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Does lamotrigine help with anxiety


What is Lamictal (Lamotrigine): Uses, Dosage, Interactions, & Side Effects

Lamictal is a prescription medication that goes by the generic name Lamotrigine. It comes in four forms that are all taken by mouth: immediate-release oral tablets, extended-release oral tablets, chewable oral tablets, and orally disintegrating tablets.

Lamictal (Lamotrigine) belongs to a class of medications called anticonvulsants, or antiepileptic drugs (AEDs). These types of drugs work by altering electrical activity in neurons or altering chemical transmission between neurons. This decreases excitation of certain mechanisms in the brain that may lead to seizures.

For that reason, Lamictal is most commonly prescribed to treat seizures or epilepsy. However, it has also been used for long term mood disorders such as bipolar disorder, and shows promise in being effective for treating anxiety.

If you’re thinking of taking Lamictal (lamotrigine), it can be helpful to have some background information before speaking to your doctor to see if it might be right for you. Here’s everything you need to know.

Lamictal (Lamotrigine) for Depression

Lamictal is not normally prescribed for treating depression on its own. Instead, it has a distinct place in pharmacology for treating bipolar disorder. Bipolar disorder is marked by shifts in mood, usually fluctuating between symptoms of depression and symptoms of mania.

There are a number of mood stabilizing medications available, but what makes Lamictal unique is that it is the only one that lifts the depressive symptoms rather than suppressing the manic symptoms. This is because it is believed to act on serotonin reuptake. 

For that reason, it can be useful for treating those on the bipolar spectrum, as the depressive symptoms often outweigh the manic ones. Plus, Lamictal doesn’t tend to come with many of the unwanted side effects that are common among other antidepressant medications.

Lamictal (Lamotrigine) for Anxiety

The Food and Drug Administration (FDA) has approved the use of Lamictal for treating seizures and bipolar disorder. However, it has not been approved to treat anxiety disorders. If a doctor prescribes this medication for your anxiety, it is known as an “off-label” use.

There are few studies that show the efficacy of Lamictal for anxiety on its own. 

With that said, some research suggests that it works especially well for individuals who experience symptoms of anxiety as a byproduct of their bipolar disorder.

Lamictal has also been used in combination with SSRIs (selective serotonin reuptake inhibitors) for people who are resistant to other types of treatment for mixed anxiety and depression symptoms.

Lamictal (Lamotrigine) Dosage

If your doctor prescribes you lamotrigine, you’ll likely start on a low dose and gradually increase over several weeks. The typical dose falls somewhere between 25 mg and 400 mg. Oral tablets are usually taken once or twice daily with or without food.

If you miss a dose, you shouldn’t double the dose or take extra to make up for forgotten doses.

Lamictal needs to be taken for some time before you start seeing the most positive results. Treatment of bipolar disorder usually requires lifelong commitment. If you happen to miss more than three days of your medication, contact your doctor, as they may need to adjust your dose.

Always follow your prescribing physician’s dosing instructions. 

Lamictal (Lamotrigine) Side Effects

As with any medication, Lamictal can come with some side effects. Some of the most common side effects include:

  • Drowsiness
  • Dizziness
  • Headache
  • Blurred vision
  • Nausea
  • Dry mouth
  • Sore throat
  • Fever
  • Tremors
  • Symptoms of anxiety

There are also more serious side effects that can occur from taking Lamictal. One that is most noteworthy is a life-threatening skin rash, also known as Stevens-Johnson syndrome. This is a rare, but serious condition that causes a rash on the skin that spreads and blisters over time.  

If you have hives, painful sores, shortness of breath, or blisters in and around your mouth, contact an emergency service immediately.

Another rare, but serious, possible side effect of taking Lamictal is aseptic meningitis. This causes serious inflammation of the protective membrane that covers the brain and spinal cord. If you experience intense headaches, fever, chills, vomiting, stiff neck, rash, unusual sensitivity to light, or confusion, you should see an emergency healthcare provider right away.

Some reports of a serious multi-organ hypersensitivity reaction have been associated with taking Lamictal. This may lead to kidney, liver, or heart damage. If you experience enlarged lymph nodes, fever, or rash, you should contact a doctor immediately.

Also, if you suddenly stop taking Lamictal without proper guidance from a doctor, it can cause seizures. You should never stop taking this medication without first speaking to your healthcare provider.

Drug Interactions with Lamictal (Lamotrigine)

Keep in mind that everyone’s body chemistry is different. You might not have a reaction if you combine Lamictal with other medications. Talk to your doctor for a comprehensive list of possible interactions that might be more in line with your individual risk factors.

This medication can interact with other medications. Namely, taking antiseizure drugs with Lamictal can decrease the effectiveness of both medications in your body. On the other hand, Depakote (Sodium Valproate), an anticonvulsant, can increase the effects of Lamictal.

Lamictal also shouldn’t be taken with certain heart arrhythmia medications, such as Tikosyn (Dofetilide). When used together, it can increase the levels of Tikosyn and lead to irregular or fatal arrhythmias.

Finally, taking Lamictal with oral contraceptives may affect how well either medication functions. If you’re on birth control, you may want to talk to your doctor about possible alternatives to Lamictal.

In Conclusion

Lamictal (Lamotrigine) is an anticonvulsant medication that is often prescribed to help reduce seizures or epilepsy. However, it is also FDA-approved to treat bipolar disorder and has shown some effectiveness as an off-label treatment for anxiety and depression.

Lamictal has some mild side effects, but there are some serious rare side effects that are possible. One is Stevens-Johnson syndrome, a deadly skin rash. Other possible serious side effects include aseptic meningitis or organ damage.

This medication should not be taken alongside other drugs without first speaking to your doctor. Its effects can be diminished if taken with certain anticonvulsants, heart arrhythmia medications, or birth control medications.

