Antidepressants during. How long to take antidepressants. Selective serotonin reuptake inhibitors

I am writing this text from three positions. From the position of a therapist who sometimes suggests that clients add medication to therapeutic care. From the position of a person who had both experience of overcoming a depressive episode using psychotherapy alone, and experience of taking antidepressants along with therapy. Each time it was my decision. The only experience I don’t have is ultimatum or forced drug treatment. Therefore, the text is exclusively for those who are ready to make their decisions independently and independently bear responsibility for their consequences.

Now essentially

First. Depression is not only when a person is already lying with his nose against the wall, unable to get up, wash, go to work or meet with friends. And not even when the whole meaning of life is lost and there is no joy at all.

Depression - its more common forms - is often mild to moderate in severity. This could be, among other things, everything that we habitually call laziness, procrastination, bad mood, spoiled character, etc. To avoid self-diagnosis, there will be no clear criteria. The diagnosis is made by a doctor . Yes, psychiatrist . And yes, he doesn't bite.

Second. There is no shame in taking antidepressants. Just like Corvalol or, for example, no-shpu or Nurofen, if something hurts. Or just as embarrassing as any other medication. Antidepressants, like intimate hygiene, are everyone’s personal business and you are not obligated to tell your boss, colleagues, friends, or relatives about this. Doctor and psychotherapist. The rest are optional. At your request.

Experiences

Subjectively, a person may be filled with hopelessness and sadness. He cannot see the good in his life. He doesn’t want to and loves to suffer, but he just can’t. Your attempts to show him how beautiful the world is create the feeling that he is not understood and increase suffering.

And this doesn’t mean you shouldn’t try - sometimes it works.

A depressed person is irritable and/or moody for no reason (to an outside observer) or for minor reasons. In fact, often very vulnerable and wounded. Not by you. And not now. And it flies to you. Because now/lately the brakes have failed. Often, irritation and tears are the only ways to slightly relieve the colossal internal tension that such a person experiences. Tension, which quickly accumulates again, because these methods are precisely a release of tension, acting out, but not satisfying an urgent need. The tighter the depression loop, the more difficult it is to recognize this very need. Loved ones and children suffer the most from the mood swings of a depressed person. And, of course, himself. Because an emotional outburst is often followed by guilt or shame for the inadequacy of this outburst. Guilt or shame keeps the inner circle going.

If there is not much guilt and shame, then some time after the outbreak is a time of relief. The love and tenderness that a depressed person feels for someone who has just irritated him is completely sincere. It just became easier and these feelings can calmly flow for some time.

Children of depressed parents mature early, learning to care for their parents during episodes of deterioration. This is neither good nor bad - it is so.

From the inside, the world seems hostile, unwarm and ungiving to a depressed person. Self-hatred and self-blame are off the charts. People around you are seen as cold and rejecting. And, naturally, from there, from the inside, it is quite difficult to imagine turning to such people for help or support.

At the same time, having the greatest need for warming, supportive relationships, a person is extremely sensitive and vulnerable precisely in relationships. Everything hurts him: words, intonations, gestures. It is impossible to please him, and there is no need to, otherwise this is fraught with your tension and desire to break contact, which he, of course, will catch, even if you do not realize this impulse. Out of hunger, he reaches out to people. Out of vulnerability and pain, pushes them away. Such a push-pull.

Things that made him happy just recently cease to please him. If the work was loved and ceases to bring joy, the person becomes even more afraid. Not all is well here either.

Hobbies, sports, loved ones, pets, colors stop making you happy, and the sense of taste of your favorite foods disappears. Often a person begins to overeat or undereat. Smoking or drinking more than usual. Partly, trying to feel at least something, partly, unable to cope with recognizing the simplest bodily needs - hunger, cold, etc.

The difficulty of recognizing basic bodily needs and, therefore, their untimelyness - to eat, drink, sleep, go to the toilet on time - reduces the already small amount of energy in a depressed person, who has spent it on an internal struggle with himself. Depressive conditions can often be accompanied by sleep disorders - insomnia, disturbances in sleep-wake cycles. Naturally, the ability to work and energy for life decreases.

The longer a person remains depressed, the greater his real dissatisfaction with life. The fewer people in reality are willing and able to stay close and provide much-needed warmth in this state.

The longer depression lasts, the fewer memories there are of what once was different, memories that you can lean on to help you get out. It seems that “that me” was a completely different person or it was a different time/youth/marriage/health. A critical attitude towards one’s condition is lost precisely as a condition, a period, a problem in which help is needed. And this is replaced by experiencing it as a given, from which there is no way out. Next comes meaninglessness and despair.

How can antidepressants help?

Firstly, they relieve the severity of the condition. There is a little more strength for life and contact, which means there is a greater chance of receiving warmth, support, and more opportunities for psychotherapeutic help.

Secondly, medications gradually level out the emotional background, outbursts of irritation, sudden tears, acute vulnerability, and conditions when one feels hot or cold become much less frequent or go away completely. Removing acute peak emotional reactions allows you to better hear and recognize less vivid feelings, and therefore more accurately identify your needs. Most antidepressants have a calming effect and improve sleep.

A more complex effect of the drugs is to gradually equalize the hormonal balance in the body, which makes the body more stable and depressive episodes more rare.

