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How long does it take for abilify to start working


Aripiprazole (Abilify) | NAMI: National Alliance on Mental Illness

​Brand names:

    • Abilify®
      • Tablet: 2 mg, 5mg, 10 mg, 15 mg, 20 mg, 30 mg
    • Abilify MyCite®
      • Oral tablet with a digestible sensor: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
    • Abilify Maintena®
      • Extended-release injectable suspension: 300 mg, 400 mg
    • Aristada® (aripiprazole lauroxil)
      • Extended-release injectable suspension: 441 mg, 662 mg, 882 mg, 1064 mg
    • Aristada Initio® (aripiprazole lauroxil)
      • Extended-release injectable suspension: 675 mg

    Generic name: aripiprazole (ay ri PIP ray zole), aripiprazole lauroxil (law rox il)

    • Aripiprazole
      • Oral tablet: 2 mg, 5mg, 10 mg, 15 mg, 20 mg, 30 mg
      • Orally disintegrating tablet: 10 mg, 15 mg
      • Oral solution: 1 mg/mL

    All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

    What Is Aripiprazole And What Does It Treat?

    Aripiprazole is a medication that works in the brain to treat schizophrenia. It is also known as a second-generation antipsychotic (SGA) or atypical antipsychotic. Aripiprazole rebalances dopamine and serotonin to improve thinking, mood, and behavior.

    Symptoms of schizophrenia include:

    • Hallucinations – imagined voices or images that seem real
    • Delusions - beliefs that are not true (e.g., other people are reading your thoughts)
    • Disorganized thinking or trouble organizing your thoughts and making sense
    • Little desire to be around other people
    • Trouble speaking clearly
    • Lack of motivation

    Aripiprazole may help some or all of these symptoms.

    Aripiprazole is also FDA approved for the following indications:

    • Acute treatment of manic or mixed episodes of bipolar disorder (when used alone or with lithium or valproate)
    • Maintenance (long-term) treatment of bipolar disorder
    • Adjunctive treatment of major depressive disorder. This means aripiprazole is used in addition to an antidepressant to help treat depression.
    • Irritability associated with autistic disorders
    • Tourette’s syndrome

    This medication sheet will focus primarily on schizophrenia. You can find more information about bipolar disorder, depression, and autism spectrum disorders here.

    Aripiprazole may also be helpful when prescribed “off-label” for borderline personality disorder or drug-induced hyperprolactinemia (elevated prolactin levels caused by other antipsychotics). “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.

    What Is The Most Important Information I Should Know About Aripiprazole?

    Schizophrenia requires long-term treatment. Do not stop taking aripiprazole, even when you feel better.

    With input from you, your health care provider will assess how long you will need to take the medicine.

    Missing doses of aripiprazole may increase your risk for a relapse in your symptoms.

    Do not stop taking aripiprazole or change your dose without talking with your health care provider first.

    For aripiprazole to work properly, it should be taken every day as ordered by your health care provider.

    Are There Specific Concerns About Aripiprazole And Pregnancy?

    If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions. This is a complex decision since untreated schizophrenia has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

    Antipsychotic use during the third trimester of pregnancy has a risk for abnormal muscle movements (extrapyramidal symptoms [EPS]) and/or withdrawal symptoms in newborns following delivery. Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization.

    In general, infants exposed to SGAs via breast milk should be monitored weekly for the first month of exposure for symptoms, such as appetite changes, insomnia, irritability, or lethargy.

    Caution is advised with breastfeeding since aripiprazole does pass into breast milk.

    What Should I Discuss With My Health Care Provider Before Taking Aripiprazole?

    • Symptoms of your condition that bother you the most
    • If you have thoughts of suicide or harming yourself
    • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
    • If you ever had muscle stiffness, shaking, tardive dyskinesia, neuroleptic malignant syndrome, or weight gain caused by a medication
    • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
    • Any psychiatric or medical problems you have, such as heart rhythm problems, long QT syndrome, heart attacks, diabetes, high cholesterol, or seizures
    • If you have a family history of diabetes or heart disease
    • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
    • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
    • If you are pregnant, plan to become pregnant, or are breastfeeding
    • If you smoke, drink alcohol, or use illegal drugs

    How Should I Take Aripiprazole?

    Aripiprazole tablets and suspension are usually taken 1 time per day with or without food.