If you’re struggling with mental health issues, YANA Mental Health can get you on the path to recovery by pairing you with a doctor who will develop a personalized treatment plan just for you. If prescribed, medication will be sent straight to your door — quickly and discreetly. YANA provides quality mental health care on your terms, at your own pace.

Sources:

Neurology : Antiepileptic medications | The Royal Children’s Hospital Melbourne

The role of lamotrigine in the management of bipolar disorder | NCBI

Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches | NCBI

Lamictal (Lamotrigine) | National Alliance on Mental Illness

Stevens-Johnson syndrome – Symptoms and causes | The Mayo Clinic.

Psychiatric Uses of Lamotrigine

Lamotrigine (Brand names: Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR)

Like other mood stabilizers, lamotrigine was originally developed as an anticonvulsant to treat seizures and is often used with other medications in the treatment of bipolar (manic-depressive) disorder. For the latest information on the use of lamotrigine, Psycom spoke with Joseph Goldberg, MD, Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York, and co-author of Managing the Side Effects of Psychotropic Medications, 2nd Ed, a textbook published by American Psychiatric Association Publishing and Christopher Aiken, MD, the director of the Mood Treatment Center in North Carolina.

Lamotrigine is the only mood stabilizer that calms mood swings by lifting the depression rather than suppressing the mania, says Dr. Aiken. "That makes it a great choice for the bipolar spectrum, where the depressive symptoms usually outweigh the manic ones. Its greatest benefit is in prevention. It can prevent both the depressive and manic side, but its benefits are much stronger for depression and it does not treat active mania or hypomania."

Dr. Aiken adds that part of the reason patients prefer lamotrigine is that it’s generally well tolerated. "In the original research studies people reported more side effects on the placebo than on lamotrigine. That may sound impossible, but it’s likely that lamotrigine helped them feel better physically by treating their depression," explains the mood disorder expert adding that lamotrigine is also largely free of the “medicated” feelings that people dislike with mood stabilizers. "People don’t tend to feel dull, flat, or groggy on it."

In some research studies comparing a placebo to the medicine, the results were exceptional. "Lamotrigine is the only medicine we know of where patients were unable to tell they were taking the medication," he explains. "It didn’t make them feel medicated, and its benefits built up very gradually. After 2 years, people taking lamotrigine had half as many days of depression as those who did not take it."

Which conditions are treated with lamotrigine?

Although lamotrigine is not considered an antidepressant, it is used as a maintenance treatment for bipolar I disorder in patients 18 and older to help stabilize mood changes by delaying the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy. (Bipolar I disorder is characterized by manic episodes.)¹˒²

It is considered second-line therapy. “The drug manufacturer’s original studies of lamotrigine in bipolar depression found that improvements were stronger in bipolar 1 than bipolar II disorder,” Dr. Goldberg recalls. (Bipolar II disorder is characterized by longer episodes and more frequent occurrence of major depression and hypomania.) Newer research suggests, however, that lamotrigine may be even more effective as a mood stabilizer in preventing relapses in treating bipolar II disorder. ²

There are also conditions lamotrigine treats off-label including borderline personality disorder, schizoaffective disorder, and obsessive-compulsive disorder (OCD), Dr. Aiken says.

How does lamotrigine work?

While the exact mechanism of action is not entirely understood, lamotrigine delays the time between mood changes and manic or depressive states in people with bipolar disorder by decreasing the intensity of irregular electrical activity in the brain. People with bipolar disorder are at high risk of experiencing recurrent and relapsing episodes of mood change. Maintenance treatment with lamotrigine helps reduce the risk by preventing or delaying these recurrences and relapses.

“Many clinicians think that lamotrigine helps achieve and sustain even moods over time by virtue of its antidepressant properties, rather than anti-manic (mood-stabilizing) properties,” says Dr. Goldberg. “It works with mood stabilizers like lithium and Divalproex, but it’s not interchangeable with these drugs and cannot be used in their place. ”

The efficacy of lamotrigine appears to be similar to the effects of lithium, yet is better tolerated.

Lamotrigine is used over time as a preventative medication. Clinical trials that looked at lamotrigine’s potential for treating acute (in-the-moment) episodes of mania found no difference between the medication and placebo.²

Is there a typical dose of lamotrigine?

Your doctor will initially prescribe a low dose of lamotrigine and gradually increase your dose every week or two for several weeks, until you reach an effective dose level.

“Treatment guidelines for target blood levels of lamotrigine have not been established for conditions other than epilepsy,” Dr. Goldberg points out. “In relapse prevention studies conducted by its manufacturer, however, 200 mg/day was found to be a better target dose than 50 mg/day, while higher doses (400 mg/day) did not provide greater benefit against relapse.”

The dosing regimen of lamotrigine can depend on which other medications you are taking to treat bipolar disorder, and is adjusted when you wean off and discontinue other medications. It may also depend on indication and patient age.

“Some medicines slow down the metabolism of lamotrigine (notably, Divalproex), requiring a slower rate of increase and a lower target dose,” notes Dr. Goldberg. “Others speed up its metabolism (notably, carbamazepine), requiring a faster-than-usual dose increase and a higher-than-usual target dose.”

Also, estrogen derivatives (including hormonal contraceptives) induce lamotrigine metabolism. Dosage adjustments will be necessary in most patients who start or stop taking estrogen-containing oral contraceptives while taking Lamictal.

Lamotrigine comes in several forms for treating bipolar disorder: Tablets, chewable tablets, dissolving tablets. Your doctor may tell you to take tablets once a day, twice a day or every other day.

If you miss a dose of lamotrigine, take the missed dose as soon as you remember. If it is close to the time of your next dose, however, skip the missed dose and continue with your usual schedule. Never take a double dose of lamotrigine.

How long does it take to work?

In certain cases, the antidepressant and antimanic benefits of lamotrigine are noticed pretty early on in the treatment cycle, says Dr. Aiken. "For some other patients, though, effects are seen after about a month of being on lamotrigine treatment. But there will always be others that take a bit longer to experience the positive effects."