In parallel with taking medications, therapeutic work is necessary, within which a person finds support, warmth, contact, as well as an analysis of the ways in which he involuntarily tightens his own noose of depression. A better awareness of situations and experiences that a person cannot cope with and that lead to depressive episodes allows each next time to go through this situation a little differently, more successfully, to organize the necessary amount of support inside and outside. Therapeutic, friendly, medicinal and any other that a person needs. This is all the work of psychotherapy. Without this work, the dependence on antidepressants that is so frightening for many may become a reality. Because if they put a cast on you, and after it is removed you persistently go and break the same arm again in the same way and come to the same emergency room again, then yes, you will become dependent on the cast. The more often you repeat this maneuver, the stronger it will be. It's the same with antidepressants.

On the Internet, in traditional books and any media, you can find a variety of information about the rules for taking antidepressants and their effects. The forums are full of opinions and advice. The topic is not new at all. Why does the correct use of antidepressants remain a stumbling block in the treatment of depression?

What are antidepressants?

Let's first understand the concept of antidepressants.

Antidepressants are substances that are used in the treatment of depression. The doctor can prescribe them for other mental disorders, in combination with drugs from different groups. Antidepressants can have more than just antidepressant effects on the body.

Properties and effects of antidepressants.

All antidepressants, depending on their effect, can be divided into three groups:

1. Sedative antidepressants. In addition to the direct effect on depressive syndrome, they can help with anxiety, restlessness, and poor sleep. The most famous representative: Amitriptyline. The drug is a hundred years old, but it is not going to lose its position in terms of the strength of its antidepressant effect. Among the more modern ones I can name Mianserin and Buspirone. Doxepin has proven itself very well in my practice.
2. Antidepressants with stimulant action. Used in cases of predominance of lethargy, passivity, depression and indifference. Everything is clear here, I think. I would like to note one fact. The stimulating effect occurs significantly earlier than the antidepressant effect. This isn't always a good thing. I usually prescribe drugs from this group together with sedatives (sedatives) in small doses. The most prominent representative is Escitalopram.
3. Antidepressants with a balanced effect. They absorbed the properties of the first and second groups. Representatives Pyrazidol and Sertraline.

Rules for taking antidepressants.

Now we can talk about the rules for taking antidepressants.

When prescribing any drug, the doctor will definitely tell the patient how to take it, and specifically answer the following questions: “What?”, “When?”, “How much?”, “How often?”

Any person who takes antidepressants himself or looks after someone taking them must remember and strictly follow the following rules:

• Take antidepressants regularly. Usually, modern drugs are taken 1-2 times a day. It is better to keep a schedule and take the medicine at the same time every day. If one dose is missed, take the next tablet at the appointed time. The dosage schedule is not shifted, the dose is not increased independently.
• Having a week's supply of medicine at home can avoid many troubles. There is no need to buy 5-10-100 packs of the drug for future use.
• You should take antidepressants with plain water. Drinking alcohol during treatment with antidepressants is strictly contraindicated.
• Only the doctor knows when to stop treatment with antidepressants. He will tell you how to properly reduce doses without harm to health.
• Antidepressants can have side effects, like other medicines, even those of herbal origin. There is no need to rush to refuse treatment if side effects appear. Most of them will go away in the first week of treatment. If the patient experiences significant discomfort or malaise, this is a reason to consult a doctor ahead of schedule.
• Choosing an antidepressant, selecting the dosage and duration of treatment is a very complex process. It is impossible to predict the same positive effect of treatment in two different patients. It is possible that during treatment you will have to change doses or antidepressants several times. It is necessary to assist the doctor in every possible way. Note positive and negative changes in your condition.
• The average course of treatment for depression is about 3-6 months. You need to be prepared to take medications for a long time.

Taking antidepressants and the main mistakes made by patients.

As you may have noticed, everything is quite simple. But. Errors in taking antidepressants occur every hour.

And here, in fact, are the main reasons I noted for the incorrect use of antidepressants:

1. Fear of becoming different, of changing. Patients are often afraid to take psychotropic medications. They believe that these drugs can “somehow change my Self.” I convince you. Psychotropic drugs used for medicinal purposes do not change personality. The person will remain as he was. Unless before illness.
2. Difficulty following doctor's recommendations due to symptoms of depression. With moderate to severe depression, it is really difficult for patients to adhere to the rules of taking antidepressants. Dear relatives! Be vigilant and show care and attention! Don't leave things to chance.
3. Influence of others. A sick person seeks help from relatives and friends. Unfortunately, due to existing stereotypes, others can cause harm by their lack of understanding of the problem. And I give up on doing anything... If I encounter such a problem with my patients, I ask you to come to the appointment with your family.
4. “And Grandma Masha from apartment 34 said...” She had a lot to say. She could say that “antidepressants turn people into vegetables” (this is my favorite phrase, especially if taken literally), she could say: “you will get used to it and will sit on this poison for the rest of your days.” Do we remember the average time for taking antidepressants? 3-6 months... For the sake of the truthfulness of the picture, I am forced to make one remark. Severe depressive disorders may indeed require very long-term medication, but this is an exceptional need. In this case, a parallel can be drawn with diabetes. Insulin is a vital substance. For those suffering from severe forms of depression, antidepressants are vital and allow them to live a full life. It's not all doom and gloom. Depression is far from a death sentence.
5. Early cancellation due to complications. Something stabbed somewhere, I got sick, and it was all to blame, of course, on antidepressants. And Grandma Masha could have left her mark here too... Most often, complications are observed in the first week of treatment. Is there any reason to blame the antidepressant? Before, before depression, did you have any tingling sensations? Or maybe you had it before, but because of depression you didn’t pay attention? A visit to the doctor will help you figure it out.
6. Refusal to take if the dynamics are positive. Almost half of all patients, even those who have repeatedly suffered from depressive disorders, stop taking antidepressants when they begin to feel better. This is the biggest mistake. Well done, well done doctor. correctly selected treatment, correct intake, positive dynamics... You cannot stop the drug even if you feel excellent. It is necessary to complete the course of admission. Most antidepressants require a gradual dose reduction. Stopping taking antidepressants too early and inappropriately stopping the drug greatly increases the risk of relapse of depression.

