What does citalopram help with

The drug was originally developed to lower blood pressure, but in the course of trials, another useful property was revealed: a small group of volunteers with mild depression significantly improved mood.

The advertised new drug suddenly seemed like a magic pill capable of unloading therapists besieged by dull hypochondriacs suffering from "everything and nothing", and where the pill is, there is the disease for which it was required.

Five years after the arrival of Prozac in the West, the novel Prozac Nation by Elisabeth Wurzel (and a film soon followed) was released, in which an American journalist describes her depression in detail. nine0011

The trend, as always, was set by stars and other celebrities who began to stun the public first with the details of their psychotherapy sessions, then with a long list of medications taken to help overcome another "life crisis".

As a century before, girls were supposed to faint, and ardent young men to suffer from consumption, so it became almost fashionable to admit to being depressed, especially among the "creative" brethren.

Runny nose in the war? nine0034

Where was the depression hiding before and why did we hear practically nothing about it in the Soviet Union? Either depression was class alien to Soviet people, or the effect of a “runny nose in the war” worked: when a family of five lives in the same room, you have to stand in queues for food, and go to the toilet with yesterday’s newspaper, then somehow it’s not up to depression?

Doctor of Medical Sciences, Professor Boris Polozhiy from the Serbsky Institute dispelled my doubts on this matter, saying that depression was also diagnosed in the USSR, although, compared with Western countries, fewer depressive disorders were registered, which is partly due to the tradition of the domestic psychiatry, which did not single out depression as part of some other mental disorder. nine0011

However, since the end of the 20th century, there has been a worldwide trend towards an increase in the number of patients with depressive disorders of various nature - and Russia is no exception, the doctor says.

The author of the photo, SPL

Prozac was also called "happiness pills"

"The attitude to this is quite serious, including the drug treatment of depression, - explains Professor Polozhiy. - The only thing we do not go for , unlike, say, the United States, we do not recommend general practitioners to deal with depression, because after all, prescribing antidepressants and treating depression is a task that requires a certain specialization. nine0011

However, as the psychiatrist says, now even in Russia they are advocating that the local doctor could at least recognize depression and refer the patient to a specialist.

"And the fact that depression remains unrecognized, undiagnosed is a problem, because, alas, often the outcome of severe, untreated depression is suicide, and in this respect our country is not yet in the most prosperous place in the world," says the psychiatrist .

Compression of feelings

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In Britain, it is true that not only the diagnosis of depression, but also its treatment (not in especially severe cases) is the prerogative of the family doctor, not the psychiatrist. And if a few decades ago going to the doctor with complaints of despondency was considered a sign of "weakness of character", now getting an antidepressant, as N., who lives in London and wished to remain incognito, says, is very easy. nine0011

N., left with a small child in financially tight circumstances after a divorce, felt she needed some help, and her family doctor promptly prescribed her the antidepressant citalopram. However, she was surprised that this drug is prescribed for any condition - depression, anxiety syndrome, and anxiety attacks, without choosing a medicine for a specific person.

"These drugs are designed to even out your condition; you stop feeling anxiety, pain, depression, but at the same time they even out your positive feelings - there are no bright emotions in one direction or the other; they do not cure", - admits N.

Can antidepressants even "cure" depression or any other psychological condition?

"Most of the people I see here with depression are triggered by social situations, the fact that the person lost his job, that the person does not have a good home, or the husband is an alcoholic - that is, situations that the pill will never cure," explains the British family doctor Marina Diel. – Therefore, here a pill is like a stick for those who are lame, so that you can overcome some little things a little, give you a little more energy to cope and look at things differently. nine0011

Prozac and related antidepressants are selective serotonin reuptake inhibitors (SSRIs) and work by slowing down the release of so-called "neurotransmitters" (chemicals that help transmit impulses between nerve fibers) from the brain, in particular serotonin, the so-called "happy hormone".