    Typically, patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

    The oral dose of aripiprazole usually ranges from 2 mg to 30 mg taken once daily. The dose of aripiprazole maintena extended-release injection ranges from 300 mg to 400 mg given once monthly; the dose of aripiprazole lauroxil extended-release injection ranges from 441 mg to 1064 mg – depending on the dose, it is given once per month, every 6 weeks, or every 2 months. Aripiprazole Maintena requires a two-week oral medication overlap; aripiprazole lauroxil requires a three-week oral overlap. Aripiprazole lauroxil Initio is typically given after an oral dose of aripiprazole along with an aripiprazole lauroxil injection – this allows for a one-day initiation and does not require further oral overlap. Only your health care provider can determine the correct formulation and dose for you.

    Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or a friend to remind you or check in with you to be sure you are taking your medication.

    What Happens If I Miss A Dose Of Aripiprazole?

    If you miss a dose of oral aripiprazole, take it as soon as you remember, unless it is closer to the time of your next dose. Do not double your next dose or take more than what is prescribed. If you miss an injection, call your doctor or pharmacist right away. Discuss this with your health care provider.

    What Should I Avoid While Taking Aripiprazole?

    Avoid drinking alcohol or using illegal drugs while you are taking aripiprazole. They may decrease the benefits (e.g., worsen your confusion) and increase adverse effects (e.g., sedation) of the medication.

    What Happens If I Overdose With Aripiprazole?

    If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

    A specific treatment to reverse the effects of aripiprazole does not exist.

    What Are Possible Side Effects Of Aripiprazole?

    Common side effects

    Headache, extrapyramidal symptoms, drowsiness, restlessness, fatigue, sedation, agitation, insomnia, anxiety, weight gain, cholesterol abnormalities, increased glucose, nausea, vomiting, constipation, application site rash (MyCite), tremor

    Rare/serious side effects

    Rash, dry mouth, muscle aches, seizure, agitation

    Aripiprazole may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term (months or years) of elevated prolactin can lead to osteoporosis or increased risk of bone fractures.

    Some people may develop muscle-related side effects while taking aripiprazole. The technical terms for these are “extrapyramidal symptoms” (EPS) and “tardive dyskinesia” (TD). Symptoms of EPS include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.

    Temperature regulation: Impaired core body temperature regulation may occur; caution with strenuous exercise, heat exposure, and dehydration.

    Second generation antipsychotics (SGAs) increase the risk of weight gain, high blood sugar, and high cholesterol. This is also known as metabolic syndrome. Your health care provider may ask you for a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c (a measure of blood sugar over time) while you take this medication.

    • Information on healthy eating and adding exercise to decrease your chances of developing metabolic syndrome may be found at the following sites:
      • http://www.helpguide.org/articles/healthy-eating/healthy-eating.htm
      • http://www.helpguide.org/home-pages/exercise-fitness.htm

    SGAs have been linked with higher risk of death, strokes, and transient ischemic attacks (TIAs) in elderly people with behavior problems due to dementia.

    All antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular heart beat). To minimize this risk, antipsychotic medications should be used in the smallest effective dose when the benefits outweigh the risks. Your doctor may order an EKG to monitor for irregular heartbeat.

    Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in <1% of patients. Symptoms include confusion, fever, extreme muscle stiffness, and sweating. If any of these symptoms occur, contact your health care provider immediately.

    All antipsychotics can cause sedation, dizziness, or orthostatic hypotension (a drop in blood pressure when standing up from sitting or lying down). These side effects may lead to falls which could cause bone fractures or other injuries. This risk is higher for people with conditions or other medications that could worsen these effects. If falls or any of these symptoms occur, contact your health care provider.

    The U.S. Food and Drug Administration (FDA) is warning that compulsive or uncontrollable urges to gamble, binge eat, shop, and have sex have been reported with the use of aripiprazole (Abilify, Abilify Maintena, Aristada, Aristada Initio). These uncontrollable urges were reported to have stopped when the medicine was discontinued or the dose was reduced. These impulse-control problems are rare, but they may result in harm to the patient and others if not recognized.

    Are There Any Risks For Taking Aripiprazole For Long Periods Of Time?

    Tardive dyskinesia (TD) is a side effect that develops with prolonged use of antipsychotics. Medications such as aripiprazole have been shown to have a lower risk of TD compared to older antipsychotics, such as Haldol® (haloperidol). If you develop symptoms of TD, such as grimacing, sucking, and smacking of lips, or other movements that you cannot control, contact your health care provider immediately. All patients taking either first or second generation antipsychotics should have an Abnormal Involuntary Movement Scale (AIMS) completed regularly by their health care provider to monitor for TD.