Dear readers. Antidepressants are designed to help, not hurt. Patients who trust the doctor and follow the recommendations recover from depression earlier. If there are any difficulties in taking medications, only a doctor can assess the patient’s condition and give practical advice.

All the best.

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The Campaign Against Depression recommends that GPs take a holistic approach to treating the condition: a compassionate approach to the patient combined with a variety of psychotherapy options, both orthodox and complementary. When prescribing medications, special attention should be paid to anxiety, mood swings, phobic and panic symptoms.

It is useful to recall the signs of depression (Table 1). Knowing them helps make a diagnosis, determine the severity of depression and assess the risk of suicide.

As for drug therapy, diagnosing a full-blown episode of depression means that 70-80% of such patients will successfully undergo treatment with modern antidepressants, which are relatively safe even in overdose.

The most common antidepressants. They are divided into four main groups: tricyclic antidepressants, new tricyclics and related antidepressants; selective antidepressants and monoamine oxidase inhibitors (MAOIs), including new reversible monoamine oxidase inhibitors (MOMAO-A).

This year, two new groups were added to the list of 31 most common antidepressants. Both belong to a new, selective type, but act on different receptors - in fact, the group of selective antidepressants is divided into four subgroups.

The term “selective” is key in understanding this new group of antidepressants. They have very high affinity for either norepinephrine (NA) or serotonin (S) synaptic receptors and very low affinity for other receptors, such as acetylcholine, which are the most commonly observed side effects in patients taking tricyclic antidepressants.

For the depressive disorders described below, the following groups of antidepressants are used.

Serotonin antidepressants are prescribed as adjuvant medications for anxiety and obsessive compulsive disorder because serotonin is a transmitter closely associated with anxiety and repetitive behaviors such as obsessive thoughts.

Norepinephrine is a transmitter responsible for motivation. NA antidepressants are especially effective for depression, where the leading symptom is a slowdown in motivation and, as a consequence, behavior.

MAO inhibitors and IOMAO-A can be very effective when other antidepressants have no effect. OIMAO-A do not require diet, but interaction with sympathomimetics remains. The list of indications includes phobias (especially social ones), hypochondria and somatic manifestations. New in the prescription of antidepressants. In 1997, there were five important innovations in the medical approach to antidepressant treatment.

Firstly, it has been proven that the effect of the prescribed dose of an antidepressant does not develop immediately - at least within eight weeks. In practice, this means that the doctor may wait a long time before changing the dose or type of antidepressant.

Second, there is evidence to suggest that an initial dose of selective serotonin reuptake inhibitors (SSRIs) is sufficient to treat most patients with depression. However, in some cases, for early-generation SOIDS, the initial dose may not be enough and needs to be increased (Table 2).

Fourth, although doctors are confident that the newer antidepressants have fewer side effects, many patients refuse to take them. A meta-analysis showed that 30% of patients stopped taking tricyclic antidepressants, while 27% took SSRIs. Discontinuation rates due to side effects alone were 20% for tricyclic antidepressants and 15% for SSRIs.

Some of the earlier antidepressants, namely the second-generation tricyclic antidepressants, have the same efficacy and safety as selective antidepressants and fewer anticholinergic side effects than the earlier antidepressants.

Fifthly, today the side effects of selective antidepressants acting on serotonin receptors are summarized. Serotonergic syndrome is caused by a direct effect on unprotected postsynaptic serotonin receptors in the brain and intestines. Side effects include nausea, insomnia, nervousness and agitation, extrapyramidal disorders, headaches and sexual dysfunction. The serotonergic syndrome is similar to the well-known anticholinergic syndrome that occurs with TCAs.

Suicidal risk. According to the recommendation of the Committee against Depression, patients should be asked about suicidal ideas/thoughts/intentions/impulses/plans in a benevolent and gentle manner, this facilitates mutual understanding. In practice, this means that the doctor should first of all establish trust between him and the patient - too early intervention leads to the patient’s refusal to communicate with the doctor, while a timely conversation helps to achieve frankness from the patient.

The Safe Prescribing Campaign for Suicide Risk was launched by the London Poisons Unit, whose most recent study dates back to 1995. According to this study, approximately 300 people died from antidepressants in 1995, mainly due to the cardiotoxic effects of amitriptyline and dothiepine.

Ineffective treatment. Double-check the diagnosis and make sure the patient is taking the prescribed medications in the right doses.

In our practice, cases of hidden alcohol intake are very common. Check to see if the patient is currently experiencing any stress or has a history of stress. It may turn out that the deterioration is due to an exacerbation of post-traumatic stress.

The doctor has at his disposal various information booklets, audio and video recordings with which he can provide the patient.

Counseling can help clarify or resolve the problem. Cognitive therapy is sometimes helpful, although its role is not yet fully understood, and is particularly useful in cases of chronic and moderately severe depression.

