Antidepressants: popular drugs, features of application
Jul 06, 2018
The first antidepressants were synthesized in the fifties of the twentieth century.Now pharmacological companies continue to work on the creation of new groups of antidepressants, taking into account modern scientific ideas about mental illness.These drugs affect the morbidly depressed mood that is observed with depression.Contents: How do antidepressants work?Kinds of antidepressants Indications for use of antidepressants Features of application Side antidepressants Popular drugs
How do antidepressants work?
Mental illness, including depression, is still an unexplored territory.There are many hypotheses explaining the nature of these diseases.According to the generally accepted monoamine theory of depression, the disease occurs due to a deficiency of monoamine neurotransmitters( serotonin, dopamine, noradrenaline).Accordingly, in order to overcome depression, it is necessary to restore the normal metabolism and balance of these neurotransmitters.This is the mechanism of action of antidepressants.
Neurotransmitters are substances that transmit information from a neuron to another cell( neural, muscular, etc.).The area of contact between these cells is called a synapse.Neuromeditors are formed in the presynaptic membrane of the neuron.Then from there they are released into the synaptic cleft - the space between neighboring neurons.Most of the neurotransmitters penetrate the adjacent neuron through the postsynaptic membrane.The smaller part of the remaining neurotransmitters is captured back into the presynaptic membrane.According to the monoamine theory of depression, with the disease there is an enhanced reverse capture of monoamine neurotransmitters, in particular serotonin.That is, neurotransmitters are produced, but do not reach their target.Because of this, mental activity is disrupted, apathy, bad mood appear.
This group of antidepressants as selective serotonin reuptake inhibitors( SSRIs) does not allow the presumptive membrane to re-capture this neurotransmitter.That is, the amount of serotonin in the synaptic cleft increases, respectively, the postsynaptic membrane receives it in the proper amount.So antidepressant effect is realized.
There is also such a group of antidepressants as monoamine oxidase inhibitors( MAO).Monoamine oxidase is an enzyme that breaks down monoamine neurotransmitters.Thus, the use of MAO inhibitors helps to suppress the activity of this enzyme, because of which the neurotransmitters do not break down and, accordingly, their concentration increases.
Kinds of antidepressants
There are various classifications of antidepressants. This is the classification according to the mechanism of action of the drugs:
- Drugs blocking the neuronal capture of monoamine neurotransmitters
- Non-selective( nonselective) actions that block the reuptake of serotonin and norepinephrine( Amitriptyline, Imipramine);
- Selective actions that block the capture of only a certain neurotransmitter:
- Blocking reuptake of serotonin, this group is also called SSRIs( Fluoxetine, Paroxetine, Citalopram);
- Blocking reuptake of norepinephrine( Maprotiline).
- Monoamine oxidase( MAO) inhibitors:
- Non-selective action( Nialamide);
- Selective action( Pirlindole, Moclobemide).
- Various( blocker of serotonin and alpha2-adrenergic receptors - preparation Mianserin, melatonergic receptor agonist - Valdoksan).
In addition, there is also a classification of antidepressants for the effect.In addition to the antidepressant effect, antidepressants have an additional effect: sedative or psychostimulating.Proceeding from this, antidepressants are mainly isolated with sedating effect( Amitriptyline, Mianserin), mainly with psychostimulating effect( Fluoxetine, Moclobemide).Also, antidepressants of balanced action( Paroxetine, Sertraline, Duloxetine) are isolated.These aspects the doctor takes into account when selecting a drug for a particular patient, because someone has depression with apathy, slowing of motor and mental activity, and someone with high anxiety and psychomotor agitation.
Indications for use
Already by the name of a group of drugs you can understand that they are used in the fight against depression.However, the range of prescription of modern antidepressants, namely, SSRIs is quite wide. They are also assigned under such conditions:
- Anxiety disorder;
- Panic disorder;
- Obsessive-compulsive disorder;
- Complex treatment of alcoholism.
Thus, antidepressants of SSRIs are widely used in general medical practice.Antidepressants appoint a doctor and only if there is objective evidence.
Many people are afraid to take antidepressants, even despite the doctor's prescription.They are guided by fears caused by popular myths about these medicines.So, many people think that antidepressants are drugs that you can not get off of.
Actually, antidepressants are not narcotic drugs.Their use can only affect the pathologically reduced mood.They do not cause euphoria, they are not able to raise the mood in people who are not depressed.That is, if a healthy person takes an antidepressant, he does not feel any effect.In addition, antidepressants do not cause dependence.
The use of antidepressants has its own characteristics.So we are arranged that we want one tablet to immediately get rid of unpleasant symptoms.However, with antidepressants this will not work.The fact is that the antidepressant effect with the use of this group of drugs occurs about two to three weeks later.
