Antidepressants are very widely used in medicine, especially in neurological and psychiatric practice. In this regard, the issue of side effects of antidepressants, which arise not so rarely, is especially relevant. All undesirable effects from taking this group of psychotropic substances can be divided into two varieties: general, characteristic of all antidepressants, and private, manifesting only in a particular group medicines.

How do antidepressants affect the brain? As a rule, these drugs alter the metabolism of neurotransmitters, substances that regulate human behavior and reactions. And, unfortunately, there are no antidepressants without side effects. Therefore, before starting therapy, it is very important to ask your doctor how to take antidepressants.

Should I take antidepressants? The purpose of these drugs can significantly improve the quality of life in patients with endogenous depression caused not by external factors, but by certain characteristics of the exchange of neurotransmitters. In this case, taking antidepressants on a regular basis is the best treatment.

Common unwanted effects

Antidepressants, regardless of which group of drugs they belong to, can cause the following disorders in the patient's body:

1. Dyspeptic symptoms. At the initial stage of therapy, patients often have abnormalities gastrointestinal tract: nausea and stool disorders (constipation or diarrhea). In this regard, antidepressants, as a rule, are prescribed in minimally low doses, gradually increasing them. This will reduce such dyspeptic manifestations. Against the background of prolonged use of these drugs, an increase in appetite and weight gain are observed, which can be observed in a very pronounced form.
2. Behavioral disorders. In some cases, patients may experience sleep disturbances in the form of, or, conversely, increased drowsiness. In addition, there is a decrease in sexual desire and the ability to experience an orgasm. These symptoms occur very rarely, and very often resolve on their own with further use of the drug.
3. Serotonin syndrome. Serotonin syndrome is extremely rare, with severe symptoms. Its occurrence is associated with the simultaneous administration of two drugs that increase the content of serotonin in the brain. It is manifested by a change in the patient's psyche (anxiety, blurred consciousness, manic-depressive syndrome, hallucinatory delirium, up to). Sometimes changes in the autonomic nervous system (pain in the abdomen or chest, profuse diarrhea, fever, increased heart rate, etc.).

Important! It is very important to monitor your condition while taking antidepressants and in cases of the appearance of such symptoms, immediately contact your doctor to adjust the dosage of the drug.

Antidepressant withdrawal syndrome

Long-term use of these drugs causes a state of a certain chemical dependence in the brain. Therefore, a sharp withdrawal of drugs can lead to various symptoms that look like a drug addict’s withdrawal: irritability and anxiety, insomnia, general weakness, etc.

How to quit drinking antidepressants? It is necessary to gradually reduce the dose of the drug, in no case stopping sharply taking it. The second very important question: how long can I drink antidepressants? The answer to this question can only be given by the attending physician. There are cases when drugs of this group are prescribed for life.

Private side effects

In addition to the common side effects for all antidepressants, there are also particular manifestations characteristic of a particular subgroup of these drugs. In this regard, before starting treatment, you need to ask your doctor what antidepressants are better to take.

Monoamine oxidase inhibitors very often cause daytime apathy, minor attacks, decreased pressure, increased irritability and sexual disorders.

Tricyclic antidepressants can lead to headaches, drowsiness, problems with urination, vision, and also cause dizziness. Antidepressants that block serotonin reuptake and norepinephrine cause less serious side effects: nausea, diarrhea or constipation, daytime fatigue, rare dizziness.

Attention!

An Israeli clinic specialist can advise you -

The ideological basis of the work of doctors and psychologists is the principle "Do no harm!". The ambiguous effect of antidepressants on the human body and possible side effects are known and are always taken into account by the attending physician when prescribing a particular drug to a patient.

The doctor’s goal is to eliminate the disease, therefore, in any case, an antidepressant is prescribed if there are indications for its use, while the doctor is repelled by the idea that the benefit of the drug will undoubtedly be greater than the possible damage to the body.

The problem is that it is impossible to know for sure how the human body will react to one or another antidepressant in advance. It sometimes takes several months to choose the right remedy for the patient and not a single attempt to replace the medicine.

However, to date, antidepressant drugs remain primary means of struggle  with diseases such as:

• depression,
• bipolar disorder,
• dysthymia
• anxiety disorder
• panic attacks,
• post-traumatic syndrome
• phobias
• bulimia and anorexia,
• severe pains of an unexplained nature and other diseases.

The more severe the psychological problem and the more it is “launched”, the more likely it is that the help of a psychologist alone will not be enough. The problem will turn into a disease, and the client will become a patient who already psychiatrist  will prescribe a course of antidepressant medication.

Maybe if our society were culturally developed to such an extent that people strive to solve their psychological problems as soon as they arise, and not reaching the pen, antidepressants would not be needed. Indeed, most serious mental problems are the result of the growth or accumulation of a huge number of smaller and seemingly frivolous psychological problems, as well as an elementary absence psychological culture  personality!

According to statistics 10%   people in developed countries buy antidepressants just to improve their mood. But low mood is not such a big problem, so as not to cope with it yourself! To solve it, you do not need to run for pills, it is better to try to understand yourself, help yourself. But to people easier  drink a “magic pill” rather than look for the reason for the lowered mood, eliminate it and resort to a more natural and useful way of raising the mood.

Someone will say: “I don’t have time to understand and have fun! A lot of work, children, debts, worries and so on! ” Without denying the negative impact of the accelerated rhythm of life, poor ecology, negative labor factors and other negative life phenomena in modern worldStill, I want to note that work on yourself  (mainly consisting in timely solving internal problems) is the key to psychological well-being and health, and therefore happiness! And what could be more important than that ?!

Everyone wants to be happyTherefore, she seeks to bring as many “attributes” of happiness into her life as possible (getting married / getting married, occupying a high post, getting rich, making her body perfect, and so on). But while practicing form, many forget about content: getting married does not mean becoming a happy wife, getting the desired position - being realized in a profession, losing weight - loving yourself and so on. The content of life consists of thoughts, desires, intentions, actions of a person, his worldview, attitude to the world and to himself. The external world of man, by and large, is determined by the internal.

Taking antidepressants is last resort. You need to do everything possible, that is, help yourself independently  (change thoughts, habits, worldview) and seek help from specialists(psychologists, psychotherapists), in order to reduce the likelihood of an extreme condition (mental disorder or pathology), when it is impossible to help yourself otherwise with pills.

Moreover, conducted relatively recently, in 2012, research  showed that even the most advanced, related to the new, fourth generation, antidepressants are not as effective as previously thought. Moreover, scientists have come to the conclusion that side effects when taking these drugs can exceed the potential benefits!

Unfortunately, many modern standards  treatments do more harm than good for a person and contradict the principle of “Do no harm!”.

As Ilf and Petrov wrote in their novel The Twelve Chairs: "The salvation of drowning people is the work of the drowning people themselves!" This principle applies to the treatment of depression, and not only because modern medicine is far from perfect, but because no one can help a person if he does not want to help yourself!

The principle of action of antidepressants

To understand how antidepressants affect the body, you need to study the principles of the brain. For a person who is not familiar with the anatomy and physiology of higher nervous activity, this will not be easy. But basic postulates  you can understand:

Most often, the “culprit” of depression is precisely insufficient serotonin. It is interesting that scientists, as ancient as the world, found the substance not only in the human body, but also in plants, mushrooms, fruits, and in animals.

