The pharmacological treatment of depressive syndromes, initiated by the introduction of imipramine, has already over 40 years of tradition. During this period, the treatment was enriched with a number of antidepressants, which differ significantly in their pharmacological properties and resulting clinical outcomes. Having such a diverse group of medicines gives us a wide range of possibilities to choose the most suitable one for our patient, who just asks us for help.
Criteria for evaluation of the antidepressant:
· Effectiveness
· Security
· Tolerance
· Costs
Why so many drug evaluations?
Different mechanisms of pharmacological action cause that different drugs differ among themselves: safety, tolerance, as well as effectiveness. The choice of the drug requires careful consideration of all these factors. Depending on the clinical situation, we assign them different meanings. In each individual case, the decision on the choice of a drug should be remembered for its therapeutic effectiveness, resulting from pharmacodynamic action, and confirmed by controlled clinical trials.
The most depends on the patient's cooperation with the doctor
Unfortunately, there are a lot of depressed people who do not keep the discipline of taking drugs. There are many reasons for this. Patients discontinue treatment or reduce the dose due to unacceptable side effects. When considering the safety of the antidepressant, remember that they can worsen the course of other diseases. When selecting the drug should take into account the phase of treatment of depression. In the acute phase, the most important is the effectiveness of the drug and safety. During the maintenance treatment, tolerance of the drug becomes more important.
When the disease is rooted in the nervous system
When the disease has its origin in disturbed metabolic processes and / or activities of specific organs determining the functions of the nervous system - is the so-called depressive syndrome with endogenous features. In this case, the antidepressants offered to the patient by the doctor may have a syndromolitic effect, which means that they will cause the depression syndrome to subside. We associate this effect of antidepressants mainly with their effect on central noradrenergic and / or serotoninergic systems.
When depression is not very severe ...
In relation to the majority of not very aggressive depressions, almost all available antidepressants show comparable efficacy. This applies to both initial treatment and stabilization treatment.
In the case of severe depression
In the case of severe depression, tricyclic antidepressants should be used. The introduction of new preparations into the treatment is reserved for depression of lesser intensity, without the threat of suicide. Drugs that selectively affect the serotonergic system seem to be particularly effective here, both in the treatment of depression itself, in its initial, maintenance and prophylaxis phase. Antidepressants acting on the serotoninergic system are used in depressive syndromes with other obsessive-compulsive disorders, social phobia, also anxiety and panic attacks. In the latter case, other antidepressants may also be used.
When do we use modern anti-depressants from the SSRI group?
Usually, modern SSRIs are used when the therapy of the "older generation" antidepressants has proved ineffective. In addition, you should use medicines from this group in people with specific diseases and health disorders.And especially in people after cardiovascular events; especially in people with recent myocardial infarction, advanced coronary heart disease, myocardial disturbances, etc. They are also indicated for patients with glaucoma (with closed-angle), as well as in men with prostatic hyperplasia. In patients with diabetes, it is also safer to use newer drugs. In addition, SSRI antidepressants should be used in patients with hepatic and renal failure, in whom pathologies and dysfunctions of these organs may limit the neutralization and excretion of metabolites after the old-generation medicines.
Side effects of antidepressants, also called undesirable
The side effects of anti-depressants are the most common at the beginning of treatment. After a few weeks, their severity decreases significantly. Often, however, these changes are inadequate and side effects persist throughout treatment, which can unfortunately have a depressing effect on the patient's motivation for therapy. Therefore, before choosing a drug, it is worth considering together with the doctor, what kind of potential side effects it can cause and how it may affect the patient's functioning and what is the individual risk of these symptoms.
Danger of too low doses of drugs and their toxic interactions
A significant percentage of antidepressant failure is due to the patient taking too low doses of the drug. This is especially true for older people. with memory disorders. In such cases, it would be best to use the medicine in a single daily dose. However, not everyone can be ordained in this way. In addition, drugs can interact chemically to become stronger, weaker or to form toxic compounds. Therefore, in older people who take different medications because of co-morbidities, who may also need to take a new medicine suddenly, starting treatment always requires careful consideration of the dose levels.
The most common reason for the patient to stop the treatment is increased side effects. They can lead to impairment of social functioning, they can reduce the quality of life. While at the beginning of treatment, especially when the symptoms of depression are significantly increased, their presence does not have to be of such significance, while in the case of long-term treatment they become a factor determining the change of the drug.
The pharmacotherapy motto:
When you add a drug - try to set one down. Clifton K. Meador. The perfect doctor
A message from the author for the reader
Depression is an emotional state characterized by sadness, less activity and the inability to enjoy life. It is one of the most common psychological problems. Depression, acting chronically as a stressfulness for many months, disturbs the functions of important organs of the body. It can cause various ailments and health disorders as well as pathogenic disease complications. The whole of the study presented on our website presents typical symptoms of depression as well as its various variants. In the following chapters, we describe how to cope with this disease, how to treat it, and how to deal with a person suffering from depression. The characteristics of depression are enriched by authentic statements of patients, descriptions of their ailments and difficulties in overcoming the disease. The author has been conducting extensive private practice for years, in which depressive patients make up the majority of applicants.
Dr. Janusz Krzyżowski, MD, psychiatrist