    Second generation antipsychotics (SGAs) increase the risk of diabetes, weight gain, high cholesterol, and high triglycerides. (See “Serious Side Effects” section for monitoring recommendations).

    What Other Medications May Interact With Aripiprazole?

    The following medications may increase the levels and effects of aripiprazole:

    • The antibiotic clarithromycin (Biaxin®)
    • Antidepressants, such as fluoxetine (Prozac®), paroxetine (Paxil®), and nefazodone
    • Antifungals, such as fluconazole (Diflucan®), ketoconazole (Nizoral®), and itraconazole (Sporanox®)
    • The antiarrhythmic agent quinidine
    • HIV medications, such as the protease inhibitors indinavir (Crixivan®), ritonavir (Norvir®), saquinavir (Fortovase®, Invirase®), and lopinavir/ritonavir (Kaletra®)

    The following medications may decrease the levels and effects of aripiprazole: carbamazepine (Tegretol®) and rifampin (Rifadin®).

    How Long Does It Take For Aripiprazole To Work?

    It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking aripiprazole. It will probably take several weeks to see big enough changes in your symptoms to decide if aripiprazole is the right medication for you.

    Antipsychotic treatment is generally needed lifelong for persons with schizophrenia. Your doctor can best discuss the duration of treatment you need based on your symptoms and illness.

    • Hallucinations, disorganized thinking, and delusions may improve in the first 1-2 weeks
    • Sometimes these symptoms do not completely go away
    • Motivation and desire to be around other people can take at least 1-2 weeks to improve
    • Symptoms continue to get better the longer you take aripiprazole
    • It may take 2-3 months before you get the full benefit of aripiprazole

    Summary of FDA Black Box Warnings

    Increased mortality in elderly patients with dementia related psychosis

    • Both first generation (typical) and second generation (atypical) antipsychotics are associated with an increased risk of mortality in elderly patients when used for dementia related psychosis.
    • Although there were multiple causes of death in studies, most deaths appeared to be due to cardiovascular causes (e.g. sudden cardiac death) or infection (e.g., pneumonia).
    • Antipsychotics are not indicated for the treatment of dementia-related psychosis.

    Suicidal Thoughts or Actions in Children, Teens, and Young Adults

    Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.

    • Patients treated with antidepressants may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking medications. This risk may persist until significant remission occurs.
    • Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or health care professional.
    • All patients being treated with this medication for depression should watch for and notify their health care provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

     

    Provided by

    (November 2022)

    ©2022 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

    This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

    8 Answers inc. Side Effects, Dosage & Uses for Aripiprazole

    Aripiprazole, sold under the brand name Abilify, is an oral and injectable medication used to treat mental disorders such as schizophrenia, Tourette’s, bipolar disorder, and in some cases, depression. Abilify is thought to restore the balance of naturally occurring chemicals within the brain to reduce symptoms such as hallucinations and improve concentration. In general, it can be used to help people with mental disorders more actively participate in everyday life.

    The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.

    What is Abilify (aripiprazole) used for?

    Abilify is used to treat the symptoms of mental or mood disorders (schizophrenia, bipolar disorder, depression, Tourette’s disorder, and irritability associated with autism spectrum disorder) but it does not cure the actual disease. It can be used alone or alongside other medications. Abilify is an antipsychotic drug, antimanic agent, making it a common prescription for those who suffer from manic episodes or hallucinations.

    How Does Abilify Work?

    It is not completely understood how aripiprazole, Abilify’s active ingredient, actually works. However, studies have suggested that the drug works by activating the serotonin and dopamine receptors in the brain which in turn stabilizes moods, behavior, and thinking. Dopamine regulates the way we think and feel, and serotonin influences your mood and behavior. Many people suffering from mental conditions have too much or too little of one or both chemicals. By stabilizing the levels of these chemicals, Abilify is thought to improve thoughts, behaviors, and mood.

    What are the side effects of Abilify (aripiprazole)?

    Abilify is a second-generation psychotic, also known as an atypical antipsychotic. In comparison to first-generation psychotics, side effects are milder. However, Abilify can still cause side effects ranging from mild to severe. Mild side effects typically go away after a few days or weeks of consistent medication-taking, but if they persist or worsen you should speak with your doctor.

