Best Antidepressant Tips From Leading PrescribersDavid Shpecel
- There are different types of treatment for depression.
- The antidepressant is one of the main treatments for curing depression, but it can cause side effects.
- Antidepressants work best to treat depression when they are paired with psychotherapy, but they do not work right away.
- Many antidepressants take between 1 to 3 weeks to start working. It can take even longer before they reach maximum efficacy.
- Stopping the antidepressant and weaning should be done gradually.
Most of the symptoms associated with depression will eventually improve with antidepressant treatment. In some rare cases, individuals may be resistant to certain antidepressants and it may take a trial and error approach with other medicines to find one that works. The effects of a drug may not be known for weeks or months.
How to recognize a depressive state before starting antidepressant treatment? Below are our best antidepressant tips from leading subscribers.
Specific criteria of the depressive state
- Depressed mood manifested by the disappearance of the desire to act, a feeling of slowing of thought and gestures, and extreme pessimism.
- Loss of interest for the world, others, withdrawal
- Altered self-image, feelings of unworthiness, inferiority, sometimes accompanied by an unwarranted sense of guilt
- Suicide ideas, obsessive thoughts revolving around death
- Sleeping troubles
- Inability to perform the usual actions or, conversely, permanent agitation
- Appetite disorders
- Difficulties to concentrate
- Chronic fatigue
To make the diagnosis of depression, the presence of 5 criteria, including 2 specific, is necessary. This clinical picture may seem familiar because we all or almost all suffered from some of these symptoms. But it’s all about intensity and duration: the more acute and prolonged the suffering, the more relevant it becomes to think about a depression.
Antidepressant: biological treatments
Antidepressants act on neurotransmitters (dopamine, adrenaline, serotonin): they are biological treatments for depression.
The antidepressant belongs to the family of psychotropic drugs, category of drugs also comprising:
- Sleeping pills.
Main types of antidepressant
There are different types of antidepressants marketed in Australia.
Tricyclics are antidepressants whose molecules have a tricyclic structure that is to say three nuclei. They increase the concentration of serotonin in the synaptic cleft. These are somehow “historical” antidepressants.
Here are the main ones:
- Anafranil, whose active substance is clomipramine;
- Laroxyl, based on amitriptyline;
- Prothiaden, with active substance dosulepine;
- Tofranil, based on imipramine;
- Ludiomil, whose active substance is maprotiline hydrochloride;
- Surmontil, based on trimipramine,
These tricyclics expose to a weight gain of up to 10% of body weight (loss of weight is observed when treatment is stopped).
MAOI: another type of antidepressant
MAOIs or monoamine oxidase inhibitors are composed of an enzyme that destroys brain monoamines such as serotonin, adrenaline and dopamine. The main ones are:
- IRS and IRSN antidepressants
IRS is the inhibitor of serotonin reuptake. They increase the concentration of serotonin in the synaptic cleft.
The main ones are: Deroxat, Prozac, Seroplex, Seropram and Zoloft.
IRSNAs are serotonin, but also norepinephrine recaptors.
They increase the concentration of these two neurotransmitters in the synaptic cleft:
Note: The other classes of antidepressants: Athymil, Norset and Zyban.
Serotonin and depression
Antidepressant: 60% improvement in patients
Antidepressants, regardless of their generation, are equivalent in terms of:
- Efficacy of about 60% improvement in depressed patients;
- Delay of action is also similar: it takes a period of 2 to 3 weeks to see the effects of antidepressants;
- Average duration of treatment:
- 6 months minimum for a first depressive episode;
- The duration of 6 months can be extended to avoid a possible relapse.
In contrast, the majority of antidepressants are ineffective in adolescents (fluoxetine is recognized as the most effective). The management of child and adolescent depression must therefore be essentially psychotherapeutic. Only if symptoms persist after one to two months of psychotherapy can antidepressant treatment be considered, but always in combination with psychotherapy.
Warning: stopping an antidepressant should never be brutal.
Neurobiological targets of the antidepressant
Overall, antidepressants affect the concentration of certain brain neuromediators in the synaptic cleft:
- The synaptic cleft is the communication space that exists between the brain cells;
- The neurotransmitters concerned are serotonin and / or norepinephrine;
- Depression causes a concentration deficit of these neurotransmitters in the synaptic cleft.
Antidepressant: acting on mood disorders
These neurotransmitters like serotonin have an impact on mood:
- They act on impulsivity, irritability, and noise tolerance, among others;
- Serotonin is suspected to play a role in eating behaviors, sleep and sexuality.
Antidepressant and fight against fatigue, sadness…
Many depressive symptoms under the control of neurotransmitter balance:
- Fatigue, psychomotor retardation, lowering of alertness and energy levels: partly subject to norepinephrine;
- Sadness, anxiety, concentration problems and physical pains: dependent on serotonin and norepinephrine.
Antidepressant: several limitations
Antidepressants have limited action.
Actual action limits of the antidepressant
Antidepressants have an effectiveness of about 60% (and they are of no interest in adolescents): 40% of cases of depression are not improved by taking antidepressants.
In addition, like any drug, an antidepressant has side effects that can be unacceptable for some patients.
Antidepressant discontinuation: progressive stop
Do not stop abruptly taking antidepressant treatment.
Similarly, we do not wean when taking the antidepressant 1 day out of 2 or 3.
The antidepressant is a very strong treatment, considered a drug.
Stopping an antidepressant must therefore be extremely slow:
- The decrease should not exceed 5 to 10% of the dose,
- The decrease is at least in stages of 2 to 3 weeks.
Accompanying the patient for antidepressant discontinuation
Many patients, believing themselves cured, decide themselves to stop their treatment or to change their doses.
But it is necessary to terminate a treatment before any antidepressant withdrawal.
It is advisable to wait at least 4 months after stopping the symptoms of depression to stop treatment: this is to avoid the risk of recurrence.
To stop their antidepressant or to adjust the doses, the patients absolutely must do it under the control of their doctor and in consultation with him.
Note: Often, patients are placed on sick leave for the duration of weaning, at their request.
Bondage and stopping the antidepressant syndrome
It is common to observe a withdrawal syndrome just after antidepressant weaning.
The symptoms, which can last from 24 hours to 2 weeks, are not the same depending on the type of antidepressant:
Symptoms of antidepressant weaning
Types of antidepressants Withdrawal Symptoms:
- Tricyclic antidepressants
- Gastrointestinal disorders,
- Fatigue, anxiety, agitation,
- Nightmares, sleep disturbances,
- Flu symptoms,
- Motor and behavioral disorders.
- Balance disorders,
- Tremors, sweating,
- Insomnia, nightmares,
- Dizziness, nausea, lethargy,
- Depression and hypnosis.
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