Antidepressants are used in the treatment of depressive disorders such as chronic depressed mood, decreased motivation, apathy, insomnia, sometimes associated with anxiety symptoms. Modern antidepressants are relatively safe and do not cause as many side effects as old generation drugs. Nevertheless, you should always take them strictly as prescribed by your doctor and carefully observe the body's reactions to the drug you are taking.

Antidepressants( antidepressants ) is a wide range of psychotropic drugs used to treat mental and depressive disorders. These disorders may manifest themselves in the course of such diseases as: depression, bipolar disorder, social phobia, agoraphobia, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, insomnia.

Antidepressants are available only on prescription, they are prescribed by a GP or psychiatrist after diagnosing the patient with characteristic affective symptoms, lasting for at least two weeks (depressive episode).

These symptoms include: sadness, depression, decreased motivation, pessimism, low self-esteem, suicidal thoughts, sometimes associated with manic episodes, psychosis, anxiety attacks.

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Effects of antidepressants

Antidepressants affect neurochemical transmission in the brain. It happens through the action of the drug on nerve cell receptors, which become more or less sensitive to the uptake of substances such as serotonin, noradrenaline, dopamine. They are the so-called neurotransmitters, the concentration of which in the body has a decisive impact on our well-being.

The most common cause of depressive disorders is the deficiency of serotonin and noradrenaline. Antidepressants compensate for the unfavorable concentration of these substances, which in a short time (after about 2 weeks) significantly improves the mood.

The patient regains the will to live, has more energy to act, starts looking positively into the future, and sleeps better. People with manic or psychotic episodes regain their balancemental and inner peace, anxiety disorders disappear.

For the treatment to be effective, the treatment with antidepressants should last no less than 6-12 months. The exact duration can be determined only by a doctor who is in constant contact with the patient. Sudden discontinuation of therapy against the psychiatrist's recommendations almost always results in a quick relapse.

Types of antidepressant drugs

Antidepressants, due to their chemical structure, are divided into two main groups:

  • tricyclic antidepressants (TLPDs)- these include drugs discovered in the 1950s.first-generation drugs , less frequently used nowadays. Non-selective type, which means that they affect the concentration of not only serotonin and noradrenaline, but also other neurotransmitters. They are highly effective, but at the same time are the worst tolerated by the body and have a number of side effects (they can contribute to the development of glaucoma, heart disease, prostate enlargement). This group includes:
    • tricyclic doneuronal reuptake inhibitors of noradrenaline (NA) and serotonin (5-HT): impyramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin
    • monoamine oxidase inhibitors (MAO): isoniazid, iproniazid, nialamide, phenelzine, tranylcypromine
    • other, unusual: mianserin, trazodone, viloxazine
  • two-ring, four-ring and other drugs- these aresecond-generationdrugs, the most modern type of antidepressant. Belong to them:
    • non-receptor norepinephrine and serotonin reuptake inhibitors (SNRIs): venlafaxine, milnacipran
    • selective serotonin reuptake inhibitors (SSRIs): citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
    • selective norepinephrine reuptake inhibitors (NRIs): maprotiline, reboxetine
    • selective MAO-A inhibitors: moclobemide
    • unusual drugs: trimipramine, mirtazapine, tianeptine

Tricyclic antidepressants (TLPDs) - characteristics

TLPDs are first-generation drugs introduced into medicine in the 1960s. Their use is primarily endogenous depressions, as well as some diseases and disorders that are not related to depression or are its secondary effects (panic attacks, obsessive-compulsive syndromes, psychogenic pain).

Tricyclic antidepressants (TLPDs) - side effects

TLPDs cause relatively many side effects. Almost all preparations have a cholinolytic effect, which includes:

  • drying of the oral mucosa,
  • accommodation disorders,
  • tachycardia,
  • glaucoma,
  • urination disorders (in men with an enlarged prostate gland),
  • delirium.

More serious complications associated with the use of TCAs are very rare. Their cause is mainly non-compliance with contraindications and rules for taking medications.

These can be:

  • sudden onset of severe anxiety,
  • anxiety,
  • psychomotor agitation,
  • exacerbation of psychotic symptoms in the course of schizophrenia,
  • mania,
  • seizures,
  • muscle tremors.

The effect of tricyclic drugs on the circulatory system is also important. Occasionally, TLPDs may cause a drop in blood pressure, increased heart rate,, less frequently, arrhythmias and a decrease in the contractility of the heart muscle.

Therefore, antidepressants of this type should not be used in patients who have problems with the functioning of the circulatory system, especially those with cardiac arrhythmias.

Selective serotonin reuptake inhibitors (SSRIs) - characteristics

SSRIs are among the most widely used second-generation antidepressants today. Many years of research and clinical observations have shown that SSRIs are generally better tolerated, safer and have a narrower range of contraindications compared to classic antidepressants.

