Properly diagnosed depression is a treatable disease. The sooner it is diagnosed, the better the effects of treatment and the greater the chance of complete recovery. Therapy of depression is also based on psychotherapy, most often cognitive-behavioral therapy, and pharmacotherapy. The choice of drugs and active substances currently used in this disease is very wide.

Treatment of depression

The most commonly used classes of antidepressants are listed below.

SSRIs – selective serotonin reuptake inhibitors

They inhibit the reuptake of serotonin by neurons. Increasing the concentration of this substance causes an increase in brain transmission. The most important active substances in this group include:

• fluoxetine
• paroxetine
• sertraline
• fluvoxamine,
• citalopram,
• escitalopram.

The side effects are mostly non-specific and transient. Belong to them:

• headaches and dizziness,
• insomnia,
• concentration disorders,
• vomiting,
• diarrhea.

These substances, inadequately combined with others – which can affect the neurotransmission – can cause serotonin syndrome. It consists, inter alia, behavior changes, muscle tremors, headaches, hallucinations, restlessness and excessive sweating. These medications include prescription MAO inhibitors (antidepressants), lithium salts and sumatriptan (anti-migraine medications), and over-the-counter cough suppressants with dextromethorphan.

Alternative way for depression treatment is TMS

SNRI – selective serotonin and norepinephrine reuptake inhibitors

This group includes venlafaxine and duloxetine. They have an advantage over the previous group in the form of a slightly faster effect of action at the initial administration of a large dose. Due to the mechanism of action, they also exhibit analgesic properties, often used in the treatment of chronic neuropathies.

The side effects are similar to those of SSRIs. Additionally, these drugs can cause ejaculation disorders more often.

TPLD – tricyclic antidepressants

This group of drugs is so named because of their basic chemical structure. The most popular tricyclic antidepressants are:

• imipramine,
• opipramol,
• amitriptyline,
• doxepin.

They may be characterized by initial troublesome side effects associated with the multi-receptor mechanism of action, such as:

• dry mucous membranes (mouth, nose),
• constipation
• problems urinating.

However, blood pressure drops and heart rhythm disturbances are more dangerous. Their use is also associated with increased appetite, insomnia, confusion and agitation.

Poisoning with these drugs is similar in symptoms to atropine poisoning (blood pressure drops, arrhythmias, tachycardia, convulsions, delirium) and is treated on an outpatient basis.

Tetracyclic antidepressants

We distinguish here:

mianserin,

mirtazapine,

maprotiline.

Similar to TPLD in action, but with milder side effects such as dry mucous membranes and urogenital problems. At the beginning of treatment, they show a suppressive effect, so they can be used in depression with anxiety and agitation.

Resources: Vita Recovery

MAO – monoamine oxidase inhibitors

We include here non-selective tranylcypromine (with a wider effect and therefore more side effects) and selective moclobemide. They increase the concentration of not only serotonin and noradrenaline, but also dopamine and adrenaline in the brain. They are activating drugs. The indication for their use are social phobias and depression with inhibition of activity.

A special diet is required for trancylpromine therapy, which should be devoid of tyramine-rich foods, i.e.

long-maturing cheese and cold meats,

pickled vegetables,

beer, wine (tyramine content in these products increases with storage time).

The above products may interact with this drug and cause, inter alia, increase in blood pressure.

Moklobemide is more selective in action, therefore such strict control of consumed products is not required when using it.

From the point of view of availability, it is the most important ingredient, because the preparations containing it are registered without a prescription. These drugs are used to treat mild or moderate depression and to treat anxiety, anxiety and intermittent insomnia.

The effect of increasing the amount of neurotransmitters in the brain is mainly caused by hyperforin, while it is likely that there are other yet unidentified compounds in St. John’s wort that enhance this effect.

The dose required for an effective antidepressant effect is 600-900 mg of the extract daily. Of course, we are talking about drugs with St. John’s wort, containing a standardized amount of active substances.

St. John’s wort, due to its significant effect on the metabolism of some drugs, is contraindicated in combination with the following preparations:

• anticoagulants (e.g. warfarin, acenocoumarol),
• immunosuppressants (cyclosporine),
• digoxin,
• hormonal contraception (not only oral),
• some antivirals, e.g. in HIV therapy,
• with other antidepressants – by overlapping the effects of action.

Despite their name, antidepressants are used to treat many other diseases, such as anxiety disorders, panic attacks, phobias, and eating disorders.

Contrary to popular belief, antidepressants are not addictive, and the withdrawal effects (worsening of well-being, dizziness and headaches, insomnia, concentration disorders and gastrointestinal disturbances) result from a sudden drop in neurotransmitters and are transient. During their use, the drugs described may cause, inter alia, disturbance of concentration and drowsiness, which is particularly important information for people driving motor vehicles.

The main disadvantage of antidepressants is the fact that their full effect occurs after 6-8 weeks, which discourages many patients waiting for quick effects and leads to premature discontinuation of drugs. It is worth remembering about this when deciding on treatment. Patience while waiting for the results will pay off with a significant improvement in the comfort and quality of life.