It is believed that depression is sometimes caused by its lack, however, experiments have shown that a decrease in the level of serotonin does not always lead a person to depression, so how much exactly a person needs for happiness and whether it is the case, scientists do not know, therefore it is not surprising that many people have a prejudice against taking such drugs. nine0011

Internet diagnostics

According to the Mental Health Foundation, one in four Britons in the UK in any given year can be diagnosed with some kind of mental disorder, and according to the US National Institute of Mental Health (National Institute) of Mental Health), 10% suffer from some form of depression.

Is it easy to diagnose? Rather no than yes, Marina Diel believes, since this is a rather subjective assessment, both on the part of the doctor and the patient. nine0011

To be honest, nowadays we are often diagnosed not by a doctor at all, but by the Internet. On the netdoctor.co.uk website, I found a Golberg test and, after answering questions, revealed that I had a "mild form of depression." However, another test - on the site depressedtest.com, where the questionnaire is larger - did not confirm the diagnosis. Can this method of diagnosis be trusted?

Of course not, says Moscow psychologist Natalya Yaroshuk: "The only big advantage of this is that for a person who doubts something, this will be another reason to turn somewhere." nine0011

At the same time, as Natalya Yaroshuk says, a competent psychiatrist, psychotherapist and even a psychologist of a depressive patient immediately calculates by appearance, since the disease "flows" outward and in posture, and in facial expression, and sometimes even in clothes .

"One of the manifestations of a depressive state is a weakening of muscle tone, a weakening of energy," she says.

How can one not recall here the directly opposite "diagnosis" of Dr. Chekhov, given by him, according to Bunin, to decadents: "What decadents they are!" he said, "they are the heaviest peasants, they should be sent to prison companies..."

Lena's story

Lena, who lives in a small English town, came to her family doctor wearing make-up in a combat "outfit" and placed a sheet of A4 paper with symptoms listed on it in front of him - it was difficult for her to speak aloud about her condition. The doctor sent her home, advising her to run for an hour every day, which, oddly enough, is also one of the ways to overcome despondency, known since the time of Horace, since endorphins ("hormones of joy") are produced during exercise. nine0011

Lena didn't have any momentary reasons to fall into depression - on the surface, everything was not so bad, but she internally experienced emigration to England, which was accompanied not only by the deterioration of the social status of the whole family, but also by financial hardships, and was dissatisfied with the new work, where the situation was not the most friendly.

On the third visit, Lena was prescribed an antidepressant, which from the very first half dose caused her to have a panic attack.

"I went to work and suddenly felt that something was happening to me: I was shaking, I had an attack, and I was working with people and I had to run away to the employees' room," says Lena. nine0011

Lena was allowed to breathe in a bag - this method of relieving an attack, probably seen by many mainly in American cinema, is based on the fact that a person breathes carbon dioxide exhaled by him and thus reduces the flow of oxygen (which increases stress and tension during hyperventilation) to the brain .

“At the institute [in the Soviet Union], I had four years of medicine and we were given a diploma of a “civil defense nurse,” but I didn’t know what to do in such cases,” my interlocutor is surprised. nine0011

Both doctors and patients emphasize that antidepressants are not aspirin, they do not start to act immediately, and their effect is not the same for different people, therefore both the drug and the dose must be selected individually.

"Antidepressants at the very beginning can have a very strong side effect, so you have to be very careful with them," Lena warns. But all people have different bodies and different reactions to medications. nine0011

N., who took an antidepressant for a short time, admits that people like her - people who like to keep everything under control, to be "in themselves" - it is very difficult to take pills that affect your emotional state and self-control.

"You feel like you're giving control to the pill, and that irritates your nature even more," N says. with depressions

Lena was finally fitted with a medication that she has been taking for many years (also starting with a lower dose than recommended) during periods of deterioration, for example, in winter, when there is little sunlight and it is difficult to get out of bed and walk to work.

Antidepressants are not considered to be chemically addictive, unlike tranquilizers. But maybe we can talk about psychological dependence?

"Most likely, yes, although not one hundred percent," answers Professor Polozhiy, "because sometimes diseases also adapt to drugs, and then you have to change drugs, use some other methods." nine0011

Patients with severe relapsing disease are forced to constantly use low doses of antidepressants as a prophylactic, although the pros and cons of this approach, according to the psychiatrist, are still actively debated.