In particular, studies conducted on laboratory animals have shown that only 5% of serotonin is found in the brain, a little more in the blood, and the main part in the intestines! This explains why people get pleasure  from food (especially from products containing a large "dose" of serotonin, such as bananas and chocolate), and some develop a dependence on a certain kind of product!

In general, the production of serotonin is determined by the central nervous system.

The important thing is that when the "neurotransmitters" carrying happiness in the brain for some reason become smaller than expected, that is not enough, the work of the nervous system is disrupted. Hence the bad mood, apathy, depression, unreasonable fears and other problems.

Antidepressants  - These are chemical drugs that prevent the breakdown of neurotransmitters in the human brain. Speaking simple languageantidepressants do the work that the brain normally needs to do on its own. They do this in order to restore balance and harmony to the body.

Here lies the main problem. If you accustom your brain to the fact that there is an artificial alternative to natural neurotransmitters, you can develop a dependence on antidepressants. Helping antidepressants can be a disservice if taken incorrectly.

Modern antidepressants successfully eliminate the symptoms of depression and similar mental disorders. If the medicine is chosen correctly, balance, energy, the ability to enjoy life both during and after taking the medicine return to the person.

But it often happens that after discontinuation of the drug, relapse, that is, the return of all the symptoms of the disease and even the deterioration of the patient’s well-being.

Symptoms of withdrawal of antidepressants are similar to withdrawal symptoms in a drug addict. Their totality was called withdrawal antidepressant syndrome.This is drowsiness, and aches in the whole body, and headache, and all the same feeling of hopelessness and terrifying anxiety.

It is very important that the doctor selects not only the right antidepressant, but also accurately determines the dose and the duration of its use!

Today, doctors are trying to prescribe only a short and sparing course of treatment with antidepressants (including a single dose), and they are canceled gradually within six months after the main course of treatment, so that the body gradually weaned from outside help and got used to working on its own.

If antidepressants are taken for too long, dependence may occur. Antidepressant Dependence  similar to narcotic. The body gets used to antidepressants and becomes unable to maintain homeostasis without them. It is very difficult to get rid of this addiction.

In pharmacies without a doctor’s prescription, of course, not a single strong antidepressant is released, but some mild antidepressants are sold, mainly on a plant basis. It is these drugs that are most often resorted to by people who want to quickly get rid of a heavy mood, anxiety and just excitement, while not consulting a doctor.

OTC antidepressants seem harmless, but even such drugs should be used with caution, they can also be addictive! Always before use, carefully read the instructions and do not exceed permissible rate  taking medication!

Self-medication and taking too long antidepressants (including those prescribed by a doctor) can cause irreparable harm to human health.

Side effects

When a person begins to take an antidepressant appropriate for him, he feels much better, anxiety, panic, apathy, insomnia, suicidal thoughts and other symptoms of depression or other mental disorders go away.

But at the same time, such antidepressant side effectsas:

Even such an effective, natural, time-tested and experimentally dispensed drug in a pharmacy as hypericum tincturehas a number of side effects, such as:

• fullness of the stomach
• constipation,
• nausea,
• flatulence,
• dizziness,
• headache,
• fatigue,
• photosensitivity (increased sensitivity to light).

You can imagine what the consequences will be if you use an antidepressant longer and more than necessary!

For example, it was found that if normally, when taking an antidepressant in a person, only a decrease in libido can be observed, then in case of an overdose, damage and death of reproductive cells begins.

In addition to side effects, natural, over-the-counter and doctor-prescribed antidepressants have a number of contraindications and are incompatible with some other drugs. These points are also important to consider.

A pill or a dummy?

Side effects and the risk factor for dependence on antidepressants have worried scientists since the time when these drugs began to be used in the middle of the last century.

American and British scientists conducted many experiments and experiments in order to find a solution to the problem "how to treat people from depression without harm to their own health?"

The following conclusion is most interesting: the effectiveness of antidepressant and placebo almost the same!

This information also “surfaced” and was confirmed several years ago when in the USA a group of scientists demanded that the organization controlling the production of licensed drugs provide access to all published and unpublished (!) Studies of the effectiveness of antidepressants.

Analysis of published materials showed that antidepressants are 94% more effective than placebo. When unpublished materials were added to the published ones, this indicator decreased only in half of the cases ( 50% ) the antidepressant was more effective than a placebo.

Today in the UK, the difference between a placebo and a real medicine is considered so insignificant that in most cases people are given a “dummy”! Antidepressants are prescribed only in very severe cases.

Placebo  from Latin it is translated as "I will be pleased - I will like it." This substance is without healing properties  (most often lactose) used as medicinal product. The therapeutic effect of such a “dummy” is determined by faith  the patient's effectiveness of the drug.

The conclusion is simple: main component  any medicine must be a person’s faith in his recovery!

Alternative  The medical treatment for depression and other similar diseases is psychodynamic and cognitive-behavioral psychotherapy, as well as simple joys and life values: walking in the fresh air, playing sports, good nutrition, healthy sleep, traveling, studying, hobbies, friendship, love, altruism.

Myosin protein molecules walk along the actin filament, dragging an endorphin ball into the inner part of the parietal cortex (precuneus), which is responsible for happiness.

Have you ever taken antidepressants (including over-the-counter drugs such as Novo-Passit or Negrustin)?

Vladimir Snigur
Antidepressants for Depression: Benefit or Harm?

The material is partially adapted from the article: Andrews, P., Thomson Jr., J. A., Amstadter, A., Neale, M. C. Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good. Frontiers in Psychology 2012; 3,177: 1 - 19. Full article on english language  available.

We continue the topic, not directly related to hypnosis, but related to psychotherapy in general. Psychotherapeutic treatment is often adjacent to the drug. Moreover, many specialists - psychiatrists and psychotherapists - assign psychotherapy a secondary role, if not conditional, giving preference to pharmacotherapy. But sometimes scientific discoveries reduce the possibilities of medicinal methods, thereby expanding the field of activity for psychotherapy.

In the history of medicine, there are many cases where the creation of a new drug caused a stir among specialists who began to prescribe it to an increasing number of patients. But as more thorough and comprehensive studies were carried out, the medical community agreed that this drug was far from being as useful and safe as was thought, after which its use was significantly limited.

In March 2012, the frontiers in psychology magazine published a most curious article, which summarizes the studies available today for several groups of antidepressants from the point of view of the evolutionary approach. These drugs have been shown to be quite effective in treating a number of disorders, primarily depression. It is possible that the results of this and other similar reviews will force specialists to seriously review their attitude to this group of drugs: it turns out that the positive effects of antidepressants are more modest than is commonly believed, and side effects may well exceed the possible benefits.

Serotonin (5-hydroxytryptamine or 5-HT) is an ancient substance with a history of evolution of at least one billion years, it is present in fungi, plants and animals. Serotonin, along with norepinephrine (NA) and dopamine (DA), belongs to the class of monoamines. Drugs that affect the metabolism of serotonin are one of the most commonly prescribed in psychiatric practice. It is believed that norepinephrine and serotonin, at least in part, are responsible for the symptoms of depression, the most common mental disorder people seek help with. In the treatment of depression, antidepressants are most often used, which affect just the mechanisms of norepinephrine and serotonin. In addition to depression, antidepressants are prescribed for other disorders, such as dysthymia, bipolar disorder, anxiety, panic and post-traumatic disorders, phobias, eating disorders, chronic pain, etc. These drugs are prescribed annually to millions of people around the world.

