The most important role in the medical treatment of depression is played by antidepressants – drugs that systematically improve the patient’s condition, relieve symptoms of depression: emotional disorders, motor and cognitive impairments (memory, attention, thinking), as well as somatic and vegetative manifestations of depression.
Antidepressants can also be effective in treating anxiety, eating disorders, obsessive-compulsive disorders, vegetative crises, and eliminating pain of various origins, for example, in rheumatism, since antidepressants usually increase the pain sensitivity threshold.
The choice of antidepressant, in the first place, is determined by the clinical picture of depression. It should be borne in mind that those antidepressants that have been effective in the past or successfully helped the family members of the patient are likely to be most helpful. Often, the selection of an antidepressant that is adequate to the patient’s condition can be quite long and takes an average of two to three weeks; in the case of dosage adjustment, this period can be extended to six to eight weeks. It requires patience from both the doctor and the patient in terms of the expected effect, and reasonable tactics are also needed in case of side effects. Usually the latter occur in the first days of therapy, and their severity can be reduced by changing the dose of the drug or prescribing correctors.
Criteria for choosing an antidepressant
- The clinical picture of depression, based on the leading modal
of affect - The effectiveness of antidepressant when stopping episodes
depression in the past - Effectiveness of antidepressant in relieving depression
close relatives of the patient - Minimum side effects tolerance
to specific side effects - Lack of somatic contraindications
- Results of hormonal, neurophysiological, pathopsi
chemical and neuropsychological studies - Economic feasibility
- Balanced effect on serotonergic and no
neurotransmitter radrenergic systems - The age of the patient
- The absence of negative interactions with other medicines used to treat the patient.
In practice, the main difficulties in using antidepressants are that their dose is not inadequate in patients with pronounced depression and not too large in patients with questionable and mild depression.
The effect of an antidepressant usually appears 2 weeks after its administration, but it may take 6 weeks or more for a more pronounced therapeutic effect.
In more than a third of patients suffering from depression, the main reason for discontinuing antidepressants and, therefore, an important factor contributing to the formation of persistent chronic depressions are side effects that develop during the first stage of taking antidepressants. Among the side effects that are most often the reason for discontinuing therapy are: persistent nausea, weight gain, palpitations, drowsiness or insomnia, sexual dysfunction, weakness, headache. Often a depressed person agrees to be treated only by an antidepressant who has a minimal amount of side effects. Such tactics of treatment of depression, as a rule, is ineffective.