    Mild Side Effects:

    • Nausea
    • Memory loss
    • Headache
    • Dizziness
    • Cold-like symptoms
    • Anxiety
    • Hair Loss
    • Libido Changes
    • Insomnia

    Severe Side Effects:

    • Stroke – If you notice numbness or weakness on one side of your body, a feeling of confusion, or trouble walking, seek immediate medical attention.
    • Neuroleptic malignant syndrome (NMS) – Symptoms include high fever, a rapid heartbeat, and stiff muscles. NMS is a medical emergency and you should seek immediate medical attention if you notice these symptoms.
    • Changes in metabolism – This is usually marked by feeling unusually thirsty or hungry, feeling confused, and gaining weight.
    • Feeling unusual urges – Urges do something you would not ordinarily do or to do something excessively, constitute an unusual urge. These can range from binge eating to sexual urges.
    • Extrapyramidal disorder – This is a movement disorder that can cause symptoms such as tremors, trouble speaking , and anxiety.

    If you experience any of these serious side effects you should speak with your doctor or seek immediate medical attention if it is an emergency.

    In some rare cases, patients can experience allergic reactions. Seek emergency medical care if you experience any of the following symptoms after taking Abilify.

    • Skin rash
    • Wheezing
    • Tightness in the throat or chest
    • Difficulty talking or breathing
    • Swelling of the face, lips, tongue, or throat

    Does Abilify cause weight gain?

    Oftentimes patients being treated for mental conditions such as bipolar disorder are used to weight gain as a potential side effect. For that reason, a common question from patients who are prescribed Abilify is “will I gain weight?” A potential side effect of Abilify and other atypical antipsychotics is weight gain. If you notice your weight increasing, speak with your healthcare provider about ways to best manage your weight.

    How long does Abilify withdrawal last and what does it entail?

    There are a variety of reasons why a person may stop taking Abilify and as with any other antipsychotic, it is possible to experience withdrawal. The limited research that has been conducted on this topic suggests that around 40% of people who stop taking antipsychotics will experience some form of withdrawal. Symptoms may include:

    • Nausea and vomiting
    • Insomnia
    • Restlessness
    • Anxiety
    • Panic attacks
    • Dizziness
    • Cold-like symptoms
    • Muscle spasms or uncontrolled movements

    If you’re experiencing these symptoms, you’re almost certainly wondering when you can expect them to end. Typically, the symptoms will reach a peak after approximately one week, and will decline gradually over time.

    A safer way to stop taking Abilify is to gradually do so under the direction and care of your healthcare provider. He or she can help you slowly reduce your dose so that you are less likely to experience severe withdrawal symptoms.

    How long does it take Abilify to work?

    Due to the nature of Abilify and the severity of symptoms it may be used to treat, it isn’t uncommon to wonder how long it will take to be effective. Since everyone is different, there is no one definitive answer. It can start making a noticeable difference in just a couple days or it may take a few weeks. However, most people will have felt the full effects of the medication within four to six weeks of beginning treatment. It is important not to stop taking Abilify just because you begin feeling better. Continue your dose as instructed by your healthcare provider to maintain the benefits.

    How much does Abilify cost?

    The price of Abilify will vary greatly depending on location and insurance coverage. However, the cash price of Abilify is $940.71 for 30 tablets of 2mg, 5mg, 10mg, or 15mg. The price for 30 20mg or 30mg tablets is $1,326.65. Regardless of the dosage, Abilify is typically taken once a day so these prices are for a one-month supply.

    Can I combine Abilify and alcohol?

    Typically, drinking is not recommended while taking Abilify, as alcohol can increase the effects of Abilify on the nervous system. This can lead to dizziness, drowsiness, and difficulty concentrating. It may also result in poor judgment and impaired thinking. Drinking alcohol can also have negative effects, depending on the medical condition you are taking Abilify to treat. If you intend to drink while taking Abilify you should first speak with your doctor.

    The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.

    Commonly prescribed autism drug linked to serious side effects

    06/08/16


    A new study shows that the antipsychotic risperidone (Rispolept) often leads to overweight and metabolic disorders in children with autism. Scientists call for careful prescribing and nutritional counseling for parents when taking it So far, only two drugs (the neuroleptics risperidone and aripiprazole) have been approved in the United States for the treatment of behavioral problems in children with autism. However, both drugs are associated with a risk of side effects. The most common unwanted side effect is being overweight.