Known fundamental principle of medicine "primum non nocere" (lat. "Do no harm"). At the same time, according to everything more  specialists, many modern diagnostic criteria and treatment standards can do more harm than good. Many of these considerations are based on evolutionary views on the nature of the disorder.

Given the fact that serotonin is involved in many processes both in the brain and in other parts of the body, as well as given the participation of serotonin in a variety of adaptive mechanisms, antidepressants can have many side effects. And, despite the abundance of experimental data, the effect of antidepressants on other serotonergic effects has so far attracted little attention from researchers.

Serotonin Homeostasis

Animal studies have found that only 5% of all serotonin is concentrated in the brain. The main part of serotonin is present in the intestine, where 90% of it is in enterochromaffin cells (where it is synthesized), and the remaining 10% is synthesized and stored in myenteric associative neurons. Enterochromaffin cells secrete serotonin into the bloodstream, where it is captured by platelets. In adults, it does not pass through the blood-brain barrier, so the central and peripheral pools of serotonin are not connected with each other.

Homeostasis (maintaining balance) of serotonin is carried out by the mechanisms of the central nervous system, intestines and blood plasma. The essence of homeostasis is to maintain an equilibrium concentration of a substance within the physiological “corridor”. In general, the mechanisms of homeostasis are a classic example of an evolutionarily developed adaptation, since they maintain the concentration of substances at the level necessary for the normal functioning of the body, and form a complex network of interactions that could arise only during natural selection. Roughly speaking, the mechanisms of homeostasis include sensors that track the level of a given substance, and feedback mechanisms that return a parameter to an equilibrium state when it is deviated. Many homeostatic mechanisms can increase or decrease the equilibrium level in response to various external conditions. For example, the body reacts to infection with an increase in temperature (which normally is in a narrow equilibrium range), which manifests itself in the form of fever. Further, feedback mechanisms maintain body temperature at this elevated equilibrium level. The concentration of serotonin in various parts of the body is supported by similar mechanisms.

In the brain, serotonergic neurons are present in the nuclei of the suture of the brain, giving projections to other parts of the brain. The dorsal nucleus of the suture contains neurons that have connections with the forebrain. After isolation of serotonin at the synapse, it is captured back by the presynaptic membrane by transport molecules, after which it is cleaved by monoamine oxidase-A.

The effect of antidepressants on body systems

According to the basic tenet of medicine and psychiatry, disorders arise as a result of deviations or impairments of biological functioning. Since natural selection is considered to be the only force capable of forming biological functions, and the features of biological functions are essentially forms of adaptation, the term “disorder” can be understood as violations and deviations in the work of the developed adaptations. In this case, in principle, interventions aimed at eliminating working adaptation mechanisms can themselves cause a disorder.

Antidepressants, entering the bloodstream and distributed throughout the body, affect the level of monoamines. The most common mechanism is binding to carrier proteins. In a normally functioning brain, the blocking of the carrier prevents the reuptake of monoamines by the presynaptic neuron, as a result of which, within minutes and hours, the concentration of monoamines in the extracellular space increases and exceeds the equilibrium concentration. However, in the case of prolonged use of antidepressants, the mechanisms of homeostasis dampen this effect through various compensatory changes, including a decrease in the synthesis of serotonin, which leads to a decrease in the total amount of serotonin in the brain. As a result, the concentration of serotonin in the extracellular fluid returns to its equilibrium level. In addition to reducing the synthesis of serotonin, there are also changes in the density and functioning of serotonin receptors, transport proteins, etc.

Scheme 1. The effect of antidepressants on intercellular concentrations of serotonin, as well as the total content of serotonin in the brain over time. Vertical columns - intercellular serotonin, curves from top to bottom - the content of serotonin in the brain and the synthesis of serotonin. Andrews et al., 2012.

But antidepressants also spread throughout the body, therefore, they can affect the corresponding processes in peripheral tissues.

Theoretically, antidepressants can disrupt normally functioning adaptive mechanisms and cause disorders in many ways. The first stems from the fact that a few weeks are usually needed to reduce the synthesis of serotonin, which should return the concentration of serotonin to an equilibrium level. During this time, the concentration of serotonin is higher than necessary, therefore, antidepressants during this period can cause various disorders.

The second way is that prolonged use of antidepressants can lead to overstrain of regulatory mechanisms, causing malfunctions in their work. For example, it was suggested that depression can occur as a result of impaired regulatory mechanisms during prolonged stress (McEwen, 2000; Ganzel et al., 2010). From the same principle, it can be concluded that prolonged use of antidepressants can lead to the degradation of homeostatic mechanisms that regulate the exchange of serotonin.

The third way implies a possible relapse of the disorder after the withdrawal of antidepressants. Although the balance is restored during their intake, this is due to other adaptations that counteract the effects of antidepressants. In case of cancellation of antidepressants, these existing adaptive mechanisms do not encounter counteraction, which again leads to a deviation from equilibrium. Such fluctuations in the level of monoamines as a “swing” can continue until the brain reconfigures its adaptation mechanisms in accordance with the new situation.

In addition, antidepressants can cause disorders by disabling key links in homeostasis mechanisms. For example, regulation of serotonin levels in blood and plasma depends primarily on the serotonin transporter. By blocking the carrier, antidepressants violate the key link of the mechanism, as a result of which a return to the equilibrium state becomes impossible.

The effectiveness of antidepressants

Antidepressants are considered very effective in reducing symptoms, but recent studies suggest that antidepressants are very modest. To begin with, studies that discussed the effects of these drugs were only partially published. Turner et al. (2008) on the basis of the FOIA (Freedom of Information Act, USA) applied to the FDA (an organization that controls, among other things, licensing of drugs in the USA) with a request to get access to all published and unpublished studies conducted by pharmaceutical companies to obtain their registration preparations. The authors found that the benefits of antidepressants over placebo were indicated in 94% of published studies. At the same time, when published and unpublished studies were analyzed together, antidepressants were superior to placebo in only 51% of them.

Kirsch et al. (2008) also contacted the FDA to understand how effective antidepressants are in reducing symptoms in depression. Changes in symptoms of depression were assessed using the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960), the most common method for assessing the effectiveness of antidepressants in studies. The total score for it can vary from 0 to 53, but researchers can interpret them very differently. The American Psychiatric Association (APA, 2000) specifically mentions the pattern used by Kearns et al. (1982), which is also used by the National Institute for Clinical Excellence in Great Britain (National Institute for Clinical Excellence, NICE, 2004). Scores in the range of 0-7 correspond to the norm, 8-13 - mild depression, 14-18 - moderate depression, 19-22 - severe depression, ≥23 - very severe depression.

Keep in mind that the diagnostic criteria for major depressive disorder (MDD) are met by all patients with a score of 13 or more. In other words, many patients who are diagnosed with MDD have only symptoms of mild or moderate depression. In addition, according to NICE recommendations, in order for the antidepressant effect to be recognized as clinically significant, the drug should reduce the severity of symptoms by 3 points in HDRS or more compared with placebo (NICE, 2004).

Kirsch et al. (2008) found that when taking a placebo, symptoms decreased on average by 7.8 points, and when taking antidepressants by 9.6 points. Obviously, significant improvements were recorded in both groups, but, with the exception of one study, all patients at the time of assessing their condition were in a state of “very severe depression” (average HDRS score ≥ 23). In other words, even taking into account the improvement caused by the placebo effect or the effect of antidepressants, most of the patients remained depressed. Moreover, antidepressants reduced symptoms of depression by an average of 1.8 HDRS points better than placebo. Although this difference was significant, it does not meet the requirements of NICE recommendations. The difference between placebo and antidepressants increased as the total score increased and reached clinical significance with an initial level of 28 points or more. However, most likely this was not due to an increase in the effectiveness of antidepressants, but due to a decrease in the placebo effect.