Cost of Lamictal/Lamotrigine

When ordered in lots of 100 tablets, here is the breakdown in pricing for one tablet of the medication in the following doses (Note: pricing information generated April 2011):

  • $4.83 for 25 mg tablet

  • $5.43 for 100 mg tablet

  • $5.93 for 150 mg tablet

  • $6.67 for 200 mg tablet

Generic cost (lamotrigine) is as follows:

  • $0.3 for 25 mg tablet

  • $0.3 for 100 mg tablet

  • $0.53 for 150 mg tablet

  • $0.53 for 2000 mg tablet

Advantages of Lamotrigine

Dr. Aiken reports there are some major advantages of lamotrigine including:

  • It's effective in a majority of bipolar patients Almost two-thirds of patients who are suffering from bipolar mood disorders have responded extremely well to lamotrigine.

  • It's ideal for mixed states People who, due to mania switches during intense cycling, have not been able to rely on other antidepressants have responded well to lamotrigine when given in therapeutic doses.

  • It's good for patients who respond to nothing else Patients who fail to respond to any other mood stabilizers and lithium have shown good results when treated using lamotrigine.

  • There are minimal side effects Lamotrigine has minimal side effects that usually fade away after some time.

Who can (and cannot) take lamotrigine for bipolar disorder?

Doctors may prescribe lamotrigine to adults or adolescents who are otherwise being treated for bipolar disorder or weaning off other medications used to treat bipolar disorder. Older adults may be more sensitive to the effects of lamotrigine and prescribed lower doses. "When people respond to lamotrigine, they often say they can see things in perspective better and are less reactive under stress. They usually still have days of depression, but these tend to be shorter and less frequent," says Dr. Aiken.

Children under age 18 are at higher risk of developing a skin rash from lamotrigine if dosed too rapidly. In spite of the potential side effects, however, Dr. Goldberg points out that many studies support the use of lamotrigine for treating bipolar disorder in youth.

Definitive information about the safety of lamotrigine in pregnancy is not available, as there are no adequate studies in a pregnant woman population, but according to Dr. Goldberg, many doctors perceive it to be among the safer options when treatment benefit outweighs risk to the fetus, especially in women who are more prone to depression than mania. Like many psychotropic drugs, lamotrigine is secreted into breast milk, so women are advised to discuss with their doctors the risk and benefits of breastfeeding while taking lamotrigine.

Lamotrigine is not recommended in patients who have demonstrated hypersensitivity to the medication or any of its ingredients.

As with any medication, Dr. Goldberg adds, allergic reactions to lamotrigine can occur. Get immediate emergency help if you show any signs of an allergic reaction, such as hives, facial or throat swelling, or difficulty breathing. Notify your doctor if you develop a skin rash, especially if it occurs within your mouth or on soft body tissue such as eyelids or around nasal openings, and if it is blistering, peeling, painful, burning, or involves a fever or sore throat. Be sure to report all medications you are taking to medical staff.

Lamotrigine Side Effects

Some people who take lamotrigine may experience adverse reactions or side effects. Serious side effects that should be reported immediately to your doctor include:

  • Any skin rash, blistering or peeling of skin

  • Painful (burning) sores in or around the mouth, eyes or genitals

  • Jaundice (yellowish skin or eyes)

  • Swollen gland, fever, severe muscle pain

  • Weakness, drowsiness, confusion

  • Stiff neck, headache

  • Increased sensitivity to light

  • Mood or behavior changes, such as depression, anxiety, agitation, hostility, restlessness, mental or physical hyperactivity, suicidal thoughts

Common side effects of lamotrigine that are not emergencies but should also be reported to your doctor include:

  • Headache or dizziness

  • Blurred or double vision

  • Dry mouth

  • Gastrointestinal distress such as nausea, vomiting, diarrhea or stomach pain

  • Fever, sore throat, runny nose

  • Drowsiness or fatigue

  • Tremor

  • Insomnia

The biggest risk with lamotrigine is a rare allergic reaction called Stevens-Johnson Syndrome, which can be fatal if left untreated. First a patient may experience flu-like symptoms of fever, cough or sore throat, then a rash or skin blistering will follow.

Most rashes have occurred within two to eight weeks of initiating treatment, and is more common in the pediatric population compared to adults. The risk of rash increases with higher starting doses, higher escalating doses and use of lamotrigine in combination with valproate. Early clinical trials and follow-up research showed that the overall incidence of any skin disorders was 11% to 12% in both bipolar I and bipolar II patients treated with lamotrigine. ²

Many medications can cause this reaction, including antibiotics like Bactrim and penicillin and over-the-counter medications like Tylenol and Motrin. Some ways to try to prevent lamotrigine rash include:

  1. Dosing increases must be raised very slowly.

  2. It should be stopped if any new rash or skin changes occur while you’re starting the medication, unless the rash is clearly known to be non-drug-related. (After the first 3 months the risk of Stevens-Johnson Syndrome declines to almost zero).

  3. To avoid false-alarm rash confusion, the use of new soaps, getting a sunburn, exposure to poison ivy and starting any other new medications should be avoided during the first 3 months of starting lamotrigine.

With those steps, the risk of this severe rash is about 1 in 3,000 in adult patients; without them, it’s more like 1 in 100. "Unfortunately, there is still a high risk of non-serious, benign rashes (10% chance), so many people have to stop lamotrigine to be on the safe side," Dr. Aiken explains. "If you responded to lamotrigine but had to stop it because of a rash, it may be possible to restart at a lower dose."

Does lamotrigine interact with any medications or other substances?

Certain other drugs can affect the way lamotrigine works in your body by decreasing its effectiveness or delaying its excretion from your body. These include hormonal birth control methods, estrogen-containing contraceptives, hormone treatments, the antibiotic rifampin, seizure medications such as phenobarbital, and valproic acid, which is also used to treat bipolar disorder.

