely important to adhere to the dosage regimen prescribed by the doctor.
Is depression a disease?
Depression is not the blues or a bad mood. This is a disease in which biochemical processes in the brain change. Symptoms of depressive disorder persist for 2 weeks or more. Sometimes the condition lasts for years, and the person does not even know about it.
True clinical depression is the result of impaired absorption or production of neurotransmitters - substances responsible for brain function and emotions. As a result, the person becomes apathetic and often has a bad mood.
Depression can be triggered by a traumatic event or prolonged severe stress. Risk factors include psychological violence in childhood or adulthood.
Often a depressive state occurs due to a lack of biologically active substances. Such symptoms are experienced by people with a deficiency of vitamin D, ferritin, and iron. Signs of depression are also observed when there is an imbalance of hormones due to a malfunction or endocrine pathology.
In some cases, depression can be caused by taking certain medications. This side effect should be recorded in the instructions.
Low mood and other symptoms of depressive disorder are sometimes associated with a lack of sunlight. Typically, the peak of such complaints occurs in spring and autumn.
Are antidepressants dangerous for the body?
As with any medicine, side effects may occur when taking antidepressants. Most often we are talking about drowsiness (and sometimes, on the contrary, insomnia), inhibition of reactions, hypotension. However, given that on the other side of the scale are often the patient’s thoughts about leaving life or causing other harm to himself, this is not regarded as a serious obstacle.
Some antidepressants are contraindicated for heart diseases (arrhythmia, conduction disorders in the myocardium), but there are drugs that are allowed to be taken even by people who have had a heart attack. A number of such drugs cannot be prescribed for pathologies of the kidneys and liver. Knowing the patient’s health characteristics, the doctor selects the most suitable option for him. Therefore, antidepressants can only pose a danger when self-medicated.
What types of antidepressants are there?
Antidepressants are a heterogeneous group of drugs.
There are several types of them: Selective serotonin reuptake inhibitors (SSRIs) . In some ways, this is the most popular type of antidepressant. It is with them that treatment is most often started, since they cause the least side effects and are most safe in high doses. This group includes drugs: paroxetine, fluoxetine, sertraline, escitalopram, citalopram.
Serotonin and norepinephrine reuptake inhibitors : venlafaxine, duloxetine, levomilnacipran, desvenlafaxine.
Tricyclic antidepressants . They are usually prescribed after other drugs have been tried and failed because they have significant side effects. This group includes: amitriptyline, imipramine, nortriptyline, desipramine, doxepin.
Monoamine oxidase inhibitors (MAOIs) have potentially dangerous side effects, so they are also used as backup drugs. This group includes: nialamide, iproniazid, isocarboxazid, tranylcypromine, phenelzine.
Atypical antidepressants include drugs that are not included in other groups: mirtazapine, trazodone, vilazodone, viortoxetine, bupropion.
These drugs are available with a prescription and can only be taken as directed by a doctor. Not all antidepressants work equally well in different patients. It is important to choose a drug or combination of drugs that will be effective in a particular case.
Is it true that once started, depression medications will have to be taken for the rest of your life?
Treatment with antidepressants is not a quick process, and its duration largely depends on the severity of the person’s condition. Typically, the course of taking these drugs lasts at least six months. If no improvement is observed after six months, the doctor may extend the course or change the drug. Therefore, you need to be prepared for the fact that you will have to take antidepressants for quite a long time. However, there is no talk of lifelong treatment: the patient will either begin to recover, and the need for antidepressants will gradually disappear, or will demonstrate resistance to them, and the doctor will choose a different strategy. There is also a WHO recommendation that antidepressants should be taken for at least another 9 months after the symptoms of depression have disappeared.
Does taking antidepressants guarantee a complete cure for depression?
Unfortunately no. Often, the causes of depressive disorders lie not in physiology, but in human psychology, so drug therapy has only a temporary effect, which gradually fades away after discontinuation of the drug. Knowing this, doctors usually use antidepressants as part of a comprehensive treatment that also includes psychotherapy sessions. However, some patients only need medication to recover. On the contrary, they don’t help some people. Depression is a very complex disorder, so doctors select their own treatment methods for each specific case.
Global trends
Since the early 2000s, the use of antidepressants has increased in almost all countries. In 2000, residents of Iceland were the most likely to use these drugs: 71 people out of a thousand admitted to regularly using them, and in 2011 this number increased to 106 people per thousand. In Canada and Australia, the figures are not much better: in 2011, 86 and 89 people out of a thousand, respectively, resorted to using medications against depression. The Scandinavians and other Europeans lagged behind, but not by much. Residents of Eastern European countries avoid taking antidepressants constantly, but often use them once (to be honest, this does not make much sense for health). Women are treated for depression more often than men, and bisexuals are treated more often than homosexuals and heterosexuals. For Russia, alas, there is no exact data.
Do antidepressants affect your sex life?
Strong antidepressants may indeed not have a very good effect on this delicate area of life in both men and women. Among the side effects of some tricyclic drugs is priapism - a prolonged painful erection not associated with sexual desire. More modern medications (MAO inhibitors) in some cases lead to anorgasmia and decreased sexual desire. This effect of antidepressants is considered a side effect, does not occur in everyone and disappears when the drug is discontinued and treatment is adjusted. Therefore, any sexual disorders that occur should be reported to your doctor immediately.
Is depression forever?
Due to the long course of the disease, there are fears that depression is forever. Actually this is not true.
You can get rid of mild depression on your own - survive the traumatic event, live through the emotions and recover. Without therapy, a condition that appears due to the use of certain medications also goes away. After they are cancelled, everything returns to normal.
If left untreated, depression can progress.
Moderate and severe conditions should be monitored by a doctor. The behavior of a sick person often increases symptoms, leads to the progression of pathology and deterioration of the condition. This is due both to the functioning of the brain and to the patterns that have developed throughout life.
With the right therapy, depression can be treated or stopped at any stage and for any duration. If the condition is caused by hormonal imbalances or a deficiency of biologically active substances, the symptoms will disappear after correction of the imbalance. In the case of psychogenic (caused by unpleasant events) and endogenous (arising from a malfunction of the psyche) diseases, specific treatment is required.
Are antidepressants compatible with alcohol?
During drug treatment of depression, alcohol consumption should be avoided. At the same time, different groups of antidepressants interact with alcohol in different ways. Mixing some (for example, tricyclic antidepressants) with alcohol can lead to serious consequences, including death. More modern drugs are not so dangerous in this regard. But MAO inhibitors, for example, can affect vasoconstriction (and therefore, indirectly, on erection), and can also enhance the effect of strong drinks and provoke, for example, damage to the liver or nervous system. Exactly how the drug interacts with alcohol is always written in the instructions. And in most cases this interaction is undesirable.
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