Table 3. Facts that are useful to know

Attention should be paid to insomnia, anxiety, panic, phobias, psychotic disorders, each of which can dominate the picture of the disease as an independent disease.

Additional sedative therapy may be necessary, since selective antidepressants do not have side sedative effects. Thus, at the beginning of treatment, you may need a sleeping pill or a daytime relaxant, such as thioridazide or diazepam. Relaxation therapy and complementary treatments also have beneficial effects.

The group of difficult-to-treat patients consists of patients with somatic disorders. As a rule, they are distrustful of the diagnosis, are difficult to persuade to take medications, and when they agree, they show increased sensitivity to side effects. In this group, low doses of drugs, even those considered subtherapeutic, can be successfully prescribed.

The longer the period of depression that occurred before the start of treatment, the longer it takes to cure it.

Referral to a Mental Health Association or secondary care psychiatrist for consultation and therapeutic assistance. If the possibility of suicide cannot be excluded, longer consultations are necessary to help relieve despair and suicidal hopelessness. Recently, the organizer of psychotherapeutic courses for general practitioners remarked on this matter: “If we manage to make a person understand that we care about him, hopelessness immediately goes away and the healing process begins.”

One study showed that early, adequate antidepressant therapy can significantly reduce the number of secondary referrals to a specialist, the need for hospitalization and the incidence of suicide.

Persistent depression. Sometimes there is a need for additional medications, increasing the dose of an antidepressant taken or replacing it.

Lithium can be added to an antidepressant. The safety of this drug has been proven in practice, but patients should be informed of its nature and mechanisms of action.

Lithium should be given once at night. To avoid possible differences in bioavailability, only high-quality drugs should be prescribed.

Before treatment, it is necessary to conduct a study of the iron-binding capacity of the blood, determine the function of the kidneys and thyroid gland. During the first month of treatment, drug concentrations in the blood and electrolyte balance are determined every 7-14 days, then monthly, once every three months, and finally once every six months. It is better if the lithium level is relatively low, around 0.4 mmol/L (compared to 0.8 mmol/L). The duration of treatment is eight weeks.

Duration of treatment. Depression is a relapsing illness, and the main predictor of relapse is a past episode of depression. You can successfully use the following data as a guide: with a single episode of depression, the probability of relapse is 50%, with a second - 70%, and with a third - 90%.

After a single episode, relapse can be prevented, but there is no consensus on how long antidepressants should be given.

Some doctors advocate three-, four-, six-, or even nine-month courses of therapy. The World Health Organization recommends prescribing a full dose of antidepressant for two, three or four months, followed by a half dose for several months. This approach requires additional study and observation.

Patients with anxiety, obsessive and phobic symptoms need to take antidepressants for a long time, although in general practice it is often difficult to persuade patients to even start taking them.

It appears that as the condition improves the patient becomes more sensitive to side effects. In practice, it makes sense to determine how long an antidepressant should be prescribed based on how severe the depression was at the time of treatment.

I always warn patients about the possibility of relapse and advise them to resume taking antidepressants as soon as they feel worse—even before they can see me. As a rule, the more relapses a patient has in history, the longer the required course of treatment.

Older patients are more susceptible to severe, prolonged depression that lasts for years. There is a significant proportion of depression-related deaths in this group, and long-term antidepressant treatment is often required in these patients. Any patient with prolonged severe recurrent depression should be treated in the same way, regardless of age.

The response to antidepressant withdrawal is different from the relapse of a depressive disorder. It can develop with the use of any antidepressant, but only after 6-8 weeks of therapy, which may indicate the involvement of adaptive processes in the central nervous system.

Note!

• One out of every three adults experiences an episode of depression at least once in their life; it is detected in one in six new patients in general practice
• The effect of the prescribed dose of antidepressant does not appear immediately - it occurs, as is commonly believed today, within eight weeks. In practice, this means that the doctor should wait before changing the dose or type of antidepressant
• Many doctors are confident that the newer antidepressants have fewer side effects, but very often patients refuse to take them. According to studies, 30% of patients stopped taking tricyclic antidepressants, while 27% took SSRIs. Discontinuation rates due to side effects alone were 20% for tricyclic antidepressants and 15% for SRIs.
• Serotonergic syndrome is caused by a direct effect on unprotected postsynaptic serotonin receptors in the brain and intestines. Side effects include nausea, insomnia, nervousness and agitation, extrapyramidal disorders, headaches and sexual dysfunction. The serotonergic syndrome is similar to the well-known anticholinergic syndrome that occurs with TCAs.
• Patients should be asked about suicidal ideas/thoughts/intentions/impulses/plans in a supportive and gentle manner - this facilitates mutual understanding. In practice, this means that the doctor should first of all establish trust between him and the patient
• If depression does not respond to treatment, double-check the diagnosis and make sure the patient is taking the prescribed medications in the right doses. Cases of taking additional medications and alcohol are very common
• Lithium can be prescribed for persistent depression once at night. The effect can be achieved at moderately low doses, approximately 0.4 mmol/l. It is advisable to continue treatment for eight weeks

« Recently, there has been more and more talk about anxiety and depressive disorders and their treatment – ​​antidepressants. On Internet forums, the most polar opinions are heard about these drugs - from enthusiastic praise to terrible curses. Is there any objective information on this matter?»

What are antidepressants?