Your doctor will carefully prescribe and monitor your dosage when lamotrigine is taken with other treatments. Avoid alcohol, cannabis, and other substances that can increase dizziness or drowsiness while taking lamotrigine. To rule out dangerous side effects, discuss all other medications or mind-altering substances you consume with your doctor before taking lamotrigine.

One recent British study found that folic acid supplements can cancel out lamotrigine’s benefits (Geddes et al., 2016). "No one expected that result, as folic acid usually helps depression, and other medications, like valproate (a mood stabilizer approved for mania associated with bipolar disorder, seizures/epilepsy, and migraine headaches)," says Dr. Aiken. "More research is needed before we can fully trust this result, but until then, we recommend taking lamotrigine without any folic acid supplements, including those found in multivitamins. Once you’re doing well on lamotrigine, if you decided to add folic acid, watch out for a potential loss of benefits. "

Is it OK to suddenly stop taking lamotrigine?

It is NOT recommended to discontinue lamotrigine abruptly, as this may increase risk of seizures. Consult your doctor before stopping lamotrigine. If you do stop for more than a few days, DO NOT restart at your current dose. Call your doctor to review your dosing schedule.

  1. MedlinePlus. Lamotrigine. Last revised January 15, 2019. Available at: https://medlineplus.gov/druginfo/meds/a695007.html. Accessed October 10, 2019.
  2. Terao T, Ishida A, Kimura T, Yarita M, Hara T. Preventive effects of lamotrigine in bipolar II versus bipolar I disorder. The Journal of Clinical Psychiatry. September 1, 2017; 78(8): e1000-e1005. Available at: www.psychiatrist.com/JCP/article/Pages/2017/v78n08/16m11404.aspx. Accessed October 10, 2019/

Notes: This article was originally published January 24, 2016 and most recently updated June 8, 2022.

Lamictal customer reviews and experiences

Lamictal reviews

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Thinks great

from 2 025 ₽

Advantages: I will sell Sizar 200 mg.

from 1 186 ₽

was taken as a mood regulator. was depressed with great anxiety. The drug itself is nothing at all. there was agitation in the first week of admission, then left. The drug didn't help at all. additional prepprats were prescribed. helps other drugs work, but from the very point of zero. nine0003

Thinks the product is excellent

from 2 025 ₽

I can give a positive review of this drug. Lamictal anticonvulsant tablets with blackcurrant flavor, which are prescribed for epilepsy or bipolar disorders. Since it is rarely used in monotherapy, I have it with Cipralex. Got better. I read the instructions and reviews and was very afraid that I would have allergies, swelling or worse, but in fact there was nothing. I drank and was afraid, but everything went extremely well. I didn’t even have the smallest rash, I didn’t feel sick, I didn’t notice irritability or breakdowns either. The maximum that was - a cramp cramped my fingers on my right leg, but I had this before, it just became more frequent with pills. In short, I am satisfied with the tablets. Ask your doctor about them (prescribed), he will tell you and make a decision - it is necessary / not necessary. nine0003

Thinks the product is terrible

from 2,025 ₽

Good afternoon! This is a very allergic drug. One that had to be canceled in one go. The whole back was covered not just with hives, a small red rash, but with huge itchy spots. My ears itched so much that I thought I would tear them off. And when all this got on my face, and the anti-allergic drugs did not work, I quickly went under a dropper with Prednisolone to relieve this attack. and so it turned out that Lamictal is anticonvulsant, but leading to such allergic reactions. Honestly, it was very scary. So, maybe he helps someone, but it's definitely not me. We will talk with the epileptologist about another treatment, but I will not touch Lamictal again. nine0003

Thinks the product is excellent

from 1,186 ₽

My daughter suffers from seizures, we have a very difficult EEG and a lot of problems. But we are moving in small steps towards a healthy life. I want to praise these anticonvulsant pills, they are prescribed to us in combination with Epix and Sabril. At first, my daughter felt nauseous and vomited, but then, when the body got used to it, everything went away. The tablets are small, but the most important plus is that they can be dissolved in water (easy, no need to crush) and get some water with a currant smell, the daughter drinks without whims. I just divide them into two halves. It is cheaper to buy 50 mg and divide by the required 25 mg. Their price is generally acceptable, especially for such efficiency. We were afraid that there would be a side effect from the central nervous system, but in general we did without it. It is better to take the drug after a prescription and under the supervision of a doctor to avoid side effects. Health to you and your children! nine0003

Thinks the product is excellent

from 1,186 ₽

Hello everyone. I take Lamictal in a maintenance dose of 50 mg, as I have been suffering from epilepsy for a long time. Therapeutic treatment was chosen for a long time, but it was worth it. There were no seizures for 6 years. The active ingredient in the drug lamotrigine. It must be carefully and under the supervision of a doctor combined with other drugs that you may be prescribed. Because with some of them you will quickly catch cramps and other troubles. So first you need to visit a doctor (the medicine, by the way, is a prescription). I was a little afraid to take Lamictal, as the instructions stated a lot of side effects. But all I had was nausea and a headache. So I can say that these pills came up to me, but only after a long and very detailed consultation with a doctor. nine0003

Thinks the product is excellent

from 1,186 ₽

These pills help stop epilepsy attacks. But they have a number of disadvantages: the price, it is impossible for people with lactose intolerance, it is allergic and not very effective in monotherapy. We tolerate lactose, the price is not so terrible (a certain category of citizens receives the medicine for free), plus complex therapy with Depakine Chrono. Started with a small dose and increased it every 2 weeks under the supervision of a physician. It turned out without consequences and side effects. What we most feared - allergies, was. But it's just a little hives on the back. But we took it off with antihistamines. After the first iteration, all the rash has already disappeared and has not returned. So for the pills I can say that they are good. But first you need to go to the doctor and clarify everything, paint. Stay safe and take care of yourself and your children! nine0003

