Drugs for depression – action, groups, rules of application

Drugs for depression are in many cases the basic and basic method of treating depressive disorders, regardless of their background. Psychotherapy and other non-pharmacological measures often turn out to be insufficient. What depressants are most often prescribed by psychiatrists? What is worth knowing about their safe use, operation and possible side effects?

Drugs for depression – characteristics and symptoms of the disease

Depression (from Latin “depressio” – depth, “deprimere” – to overwhelm) is a fairly broad concept that includes several similar disease entities, referred to as depressive disorders. Estimates of the World Health Organization (WHO) indicate that depression is the most common mental illnessover a dozen percent of the entire population suffers from it throughout their lives.

While many of us have used the term “depression” to refer to bad days and short-term depressed moods, the reality is that the clinical picture of depression is more complex. In addition to mood disorders, feeling sad and depressed, and deeply pessimistic thinking about the future, the symptoms of depression can also include:

1. sleep and circadian rhythm disorders – excessive sleepiness or insomnia, as well as daily fluctuations in well-being (usually patients feel worse in the morning and it is very difficult for them to start the day);
2. loss of joy in life and the ability to feel pleasure (anhedonia);
3. apathy and indifference to the environment, a sense of emptiness;
4. problems with controlling emotions, irritability and increased impulsiveness;
5. chronic fatigue and withdrawal from life activities, significant difficulties in carrying out everyday activities, until their abandonment (abulia) – the patient may not be able to get out of bed, wash or dress;
6. low self-esteem and depressive delusions about feelings of guilt or lack of future prospects;
7. problems with concentration, memory and other cognitive functions;
8. a significant decrease in sex drive (libido).

The symptom set does not always look the same, and depression can develop differently from person to person.

Symptoms of depression are (according to many researchers) the effect of disturbances in the field of neurotransmission in the central nervous system – they most often concern abnormalities in the transmission of serotonin, norepinephrine (norepinephrine) and dopamine. What is the cause of them? It is not fully explained and described – the underlying cause of depression can be very complex.

However, according to the traditional model, there are two basic types of depression:

1. endogenous depression – is characterized by the lack of a tangible external cause, such as stressful experiences or difficult life circumstances, it is often genetically determined;
2. exogenous (reactive) depression – is associated with various psychosocial factors or is preceded by traumatic, overwhelming circumstances, such as other serious illness, loss of a loved one, serious relationship problems.

The sooner we pick up on depression symptoms, the easier it will be to cure it. The treatment of this disease usually consists of pharmacotherapy, i.e. drugs for depression appropriately selected for the patient’s needs in a strictly defined dose, and psychotherapy in the current most appropriate to the individual conditions of the patient. Sometimes other measures are also included, such as occupational therapy, group therapy or various types of treatments improving the overall quality of life of the patient.

Find out more: Depression – who does it affect and why? How to cure depression? [WE EXPLAIN]

Drugs for depression – general information on use

Medicines for depression available on the Polish market often differ significantly in terms of active substances and auxiliary substances, recommended doses or possible side effects. However, there are some general rules for the use of such preparations, which should be followed in order for pharmacotherapy to bring the desired results.

What should i be aware of when taking medication for depression?

1. You should always stick to the doses prescribed by your psychiatrist, as well as the frequency and time prescribed. Medicines for depression have a strong effect on the nervous system, even in a small amount – so you cannot exceed the prescribed dose or skip one of them during the day. In order not to forget about the times of taking the medication, it is worth, for example, set up a cyclical notification on the phone or ask a loved one for help.
2. You must not stop taking medication for depression on your own (or start treatment yourself) without consulting a psychiatrist. The observed significant improvement in the patient’s condition does not mean that he or she does not need the drug, but on the contrary – it is a confirmation that the drug has been selected correctly and works as expected. Discontinuation of medication for depression on your own may lead to a recurrence of the disease and the frustration of the results of the previous treatment.
3. It is not always possible to choose the right drugs for depression the first time. If the patient does not notice any improvement after a few weeks of use, has the impression that his condition continues to worsen or notices disturbing side effects of using the drug, he should consult his psychiatrist as soon as possible in order to change the selected dose or change the drug used to a different one. bow.
4. Drugs for depression should not be combined with alcohol or any other consciousness-altering agents. Such a mixture is very dangerous and in extreme cases can even lead to the death of the patient. Therefore, you should refrain from drinking alcohol and avoid other stimulants when taking medications for depression.
5. Medicines for depression may also interact with other medications that the patient is taking, especially those taken continuously or over a long period of time.. Therefore, we must always inform the psychiatrist about all other drugs, dietary supplements or herbs that we take every day, so as not to expose ourselves to unpleasant health consequences.

Drugs for depression – dosage

Only after a thorough medical interview (sometimes also after conducting additional tests), the psychiatrist can decide whether the patient really needs pharmacological treatment, and if so, what substance will be the most beneficial for him and in what dose. Various factors are then taken into account, including a set of depressive symptoms occurring in a patient or comorbidities.