ANTIDEPRESSANTS new generation is a special group of psychotropic drugs that never and under no circumstances cause drug dependence (this risk exists only if used incorrectly tranquilizers), nor prolonged lethargy, emotional flatness or decreased clarity of consciousness, memory, attention, mental activity (these negative effects are possible mainly when using antipsychotics and tricyclic antidepressants of the previous generation). The vast majority of neurotic psycho-emotional disorders that are treated by a psychotherapist are successfully treated with one well-prescribed antidepressant. The cause of failure, as practice shows, is not the drug itself, but.

What are new generation antidepressants?

New generation antidepressants, or serotonin-selective antidepressants, refer to SSRI group– selective serotonin reuptake inhibitors. They are ideally tolerated and do not have cardio-, nephro- or hepatotoxic effects, i.e. do not have a negative effect on the liver, kidneys, heart and other organs, many of them are widely used in childhood and old age, with concomitant physical diseases, in the post-infarction and post-stroke periods, in combination with other therapeutic agents. In Western countries, modern antidepressants are increasingly positioned as drugs that improve quality of life, since they allow you to maintain a long-term and stable sense of inner comfort, resistance to stress and a positive attitude in life.

How does an antidepressant work?

To put it simply, antidepressant effect manifested by the fact that the brain comes out of the stressful mode of functioning - anxiety decreases, internal tension is relieved, mood improves, irritability and nervousness disappear, night sleep normalizes, the autonomic nervous system stabilizes - for example, heartbeats, dizziness, headaches, fluctuations in blood pressure, emotional caused by disorders of the stomach, intestines, etc. This is achieved by restoring the proper functioning of brain neurotransmitters - serotonin, norepinephrine, dopamine and other protein molecules that ensure the transmission of electrical impulses between neurons. This takes time, so the effect of modern antidepressants develops very gradually, manifesting itself no earlier than 3-5 weeks from the start of taking the drug. The full final effect highly depends on: 1) the correct choice of drug, 2) the correct selection of dosage, 3) the correctly determined duration of treatment; 4) correct cancellation. Violation of even one of the points can lead to the ineffectiveness of the entire treatment, and such cases are widely discussed by patients who unjustifiably consider the drug itself to be the cause of failure.

How to take an antidepressant correctly?

Treatment with antidepressants consists of two main stages:

1) main, during which all symptoms of depression, anxiety neurosis or autonomic dysfunction should disappear ( The use of an antidepressant does not mean that the patient’s problem is specifically or only depression);

2) supportive, preventive(or control), during which It is absolutely necessary to continue treatment if there are no symptoms and the patient is in ideal health. Moreover, only under this condition does maintenance treatment make sense, otherwise the choice of drug and/or its dosage must be reconsidered.

Thus, if the full effect is absent at the first stage of treatment, then continuing it in a maintenance regimen is pointless and incorrect, since this may cause a decrease in the body’s susceptibility to the action of the drug (resistance, tolerance) and its further ineffectiveness.

How long should you take an antidepressant?

With a competent approach, drawing up a final treatment regimen usually requires only 2-3 consultations with a psychotherapist in the first 2-3 months of treatment. The main period of treatment until all symptoms of a psychoemotional disorder are eliminated usually takes 2-5 months. After this, therapy in no case stops, but moves to the maintenance stage, which, in the absence of external aggravating factors (continuing or new unexpected emotional stress, endocrine disorders, somatic diseases, etc.) usually lasts 6-12 months, in In much rarer, but demanding cases, it can last for years.

It is appropriate to compare this situation, for example, with the treatment of hypertension, when long-term or even constant use of a drug that normalizes blood pressure is necessary. No one would think that a hypertensive patient is “addicted” or “accustomed” to a drug that allows him to live with normal blood pressure; everyone understands that long-term treatment is necessary based on the characteristics of the disease. However, even this is an exaggeration: In the vast majority of cases, the course of taking an antidepressant is only long-term and not lifelong.

I would like to emphasize once again that A long course of treatment with an antidepressant makes sense not in anticipation of the result, but after it has been achieved, i.e. carried out when the patient is in ideal health.

When can you stop taking an antidepressant?

Stopping antidepressant treatment, as well as its beginning, must be agreed upon with the attending physician and is carried out not so much for medical reasons (especially since the date of cancellation is not determined by any calendar period), but for socio-psychological indications, i.e. when positive changes consistently manifest themselves not only in the patient’s well-being, but also have a positive impact on the events of his life, for example, lead to a real way out of the negative traumatic situation in which the neurosis arose.

How to properly stop taking an antidepressant?

Antidepressant withdrawal should be carried out gradually according to the scheme proposed by the attending physician and should not be sharp or sudden, but also excessively prolonged. The higher the dosage of the drug, the longer the withdrawal takes, but in any case this period takes no more than a month, otherwise the situation described in.

During treatment, unforeseen breaks are undesirable (there should always be a supply of 1-2 packages at home), because on the 3-4th day after sudden cessation of taking an antidepressant, a non-dangerous, but subjectively unpleasant withdrawal syndrome, caused not by dependence or addiction to the drug, but by the “unexpected” cessation of its entry into the blood for brain receptors, which often happens also with abrupt withdrawal of other drugs that are not psychotropic.

In the event of an unexpected break in taking an antidepressant, all manifestations of withdrawal syndrome disappear within the next few hours after resuming its use, and if use is not resumed, they completely disappear within 5-10 days.

