How long are antidepressants prescribed for

Overview - Antidepressants - NHS

Antidepressants are a type of medicine used to treat clinical depression.

They can also be used to treat a number of other conditions, including:

obsessive compulsive disorder (OCD)
generalised anxiety disorder
post-traumatic stress disorder (PTSD)

Antidepressants are also sometimes used to treat people with long-term (chronic) pain.

Read more about when antidepressants are used.

How antidepressants work

It's not known exactly how antidepressants work.

It's thought they work by increasing levels of chemicals in the brain called neurotransmitters. Certain neurotransmitters, such as serotonin and noradrenaline, are linked to mood and emotion.

Neurotransmitters may also affect pain signals sent by nerves, which may explain why some antidepressants can help relieve long-term pain.

While antidepressants can treat the symptoms of depression, they do not always address its causes. This is why they're usually used in combination with therapy to treat more severe depression or other mental health conditions.

How effective are antidepressants?

Research suggests that antidepressants can be helpful for people with moderate or severe depression.

They're not usually recommended for mild depression, unless other treatments like talking therapy have not helped.

Doses and duration of treatment

Antidepressants are usually taken in tablet form. When they're prescribed, you'll start on the lowest possible dose thought necessary to improve your symptoms.

Antidepressants usually need to be taken for 1 or 2 weeks (without missing a dose) before the benefit starts to be felt. It's important not to stop taking them if you get some mild side effects early on, as these effects usually wear off quickly.

If you take an antidepressant for 4 weeks without feeling any benefit, speak to your GP or mental health specialist. They may recommend increasing your dose or trying a different medicine.

A course of treatment usually lasts for at least 6 months after you start to feel better. Some people with recurrent depression may be advised to take them indefinitely.

Side effects

Different antidepressants can have a range of different side effects. Always check the information leaflet that comes with your medicine to see what the possible side effects are.

The most common side effects of antidepressants are usually mild. Side effects should improve within a few days or weeks of treatment, as the body gets used to the medicine.

Coming off antidepressants

Talk to your doctor before you stop taking antidepressants. It's important that you do not stop taking antidepressants suddenly.

Once you're ready to come off antidepressants, your doctor will probably recommend reducing your dose gradually over several weeks – or longer, if you have been taking them for a long time.

This is to help prevent any withdrawal symptoms you might get as a reaction to coming off the medicine.

Read more about stopping or coming off antidepressants.

Types of antidepressants

There are several different types of antidepressants.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the most widely prescribed type of antidepressants. They're usually preferred over other antidepressants, as they cause fewer side effects. An overdose is also less likely to be serious.

Fluoxetine is probably the best known SSRI (sold under the brand name Prozac). Other SSRIs include citalopram (Cipramil), escitalopram (Cipralex), paroxetine (Seroxat) and sertraline (Lustral).

Serotonin-noradrenaline reuptake inhibitors (SNRIs)

SNRIs are similar to SSRIs. They were designed to be a more effective antidepressant than SSRIs. However, the evidence that SNRIs are more effective in treating depression is uncertain. It seems that some people respond better to SSRIs, while others respond better to SNRIs.

Examples of SNRIs include duloxetine (Cymbalta and Yentreve) and venlafaxine (Efexor).

Noradrenaline and specific serotonergic antidepressants (NASSAs)

NASSAs may be effective for some people who are unable to take SSRIs. The side effects of NASSAs are similar to those of SSRIs, but they're thought to cause fewer sexual problems. However, they may also cause more drowsiness at first.

The main NASSA prescribed in the UK is mirtazapine (Zispin).

Tricyclic antidepressants (TCAs)

TCAs are an older type of antidepressant. They're no longer usually recommended as the first treatment for depression because they can be more dangerous if an overdose is taken. They also cause more unpleasant side effects than SSRIs and SNRIs.

Exceptions are sometimes made for people with severe depression that fail to respond to other treatments. TCAs may also be recommended for other mental health conditions, such as OCD and bipolar disorder.

Examples of TCAs include amitriptyline, clomipramine, dosulepin, imipramine, lofepramine and nortriptyline.

Some types of TCAs, such as amitriptyline, can also be used to treat chronic nerve pain.

Serotonin antagonists and reuptake inhibitors (SARIs)

SARIs are not usually the first choice of antidepressant, but they may be prescribed if other antidepressants have not worked or have caused side effects.