Depression

Russian Academy of Medical Sciences
SCIENTIFIC CENTER FOR MENTAL HEALTH









DEPRESSION (from hope to certainty).
(INFORMATION FOR PATIENTS AND THEIR FAMILIES)








nine0059





MOSCOW
2008


Oleichik I. V. - Candidate of Medical Sciences, Leading Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States

© 2008, Oleichik I.V.
© 2008, NTsPZ RAMS

The vast experience accumulated by mankind and reflected in many literary works convincingly shows that sadness (sadness, melancholy) has always gone side by side with people, being one of the natural human emotions. None of us is immune from failures, illness, breakups, loss of loved ones, financial collapse. Each person can face something inevitable and inevitable, when it seems that life loses its meaning, and despair becomes boundless. However, normally, sadness, sadness and melancholy, as natural reactions to traumatic events, weaken over time and the person's condition returns to normal without special treatment. The situation is different with depressions, which are mental disorders that differ from natural physiological reactions in greater intensity, special severity of experiences and persistence of manifestations. True depression rarely goes away on its own, requiring persistent, sometimes long-term treatment. nine0059 A depressive state (from the Latin word depressio - suppression, oppression) is a disease that concerns not only an individual specific sick person, but is also a significant burden of modern society, since it is spreading more and more widely in the world, causing enormous damage to the health of the population and the state. economy. And this applies to all countries, regardless of their level of social development. Every year, at least 200 million people in the world fall ill with depression. Perhaps these figures are even higher, since most victims of depression do not seek help because they are not aware of the painfulness of their condition. Scientists have calculated that almost one in five people who have reached adulthood will experience at least one episode of depression during their lifetime. nine0059 In the most general sense, a depressive state is one of the possible forms of a person's response to the impact of stress factors. In some cases, depression can be triggered by external negative influences, for example, mental trauma, excessive educational or work overload, infection or other serious somatic disease, traumatic brain injury, changes in the hormonal background, which is especially important for the female body, regular certain medications, such as hormones, blood pressure medications, alcohol or other drug abuse. In other cases, depressive states develop as a manifestation of such mental illnesses, in which the main influence is heredity or characteristics of the nervous system (cyclothymia, dysthymia, manic-depressive psychosis, schizophrenia, etc.). If, based on the description of depressive symptoms set out later in our brochure, you realize that you have indeed developed a depressive state, do not fall into despair, do not “try to control yourself”, remember that depression is not a manifestation of weakness of will or character, on the contrary, weakening of volitional qualities is one of the main symptoms of depression. Depression is a disease like rheumatism, arthritis or hypertension, it responds well to treatment, resulting in almost always a full recovery. You should not blame yourself for the occurrence of depression, it does not indicate either your fault, or your weakness, or the possible development of a more severe mental pathology. Below we will tell you about the symptoms of depression, which can be extremely diverse. nine0003

Manifestations of depression

Manifestations of depression can be very different. Depressive states can be manifested by a violation of almost all aspects of mental life: mood, memory, will, activity, which is expressed in the appearance of sadness, sadness, mental and muscle retardation, lasting at least 2 weeks. Depressed mood during depression can manifest itself as mild sadness, sadness, and boundless despair. Often it is accompanied by a feeling of melancholy, unbearable heaviness in the soul, with excruciating pain behind the sternum, a feeling of hopelessness, deep depression, hopelessness, helplessness, despair and uncertainty. At the same time, the patient is completely immersed in his gloomy experiences, and external events, even the most joyful ones, do not affect him, do not affect his mood, and sometimes even worsen the latter. A constant "companion" of a depressive mood is also anxiety of varying severity: from mild anxiety or tension to violent excitement, riot. Anxiety and bad mood arise at the mere thought of the need to make some kind of decision or change your plans due to suddenly changed circumstances. Anxiety can also manifest itself on the physical (bodily) level in the form of belching, intestinal cramps, loose stools, frequent urination, shortness of breath, palpitations, headaches, increased sweating, etc.
The picture of depression is complemented by the disappearance of desires, interests, a pessimistic assessment of everything around, ideas of one's own low value and self-blame. Deficiency of vital impulses is manifested in patients with a variety of symptoms - from lethargy, physical weakness to a state of weakness, loss of energy and complete impotence. Where an important decision is required, a choice between different options, human activity is sharply hampered. Depressed people are well aware of this: they complain that insignificant everyday tasks, small issues that used to be solved almost automatically, take on the significance of complex, painful, insoluble problems. At the same time, a person feels that he began to think, act and speak slowly, notes the suppression of instincts (including food and sexual instincts), the suppression or loss of the instinct of self-preservation and the lack of the ability to enjoy life up to complete indifference to what used to be liked evoked positive emotions. nine0059 People suffering from depression often feel "stupid", "mentally retarded", "feeble-minded". Thinking in depression becomes viscous, painful, requires special efforts, one mental image is hardly forced out by the next. The sick person is oppressed by the feeling of his own intellectual insolvency, professional collapse. Depressed patients can hardly describe their painful experiences to the doctor. Only after getting out of depression, many of them say that the mood at that moment was lowered, thinking was slow, all undertakings (including treatment) seemed in vain, and the years lived were empty and useless. However, at the time of the first visit to the doctor, they could not explain this because of the almost complete absence of thoughts in their heads, “para-lich of thinking”. With depression, there are also often complaints of memory loss, which is why those suffering from it assume that they have "Alzheimer's disease", "schizophrenia", "senile dementia", which is not true. Especially often these complaints are found in depressions that develop in adolescence. nine0059 Typical story
Aleksey, 18 years old, 1st year student of a technical university, describes his condition during depression in this way:
“From childhood, I was fond of technology and modeling, I could read special literature for hours, won school and regional olympiads in mathematics and physics. After graduating from school, my dream came true - I brilliantly passed the exams to a prestigious university. Then it seemed to me that the whole world was at my feet, I flew with happiness "as if on wings." In September, I happily began to study. At the beginning, everything worked out well, but after 2 months I began to notice that it was becoming increasingly difficult for me to absorb what I read, I did not remember the simplest text, I could not solve problems that I used to “click like nuts”. Trying to achieve success through many hours of brainstorming or drinking a few cups of coffee led to the fact that I completely stopped thinking about anything. It seemed to me that I was "finally and irreversibly stupid." At night I sobbed, wrapped in a blanket and thought about how best to commit suicide. Luckily, I met a senior in the library and shared my problems with him. My new acquaintance said that he experienced something similar and advised me to contact the psychiatrist of the student clinic. After the examination, I was diagnosed with juvenile depression and sent for treatment to a specialized medical center. After 2 months, I felt completely healthy, returned to my studies and caught up with my classmates. nine0003