These results suggest that antidepressants do not actually have a significant clinical effect on the symptoms of depression, except with the exception of "very severe" cases. The findings that antidepressants have a very modest effect compared with placebo have been confirmed in other studies (Khan et al., 2002, 2005, 2011; Fournier et al., 2010). In the UK, the difference between antidepressants and placebo is considered so insignificant that prescribing antidepressants is recommended only in cases of severe depression.

Perhaps the low efficacy of antidepressants indicates that serotonin is not involved in the management of depressive symptoms. However, it can also be assumed that the mechanisms of homeostasis that regulate the exchange of serotonin remain intact, since the brain counteracts the influence of antidepressants.

The topic of the effectiveness of antidepressants and methods of treatment for depression will be discussed in more detail on this site in the next article “ Suggestion for Depression Therapy».

Problems with long-term use of antidepressants

Even in those patients who respond well to antidepressant treatment, over time there is a decrease in their effectiveness, which sometimes leads to a full relapse. This fits into the framework of the hypothesis of the brain counteracting the influence of antidepressants. Initial studies reported a 9–57% chance of relapse with prolonged use of these drugs (Byrne & Rothschild, 1998). In modern researchers, the likelihood of relapse is also rated as quite high. In one study of fluoxetine, 35.2% of participants had a relapse after 6 months of taking the drug continuously, and the number of relapses increased to 45.9% after 12 months of taking (McGrath et al., 2006). In another study, 68% of patients who initially went into remission and received only long-term antidepressant treatment had relapse at the end of a two-year follow-up period (Bockting et al., 2008). In these studies, only an increase in symptoms was indicated that met the criteria for relapse, and the overall decrease in effectiveness with long-term use is much more significant.

The long-term effects of antidepressants in depression were studied in the STAR * D study (Sequenced Treatment Alternatives to Relieve Depression), which has been repeatedly mentioned in various publications as an argument in favor of the effectiveness of these drugs. This study involved 3,110 depressed patients who received consecutively up to four different drugs (in the case of inefficiency of a narrow-spectrum drug, drugs of a wider spectrum were sequentially prescribed). The overall frequency of remissions during all stages of treatment was estimated at 67% (Rush et al., 2006). However, in this study, there was no control group receiving placebo, so the positive results cannot be explained by the effect of antidepressants - these results include the combined effect of antidepressants and the placebo effect. In addition, according to reports of other authors who reanalyzed the data after the completion of the study, 93% of 1518 participants with remission 12 months after the end of treatment or exclusion from the study had relapses of depression (Pigott et al., 2010). Even this fact alone indicates that the effectiveness of antidepressants decreases over time. In addition, independent researchers reported numerous inaccuracies in the results of the authors of the study.

Increased risk of relapse after completing a course of antidepressants

When the mechanisms of homeostasis are shifted from the equilibrium point, an oppositely directed force arises, which tends to restore equilibrium. Different antidepressants have different effects on the concentration of monoamines in the brain. If the mechanisms of homeostasis that regulate their concentration work correctly in most patients with depression, we should see a surge in symptoms of depression after drug withdrawal. And the degree of this surge should be proportional to the activity of the antidepressant.

To test this hypothesis, a meta-analysis of studies in which antidepressants were withdrawn was performed (Andrews et al., 2012). Since it is difficult to assess the degree of their influence on the concentration of monoamines in humans, such measurements were carried out on rodents in the area of \u200b\u200bthe prefrontal cortex (Amat et al., 2005). Placebo had no effect on the concentration of monoamines, and the most powerful antidepressants can increase the level of monoamines in PFC up to 400% and even more (Bymaster et al., 2002). After introducing the necessary amendments, the authors found a positive correlation between the antidepressant power in relation to the concentration of monoamines (serotonin and norepinephrine) and the likelihood of developing a relapse of depression after drug withdrawal. In other words, the stronger the antidepressant affects the concentration of these substances, the stronger the brain counteracts this effect and the greater the likelihood of exacerbation after drug withdrawal  (see schemes 2 and 3). Based on these findings, it can be argued that those patients who improve without the use of antidepressants are less likely to relapse.

Scheme 2. Relation of the risk of relapse with the power of an antidepressant. Y-axis: risk of relapse due to withdrawal of antidepressants. On the x-axis: the degree of influence of the antidepressant on the content of serotonin in the prefrontal cortex of rodents. A 100 along the x-axis indicates that the antidepressant does not affect serotonin levels. Andrews et al., 2012.

Scheme 3. Relation of the risk of relapse with the power of an antidepressant. Y-axis: risk of relapse due to withdrawal of antidepressants. On the abscissa: the degree of influence of the antidepressant on the content of norepinephrine in the prefrontal cortex of rodents. A 100 along the x-axis indicates that the antidepressant does not affect the level of norepinephrine. Andrews et al., 2012.

These observations contradict the hypothesis that antidepressants interrupt the stress response by allowing the brain to recover in order to better resist depression (Sapolsky, 2001; Kramer, 2005). On the contrary, antidepressants seem to be increase susceptibility to depression.

The authors conducted a regression analysis, which allowed us to assess the effect of specific drugs on the risk of relapse of depression. Thus, the three-month risk of relapse in patients who began to recover on a placebo was 21.4%, while risk after antidepressant withdrawal increased as drug activity increased  and made up: 43,3% for SSRIs (serotonin reuptake inhibitors), 47,7%   for SSRI (serotonin and norepinephrine reuptake inhibitors), 55,2%   for tricyclic antidepressants, 61,8%   for fluoxetine and 75,1%   for MAO inhibitors.

Neuronal proliferation, death and differentiation

Serotonin is involved in various processes of brain formation, including cell differentiation, apoptosis (programmed death) of neurons, neurogenesis (birth and growth of neurons), and neuroplasticity (Azmitia, 2001). Given the complex functions of serotonin, the effect of antidepressants can have complex consequences for the functioning of neurons.

For example, it is believed that antidepressants contribute to neurogenesis, some researchers even believe that this effect is the basis of the therapeutic effect of antidepressants. But do not uncritically take the assertion that increased neurogenesis in itself is a beneficial effect. This process is finely regulated throughout life; moreover, congruent functions are not directly dependent on the number of neurons in the brain. In fact, if antidepressants stimulate the proliferation of new neurons, it would be worthwhile to carefully weigh the risk of stimulating brain tumors. On the contrary, there is evidence that in vitro  antidepressants reduce the volume of gliomas and neuroblastomas through apoptosis of neurons (Levkovitz et al., 2005; Cloonan & Williams, 2011). Moreover, a recent epidemiological study reported that prolonged use of tricyclic antidepressants may reduce the risk of developing gliomas (Walker et al., 2011), although antidepressants may reduce the risk of other forms of cancer (Cosgrove et al., 2011). The proapoptotic effect is not limited to tumor tissue alone. Antidepressants can lead to apoptosis of ordinary hippocampal neurons, which is confirmed in experiments in vitro  (Post et al., 2000; Bartholoma et al., 2002) and in vivo  (Sairanen et al., 2005). These drugs can also cause sperm death. In other words, there are good reasons to argue that antidepressants stimulate apoptosis.

