antidepressant

Synonyms in a broader sense

• depressive symptoms
• Antidepressants,
• depressions
• bipolar disease
• melancholy
• Therapy for depression

introduction

As a rule, it is not drugs alone that lead to an improvement in depressive symptoms (see therapy for depression). Nonetheless, the drug approach is now part of the treatment concept for depression. As with many drugs that are used in the treatment of mental disorders, antidepressants also belong in an overall concept that should be composed of various pillars. It is particularly important to inform the patient about the effects and side effects of the drugs, but also to provide therapeutic information on the severity of the depression. As this severity changes, the drug treatment will also change in most cases. You have to do this, similar to e.g. in the treatment of schizophrenia, distinguish between acute, conservative, and preventive therapy.

The urgency of drug therapy also depends on the severity of the disorder. It is quite obvious that a patient with specific suicidal intentions needs relief much faster than e.g. someone with a "winter depression".

In the following some general information about (m) antidepressants / antidepressants.

• Indications (when are antidepressants / antidepressants appropriate and necessary) for the use of antidepressants.
• Onset of action
• How long must an antidepressant take?

Medical therapy

Indications for the use of an antidepressant

According to the name, antidepressants (antidepressants) are of course used in the so-called depressive episode. Recommendations can be found in the literature, but these should only be understood as such, i.e. you always have to see the individual, unique patient and not just the diagnosis.

1. Severe depressive episode: Drugs that influence more than one messenger substance (e.g. venlafaxine as SNRI) are recommended here rather than drugs that only influence one messenger substance such as the SSRI (e.g. fluoxetine)
2. If the depression goes hand in hand with anxiety, we recommend a drug that also has a depressant effect.
3. In the case of dysthymia, i.e. the slight but permanent depressive mood, SSRIs are particularly recommended, as they are on the one hand well tolerated and on the other hand have a demonstrable improvement effect even with small amounts.
4. In the case of seasonal depression e.g. the winter depression is also suspected to be a particular disturbance of the serotonin messenger substance. For this reason the recommendation goes in the direction of the SSRI.
5. In the case of depression in the elderly (depression in old age) one should avoid the use of tricyclic antidepressants if possible, as they are known to affect the heart. For this reason, SSRIs should primarily be used in this area of ​​application today.

Read more on this topic: The role of serotonin / neurotransmitters in depression

Also in the context of the premenstrual syndrome strong mood drops or depressive moods can show. Antidepressant therapy can be considered for prolonged depression. Read our article on this: This is how premenstrual syndrome is treated

Well demonstrable therapeutic success through the use of antidepressants / antidepressants can also be demonstrated in the drug treatment of anxiety disorders.

• Generalized anxiety disorder: There are proven studies here that venlafaxine (SNRI) in particular is suitable for treating the depressive symptoms that are often associated with the anxiety disorder.
• Panic disorder / panic attack: Depressive symptoms are also often found in panic disorder, but these can be treated well with SSRIs. The recommendation is made primarily because of the good tolerability.
• Phobias: In general, psychotherapy is the method of choice for phobia, but there are very promising studies in which SSRIs and MAOIs have been shown to be effective for social phobia.
• Obsessive-compulsive disorder: The effectiveness of SSRIs has also been demonstrated for obsessive-compulsive disorder. Problems with this, however, are that an improvement only occurs after months and that several years of treatment are often necessary to achieve lasting success.
  You can find more information under our topic. Obsessive-compulsive disorder.

Read more on the topic: Drugs for Anxiety

In the treatment of post-traumatic stress disorder, in addition to psychotherapeutic support, the administration of SSRIs is recommended. Here, too, the recommendations go in the direction that treatment over several years can be useful.

Pain: almost every antidepressant seems to have pain-relieving mechanisms of action. For this reason, they are often used in today's pain medicine (e.g. for headaches or migraines). Here, the tricyclic antidepressants seem to be superior to the SSRI. There seems to be no connection between the actual antidepressant potency and the analgesic effect. Another positive feature is the fact that pain treatment often only requires very small amounts of the drug, which of course reduces the risk of side effects.