Much more previously implemented an additional action of the drug: soothing or stimulating.It is thanks to this that antidepressants of SSRIs are used in the treatment of anxiety disorders, because anxiety and anxiety decrease rather quickly.
Please note! Due to the fact that the antidepressant effect does not develop immediately, many people stop taking the medication on their own, considering it useless.You can not do this.The effectiveness of the drug can be accurately told after a month.If the medicine really turned out to be ineffective, the doctor will replace it with another medicine.
The dose of the medicament is increased gradually, achieving the necessary clinical effect.That is, the dose is selected individually for each patient.The course of taking antidepressants is quite long.Initially, their application is aimed at eliminating the painful condition, it takes an average of two to three months.After elimination of depressive symptoms, antidepressant medications do not stop and as a supportive therapy take another four to six months.In case of normalization, the doctor cancels the drug.This should be done in a measured way, gradually reducing the dose of the medicine.In general, the course of taking an antidepressant is at least six months.Sometimes treatment can take a year or even two.
Important! The way to recover from depression can be quite long, but do not give up.Observing the doctor's instructions and working on yourself, you can get rid of painful symptoms and rejoice in life again!
First-generation antidepressants( tricyclic antidepressants, irreversible MAO inhibitors) had many side effects.These are constipation, urinary retention, orthostatic hypotension, tachycardia, edema, cardio- and hepatotoxic effects, headaches, tremor, erectile dysfunction.
Antidepressants of the last generation have fewer side effects, but they still need to be considered.First of all, at the beginning of treatment with the drug, there may be an increase in anxiety, anxiety, suicidal thoughts.This is due to the stimulating effect of the drug.To prevent this side effect, antidepressants are often prescribed with tranquilizers at the initial stage.Treatment should be under the supervision of a doctor.
Side effects of SSRI inhibitors are also associated with the fact that serotonin receptors are found in many organs. Stimulation of receptors can cause such side effects:
- Nausea, vomiting, diarrhea, constipation;
- Daytime sleepiness, insomnia;
- Rapid fatigue;
- Decreased sex drive, anorgasmia.
Side effects occur during the first weeks of treatment and tend to disappear as therapy continues.
Please note! The use of any antidepressant is associated with a risk of developing manic conditions.Therefore, antidepressants should be used with caution in bipolar affective disorder.
The most modern and widely used antidepressants are SSRIs.They are carried by patients much better than the antidepressants of other groups.Their use has fewer contraindications and side effects.In addition, they can be used not only with depression, but also with anxiety disorders.
A drug from the tricyclic antidepressant group( TCA).Produced in tablet form and solution for injection.The medicine quickly has a pronounced antidepressant effect.Also has a soothing, anti-anxiety, hypnotic action.
Amitriptyline is tolerated by patients worse than SSRIs. Its main side effects are:
- Dry mouth;
- Enlarged pupils;
- Impaired accommodation of the eye;
- Delayed urination;
- Tremor of the hands;
- Heart rate disturbances.
Amitriptyline is contraindicated with high intraocular pressure, cardiac conduction abnormalities, prostate adenoma, epilepsy.
The drug is not as widely prescribed as SSRIs.Amitriptyline is used in the treatment of severe endogenous depressions.The drug should be treated in a hospital under the supervision of a doctor.
This is a popular antidepressant from the SSRI group, also known under the trade name Prozac.The drug normalizes the mood, reduces anxiety and a sense of fear.However, in this case, fluoxetine is referred to psychostimulating antidepressants.Accordingly, it is prescribed for depression, occurring with a slowing of motor activity and thought processes.In patients with psychomotor agitation, expressed anxiety, the drug may aggravate pathological symptoms.It is prescribed for moderate depression, anxiety disorders.Suitable for outpatient treatment.
The drug does not cause orthostatic hypotension, it does not have a toxic effect on the heart, unlike Amitriptyline.In this case, taking fluoxetine is not without side reactions in general.It can be headaches, daytime drowsiness, nausea, vomiting, dry mouth.
Refers to the SSRI group, the active substance is escitalopram.It is indicated for depression and panic disorder.The antidepressant effect is formed approximately 2-4 weeks later.In the treatment of panic disorder, the maximum therapeutic effect can be achieved after three months of treatment.
With care, the drug is used to treat people with kidney failure, epilepsy, liver cirrhosis, diabetes mellitus.
The drug from the SSRI group has a pronounced anti-anxiety effect.The spectrum of application of Paroxetine is very wide: from depression to post-traumatic stress disorder.Preference is given to this medicine for anxiety disorders.With a depressive disorder with motor retardation, apathy, the drug can aggravate this symptomatology.
For Paroxetine, all typical side effects of SSRIs are inherent.Paroxetine is contraindicated in epilepsy.With caution, this medicine is prescribed for hepatic and renal failure, as well as for closed-angle glaucoma, prostate adenoma.
Grigorova Valeria, medical reviewer