With a well-planned withdrawal from an antidepressant, no matter the duration of its use, the withdrawal syndrome, if felt, does not cause any serious inconvenience. Some antidepressants (for example, fluoxetine, vortioxetine) are not capable of causing withdrawal symptoms under any circumstances.

What happens after you stop taking an antidepressant?

With proper treatment, after stopping the antidepressant, the effect that was achieved at the main stage of treatment and consolidated at the maintenance stages of treatment will remain in the foreseeable future.

Antidepressant withdrawal syndrome

The widely discussed “consequences” of taking antidepressants (most often they talk about allegedly “getting hooked” on the drug or the inability to stop taking it due to severe “withdrawal syndrome”) can really frighten the patient in the following cases:

1) the drug and/or its dosage were selected incorrectly, as a result, the full therapeutic effect was not achieved at all, only masking of the symptoms of a psychoemotional disorder occurred, the improvement was partial, the patient’s well-being became “somewhat easier”, but did not change radically and qualitatively;

2) maintenance treatment was carried out with an incomplete therapeutic effect, the patient was not aware of what result should be achieved, and balanced between poor and “acceptable” health, from which, after discontinuation of the drug, health naturally became persistently poor again;

3) maintenance treatment was not carried out at all, the antidepressant was discontinued immediately after achieving the effect, i.e. clearly premature;

4) the patient was not warned by the doctor about possible temporary discomfort lasting 5-10 days (minor nausea, dizziness, lethargy, headache, sleep disturbance) when discontinuing an antidepressant, mistaking these sensations for the resumption of neurosis (detailed description of the sensations that arise during withdrawal syndrome - );

5) the drug was discontinued rudely, abruptly, suddenly, without the consent of the doctor, as a result of which the patient was faced with a pronounced withdrawal syndrome, mistaking its symptoms for the resumption of neurosis, or even deciding that he was “used to it”, “addicted to the drug” and was worried "breaking";

6) drug withdrawal was protracted and took an unreasonably long time: faced with the first manifestations of withdrawal syndrome when reducing the dosage, the patient got scared and stopped further reducing it (for example, taking “quarters”, “halves” tablets a day or every other day, or depending on well-being for a long time), thereby artificially keeping oneself in a state of withdrawal syndrome, not allowing it to end, while, as a rule, complaining of extremely severe “withdrawal” from the drug; in some cases this situation can last for months.

Which drugs are the new generation of antidepressants?

SSRIs - selective serotonin reuptake inhibitors: fluoxetine (Prozac, fluoxetine-lannacher, apofluoxetine, prodep, profluzac, fluval), fluvoxamine (fevarin ), citalopram (cipramil, pram, oprah, siozam), escitalopram (cipralex, Lexapro, selectra, elycea, lenuxin), sertraline (zoloft, asentra, stimuloton, serlift, aleval, serenata, torin), paroxetine (Paxil, rexetine, adepress, plizil, actaparoxetine).

SSRI is a selective serotonin reuptake inhibitor of multimodal action - an antagonist of 5-HT 3 -, 5-HT 7 -, 5-HT 1D receptors, a partial agonist of 5-HT 1B - and an agonist of 5-HT 1A receptors: vortioxetine (brintellix ).

SSRI - selective serotonin reuptake inhibitor, partial agonist of 5-HT 1A receptors: vilazodone (viibrid). Vilazodone is currently not available in the Russian Federation.

SSRIs - selective serotonin and norepinephrine reuptake inhibitors: duloxetine (Cymbalta, duloxent), milnacipran (ixel ).

SSRI - selective reuptake inhibitor of serotonin, norepinephrine and dopamine: venlafaxine (effexor,Velaxin , venlaxor, velafax, newelong, ephevelon).

SSRI is a selective norepinephrine and dopamine reuptake inhibitor: bupropion (wellbutrin, zyban). Bupropion is currently not available in the Russian Federation.

SNRI - selective norepinephrine reuptake inhibitor: reboxetine (endronax). Reboxetine is currently not available in the Russian Federation.

SRIs - serotonin reuptake inhibitors, 5-HT 2 receptor antagonists: trazodone (desirel, oleptro, trittiko , azona), nefazodone (season). Nefazodone is currently not available in the Russian Federation.

Tetracyclic antagonist of central presynaptic α 2 -adrenergic receptors: mirtazapine (remeron, Calixta, myrzaten, myrtazonal).

Melatonin receptor stimulator - agomelatine (valdoxan ) .

Note: bold International names (active ingredients) of new generation antidepressants are highlighted in font; italics- trade names of original drugs; others given in brackets are trade names of some generics/analogues produced by various pharmaceutical companies. The trade names of new generation antidepressants currently sold in pharmacies in the Russian Federation (strictly by prescription) are highlighted with a blue background. The last antidepressant on the list, agomelatine (Valdoxan), according to some sources, does not have the proven effectiveness declared by the manufacturer and does not exclude hepatotoxicity.

WHY DOESN'T AN ANTIDEPRESSANT WORK? WHAT MAKES A DRUG NOT EFFECTIVE?

TYPICAL MISTAKES WHEN USING ANTIDEPRESSANTS

1. The antidepressant was selected independently (for example, on the advice of friends) or the doctor prescribed it “mechanically”, without telling the patient about the peculiarities of the action of antidepressants, their differences from other groups of psychotropic drugs (tranquilizers, antipsychotics, psychostimulants), the degree of safety, prevalence of use, possible sensations during the intake process, the expected dynamics of changes in well-being, duration of treatment, withdrawal conditions. As a result, the patient remained concerned about taking “some possibly dangerous psychotropic drug,” which did not allow him to overcome the main component of almost any psycho-emotional disorder—anxiety. For more details about this, see - "HORROR STORIES (MYTHS) ABOUT ANTIDEPRESSANTS. YES OR NO TO DRUG TREATMENT?".