It would be very strange if antidepressants simultaneously and directly stimulated both neurogenesis and apoptosis. In fact, the evidence that antidepressants stimulate neurogenesis is very mixed. The fact is that the vast majority of studies in the field of neurogenesis are based on techniques using 5-bromo-2′-deoxyuridine (NOS). This is an analog of thymidine nucleotide, which is incorporated into DNA (deoxyribonucleic acid, the main molecule of genetic information) and can be detected using immunohistochemical methods. In other words, NOS is a marker of DNA synthesis, which allows it to be used as a marker of cell proliferation, since DNA synthesis occurs precisely during cell division. However, the interpretation of the signal from the NOS is complicated by the fact that the NOS can be included in the DNA not only during division, but, for example, during DNA repair (restoration), abortive repetition of the cell cycle, DNA duplication without cell division (Taupin, 2007). What is important, very often DNA is synthesized in connection with the processes of apoptosis. Problems with the interpretation of the signal from the NOS led to the fact that one of the researchers called the NOS “one of the most abused techniques in neuroscience” (Taupin, 2007, p. 198).

Recently, researchers in combination with NOS have used other methods to find out the fate of neurons after taking antidepressants. One way is to study neurons for the presence of Ki-67 and X-linked doublecortin (DCX), which are proteins synthesized by growing neurons, as well as NeuN, which is considered a marker of adult neurons. A positive signal from these markers allows more accurate talk about neurogenesis.

However, a recent study using modern technology did not find any evidence that fluoxetine stimulated neurogenesis (Kobayashi et al., 2010). But in this study, it was shown that mature neurons adopted immature functional characteristics, including an immature synaptic plasticity and gene expression profile.

This degradation of neurons can be caused by a decrease in the synthesis of serotonin, which occurs during a protective reaction of the brain to the effect of antidepressants. A constant level of serotonin is necessary to maintain the mature state of neurons. When serotonin synthesis decreases, the cytoskeleton begins to degrade, synapses and dendrites degrade, which together indicates a return to an immature, undifferentiated state (Chen et al., 1994; Wilson et al., 1998; Azmitia, 2001). This process may play a role in stimulating apoptosis (Azmitia, 2001), although the nature of this relationship is not fully understood.

Another mechanism of apoptosis when exposed to antidepressants may be the direct damaging effect of drugs on neurons, since damaged neurons often become targets for apoptosis. One study is known in which the effect of antidepressants on the structural damage of neurons has been studied (Kalia et al., 2000). The authors found that the introduction of clinically significant doses of fluoxetine (28.6 mg / kg orally) into the brain of healthy rodents for 4 days caused axon shortening, defects and swelling at the nerve endings. Such changes are usually mistaken for actual signs of damage to neurons. It is believed that similar changes are present in the brain in Parkinson's disease.

Degradation and damage to neurons can interfere with normal brain function. The changes described above can explain parkinson's dyskinetic phenomena (involuntary repeated muscle contractions) that sometimes occur when taking antidepressants. In experiments on rodents, antidepressants led to a decrease in performance in a variety of educational tasks. A recent large study in humans has found that antidepressant medication is associated with an increased risk of mild cognitive impairment in older women by 70%, as well as an increased risk of dementia (Goveas et al., 2011).

Attention

A common symptom of depression is difficulty concentrating. Often this is due to obsessive recalls and thoughts that are difficult to suppress or control. They create difficulties for focusing, occupying the resources of immediate memory. These mechanisms are partially regulated by serotonin. One study showed that the antidepressant sertraline reduces the number of obsessive memories in patients with dysthymia. This is usually considered a beneficial effect, but many researchers believe otherwise. Interventions aimed at reducing obsessive recalls (for example, distraction, suppressing thoughts) really reduce the severity of symptoms in the short term, but in the long run the effect is the opposite. Therefore, apparently, this effect is palliative in nature and does not affect the cause of the condition. On the other hand, interventions aimed at encouraging intrusive recalls (e.g., recording the most vivid thoughts and feelings about one's own condition) increase awareness and shorten such episodes (Hayes et al., 2005, 2007; Gortner et al., 2006; Graf et al., 2008), that is, apparently, such interventions affect the cause of the condition. In other words, blocking obsessive memories seems to be unproductive.

Other studies suggest that antidepressants have a negative effect on attention work. In healthy volunteers, taking antidepressants for several weeks led to cognitive impairment, especially in tasks requiring increased and prolonged attention and active work with direct memory. This has been demonstrated on drivers (Ramaekers et al., 1995; O’Hanlon et al., 1998; Wingen et al., 2005). Recently, the same authors investigated the effect of antidepressants on real statistics on road traffic crashes using the UK primary care database (Gibson et al., 2009). As a base level, the authors took the condition a year before the drug was prescribed (incidence rate (IRR) \u003d 1). For people who were prescribed SSRIs, a month before the appointment of drugs, the risk of accidents increased (IRR \u003d 1.7, 95% CI \u003d 1.47 - 1.99). In other words, depression, anxiety and other conditions that lead to the appointment of antidepressants are risk factors for accidents. During the first month of taking an SSRI, the risk of an accident returned to normal (IRR \u003d 0.92, 95% CI \u003d 0.75 - 1.12). If you consider this in isolation, you might think that antidepressants protect against accidental accidents. But SSRIs only reduce symptoms by a few weeks of admission, in addition, this study was not placebo-controlled, therefore, the decrease in the risk of accidents could well occur for other reasons not related to taking SSRIs. When using other drugs that affect attention (benzodiazepines, hypnotics, beta-blockers, opioids, antihistamines, etc.), a similar decrease in the risk of accidents was observed. But after four weeks of using SSRIs, the risk increased again and remained high throughout the treatment (IRR \u003d 1.16, 95% CI \u003d 1.06 -1.28). As soon as the treatment of SSRIs was stopped, the risk of an accident returned to normal (IRR \u003d 1.03, 95% CI \u003d 0.92 - 1.16). A similar picture was observed in the case of the use of benzodiazepines, opioids, etc. In other words, the described scheme suggests that SSRIs - like benzodiazepines, hypnotics, opioids and antihistapines - affect attention and increase the likelihood of traffic accidents.

Other effects

The negative effects of antidepressants on the processes of thrombosis, platelet activation, which may increase the risk of bleeding (especially in combination with aspirin and other NSAIDs, Dall et al., 2009). The effect of antidepressants on the likelihood of cardiovascular events has not yet been unambiguously described, studies give mixed results. There is also no clear evidence of the effect of antidepressants on the likelihood of strokes. In a recent French randomized controlled trial involving 118 patients with ischemic strokes, fluoxetine treatment resulted in better recovery of motor skills on day 90 of observation (Chollet et al., 2011). The mechanisms for this are not completely clear. Given the above data, it is hardly possible to explain this improvement by direct stimulation of neurogenesis. Perhaps the improvement in recovery can be explained by the removal of damaged neurons through apoptosis mechanisms, degradation and rejuvenation of adult neurons (which can stimulate neuroplasticity), as well as compensatory neurogenesis.

What next?

These data indicate that antidepressants increase the susceptibility of the brain to depression, cause damage to neurons and their reverse development. Information about direct stimulation of neurogenesis is contradictory: it is possible that compensatory stimulation of neurogenesis occurs as a result of apoptosis caused by antidepressants. Among the side effects of antidepressants, problems of early development, sexual dysfunction, and an increased risk of hyponatremia and stroke are also listed.