Eating disorder: there are some studies that suggest the effectiveness of antidepressants in eating disorders, for example in the treatment of bulimia and binge eating.

Pre-menstrual dysphoric syndrome (PMDS / PMS): This complex of symptoms, which is very tormenting for many women, leads to physical and psychological changes. These changes depend directly on the menstrual cycle. The SSRI sertraline (e.g. Zoloft) has been particularly recommended for treatment. Here, too, low dosages are often sufficient. The medication can also be given for prevention, i.e. before a new PMR "attack" occurs.

Read more on the topic: Premenstrual Syndrome and Depression.

Onset of action of antidepressant therapy

Of the Onset of action An antidepressant is typically a slow, steadily increasing one. In order to achieve the fastest possible therapeutic success, however, constant and regular medication intake is necessary. If this requirement is met, the symptoms should slowly and slightly improve within 14 days. Real clinical improvements are usually just beginning after about 4 weeks on. However, if there is no tendency for the symptoms to improve between the 2nd and 4th week, it should be reconsidered whether this is the right drug for this particular patient. With antidepressants, it is no different than with almost all therapeutic measures in medicine. Not every person is the same and therefore it can happen that a drug that has been well researched for depression has an excellent effect on 100 patients and the 101st does not have any therapeutic success at all. Both therapist and patient must be aware of this possibility. Basically it is not dramatic, as there are many alternative options in therapy for depression nowadays.

The doctor's task is to find the balance between increasing the dose quickly, but not too quickly. If the dose is increased too cautiously to the necessary level at the beginning of therapy, there may be a delay until the onset of action. On the other hand, if you increase the dose too quickly, more side effects can of course occur.

As a rule, however, the guideline values ​​according to which one should increase the dose for the individual preparations are well known.

Also important in drug therapy is the understanding of depression as a symptom complex, i.e. an accumulation of several ailments (e.g. sleep disturbance, bad mood, loss of appetite, etc.). As a rule, antidepressants do not affect all symptoms at the same time, but gradually. Some initially affect sleep, others affect drive. It is important that the patient talks to the prescribing doctor not only about side effects, but also about the expected effect.

Duration of use of an antidepressant

The goal of one antidepressant therapy must always be the complete mental and physical recovery of the patient (remission). There is evidence that antidepressants can do this. Unfortunately, it has also been proven that a patient who has survived a depressive episode has a near 50% risk of relapse. For this reason, a continuation of the drug therapy is strongly recommended even after the acute symptoms have subsided. In this context, it is the doctor who carries out further treatment in particular the task of providing comprehensive information. You have to make it clear to the patient that he is continuing his "Pills" has to swallow even though he no longer has any symptoms of the disease.

The recommendation for further treatment with an antidepressant / antidepressant to avoid a relapse (i.e. the recurrence of symptoms in the same episode) vary between 6 and 12 months.

However, if other episodes are already known in the medical history, it is no longer just about avoiding a relapse, but rather about avoiding the occurrence of a new episode (relapse prevention). The recommendations vary here between years to lifelong.

In general, termination of drug therapy must be discussed with the prescribing doctor. If it comes to a termination, it is important not to stop the medication abruptly, but to taper it off over a period of several weeks, as this can otherwise lead to withdrawal effects. These effects typically include dizziness, nausea, vomiting, insomnia and difficulty concentrating. These effects can be avoided by tapering off, i.e. slowly stopping the medication. At this point it seems important to me to point out once again that these drugs, despite the withdrawal phenomena described, not addicting do, although there are some parallels to withdrawal. By definition, a drug must be classified as a Addiction The fact of the development of tolerance also applies in a generating manner. Tolerance means that in order to achieve the same positive effects, the dose needs to be steadily increased. In antidepressant therapy, the drug is dosed to a therapeutic level and no further.