2.The antidepressant was chosen incorrectly. For example, for anxiety neurosis without pronounced depressive symptoms, a tricyclic (amitriptisine, clomipramine, etc.) rather than a serotonin-selective (fluvoxamine, escitalopram, etc.) antidepressant was prescribed; or - for panic disorder, a serotonin-selective antidepressant with an activating component of action (fluoxetine, milnacipran) is recommended instead of a drug with a sedative effect (paroxetine, escitalopram).

3. Antidepressant of choicewas stopped prematurely or replaced with another drug due to its supposed ineffectiveness(for example, already 2 weeks from the start of treatment), contrary to the absolute rule that the effect of an antidepressant cannot fully manifest itself earlier than after 3-5 weeks, and for some disorders (for example, OCD) - 3-5 months.

4. The antidepressant was prescribed in a subtherapeutic setting, i.e. dosage insufficient to produce a therapeutic effect, or with insufficient frequency of administration with a short half-life of the drug. For example, fluvoxamine at a dosage of 50 mg/day with proven effectiveness of this drug in the range of recommended doses from 100 to 300 mg/day; or paroxetine at a dosage of 10 mg/day with a proven dosage range of 20 to 60 mg/day; or venlafaxine in a non-extended (non-retarded) form once a day if it is necessary to take it 3-4 times. As a result, it was able to provide, at best, a placebo effect.

5. There was no titration of antidepressant dosage, i.e. the dosage was not selected individually for this patient, the need for its correction during treatment was not determined, and accordingly, the results could not be optimal.

6. The principle of a gentle, smooth, gradual increase in the dosage of an antidepressant while taking a benzodiazepine tranquilizer (phenazepam, clonazepam, alprazolam, diazepam, etc.), which is mandatory for starting treatment, was not followed., i.e. from the very first day of treatment, the antidepressant was taken in full therapeutic dosage (for example, escitalopram - 10 mg/day or paroxetine - 20 mg/day) without “covering up” with a tranquilizer, as a result of which the patient was faced with a sharp increase in anxiety and/or existing symptoms. he suffered from vegetative symptoms, which aggravated the discomfort caused by the antidepressant itself (dry mouth, nausea, dizziness, weakness, drowsiness, apathy, headache, intestinal upset), and stopped treatment.

7. The patient was not warned by the doctor that the new generation antidepressant does not show the main therapeutic effect in the first 2-3 weeks of use; on the contrary, an increase in vegetative discomfort, anxiety or apathy, which is absolutely natural for this period, is possible. Also at the stage of adaptation to an antidepressantit is quite possible to feel dry mouth, nausea, weakness, drowsiness, lethargy, laziness, phlegmaticity (), in men - delayed ejaculation without impairing potency and erection, in women - decreased sexual excitability, anorgasmia () and, fearing the development of “severe side effects” ", stopped treatment.

8. The antidepressant was discontinued immediately after feeling better and symptoms of psychoemotional disorder eliminatedwithout absolutely necessary supportive (preventive) treatment, as a result, the symptoms gradually (for example, over the next 3-5 months) resumed, and the entire treatment course was considered ineffective, or the patient was considered difficult to treat.

9. Maintenance treatment was carried out in case of incomplete elimination of symptoms of psychoemotional disorder or/and was not long enough in time, or/and was carried out with a subtherapeutic dosage of an antidepressant (see point 4) and/and ended before the traumatic (stressful) situation lost its relevance for the patient. As a result, the symptoms gradually (for example, over the next 3-5 months) resumed, and the entire treatment course was considered ineffective, or the patient was considered difficult to treat.

10. Antidepressant withdrawal was not carried out according to the rules– rudely, abruptly, suddenly, without the consent of the doctor, or the doctor did not warn the patient about the peculiarities of the short-term (5-10 days) withdrawal syndrome and the resulting discomfort, the appearance of which was perceived by the patient as a resumption of psycho-emotional disorder or even as a manifestation of “dependence”, “addiction” to the drug, which led to another unexpected increase in neurotic anxiety, or, in fact, to the appearance of a new neurotic symptom - pharmacophobia.

11. When prescribing therapy there was polypharmacy– unreasonable prescribing of 3-4 (sometimes even more) drugs at the same time instead of following the necessary principlemonotherapy – competent selection and use throughout the entire period of treatment of ONE drug that is most effective for a given disorder and optimally tolerated by a given patient.A polypragmatic approach makes it impossible to take into account a number of chemical interactions between drugs in the body, which significantly worsens the tolerability of treatment and increases the likelihood of side effects, does not allow determining the effectiveness and, accordingly, the need to use each specific drug from the “scheme”, deprives the patient of the opportunity to understand the course of treatment process and actively participate in your recovery process.

12. For a long time (several years), treatment was carried out on the basis of empirical selection of the drug, i.e. “at random”, “by trial and error”, “until a suitable one is found”, as a result, a large number (up to several dozen) of pharmacological agents and their combinations were “tried”. In such cases, brain receptors can become tolerant (resistant, resistant, unresponsive) to the action of truly necessary drugs. In such circumstances, it is especially difficult to obtain the desired effect even with the most adequate treatment approach.