The main SARI prescribed in the UK is trazodone (Molipaxin).

Monoamine oxidase inhibitors (MAOIs)

MAOIs are an older type of antidepressant that are rarely used nowadays.

They can cause potentially serious side effects so should only be prescribed by a specialist doctor.

Examples of MAOIs include tranylcypromine, phenelzine and isocarboxazid.

Other treatments for depression

Other treatments for depression include talking therapies such as cognitive behavioural therapy (CBT).

People with moderate to severe depression are usually treated using a combination of antidepressants and CBT. Antidepressants work quickly in reducing symptoms, whereas CBT takes time to deal with causes of depression and ways of overcoming it.

Regular exercise has also been shown to be useful for those with mild depression.

Read more about alternatives to antidepressants.

Yellow Card Scheme

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you're taking. It's run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).

See the Yellow Card Scheme website for more information.

Community content from HealthUnlocked

How Long Should You Take Antidepressants?

Written by Carolyn Crist

If you start to feel better while taking antidepressants, you may wonder how long you should take this medication or whether you can stop.

Expert guidelines about antidepressants can be confusing. They depend on a variety of factors, including:

The type of prescription you take
Your dosage
The number of depressive episodes you’ve had
Your risk of relapse

Whether it’s a good idea to stop depends on you.

“We know that taking antidepressants for too short a time might pose real risks for some people, but for others, taking them for longer could be more than you need,” says David Baron, a psychiatrist and provost of the Western University of Health Sciences in California.

“This decision needs to be made with a professional, just as a patient who takes insulin or chemotherapy would have specific discussions with their specialist,” he says. “Antidepressants can and do work, but they should be used like any other medication.”

If you and your doctor decide it’s time to stop, you’ll need to know the best way to do it and how to avoid possible side effects.

When to Stop

Under American Psychiatric Association guidelines, if you are taking an antidepressant for your first depressive episode, you should stay on it for at least 4 or 5 months after your symptoms of depression stop. Keep in mind that you may need to try several different antidepressants to find the right option for you, and even then, it can take 2 or 3 weeks to see an initial improvement. After that, it can take 3 to 6 months for symptoms to improve to the point that you are no longer depressed. Altogether, this could mean taking a prescription for about a year to get the full benefits.

If you have ongoing major depressive disorder, or you have had three or more depressive episodes, the APA recommends treatment for at least a few years. Doctors may also recommend longer treatment when the risk of relapse is high.

This can depend on a few factors including your:

Family history of mental illness
Other long-term medical or mental health problems
Ongoing symptoms while you’re on medication
Ongoing stressors, such as trouble sleeping or work or relationship problems

“Decide with your doctor what you expect to gain and improve from taking medication,” Baron says. “Poor sleep, low energy and low self-esteem symptoms might respond to medication, but antidepressants don’t take care of relationship problems.”

How to Stop

If you decide to stop taking antidepressants, don’t quit taking them on your own. And don’t stop all at once. A major drop in medication levels can trigger a relapse or other harmful symptoms, such as suicidal thoughts.

Work with your doctor to create a plan to gradually reduce your medication dose over time. Every antidepressant enters and exits the body at a different speed. It may take several weeks to decrease medication levels safely. During this process, you should schedule regular follow-ups so your doctor can closely monitor you for any side effects or signs of relapse.

You may also want to schedule sessions with a therapist to deal with other life issues, such as grief, low self-esteem, or negative thinking that may control your mood.

“Cognitive therapy can help people reexamine the accuracy of their negative beliefs, which can relieve their distress,” says Steven Hollon, a professor of psychiatry who researches the prevention and treatment of depression at Vanderbilt University in Nashville.

Consider your daily routine, too. Healthy lifestyle habits, such as proper sleep, good nutrition, regular physical activity, and stress reduction techniques, can help your body adjust to the changing medication levels.

What to Expect

Some people report side effects or noticeable changes when they lower their antidepressant dose. Common complaints include:

Dizziness
Fatigue
Flu-like symptoms, such as chills and aches

Keep track of any symptoms you have and discuss them with your doctor. They may be able to further tweak your dose to reduce the discomfort or prescribe something else to relieve the symptoms.