Usually, at the beginning of treatment, the minimum effective dose of the drug is used to minimize the risk of side effects. The decision on its possible increase is made not earlier than 2-4 weeks from the start of treatment. Medicines for depression affect complex cellular processes, so prior evaluation of the effectiveness of treatment is not reliable.

If, after 6-8 weeks of taking the maximum dose of a particular drug, no improvement in the patient’s condition is observed, a change of preparation is indicated. Usually, an attempt is made to replace a drug with another drug from the same group first, and if this does not work – after a few more weeks, a drug from a different group can be introduced.

In the first depressive episode, it is recommended to use drugs continuously for at least 6 months after symptoms have disappeared. The second episode of depression is usually treated longer – it is recommended to continue taking medications for 2 years after symptoms disappear. Subsequent episodes may be the basis for introducing the patient’s pharmacological treatment on a permanent basis.

Drugs for depression – what groups do we distinguish?

Depression medications can act in many ways on neurotransmitter abnormalities in the central nervous system. Due to the mechanism of their action, they are divided into several groups.

SSRIs – selective serotonin reuptake inhibitors

They are usually the group of drugs of first choice in the treatment of depression. The specificity of this group means that the return of serotonin to the nerve cell is impossible, thanks to which its concentration in the brain increases. The characteristic feature of SSRIs is also their anxiolytic effect – so they can help patients who suffer from anxiety disorders in addition to depression. The SSRI group includes:

1. citalopram;
2. escitalopram;
3. fluoxetine;
4. fluvoxamine;
5. paroxetine;
6. sertraline.

Selective serotonin reuptake inhibitors can cause side effects such as:

1. digestive system disorders: nausea, abdominal discomfort, loss of appetite;
2. sleep disturbances: insomnia or excessive sleepiness;
3. sexual disorders: decreased libido, problems with reaching orgasm;
4. weight changes (both increase and decrease);
5. hyponatraemia (low sodium in the blood);
6. very rarely – serotonin syndrome.

Also read: SSRI’s to help with depression

SNRI – noradrenaline and serotonin reuptake inhibitors

Depression drugs included in this group, as the name suggests, block the re-transport of norepinephrine and serotonin to nerve cellsso that the concentration of these two neurotransmitters increases in the brain. Moreover, SNRIs are characterized by an analgesic effect, so it is recommended to use them in patients whose depression is associated with pain. This group includes:

1. venflafaxine;
2. duloxetine;
3. milnacipran.

Symptoms of side effects are similar to those of the SSRI group. Due to the stimulation of norepinephrine levels, these drugs for depression can also cause increase in blood pressure. Hence, arterial hypertension is always a contraindication to the use of SNRI.

Find out more: What is Duloxetine and what is it used for?

TLPD – tricyclic antidepressants

The substances included in this group act not only on serotonin and noradrenaline, but also on other neuroreceptors. This makes the are associated with numerous troublesome side effects and they are rather abandoned today. Due to their strong effect, however, they sometimes turn out to be the only effective remedy in people who have not worked with drugs for depression from other groups. Still used drugs from the TLPD group are:

1. amitriptyline;
2. desipramine;
3. imipramine;
4. clomipramine;
5. nortryptylina;
6. doxepin.

The most common side effects of TLPD have:

1. somnolence;
2. concentration disorders;
3. difficulty urinating;
4. orthostatic hypotension (a sudden drop in blood pressure when standing up suddenly);
5. decrease in visual acuity;
6. feeling of dry mouth.

IMAO – inhibitory monoaminooksydazy

Currently, only one substance from this group is used in medicine – moclobemide. It is a reversible inhibitor of monoamine oxidase type A, an enzyme whose task is to break down serotonin, norepinephrine and dopamine. By blocking its action, the levels of these neurotransmitters can be increased in the brain.

Due to interactions with numerous other drugs, moclobemide is used relatively rarely in the treatment of depressionalthough it is very effective for some people. Common side effects of its use include:

1. headache and dizziness;
2. insomnia;
3. Heart arythmia;
4. fluctuations in blood pressure.

Other drugs for depression

In the treatment of depression, sometimes other drugs are also used that cannot be included in any of the indicated main groups. They have different mechanisms of action, but most of them are focused on an increase in the levels of serotonin, noradrenaline and dopamine (or all three) in the brainbe on stimulation of the receptors of these neurotransmitters.

Sometimes psychiatrists decide to initiate treatment agomelatine, which stimulates the receptors of melatonin – a substance responsible for regulating the circadian rhythm of our body. This drug works well for people who have sleep problems as the leading symptom of depression.

In some cases, you can also use medications that are not typical antidepressants, which can eliminate the disorders associated with this disease, for example:

1. medicines for anxiety – usually from the benzodiazepine group (they can be addictive – they are usually used for a short time);
2. antipsychotics – such as olanzapine or quetiapine.

Also check: February 23 – National Day for Combating Depression

Before use, read the leaflet, which contains indications, contraindications, data on side effects and dosage as well as information on the use of the medicinal product, or consult your doctor or pharmacist, as each drug used improperly is a threat to your life or health. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home. Now you can use e-consultation also free of charge under the National Health Fund.