The main goal of antidepressants is to reduce the symptoms of depression, which stems from the conceptual concept of depression as impaired brain function. An alternative point of view is that modern diagnostic criteria do not clearly distinguish between a normal, evolutionarily developed response to stress and a pathological one. As a result, attempts to pharmacologically change and reduce the symptoms of depression can adversely affect the brain's ability to cope with stress.

Given the limited effectiveness of antidepressants in combination with their side effects, it can be assumed that antidepressants can do more harm than good, although they may be useful for some categories of patients. There is no doubt that the above list of positive and negative effects of antidepressants is still far from complete. Some additional information on this topic can be found in an article by Andrews et al. (2012). However, knowing about these negative effects, we can more carefully and accurately choose therapeutic tactics and pay more attention to psychotherapeutic methods.

Despite the fact that the benefits of psychotherapy for depression are diminished and depreciated by many experts, psychotherapy can achieve significant results. To date, depression has proven the effectiveness of both psychodynamic and cognitive-behavioral therapy, and according to recent data, short-term psychodynamic therapy is superior to CBT in terms of effectiveness and has better long-term results. Robertson (2009), in his review of empirically sound methods of psychotherapy, also put hypnotherapy on the list of “possibly effective” for depression. It is proved that the combination of hypnotherapy with CBT or psychodynamic therapy increases the effectiveness of treatment by 2 times or more (see the articles “ Hypnosis and Psychodynamic Therapy», « Hypnosis and Cognitive Behavioral Therapy"). New Hypnosis, which is also called psychodynamic hypnosis, in this light seems to be an absolutely safe and very promising method that combines trance techniques with psychodynamic, which makes it a flexible and universal tool.

Antidepressants can improve symptoms of depression, but are there antidepressants without side effects? The answer is unequivocal - like all medicines - they can! The vast majority of people who take antidepressants have at least once had the sad experience of how antidepressants caused side effects and complications. Most of them are insignificant and, as a rule, pass independently. Particularly annoying side effects of taking antidepressants are treated with medication or a dose reduction, a change in timing, or switching to another drug.

Are there any antidepressants without side effects?

Practice shows that antidepressants should be taken with caution, with full awareness of the risks and close attention to side effects. Nevertheless, antidepressants have been used safely by millions of people for several decades.

Antidepressants and side effects

Side effects common to most, if not all, antidepressants include:

Gastrointestinal Disorders:  nausea and diarrhea are dose-dependent and usually resolve within the first two weeks of antidepressant treatment. Starting medication in low doses or starting to take antidepressants with food can reduce nausea and diarrhea.

Weight gain: Depression  often associated with appetite suppression and weight loss, weight gain during antidepressant treatment can be either a sign of symptom improvement or a side effect of antidepressants. Weight gain can occur after taking almost all antidepressants, in part due to increased appetite and thirst for carbohydrates.

Generally speaking, some antidepressants seem to cause weight gain more often than other drugs in this class. For example, tricyclic antidepressants (TCAs) and possibly monoamine oxidase inhibitors (MAOIs) are more likely to cause weight gain than selective serotonin reuptake inhibitors (SSRIs) or new-generation antidepressants, with the exception of Remeron. SSRIs tend to lead to an early loss of appetite, sometimes due to side effects such as nausea, while others can cause weight gain with long-term use (for example, Paxil). Some antidepressants, like Velbutrin and Effexor, are less likely to affect weight.

The degree of weight gain largely depends on the specific dosage and duration of treatment. Prevention is an ideal strategy to cope with weight gain and typically includes healthy eating habits and physical activity.

Sleep Disorders:  insomnia and drowsiness may be controlled by other medications, dose changes, or by administering antidepressant medications. Some patients report nightmares or surprisingly vivid dreams, but these side effects often go away within a few weeks and rarely lead to a change in prescription.

Sexual Dysfunction: Sexual dysfunction is a reversible side effect, usually characterized by delayed ejaculation, decreased libido or anorgasmia (inability to achieve orgasm), which are found in men and women taking antidepressants. Negative effects can be mitigated by reducing the dosage, switching to another drug, or by adding another medicine to overcome sexual side effects. It is important to remember that mental illness in itself can affect sexual desire and the ability to have sex.

Serotonin syndrome (serotonin intoxication)  : Serotonin syndrome is a rare but serious reaction to a drug that occurs when two serotonergic drugs (drugs that increase the level of serotonin in the brain) are taken at the same time. Serotonin syndrome is associated with side effects such as:

• Changes in mental status (agitation, anxiety, delirium, euphoria, manic syndrome, hallucinations, confusion, mutism, coma)
• Symptoms of autonomic dysfunction (abdominal pain, diarrhea, hyperthermia, headaches, lacrimation, dilated pupils, nausea, tachycardia, tachypnea, fluctuations blood pressure, chills, sweating).
• Neuromuscular disorders (akathisia, bilateral Babinsky symptom, epileptiform seizures, hyperreflexia, impaired coordination, myoclonus, horizontal and vertical nystagmus, oculogyric crises, opistotonus, paresthesia, muscle rigidity, tremor)

Antidepressant withdrawal syndrome:  after a sudden cessation of these drugs, patients may experience dizziness, nausea, weakness, insomnia, anxiety, irritability, and headache. These symptoms usually go away within a week. A gradual decrease in the dose of antidepressants and the practice of relaxation methods should help avoid antidepressant withdrawal syndrome.

Suicidal thoughts or actions:  antidepressants may increase suicidal thoughts or actions in some children, adolescents, and young adults when they are first prescribed. Depression and other mental illnesses are the most important causes of suicidal thoughts and actions.

Side effects of different types of antidepressants

Monoamine oxidase inhibitors: MAO inhibitors associated with daytime sedation, dizziness, orthostatic hypotension (orthostatic changes in blood pressure), dry mouth, nervousness, muscle pain, paresthesia (tingling sensation), insomnia, weight gain, sexual dysfunction, and urinary difficulty.

Tricyclic antidepressants:  tricyclic antidepressants tend to have more side effects than other antidepressants, including headaches, drowsiness, significant weight gain, nervousness, dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash and changes in heart conduction.

Selective Serotonin Reuptake Inhibitors:  SSRIs are generally generally well tolerated. Transient side effects of SSRIs: nausea, vomiting, diarrhea, headache, fatigue, nervousness, dry mouth. Some of the more persistent, chronic side effects include daytime fatigue, insomnia, sexual problems, and weight gain.

Selective noradrenaline reuptake inhibitors:  side effects are similar to SSRIs. The most common side effects of these antidepressants include nausea, dizziness, insomnia, drowsiness, dry mouth, and sexual dysfunction. Selective noradrenaline reuptake inhibitors can increase blood pressure, especially at high doses.

Side effects of atypical antidepressants

• Trazodone usually causes sedation, dizziness, orthostatic hypotension, dry mouth, nausea, and headache.
• Velbutrin usually causes insomnia, headache, anxiety, irritability, agitation. Wellbutrin has a low risk of sexual side effects, fatigue and weight changes compared with all antidepressants. Higher doses of Velbutrin are associated with seizures.
• Remeron usually causes fatigue, dizziness, sedation, weight gain. Less commonly, it can cause insomnia, sexual side effects, and nausea.