    The recommended approach for tantrums, aggression and self-injury in children with autism is behavioral therapy. However, in some cases it may not be enough to correct behavior. In such cases, doctors may recommend risperidone (Rispolept) to reduce these problems that interfere with the child's learning and social life.

    However, risperidone can lead to weight gain, and a new study published in the Journal of the American Academy of Child and Adolescent Psychiatry confirms that weight gain with the drug may have undesirable effects on overall health. The results of the study showed that weight gain while taking risperidone is associated with a significant increase in insulin resistance and metabolic syndrome, which increases the risk of developing diabetes, heart disease and liver disease. (The same may be true for aripiprazole, which is also associated with a risk of weight gain, but was not studied in this study. )

    We asked the lead author of the study, Lawrence Scahill of Emory University School of Medicine and Marcus Autism Center, a few questions to understand how the results of his study might influence the decisions of parents and doctors, and whether safer and more effective treatments can be expected in the future. . Dr. Scahill is a leading expert in behavioral and pharmacological treatments for autism.

    Are you suggesting that the metabolic disturbances while taking risperidone are directly caused by weight gain? Is the increase in appetite the cause of weight gain? And why is it important to answer these questions?

    It seems that the sequence of events here is as follows. Soon after the start of the drug, the child's appetite increases, which leads to an increase in daily food intake. Many, though not all, children begin to eat a lot of high-carbohydrate foods at this time. On average, after 24 weeks of clinical trials, children's weight increased by about 15% compared to baseline.
    Faster weight gain was observed in those children whose parents reported an increase in appetite during the first eight weeks of the study. An increase in appetite was observed in three quarters of the sample. Importantly, we found a link between an increase in appetite and significant weight gain.

    In your conclusions from the study, you suggest giving parents clear instructions on nutrition and weight control when prescribing risperidone. Who can provide such advice, and what should it ideally be?

    The results of the study suggest that the prescribing physician or other specialist should talk to parents about the child's nutrition and food choices on the first day of prescribing. Parents should be advised that risperidone is very likely to cause increased appetite, which may lead to weight gain, and that this depends largely on what the child eats.

    There should be no soda and other sugary drinks, sweets and the like at home. I know it sounds too harsh. However, rapid weight gain must be prevented. More importantly, drugs should only be used as a last resort if the child has serious behavioral problems.

    During the 24 weeks of the study, each child taking risperidone was followed up by a physician who assessed behavioral changes and a physician who was in charge of taking the drug. Why?

    We wanted one specialist to focus entirely on whether there was improvement in the child's behavior, regardless of which group the child was in (in the risperidone-only group, or taking the drug at the same time as the parent education course). And of course, we had to watch the dosage and side effects of risperidone. This was done by a therapist as part of the study. During each examination, children were weighed and parents were asked questions about the child's appetite, sleep, and physical activity level to assess possible side effects.

    In your study, how did you choose the dosage of the drug for each child?

    In our study, the dose of the drug remained almost unchanged from the fourth week. Thereafter, changes were minimal, usually a reduction in dosage due to side effects.

    Do you or other studies indicate that the negative effect on metabolism is related to the duration of treatment? What about other side effects such as breast enlargement or obsessive-compulsive behavior?

    It is probably more accurate to say that metabolic disorders are associated with rapid weight gain. As already mentioned, risperidone seems to be able to lead to a dramatic increase in appetite, which leads to overweight. The metabolic effects were similar to those seen in obese children. However, the consequences of obesity are well known to worsen if a person remains overweight.

    Many physicians and researchers have reported that risperidone can cause breast enlargement in boys and menstrual irregularities in girls. These side effects are likely related to increased levels of the hormone prolactin. The attending physician should discuss with parents their concerns about these side effects. In our study, we did not observe such phenomena, nor did we record an increase in compulsive behavior.

    Your study compared risperidone dosage and side effects in a group of children whose parents participated in a parent education program and a group of children whose parents did not. What exactly did this training include? And did parental education help to reduce the required dosage of the drug? Did it prevent weight gain and other unwanted side effects?

    The parent education program was based on the principles of applied behavior analysis. During the training, parents were taught specific strategies for dealing with temper tantrums, non-cooperation, and aggression. The program included 12-13 specialist home visits over 24 weeks. The study compared a group of children who were simply prescribed risperidone and a group of children who took risperidone and whose parents participated in the education program. Thus, children from both groups took the drug. In the group where parents were trained, the effective dose of the drug was slightly lower. Side effects in both groups did not differ.