Depression can also be accompanied by real setbacks: for example, a decrease in academic performance, the quality of work, family conflicts, sexual disorders and their consequences for personal relationships. As a rule, the significance of these failures is exaggerated and as a result there is a false sense of the irreparability of what happened, "the collapse of all hopes."
Another generally recognized danger of depression is the possibility of suicidal thoughts, which often lead to suicide attempts. The condition of a person suffering from depression can suddenly deteriorate sharply, which happens either without clear external causes, or under the influence of traumatic situations, unpleasant news. It is during these hours, and sometimes even minutes, that a fatal decision is made. Factors that increase the risk of suicide in depression are past suicide attempts, the severity and duration of the depressive state, the presence of anxiety in its structure, prolonged insomnia, loneliness or alienation in the family, alcohol and drug abuse, loss of work and a sharp change in lifestyle, as well as relatives commit suicide. nine0059 Typical story
Eugene E., 35 years old, leading manager of the company.
Almost all my life, my career went “on the ascending”, the goals set were clear, clear and achievable. The marriage was extremely harmonious, two beloved children grew up. He devoted almost all the time to the affairs of the company, occasionally, once every 1-2 months, he escaped with his family out of town, to the country. He often lacked sleep, stayed late at work, took home assignments, and was deeply worried about the affairs of the company. Gradually, irritability, fatigue, insomnia, difficulty concentrating appeared, more and more often he suffered a “fiasco” in intimate life. Thoughts appeared that life was lived in vain, that it is a "chain of tragic mistakes" that led to a dead end. He began to believe that the choice of work, friends, family was wrong, for which now "retribution has come." Analyzing the past years for a long time, he found more and more evidence and examples of his "duplicity, hypocrisy, insincerity, etc." I realized that the only way to solve all problems is to voluntarily leave this life. At the same time, he believed that by this act he would free the family from the “burden”, “loser”, “loser”. I decided, having locked myself in the garage, to get poisoned by the exhaust gases of the car. However, by chance, in a semi-conscious state, he was discovered by an employee of a garage cooperative. He explained what happened as an "accident". The thought of leaving life did not leave the patient. I decided to shoot myself with a gas pistol, which I had long ago acquired for self-defense. After a shot in the mouth, in a serious condition, he was taken to the Research Institute. Sklifasovsky, from where he was discharged a week later. The alarmed wife, suspecting something was wrong, decided to consult her husband with a psychiatrist. He was admitted to the clinic. He agreed to this only out of respect for family relations, he himself believed that treatment by psychiatrists was completely useless, because. his situation is hopeless and no medicines will help here, but will only "stupefy" his psyche. However, after two weeks of taking a modern antidepressant, the patient's point of view changed. Everything began to look not so bleak and hopeless, interest in work and life in general returned, I began to feel more cheerful, more energetic, interest in intimate life appeared. He took work to the clinic, called up colleagues. After two months of treatment, he fully returned to his usual life. With bewilderment, he recalled his thoughts about insolvency, the collapse of life, suicide. He took the drug prophylactically for about six months, then, on the recommendation of a doctor, he gradually reduced the dose and stopped taking it. Over the next two years, the condition remained stable, career growth continued, another child was born. nine0003

Depression is also characterized by sleep disturbances, occurring in approximately 80% of patients. As a rule, these are early awakenings with the inability to fall asleep, lack of a sense of sleep, difficulty falling asleep. These disorders, as well as restless sleep with unpleasant dreams, are often the very first symptoms of incipient depression.
If the depression is not deep, it is sometimes difficult to recognize it. This is due to the fact that people are ashamed to tell others about their problems, to admit to "weaknesses". Quite often, especially in Russia, depressive states are masked by alcohol abuse (“vodka heals”). In addition, often patients suffering from depression, in order to "shake themselves up", "throw into all serious", engage in casual sex, are fond of gambling or extreme sports, leave to serve on a contract in "hot spots", lead an idle lifestyle with constant attendance at entertainment events. Surrounding people, relatives who do not have psychiatric knowledge, often accuse them of debauchery, drunkenness, riotous lifestyle, parasitism. Meanwhile, this behavior is a kind of “cry for help”, an attempt to fill the spiritual emptiness brought by depression with new acquaintances and impressions. nine0059 Depressive conditions can occur in shallow forms that are easily treatable, but at least a third of depressions are more severe. Such depressions are characterized by:
- ideas of guilt, sometimes reaching the degree of delirium, i.e. unshakable conviction in their sinfulness, low value (patients consider themselves great sinners, believe that because of them all relatives and Mankind will die, that they are “moral freaks” from birth, supposedly deprived of the foundations of morality and a sense of empathy for other people that they have no place on earth They find in their past numerous "confirmations" of what has been said above, they believe that the doctor and other patients are aware of these transgressions and express contempt and indignation with their facial expressions and gestures, but in the words “they hide, deny the obvious. ” Both the patients themselves and their relatives must remember this in order to prevent the impending threat in time: remove all firearms, piercing and cutting objects, ropes, potent drugs and poisonous close household fluids, close windows or shutters, do not let the patient go anywhere alone.If these ideas become persistent and cannot be dissuaded, it is urgent to seek advice from a psychiatrist. neurological institution or call a psychiatrist at home. nine0059 - mood swings during the day: in typical cases, the patient, waking up, immediately feels longing. Sometimes, even before full awakening, through a dream he experiences a painful premonition of a heavy coming morning. In the evening, the state of health improves somewhat.
- the patient may experience a feeling of unmotivated hostility towards relatives, friends, constant internal discontent and irritation, which makes him unbearable for the family.
- in a number of people suffering from depression, constant doubts, fear for the health and well-being of loved ones, obsessive ones, come to the fore. arising against the will, ideas about the misfortunes and troubles of family members. nine0003