For a detailed overview of the alleged and real side effects of antidepressants, see the article:

"HORROR STORIES (MYTHS) ABOUT ANTIDEPRESSANTS or ALL ABOUT THE SIDE EFFECTS OF PSYCHOTROPIC DRUGS. YES OR NO TO DRUG TREATMENT?"

For a popular description of the features of the action and use of basic psychotropic drugs, see the article:

"PSYCHOTROPIC DRUGS: ANTIDEPRESSANTS, TRANQUILIZERS, NEUROLEPTICS - WHAT IS THE DIFFERENCE?"

This material is provided solely in the form of theoretical information and in no case can be used as a guide for self-medication without the participation of a doctor. When copying, a link to the author is required.

Many people whose profession has nothing to do with medicine or pharmacology know little about antidepressants or have a very vague understanding of such drugs. When prescribing such medications, a person faces many questions and concerns.

Can antidepressants be addictive? How effective are such drugs? Are they capable of changing a person's personality? Do they improve your mood? This article will provide answers to these and other popular questions about such medications that can be prescribed by doctors of various specialties.

Indications for prescribing antidepressants

Antidepressants are prescribed to patients who cannot independently cope with signs of anxiety, melancholy, apathy and depression. The main indication for the use of such drugs is depression. Drugs from this series can be used to prevent and treat anxiety and obsessive-compulsive disorders, bipolar personality disorders, sleep disorders, etc.

How do antidepressants work?

Antidepressants can increase the levels of serotonin, norepinephrine, dopamine and other neurotransmitters that affect a person’s mood. In addition, they slow down their decay.

There are several types of such medications. Depending on the clinical case, the doctor may prescribe an appointment:

• antidepressants-stimulants - such drugs stimulate the psyche in cases of lethargy or apathy;
• antidepressants-sedatives - such drugs help eliminate anxiety or panic and have a sedative effect;
• antidepressants of balanced action - the effect of these drugs depends on the daily dosage of the drug.

Why do many people think that being treated for depression is shameful?

Unfortunately, many people have a stereotype that has been established for decades - it is a shame to seek help from a psychiatrist or psychotherapist. This fact, according to such people, means recognition of their own mental inferiority. However, depression is not a sign of intelligence level; such a patient will not be registered at a psychoneurological dispensary and no one will report his illness to work. In addition, it should be noted that not in all cases a person with depression can overcome this condition on their own. This disease can affect the patient’s life in the most negative way:

• performance decreases;
• relationships with loved ones and surrounding people deteriorate;
• sleep is disturbed;
• life goals are lost;
• sometimes depression causes suicide attempts.

Contacting a specialist in such cases radically changes the development of events. Properly prescribed treatment relieves the patient of painful symptoms. The treatment plan also includes taking antidepressants. And in case of severe depression, in addition to taking such medications, the patient may be recommended observation at a crisis center.

Is it possible to do without taking antidepressants?

Antidepressants are rarely prescribed for mild cases of depression because their side effects may outweigh their benefits. In addition, in such clinical cases, treatment may consist of psychotherapy and lifestyle changes.

Such medications can only be prescribed by a doctor who takes into account all the pros and cons. Typically, such drugs are included in the treatment plan when the psychotherapeutic methods used do not give the desired result and the patient cannot get rid of the depressed state.

Is taking antidepressants very harmful?

Antidepressants belong to the group of potent drugs, and this fact means that if used incorrectly, they can lead to dangerous consequences. Their harm to the body is determined by the type of drug and its dosage.

Common negative side effects of antidepressants include the following:

• tremor;
• anxiety;
• lethargy;
• sensory disorders;
• sexual dysfunction;
• deterioration of cognitive abilities;
• lethargy, etc.

After a long course of taking such drugs, withdrawal of the drug should be carried out gradually. If you stop taking it abruptly, a person may experience withdrawal symptoms.

Are antidepressants addictive?

Taking antidepressants is not addictive even when prescribed such drugs for 1-2 years. After stopping treatment, the patient may experience withdrawal syndrome, which will make itself felt for 2-4 weeks. It is during this period that all components of the drug will be eliminated from the body. Dependence on antidepressants is a myth. This fact is confirmed by both doctors and patients themselves taking such medications.

Often, people who are prescribed a course of treatment with such drugs are afraid not only of becoming addicted, but also afraid that their character will change. Experts completely deny the possibility of such a consequence. Taking antidepressants can affect a person’s concentration, memory, and activity. However, the characteristics of a person’s personality do not change when taking them. When depression develops, a person should think about something else - it is the condition itself that can have a negative impact on character, and not the drugs to treat it.

Can you buy antidepressants without a prescription?

As mentioned above, only a doctor should choose an antidepressant drug for treatment and calculate its dose and duration of use. Self-medication with such drugs can aggravate the course of depression or other mental disorders. The patient must understand that each person has his own antidepressant threshold, and if the chosen drug does not reach it, then taking the medicine will be in vain. This is why antidepressants are sold in pharmacies only by prescription.

Answers to the most popular questions about antidepressants help to understand that taking such medications is indicated only in specific clinical cases. When prescribed correctly, they are beneficial, but self-medication with such drugs can be either useless or harmful to health. Antidepressants are always selected by a doctor individually, and only a specialist can determine the drug and its dose that will help the patient get rid of depression or other disorders.

Educational video about how antidepressants work: