Synonyms in a broader sense
- Depressive symptoms
- Bipolar disorder
- Therapy of depression
As a rule, it is not medication alone that leads to an improvement in depressive symptoms (see Treatment of depression). Nevertheless, the drug approach is nowadays part of the treatment concept for depression. As is the case with many drugs used in the treatment of mental disorders, antidepressants also belong to an overall concept which should be made up of different pillars.
In this context, it is particularly important to inform the patient about the effects and side effects of the medication, but also to convey the severity of the depression therapeutically. As the severity of the depression changes, in most cases the treatment with medication will also change. As in the treatment of schizophrenia, for example, a distinction must be made between acute, conservative and preventive therapy.
The urgency of drug therapy also depends on the severity of the disorder. It is quite obvious that a patient with concrete suicidal intentions needs relief much more quickly than, for example, someone with “winter depression“. The following is some general information about antidepressants. – Indications (when are antidepressants /antidepressants appropriate and necessary) for the use of antidepressants. – Start of action
- How long must an antidepressant be taken?
Indications for the use of an antidepressant According to the name, antidepressants (antidepressants) are naturally used in the so-called depressive episode. In the literature there are recommendations for this, but these should only be understood as such, i.e. one must always look at the individual, unique patient and not just the diagnosis. Also in the context of the premenstrual syndrome, severe mood swings or depressive moods can be observed.
If mood lows persist for a longer period of time, a therapy with antidepressants can be considered. – Severe depressive episode: Here, drugs that influence more than just one messenger substance (e.g. venlafaxine as SNRI) are recommended rather than drugs that only influence one messenger substance, such as SSRIs (e.g. fluoxetine)
- If the depression is accompanied by anxiety to a high degree, a medication is recommended which also has a dampening effect.
- In the case of dysthymia, i.e. the slight but permanent depressive mood, SSRIs are particularly recommended, as they are well tolerated and have a demonstrable improvement effect even in small amounts. – Seasonal depression, e.g. winter depression, is also suspected to be a disorder of the serotonin messenger substance. For this reason, the recommendation goes in the direction of SSRI.
- In the case of depression in the elderly (old-age depression), tricyclic antidepressants should be avoided if possible, as they are known to affect the heart. For this reason, SSRI should be the primary method of treatment in this area of application today. Well-documented therapeutic successes through the use of antidepressants/antidepressants can also be demonstrated in the drug treatment of anxiety disorders.
In the treatment of post-traumatic stress disorder, the use of SSRI is also recommended in addition to psychotherapeutic support. Here too, the recommendations are that treatment over several years may be useful. Pain: almost every antidepressant seems to have pain-relieving mechanisms of action.
For this reason, they are frequently used in modern pain medicine (e.g. for headaches or migraines). Here, tricyclic antidepressants seem to be superior to SSRIs. There seems to be no connection between the actual antidepressant potency and the pain-relieving effect.
Another positive feature is the fact that pain treatment often requires only very small amounts of the drug, which naturally reduces the risk of side effects. Eating disorder: there are some studies that suggest that antidepressants are effective in eating disorders, for example in the treatment of bulimia and binge-eating. Prementrual Dysphoric Syndrome (PMDS /PMS): This is a very distressing complex of symptoms for many women, which leads to physical and psychological changes.
These changes are directly related to the menstrual cycle. The SSRI Sertraline (e.g. Zoloft) is particularly recommended for treatment. Here too, low doses are often sufficient.
The medication can also be given as a preventive measure, i.e. before a new PMR “surge” occurs. . Also in the treatment of post-traumatic stress disorder, the administration of SSRI is recommended in addition to psychotherapeutic support.
Here too, the recommendations are that treatment over several years may be useful. Pain: almost every antidepressant seems to have pain-relieving mechanisms of action. For this reason, they are frequently used in modern pain medicine (e.g. for headaches or migraines).
Here, tricyclic antidepressants seem to be superior to SSRIs. There seems to be no connection between the actual antidepressant potency and the pain-relieving effect. Another positive feature is the fact that pain treatment often requires only very small amounts of the drug, which naturally reduces the risk of side effects.
Eating disorder: there are some studies that suggest that antidepressants are effective in eating disorders, for example in the treatment of bulimia and binge-eating. Prementrual Dysphoric Syndrome (PMDS /PMS): This is a very distressing complex of symptoms for many women, which leads to physical and psychological changes. These changes are directly related to the menstrual cycle.
The SSRI Sertraline (e.g. Zoloft) is particularly recommended for treatment. Here too, low doses are often sufficient. The medication can also be given as a preventive measure, i.e. before a new PMR “surge” occurs.
. – Generalized anxiety disorder: There are studies that show that venlafaxine (SNRI) is particularly suitable for treating the depressive symptoms often associated with an anxiety disorder. – Panic disorder / panic attack: Depressive symptoms are also frequently found in panic disorder, but these can be treated well with SSRI.
The recommendation is made primarily because of the good tolerability. – Phobias: In general, psychotherapy is the treatment of choice for phobias, but there are promising studies that have shown good efficacy of SSRI and MAO inhibitors for social phobia. – Obsessive-compulsive disorder: The good efficacy of SSRIs has also been demonstrated for obsessive-compulsive disorder.
However, the problems here are that it takes months for improvement to occur and that several years of treatment are often necessary to achieve lasting success. You can find further information under our topic. OCD.
The onset of action of antidepressant therapy The onset of action of an antidepressant is typically a slow, steadily increasing one. In order to achieve the fastest possible success of the therapy, however, it is necessary to take medication on a long-term and regular basis. If this condition is met, a slow, slight improvement in symptoms should occur within 14 days.
Real clinical improvement usually occurs only after about 4 weeks. However, if there is no tendency for symptoms to improve in the period between the 2nd and 4th week, it should be reconsidered whether this is the right medication for this particular patient. After all, antidepressants are no different from almost all therapeutic measures in medicine.
Not every person is the same and therefore it can happen that a well-researched medication for depression has an excellent effect on 100 patients and that the therapy is not successful at all for the 101st patient. This possibility must be known by therapist and patient. Basically, it is not dramatic, as there are many alternative possibilities in the therapy of depression today.
The doctor’s task is to find a balance between rapid but not too rapid dosage. If the dose is increased too cautiously to the necessary level at the beginning of the therapy, there may be a delay until the effect is felt. On the other hand, if the dosage is increased too quickly, more side effects may occur.
As a rule, however, the guideline values according to which the dosage should be increased are well known for the individual preparations. Also important in drug therapy is the understanding of depression as a complex of symptoms, i.e. an accumulation of several ailments (e.g. sleep disturbance, bad mood, loss of appetite etc.).
Antidepressants usually do not affect all symptoms at once, but gradually. Some affect sleep first, others affect the drive. It is important that the patient talks to the prescribing doctor not only about side effects, but also about expected effects.
The goal of antidepressant therapy must always be the complete psychological and physical recovery of the patient (remission). It is proven that antidepressants can achieve this. Unfortunately, it is also proven that a patient who has survived a depressive episode has an almost 50% risk of relapse.
For this reason, it is strongly recommended that medication be continued even after the acute symptoms have subsided. The doctor providing further treatment has the particular task of providing comprehensive information. It must be made clear to the patient that he must continue to swallow his “pills” even though he no longer feels any symptoms of the disease.
The recommendation for further treatment with an antidepressant/antidepressants to prevent a relapse (i.e. the recurrence of symptoms in the same episode) varies between 6 and 12 months. However, if further episodes are already known in the history of the disease, the aim is no longer just to prevent a relapse, but rather to avoid the occurrence of a new episode (relapse prophylaxis). The recommendations here vary from years to life-long.
In general, an end to drug therapy must be agreed with the prescribing doctor. If it should come to an end, it is important not to stop the medication abruptly, but to balance it out over several weeks, as otherwise it can lead to discontinuation effects. These effects are typically the occurrence of dizziness, nausea, vomiting, sleep disturbances and concentration problems.
These effects can be avoided by slow discontinuation of the medication. At this point it seems important to me to point out once again that these drugs are not addictive, despite the described withdrawal phenomena, although there are some parallels to withdrawal. By definition, a drug that is considered addictive must also meet the fact of tolerance development.
Tolerance means that in order to achieve the same positive effects a steady increase in dose is required. In antidepressant therapy the drug is dosed to a therapeutic level and no further.