"Psychological reasons cannot be ruled out: a person is simply afraid of this condition and prefers to take drugs," says the psychiatrist.

On the other hand, a 2008 experiment in the Department of Psychology at the University of Hull in England found that patients with depression responded just as well to a placebo pill as those who took antidepressants. nine0011

As a result of these studies, scientists led by Professor Irwin Kirsch came to the conclusion that Prozac and other similar antidepressants are needed only for patients with severe clinical depression.

Where can I get strength?

How can you help yourself? Lena, for many years of fighting depression, which, according to her, is caused not only by socio-psychological, but also genetic, and even seasonal factors (this is called seasonal affective disorder - SAD), has developed her own recipes. “Even if you don’t feel like moving at all, at least do finger exercises in the morning, massage your head, arms, legs and neck,” she says. “And if it’s really bad, look in the mirror and see what kind of expression you have: the corners of your mouth are down , eyes half-closed, that is, the expression is very unpleasant ... "

Many who are familiar with the depressive state firsthand testify that they overcame themselves through force, each in their own way: by physical exercises, walking, fasting (under the supervision of a specialist), reading only humorous literature or watching only comedies.

One woman confessed that in especially difficult periods, walking near the school next to her house helped her a lot: the sonorous voices of children running out for recess, their causeless laughter charged her with at least a small fraction of the joy of life. nine0011

The fact that depression is now more frequently reported is hardly surprising. As medical specialists point out, against the background of the loss of the meaning and values ​​of life for many, depression cannot but arise, and this happens not only in the post-Soviet space, where a huge country collapsed overnight, but throughout the world.

Globalization, migration, emigration; when former doctors of sciences become fitters and floor polishers, when those who remain in their own country turn into downtrodden outcasts, when youth lasts until botox old age, and life still does not begin - all this does not contribute to mental health. nine0011

Another question, is it necessary to rush to the first aid kit at every turn of fate or its absence? As the ancient Romans said, what doesn't kill us makes us stronger.

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. nine0011

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.

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. nine0011

Go 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 can increase anxiety in anxiety disorders, as well as cause irritability and agitation - the so-called causeless motor agitation, 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. nine0011

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. nine0011

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. nine0011

/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.

Fact No. 2

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. nine0011

It is better to get ready 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

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. nine0011

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. nine0011

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.

Fact No. 4

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. nine0011

For the first couple of weeks of taking it, there is a risk that you will not feel well - you should think about it. 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 to 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. nine0011

There are mixed data on how common 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; nine0004
• 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. nine0011

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. nine0011

Side effects should not be tolerated - if something is very disturbing, frightening 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. nine0011 I wrote to the doctor again when my visual acuity decreased

Fact No. 5

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. nine0011

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

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. nine0011

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. nine0011

/psychotherapy/

How psychotherapy works

Fact No. 6

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as discharges of electric current 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. nine0011

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. nine0011

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

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. nine0011

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. nine0011

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

Preparations can be original and 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 effect of generic drugs should not differ from the effect of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials. nine0011

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. nine0011

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

CERTRALIN

Original

"Zoloft"

The cost of the original

about 700 r, tablets 100 mg

Generica

"Serenate", "Servifte"

500 - cost of genericists 9000 500- , tablets 100 mg

Escitalopram

Original

Cipralex

Original cost

3000 r, tablets 10 mg

Generiki

"Selectra", "Elicea"

The cost of generics

500-1300 r, tablets 10 mg

Fluoxetine

Original

"PROMIC original

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100—200 R, tablets 20 mg 9001 one remained unclaimed

Fact No. 9

Drinking alcohol while taking antidepressants can 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 Antidepressants and Alcohol Shouldn't be Mixed - Mayo Clinic

Certain groups of antidepressants should not be consumed with alcohol, such as tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in blood 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. nine0011

With other antidepressants, moderate use may not be dangerous and 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

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 medication. 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.

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