    In your study, some children (22 out of 124 participants) did not experience an increase in appetite or weight when taking risperidone. How can this be explained?

    It is not clear why about 20% of the sample did not have an increase in appetite. We know that children whose parents did not report increased appetite gained less weight. So far, we can conclude that changes in appetite and weight should be monitored from the start of taking the drug.

    During your study, 12 children switched from risperidone to aripiprazole because they did not benefit from risperidone. Is there evidence that aripiprazole has fewer side effects?

    The drug change was considered as part of the study. Existing evidence suggests that aripiprazole also leads to weight gain. We focused on risperidone because we had a large enough sample to collect clinically relevant information. In addition, children who switched to aripiprazole took risperidone for an average of eight weeks. So either or both drugs could affect weight in children who switched to aripiprazole.

    If both drugs can lead to weight gain, why did your team only study risperidone?

    We have been studying risperidone for a long time. We started studying it in the late 1990s with a grant from the US National Institutes of Health. In those days, risperidone was still considered a relatively new drug. We were interested in it because we thought it would be much better than the old antipsychotics in treating serious behavioral problems. Older antipsychotics caused serious neurological side effects in some children. We were looking for an alternative. Then our studies showed that risperidone is much less likely to cause neurological problems.

    In the first study, children with ASD and severe behavioral problems were randomly assigned to risperidone or an identical-looking placebo. Researchers, parents, and children did not know until the end of the study who was taking the active drug and who was taking the placebo. After eight weeks of treatment, behavioral problems were significantly reduced in the risperidone group of children. The placebo group showed little to no improvement.

    After we had shown that risperidone could reduce problems such as tantrums, aggression and self-injury, we planned a second study. In this study, children with ASD and the same behavioral problems either simply took risperidone or took the drug, and their parents learned behavioral strategies for dealing with the problem behavior for six months. We did not include in the sample children who had previously taken risperidone or whose parents had already received similar training.

    In the conclusion of your study, you say that more research is needed on safer treatments for risky behaviors associated with autism. Which treatment approaches seem more promising to you?

    As I have already said, old generation antipsychotics have shown certain results in correcting serious behavioral problems in children with ASD. We hoped that new generation antipsychotics such as risperidone and aripiprazole would be better than older drugs. And so it turned out. But we have to go beyond just antipsychotics. We must also carefully plan large-scale randomized clinical trials of new drugs. For example, before investing in a multimillion-dollar study, we must conduct small trials to identify the most promising drugs. Biological measurements such as EEG, pulse changes, eye-tracking technologies, and direct behavioral assessments in the laboratory may be useful in such studies. Although this approach is not possible in large-scale trials, it is suitable for small-scale studies.

    What can you tell parents about drugs such as metformin, which can reduce the side effects of risperidone in some patients?

    I don't particularly like prescribing another drug to treat the side effects of the first one, especially if it's a preventable problem. The best approach is to prescribe such drugs only to children with severe behavioral problems, and to advise parents on nutrition at the beginning of treatment.

    Do you agree that lack of access to quality behavioral therapy leads to drug overuse?

    The availability of effective behavioral therapy is a huge problem. A recent study by the US National Institutes of Health found that behavioral problems in children with ASD between the ages of 3 and 7 can only be reduced with parental education. So, at least in the case of young children, we can safely recommend parental education as the first line of intervention.

    How can scientists, doctors, teachers and government officials solve this problem?

    The Parental Education Study included 180 children. This is the largest randomized clinical trial of a behavioral intervention for children with ASD. Now we are looking for ways to introduce such training everywhere.

    We hope that the information on our website will be useful or interesting for you. You can support people with autism in Russia and contribute to the work of the Foundation by clicking on the "Help" button.

    Methods and treatment, Research, Psychiatry

    Depression

    Russian Academy of Medical Sciences
    SCIENTIFIC CENTER FOR MENTAL HEALTH









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















    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.
    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.
    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.

    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.
    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.
    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.

    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.
    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.

    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.
    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.
    - 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.

    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. ”

    - 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.
    - 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.
    - 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 .
    - 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.

    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.
    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.
    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.
    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 often. 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.
    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.
    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.
    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.
    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.
    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.
    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. Breaking therapy is fraught with serious troubles.
    Conducted along with drug treatment, psychotherapy of patients with depressive states implies various systems of influence, including individual conversations, family and group therapy, etc.

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