Typical story
Dmitry Petrovich, 58 years old, teacher.
“After minor troubles at work, I began to feel incomprehensible anxiety and agitation. Unpleasant thoughts came into my head that I did something wrong at work, because of which I double-checked everything many times and went home later than everyone else. But even at home, the anxiety did not let go: as soon as the daughter or wife lingered for at least half an hour, terrible pictures of traffic accidents or violence were drawn in the imagination. I fell asleep only in the morning, got up broken and felt sleepy all day. I took Valerian, Corvalol, but it practically did not help. At work, they hinted whether I should take a vacation. Friends advised me to consult a neuropathologist, but he did not find his pathology and sent me to a psychiatrist. I was diagnosed with anxiety depression. After a course of outpatient treatment, I completely recovered. ” nine0003

- in many cases, depression is characterized by unpleasant sensations in the body, disturbances in the activity of internal organs in the absence of objective signs of true somatic, i.e. non-mental illness. At the same time, many patients constantly report pain, internal discomfort. Some complain of headaches, pains in the stomach, joints, lower back, others - of disorders in the intestines: constipation, indigestion, irritation of the colon, others pay attention to a decrease in sexual desire and potency. In women, menstruation often becomes painful and irregular. Approximately 50% of depressed people at the doctor's office complain of such physical ailments, without mentioning the depressed mood or state of mind underlying the depression. Experiencing chronic pain or other unpleasant sensations in the body, patients may not realize that they are suffering from depression, even with severe melancholy, considering the latter a reaction to painful bodily discomfort. nine0059 - some patients are convinced that they have some rare and difficult to diagnose disease and insist on numerous examinations in general medical institutions. Doctors call this condition masked (hidden) depression, in which a person may experience pain in the head, in the limbs, behind the sternum, in the abdomen and in any other parts of the body, he may be haunted by anxious fears, he may suffer from insomnia or, on the contrary, too much sleep. nine0059 - Patients may experience disturbances in the cardiovascular system, skin itching or lack of appetite. All of these are manifestations of depression.
- the pathological sensations that patients experience during such depressions are quite real, painful, but they are the result of a special mental state, and not an internal disease. It must be remembered that the frequency of latent depressions exceeds the number of explicit ones many times over.
- with such depression, patients, as a rule, also have a changed attitude towards food: they can go without food for a long time and not feel hungry, and sitting down at the table, eat only 1-2 spoons - they have neither strength nor desire for more . nine0059 - a sign of depression can serve as a weight loss of more than 5 kg. within a month. In some people, especially women, the appetite for depression, on the contrary, increases, sometimes reaching the level of excruciating hunger, accompanied by severe weakness and pain in the epigastric region. In some cases, food is taken in excess due to an increased craving for sweets or attempts to distract oneself from painful thoughts by frequent eating.
Thus, we see that depression is a disease with many different manifestations that do not go away on their own, requiring special, sometimes long-term, medical intervention. Therefore, when the symptoms described above appear, it is necessary to seek help from a psychiatrist who will prescribe and monitor antidepressant treatment. nine0003