If you quit taking antidepressants suddenly, you may get “antidepressant discontinuation syndrome,” especially if you’ve been taking medication for more than a month or two. Symptoms can include:

Anxiety
Insomnia
Headaches
Irritability
Electric shock sensations

It’s important to talk to your doctor about these symptoms to avoid a relapse and to find the right solution to ease symptoms as your body adjusts.

What you should know about antidepressants

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my illness. nine0003

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control. nine0003

See a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants may make symptoms worse at first

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - this is the name for causeless motor arousal, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it. nine0003

Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks. nine0003

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken. nine0003

/list/antidepressant-myths/

8 myths about antidepressants

I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

Fact No. 2

The effect of antidepressant treatment will not be immediate

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage - NHS

What doses of antidepressants will be optimal - an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work. nine0003

It is better to prepare for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Antidepressants are usually taken in combination with other drugs

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer. nine0003

Antidepressants together with benzodiazepines work better for depression - BMJ magazine

My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby. nine0003

As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

Fact No. 4

Side effects are not always, but they are

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed. nine0003

Side effects of antidepressants - the National Health Service of the UK

Side effects of various antidepressants - Uptodate

Side effects of antidepressants and their impact on the treatment of a large depressive disorder - the journal NATURE

STRICTIC STRICTION OF REDICAL

. effects of antidepressants - advice from the Mayo Clinic staff

Choosing an SSRI drug does not guarantee the absence of side effects - many people tolerate treatment easily, but sometimes a change in drug may be necessary. nine0003

The first couple of weeks of taking there is a risk that the state of health will be so-so - it's worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy. nine0003

There are mixed data on how common the side effects of antidepressants are. If we summarize them, then the numbers look something like this:

nausea - about 25% feel it;
diarrhea - it happens in 15% of people, and 5%, on the contrary, will have constipation;
sweating and a feeling of heat occur in about 20% of people;
sexual dysfunction, decreased libido may occur in 80% of cases;
insomnia - in 11% of cases;
headache and dizziness - in about 10-11% of cases; nine0100
weight gain - not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses. nine0003

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1.5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses. nine0003

Side effects should not be tolerated - if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects. nine0003 I wrote to the doctor again when my visual acuity decreased

Fact No. 5

Antidepressants need to be taken long term

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy - UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine. nine0003

The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.

Psychotherapy review - UpToDate

Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often. nine0003

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and sustain the effects of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more. nine0003

/psychotherapy/

How psychotherapy works

Fact No. 6

Antidepressants should not be stopped abruptly

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images. nine0003

Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry

How difficult it is to stop taking antidepressants - American Psychological Association

Stopping antidepressants in adults - UpToDate

treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake. nine0003

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

If you need to change the drug, everything will start over

It is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one. nine0003

Changing antidepressants in adults - UpToDate

Serotonin syndrome - MSD

Most often, it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.

You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs. nine0003

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

/psychotherapy-search/

How to choose a psychotherapist

Fact No. 8

Among antidepressants there are original drugs and generics

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the action of generics should not differ from the action of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials. nine0003

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

/list/covid-depression/

Psychoneurological complications after covid: memory problems and depression

As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened. nine0003

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

Active ingredient	Original	Original cost	Generics	Cost of generics
Sertraline	Zoloft	About 700 R, 100 mg tablets	Serenata, Sirlift	500-600 R 100mg tablets
Escitalopram	Cipralex	3000 R, tablets 10 mg	"Selektra", "Elycea"	500-1300 R 10 mg tablets
Fluoxetine	Prozac	About 350 R, 20 mg tablets	Profluzak, Fluoxetine	100-200 R, tablets 20 mg

CERTRIN

Original

"Zoloft"

Original cost of the original

about 700 r, tablets 100 mg

generics

"Serenata", "Cerelift"

The cost of Jeeneriki

9000 500-600 r.

, tablets 100 mg

Escitalopram

Original

Cipralex

Original price

3000 r, tablets 10 mg

generics

“Chektra”, “Elice”

The cost of generics

500-1300 r, tablets 10 mg

Fluoxetine

“Przak”

cost

cost cost

Cost cost cost original

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100—200 R, tablets 20 mg

one remained unclaimed

Fact No. 9

Do not take alcohol along with antidepressants

Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn't mix antidepressants and alcohol - Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited. nine0003

With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

/trevoga/

How I Treated Generalized Anxiety Disorder under CHI

Fact No. 10

Antidepressants are incompatible with certain drugs and have contraindications nine0017

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

Antidepressant Warnings - NHS

Drug Compatibility Test - Drugs.com

It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.