Their effectiveness is similar to that of tricyclic drugs. However, among some psychiatrists the opinion is that SSRI drugs are better suited for mild and moderate depressions, while in the case of severe melancholic depression, combined with additional psychotic symptoms, treatment with TLPD is indicated.

The indication for the use of SSRIs is the therapy of various depressive disorders. They are effective primarily in the treatment of recurrent disorders, depression accompanying bipolar disorder, and depression in old age.

They are also used in the case of ineffectiveness of the treatment with TLPD (studies have shown improvement in nearly half of the patients who were previously ineffectively treated with old-generation antidepressants). In addition, SSRIs are often used in the treatment of obsessive-compulsive disorders (obsessive compulsive disorders) and emotional disorders (social phobia, panic disorder, post-traumatic stress disorder, bulimia).

Contraindications to treatment with SSRIs are few and include the period of breastfeeding, parkinson's disease, epilepsy, and liver and kidney failure. Caution should be exercised in diabetics, system dysfunctionscirculation, glaucoma, prostatic hyperplasia.

Side effects of antidepressants

Contrary to the fears of many patients, the benefits of using antidepressants almost always outweigh the negative consequences of their use. The condition is the appropriate selection of the agent by a doctor, who will take into account, inter alia, the advancement of the disease, its nature (depressive episode, chronic depression, atypical depression with manic episodes, etc.), as well as take into account the individual characteristics of the patient (his temperament, diseases, other medications).

Side effects can be especially painful if the drug is incorrectly selected or the dosage is not correct. Then the most frequently observed side effects include:

  • somnolence (this symptom is especially common at the beginning of treatment)
  • feeling tired
  • decreased appetite
  • stomach ache, nausea
  • sexual dysfunction
  • weight gain
  • dry mouth
  • increased sweating
  • muscle tremors
  • constipation
  • difficulty urinating
  • skin rash

In the case of second-generation drugs, it is estimated that side effects occur in about 40% of patients. According to research, in about 10% of them they may be an obstacle in continuing the therapy.

If you notice any side effects, do not immediately stop taking the drug yourself. If the symptoms are not bothersome, it is worth waiting a few or a dozen days - they often disappear on their own or significantly decrease with the general improvement of the patient's well-being. If we experience great discomfort, go to a doctor who will adjust the dose of the drug or replace it with a different one.

Antidepressants and alcohol

Combining antidepressants with alcohol is very dangerous as it increases the negative effects of both substances. As a result of the interaction, the toxicity of alcohol may increase, the impact of which on the body is multiplied (symptoms include, among others, concentration disorders, motor hyperactivity, tendency to aggressive behavior, slowing down of thought processes).

On the other hand, the effect of the psychotropic drug is intensified - as a result, drowsiness, anxiety, tension, anxiety, consciousness disorders, hallucinations, and memory problems may appear.

Are antidepressants addictive?

It is commonly believed that antidepressants can be mentally and physically addictive. As psychiatrists emphasize, this is not true. Patients often confuse addiction with withdrawal symptoms (withdrawal syndrome). These symptoms appear when the sick person suddenly, without consultationstop taking the drug or reduce the dose significantly.

The side effect of doing this is a sudden imbalance in the level of neurotransmitters in the brain, which translates into severe mood swings. The patient experiences the following symptoms:

  • sudden deterioration in well-being or (less frequently) manic, euphoric states
  • anxiety, irritability, crying
  • abdominal pain, nausea, vomiting, diarrhea
  • sleep disorders psychomotor disorders (excessive excitability or slowness of movement, muscle tremors, visual impairment)
  • muscle aches, tingling or numbness of the skin
  • photosensitivity
  • sweating more.

Gradually reducing doses under medical supervision reduces the risk of withdrawal symptoms.

The most severe side effects are observed in patients who previously took preparations with paroxetine, sertraline and fluvoxamine. In rare cases, the withdrawal syndrome may cause depression to come back and treatment must be restarted.

  • Treatment of depression. How to treat depression?
  • Where does depression (affective disorder) come from?
  • Diagnosis: DEPRESSION - where and how to treat depression
  • Recurrent depression - symptoms and treatment
  • Masked depression - how to recognize it? Symptoms and treatment of masked depression
  • Endogenous depression - common causes, symptoms and treatment
  • Dysthymia (chronic depression) - causes, symptoms, treatment
  • Neurotic depression and depressive neurosis - are they the same disease?
Worth knowing

Taking antidepressants increases the risk of suicide?

According to some scientists, the use of antidepressants may increase the risk of aggressive behavior, including suicidal behavior, in people with major depression. This risk increases at the beginning of an episode, when changing the dose of drugs and about 2-3 weeks after starting treatment, when the patient's condition improves with still unchanged, still depressed mood.

This also applies to teenagers. Research shows that the use of antidepressants by minors causes a 2 times greater risk of suicide, and also increases aggression among children.

It should be emphasized, however, that these conclusions were formulated based on the results of studies involving small groups of participants, and moreover, the data collected in the following years seem to question this recommendation

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