TREATMENT OF DEPRESSIVE DISORDERS


To date, it can be argued that the vast majority of cases of depression respond well to treatment. According to modern views, effective treatment of depression consists of a combination of pharmacotherapy, psychotherapy and, if necessary, other types of treatment. At the same time, the main role in therapy, of course, belongs to antidepressants - drugs specially designed for the treatment of various types of depression. nine0059 The creation of antidepressants is based on the discovery of scientists that depression develops as a result of a violation of the mechanism of biochemical transmission of nerve impulses in the brain regions responsible for mood, behavior, response to stress, sleep and wakefulness, appetite and some other functions. To ensure the coordination of the work of all these functional divisions, the brain sends special "commands" to them in the form of chemical impulses transmitted from the processes of one nerve cell (neuron) to the processes of another. This transmission is carried out with the help of chemical mediators (neurotransmitters), which, after transmitting a signal, partially return to the original neuron. This process is called neurotransmitter reuptake. Thanks to him, the number of mediators in the microscopic space between the processes of neurons (in the so-called synaptic cleft) decreases, which means that the necessary signals are transmitted worse. Numerous studies have shown that mediators of various structures, in particular, norepinephrine and serotonin, are involved in the transmission of signals that ensure the normal functioning of the nervous system. The first of them has a general activating effect, maintains the level of wakefulness of the body and takes part in the formation of adaptive reactions, and the second has the main antidepressant effect, controls impulsive actions, anxiety, aggressiveness, sexual behavior, falling asleep, feeling of pain, therefore serotonin is called sometimes a "good mood" regulator. A decrease in the number of mediators in the synaptic cleft causes symptoms of depression, while an increase, on the contrary, prevents their appearance. The ability of some drugs in one way or another to increase the concentration of mediators in the synaptic cleft allows them to be used as antidepressants. nine0059 Now antidepressants are used in Russia, which can be conditionally divided into 4 generations according to the time of creation.
The first antidepressants to find wide clinical use were tricyclic drugs: amitriptyline and imipramine. They have a fairly powerful effect on most depressive states by blocking the reuptake of both norepinephrine and serotonin. However, the real clinical effect of these drugs is significantly offset by their undesirable side effects, which drastically reduce the quality of life of patients during treatment. Side effects of tricyclic antidepressants arise due to the nonspecificity of their effect on receptor structures. Acting in addition to the serotonin and norepinephrine system and other neurotransmitters (acetylcholine, histamine, dopamine), these antidepressants cause side effects such as urinary retention, dry mucous membranes, constipation, palpitations, fluctuations in blood pressure, confusion, tremor, sexual dysfunction. functions, weight gain. In such cases, it is necessary to prescribe other drugs to correct side effects or reduce the therapeutic dose of drugs, which naturally affects the effectiveness of the antidepressant action. It has been observed that up to 50% of patients refuse to take tricyclic antidepressants due to severe side effects. For the same reason, physicians are less likely to prescribe these drugs to patients on an outpatient basis. nine0059 The situation was somewhat improved by the introduction into practice of drugs of the second generation - tetracyclic antidepressants, which, along with the ability to block the reuptake of norepinephrine and serotonin, could also affect some other receptors. Being analogues of tricyclic compounds, these drugs have antidepressant activity comparable to them, but unlike their predecessors, they are safer, since they cause unwanted side effects much less frequently. In addition to the antidepressant, mianserin (lerivon) has a clear sedative, anti-anxiety and hypnotic effect. Maprotiline (Ludiamil) has a mild balanced antidepressant effect. In general, these drugs are able to cure mild to moderate depression, but are ineffective in patients with severe depression. nine0059 To date, antidepressants of the 3rd generation, such as fluoxetine (Prozac), fluvoxamine (Fevarin), paroxetine (Paxil), sertraline (Zoloft), citalopram (Cipralex) and some other drugs that selectively (selectively) affect the serotonin metabolism system, have received widespread recognition today. , preventing its reuptake in the synaptic cleft. Based on the mechanism of action, these antidepressants are combined into a group of selective serotonin reuptake inhibitors. In addition to treating depression, they are used to correct eating disorders, level panic disorders, so-called social phobias, various obsessive-compulsive disorders and chronic pain symptoms. These drugs have gained popularity due to the possibility of a once-daily intake, concomitant anti-anxiety effect, the presence of a psychostimulant component and a small number of side effects. In addition, they have low toxicity and are well tolerated by elderly patients. However, some researchers note their lack of effectiveness in the treatment of severe forms of depressive states, probably associated with selective activity in relation to only one neurotransmitter - serotonin. It should be noted that in recent years, some American scientists have associated the use of these drugs with an increased risk of suicide, which, however, is not proven. nine0059 Considering the high frequency of side effects in some of the above drugs and the insufficient antidepressant activity in others, psychopharmacologists have taken the path of developing more effective antidepressants - IV generation drugs that selectively block the reuptake of both serotonin and noradrenaline, without affecting other mediators. system and with minor side effects. Currently, 3 drugs meet these requirements: milnacipran (Ixel), duloxetine (Cymbalta) and venlafaxine (Effexor). Their antidepressant activity in the treatment of patients with severe and moderate depression has been confirmed in a number of specially conducted studies, which at the same time showed that these drugs are well tolerated. nine0059 It should be noted that antidepressants of plant origin (negrustin, gelarium hypericum, deprim, etc. ) can be effective in mild depressive states, but there are no reliable data guaranteeing their effectiveness. The opinion of a number of doctors that all depression can be treated with herbs or, say, acupuncture, should be recognized as unfounded.
For extremely severe depressions that do not improve despite the use of the most powerful antidepressants, electroconvulsive therapy (ECT) can be effective, but this situation is extremely rare and requires careful justification by the commission of doctors and the consent of the patient. nine0059 An important additional role in antidepressant therapy, especially with concomitant anxiety, is played by tranquilizers - anti-anxiety drugs, such as Xanax, phenazepam, diazepam, nitrazepam, atarax, etc. Drugs that can, when taken systematically, prevent mood swings in various depressive disorders include so-called mood stabilizers or mood stabilizers - lithium preparations, carbamazepine, valproic acid salts, lamotrigine, topiramate. With their systematic intake in most patients, the clinical manifestations of depression either completely disappear or become rare and mild, requiring no hospitalization and not significantly affecting the ability to work. nine0059 Antipsychotics play a significant role in the treatment of certain forms of depression. These include both traditional drugs - fluanxol, triftazin, eglonil, teralen, neuleptil, sonapax, and atypical antipsychotics that are gaining more and more recognition among doctors: seroquel, solian, zeldox, rispolept, abilify, serdolect and others.
In drug therapy of depressive conditions, an unconventional, strictly individual approach is used, with the obligatory provision of fruitful cooperation between the patient and the doctor. Otherwise, there may be a violation of medical recommendations regarding doses and regimens for taking medications. The patient's faith in the possibility of recovery, the absence of prejudice against the "harm" caused by psychotropic drugs, the systematic observance of the prescriptions prescribed by the doctor largely contribute to the achievement of therapeutic success. nine0059 Drug treatment of depression takes time. You should not expect a complete cure already in the first days of taking the drug. It must be remembered that all modern antidepressants begin to act on depressive symptoms no earlier than 1-2 weeks after the start of treatment. Cancellation of an antidepressant, as well as its appointment, should be carried out only by a doctor. Cancellation is usually made no earlier than 6 months from the normalization of the mental state. Even after the complete disappearance of all symptoms of depression, do not rush to stop taking the drug yourself, as there is a risk of an exacerbation of the disease. Therefore, doctors recommend continuing to take the antidepressant for a certain period of time. A common mistake is the premature withdrawal of drugs soon after a significant improvement in the condition or due to "forgetfulness". To avoid this, try to include the drug in the list of daily urgent matters - for example, store it in the bathroom and take it after hygiene procedures. When planning a trip, calculate exactly how many tablets you need for the entire period of absence from home.

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