People respond differently to antidepressants and often have to experiment before you find the one that works best. Careful monitoring of any side effects that you experience is required. Call your doctor right away if the symptoms of your disease become worse - he will most likely prescribe another drug for you. Management of side effects can improve the success of antidepressant therapy.

Denial of responsibility: The information presented in this article about antidepressant side effects is intended to inform the reader only. It cannot be a substitute for consultation by a professional medical professional.

  The purpose of this article is to cover a largely complex and painful topic affecting antidepressants. Today, the word "depression" is already used to, it has even become fashionable. But the mention of antidepressants often causes a sharply negative reaction. At the same time, these two concepts are connected: the second exists because of the first.

Suicidal thoughts are most often (though by no means always) one of the symptoms of a depressed state. You can and should get out of it. The question is in the methods. Although I am a supporter of personal resources and psychological methods of work, I still have to note that some conditions require medical intervention. But on the proposal to turn to medicine, one can often hear the answer: “I do not want to drink pills!” Sometimes a person cannot explain his decision, sometimes you have to hear many "minuses" of antidepressants, many of which, however, do not correspond to reality. In principle, this reaction is understandable: ordinary people are little aware of this topic, so there is a fear of the unknown and a lot of myths. Based on my own experience, collecting information and getting expert advice, I want to talk in more detail about the myths and reality of the use of antidepressants.

To begin with, a brief theoretical information about what antidepressants are. They are distinguished by several groups:

1) MAO inhibitors

2) Tricyclic and tetracyclic

3) SSRIs (selective serotonin reuptake inhibitors)

4) SSRIs N (selective serotonin and noradrenaline reuptake inhibitors)

5) NACCA (noradrenergic and specific serotonergic antidepressants)

6) SIOZNiD (selective inhibitors of reuptake of norepinephrine and dopamine)

7) CCA (Specific Serotonergic Antidepressants)

8) Melatonergic antidepressants

In each of the groups there are several basic drugs and many generics.

(Generic is a drug made according to a patent bought by any pharmaceutical company from a company that developed the drug and put the drug on the market for wide sale.)

This information helps to imagine how broad the concept of “antidepressants” is. The difference in antidepressants is in the direction of their action. Over time, with the development of pharmacology, more and more new groups of antidepressants appear, not to mention new drugs in each group. There are no good and bad, new does not always mean the best - each medicine is intended for a particular case. Here you need to understand that, due to the wide range of drugs available in pharmacies, the doctor always has a choice when prescribing. In 6 out of 10 cases according to statistics  the first prescribed antidepressant is effective. In other cases, there is always the opportunity to choose "your" antidepressant for a person.

But before you go to the doctor, it is advisable to have at least some idea of \u200b\u200bthe reality of antidepressants. So, let's pay attention to the following "myths"

Myth 1. Antidepressants cause addiction..

Reality.Not all groups of antidepressants are addictive. Among the drugs there are those that you can stop taking without changing the achieved therapeutic effect and without unpleasant consequences (the so-called "withdrawal syndrome"). There are those that need to be discarded gradually, in this case, you need to endure while the body learns to cope on its own. The most common among antidepressants is a gradual dose reduction over a month. Yes, there are also drugs that it’s difficult to quit on their own, they cause quite good drug remission, but they don’t treat the malfunction in the production of certain mediators and hormones, therefore, when they are canceled, the condition worsens significantly.

Opinion of Marina V. Karpova, psychiatrist:

None of the antidepressants in predetermined therapeutic doses (permitted for use) is addictive, addictive. What is meant by Dependency? It is likely that when a layman talks about this, there are the following common misconceptions:

  “Having started taking the drug, I can never do without it again, I will have to take it all my life”

  - "If I want to stop taking the antidepressant, I will overtake" terrible consequences, I will feel bad without it, or even worse than before. "

The timing of prescribing antidepressants varies depending on the degree to which the symptoms of the disease are expressed in severity and duration. If we are talking about reactive (arising in response to a stressful situation) depression - the appointment dates range from 3-4 months, but if we are talking about endogenous depression - then it can take from six months or more. An important condition for good tolerance and effect is the correct selection of the drug, a gradual selection of the required dose and a smooth reduction according to the scheme, made under the supervision of a doctor. In other cases, you may encounter unpleasant consequences of the action of drugs, which will be mistakenly evaluated as “addiction”, or “side effect”. There are such concepts as “withdrawal syndrome” and “recoil syndrome”. Withdrawal Syndrome - side effectsobserved with a sharp discontinuation of the drug without observing the recommended nuances of reducing dosages. The concept of withdrawal syndrome includes such unpleasant physical sensations as headaches, dizziness, sleep disturbances, trembling in the body, muscle cramps, fever and others. For different antidepressants, this syndrome is characterized to varying degrees. Recoil syndrome is a phenomenon of sharply recurring depressive symptoms, as well as all the symptoms of the disease in which an antidepressant was prescribed. This syndrome occurs, as a rule, when antidepressants are canceled earlier than the recommended duration of therapy, or a dose is reduced too quickly, and the timing of supportive treatment is not observed (on average, from 2 months or more).

Myth 2. Antidepressants take control of a person’s personality, a person ceases to be himself.

Reality.  Antidepressants in no way affect the personality component and mental abilities, in particular. A man has a mind that always stays with him. Sometimes a person’s ability to think is influenced by different conditions - painful, asthenic, affective and others. So antidepressants can reduce this harmful effect. Antidepressants remove the excessive emotional component (anxiety, stress, difficulty concentrating), while leaving a field for rational thinking. Will suppression can occur only with very large doses of drugs or when taking drugs with a strong sedative effect, which is expressed in severe drowsiness.

It must be remembered that depression is a painful condition that prevents a person from thinking and acting, so getting rid of it is a paramount task to maintain normal activity. It is scientifically proven that nerve cells are restored (up to 500 thousand per day), exceptions are for coma and depression!

The lack of excitement provides a field for reflection on the situation and life in general. Why are people afraid not to feel? This is sometimes useful. When a therapeutic effect is achieved, normal emotions are restored, and positive in the first place.

Marina V. Karpova :

What does an ordinary person understand when he talks about it, is afraid to “stop being himself”? As a rule, an image of a retarded, insensitive person who has ceased to be spontaneous arises in consciousness. In fact, the very presence of depression can "make a person stop being himself." In a depressed state, a person experiences strong negative emotions that absorb the ability to sensibly assess the situation, to respond to a situation without excessive pain. The ability to think soberly, the ability to concentrate, to focus attention is also changing. When taking antidepressants, a person does not change as a person, he retains the ability to feel - get angry, love, cry, laugh in response to different life situations. Antidepressants do not develop the ability to “not feel,” they only regulate emotions in such a way as to prevent negative feelings from obscuring other aspects of life, painting them black and gray.

Myth 3. Antidepressants are serious. side effects.

Reality. Like any other medication, antidepressants can have side effects, but with proper admission and under the supervision of a doctor, they do not cause serious harm to health. It is also important that the drugs are selected by the doctor, taking into account the patient’s somatic health and possible side effects of the drug, as a result of which the negative consequences are minimized. In case of discomfort, the antidepressant can and should be replaced with another.

The most common among antidepressants and frequent when used (and "frequent" in clinical trials is the probability of occurrence in 1-10% of cases) side effects are nausea, sexual dysfunctions, weight gain or loss, some antidepressants can cause sedation, heart rhythm disturbance (arrhythmia or tachycardia), insomnia. BUT, most side effects are dose-dependent, that is, the likelihood increases if the drug is overused.