If it is not possible to consult a doctor before taking any medication, carefully read the instructions for it and your antidepressant. It is also worth informing all doctors who prescribe something to you during the therapy period about taking antidepressants. nine0003

Why do neurologists prescribe antidepressants?

A couple of decades ago, the use of psychotropic drugs was the exclusive prerogative of the psychiatrist. Therefore, it seems to me that fear and distrust remain in relation to this class of drugs.

However, the trends of modern medicine are such that a neurologist working based on the principles of evidence-based medicine and adhering to international clinical recommendations should understand psychotropic drugs, as they allow the doctor to improve the patient's quality of life, avoid endless and useless consultations with doctors and additional expensive examinations . nine0361
In this article I will talk about the main types of psychotropic drugs that a neurologist can prescribe on an outpatient basis: tranquilizers / anxiolytics, antidepressants, antipsychotics, antiepileptic drugs.

Some basics. How does our brain work?

Brain is a lot of neuron cells. Neurons transmit information to each other with the help of molecules - neurotransmitters.
There are a lot of neurotransmitters: acetylcholine, histamine, serotonin, dopamine, GABA, etc.
The mediator is ejected from the process of one neuron and "sits down" on the receptor, which is located on the process or body of another neuron.

Some neurotransmitters activate another neuron, some inhibit it.

The mechanism of action of most psychotropic drugs is associated with exposure to receptors for certain mediators - one or several at once.

What is the fundamental difference between classes of psychotropic drugs?

1. Tranquilizers (anxiolytics, anti-anxiety drugs)

Representatives: benzodiazepines (phenazepam, alprozalam, clonazepam), hydroxyzine (atarax), tofisopam (grandaxin), etifoxine (stresam) and others.

Act on the receptors of "brake" mediators. Due to this, they have a calming, sedative effect. The drugs differ in the "strength" of the impact and the severity of the calming effect.

The effect develops quickly but does not last long. nine0003

When prescribed: if you need to quickly relieve anxiety, panic attacks, correct insomnia, reduce anxiety before surgery or medical interventions, to reduce the side effects of antidepressants at the beginning of their use.

Course duration: short, no more than 4 weeks, especially benzodiazepine drugs, which may develop tolerance with longer use.

Tranquilizers are not sold without a prescription. Some drugs are released only on a special prescription with a number and series. nine0361
2. Antidepressants
These include tricyclic antidepressants (amitriptyline, clomipramine), selective serotonin reuptake inhibitors (escitalopram, sertraline, fluoxetine and others), selective serotonin and norepinephrine reuptake inhibitors (venlafaxine, duloxetine) and others.

Old groups of antidepressants act on the receptors of several types of mediators at once, this causes a large number of uncomfortable side effects (weight gain, drowsiness, arrhythmia, increased intraocular pressure, and others). nine0361
The more modern the drug, the more “pointed” its effect. Some drugs act on a specific subtype of neurotransmitter receptor. This reduces the likelihood of side effects, but their effectiveness remains high.

In order to minimize the side effects of antidepressants, which can be especially disturbing at the beginning of treatment, the doctor will select the optimal dosage increase regimen (with the lowest possible dose and a gradual gradual increase) and drug withdrawal. nine0361
The effect of this group of drugs unfolds within 2-3-4 weeks, but after the drug is discontinued, a “tail” of their positive action remains for some time.

The course of treatment is long, at least 6 months.

When properly prescribed, taking into account the individual characteristics of the patient and his comorbidities, taking antidepressants, even long-term, is safe.
Antidepressants are not addictive or addictive.

Used for: Anxiety, phobias, panic attacks, as part of the treatment of post-traumatic disorder and reaction to a stressful event, insomnia, chronic headaches, chronic back pain, painful polyneuropathies, psychogenic dizziness, irritable bowel syndrome, somatization disorders. nine0361
Antidepressants are prescribed by a physician and are not available without a prescription.

3.Neuroleptics
Of the most commonly prescribed by a neurologist are quetiapine, olanzapine, risperidone, alimemazine (teraligen).

Learn more