Information about “side effects” is always contained in the instructions for the drug, but it is better if the doctor gives explanations, since often medical experience is a more reliable source of information. New developments in pharmacology are also underway to minimize side effects.

Marina V. Karpova :

The first antidepressants that appeared in psychopharmacology were tricyclic antidepressants (amitriptyline, imipramine, nortriptyline). Some of them exist and are applied now. These drugs are indeed the most difficult to tolerate when used by patients. The main side effects on their part were: dry mouth, weight gain, negative effect on the cardiovascular sphere, lethargy, drowsiness, dizziness. These side effects persisted to a greater or lesser extent throughout the entire period of their administration, and had a dose-dependent effect. Currently, these drugs are trying not to be used in outpatient practice. Especially, given that the onset of their action is more delayed than other, more modern antidepressants, this takes about 3 weeks. The main drugs for the treatment of depression are currently drugs based on the mechanism of regulation of serotonin - serotonergic. When taking them, side effects are also not excluded, the main of which are nausea, a possible increase in anxiety at the beginning of the intake, muscle tremors, sleep disturbances during the period of “entering the drug”, sexual dysfunctions. These effects, as a rule, are short-lived, well-studied, predictable, and pass during the first period of getting used to the drug. In addition, there are many ways to correct these side effects until adaptation to the drug occurs. One of the strongest fears of patients encountered in the practice of prescribing antidepressants is the fear that a person will lose the ability to experience sexual satisfaction. Yes, sometimes an antidepressant affects orgasmic function. As a rule, this side effect is dose-dependent, and either the ability to experience an orgasm during the further administration of antidepressants is gradually restored, or a corrector is prescribed to block this side effect from the drug being taken. All this makes serotonin antidepressants the drug of choice for the treatment of depression in modern conditions.

Myth 4. Antidepressants can be simultaneously withdrawn from depression, they do not have to be taken with a course. You can quit your appointment right away, as it gets better.

Reality. In most cases, antidepressants need to be taken for 2-3 weeks to achieve a tangible effect. But when taking it, it is important not only to remove the symptoms that lie on the surface, but to cure the disease itself, otherwise the likelihood of relapse is quite high. Therefore, taking antidepressants should most often be course, until complete remission is achieved. A course is prescribed by a doctor depending on the condition and positive dynamics during admission. But you need to be prepared for the fact that a full treatment will take time.

Marina V. Karpova :

Antidepressants that can remove from a depressive state in 2-3 days do not exist. For the vast majority of antidepressants, the average deployment time for a distinct clinical effect is about 2 weeks. During this period, part of the symptoms (anxiety, panic, fears, etc.) can be smoothed out, partially or completely disappear due to the blockade of part of the receptors responsible for the presence of these symptoms, i.e. due to additional features of this or that drug (anti-anxiety, sedative and other). But this does not mean that during this time the biochemical malfunction of the receptors, which led to depression, was eliminated. And at the risk of canceling the drug at the first positive effect in the condition, you can get the “withdrawal syndrome”, or “recoil syndrome”, which was mentioned above. Therefore, an antidepressant should be taken in a long-term course and must be strictly determined by a doctor.

  First Aid antidepressants, which often include tricyclic antidepressants, are also a definite myth. They are often prescribed in hospitals, but not because they quickly smooth out symptoms. Amitriptyline (and many similar drugs of the tricyclic antidepressant group) has a very strong sedative effect, so when it removes superficial anxiety and arousal, it creates the erroneous impression that the drug “started to work”. In fact, at the time of the onset of antidepressant action, amitriptyline has the longest time — it begins to work by the end of 3 weeks. He is often prescribed in hospitals out of habit, because sedation with the drug allows you to "have less trouble with an anxious patient in the ward." Under the conditions of psychiatric practice in Russia, there is no generally accepted habit of prescribing amitriptyline in therapeutic doses (it starts to work in a dose of more than 150 mg, while the common scheme is to prescribe 75-100 mg).

It also makes no sense to prescribe several antidepressants at the same time - a mechanism competing for receptors is turned on, side effects reinforce each other, and there are many other difficulties. The combination of several antidepressants is allowed only in exceptional cases, when resistance to treatment with one blood pressure is established, and these combinations have a proven compatible effect and have been thoroughly investigated. In all other cases, a combination of two drugs of the same group is a tactical error. Therefore, it is more correct to prescribe immediately well-established blood pressure, the most tolerated taking into account the subsequent long-term administration.

Myth 5. You can take antidepressants for prevention.

Reality. Antidepressants are taken for prophylaxis if a person has had several depressive episodes or with endogenous depressions. That is, if a person has already experienced relapses of depression under unfavorable life circumstances or even without them, then he needs to be very attentive to himself and when he has a feeling that he can’t cope himself, he needs to consult a doctor and carry out prophylaxis. Also, such patients need to accept the need for maintenance (prophylactic) antidepressant treatment for up to several years. Also, in the case of a recurrent (endogenous) disease, so-called normotics are prescribed to maintain a normal state, and not antidepressants.

Myth 6. Antidepressants create the illusion that all is well.

Reality. As mentioned above, antidepressants remove excess negative emotionality, leaving a field for an adequate assessment of the real situation. They cannot create any illusions of reality.

Myth 7. Antidepressants will solve all my problems.

Reality. Antidepressants, if a therapeutic effect is achieved, relieve symptoms of depression. Then everything is in the hands of man himself - rethinking the situation, specific actions to change it and working on himself. It is very important for a real improvement in the situation to exert one's strength, which, with the disappearance of depressive symptoms, still becomes more. If you do not start to change something yourself, then the circumstances of life can again lead to depression.

It must be remembered that antidepressants are prescribed only by a doctor; according to the law, they cannot sell them in pharmacies without a prescription. No need to self-medicate and experiment with your own psyche. The doctor knows what drug and for what specifically is intended, selects an antidepressant depending on the severity of the condition, age, physical health, etc. The main thing is to be frank with the doctor. It is better to immediately ask the doctor harassing questions about antidepressants, find out the prognosis of the duration of admission, possible side effects. If the first prescribed drug did not fit for some reason, do not immediately be disappointed - it is better to discuss the problem with the doctor, ask to change the drug. It is easier to express all your doubts and expectations than to blame the pills and the doctor later. Sometimes hard to find with a doctor mutual languagebecause doctors are different - both as people and as specialists. It makes sense then to look for "your" doctor. This is the little that can be done for your health.

It is clear that not everyone can afford the advice of a private psychiatrist, then the question arises of contacting a polyclinic or neuropsychiatric dispensary - PND (which also provides outpatient care). This question is also painful and causes a negative reaction. In this area also exists   Myth: A registered state and a psychiatric diagnosis are a stigma for life.IN realities  but we do not live in the USSR, where information about the mental health of a person was reported immediately to the family, to work, and to other institutions. Today this information is a secret. Information about the state of a person registered in the IPA can be obtained only at the request of the court or internal affairs bodies (at the institution of a criminal case). Also, when applying for a job, sometimes you need a certificate from a psychiatrist (this often applies to public service, work in medical institutions and in harmful working conditions). But the psychiatrist again does NOT write in the certificate whether the person is registered or not, but gives a conclusion about the person's ability to work in this position. With a positive decision of a psychiatrist, the conclusion for a person who is registered is no different from a certificate from an absolutely healthy person. And in the case of successful treatment and the absence of relapse of depression after 1-3 years, a person is generally removed from the register.