Introduction
Depression is a psychiatric disease. It manifests itself through various symptoms such as a depressed mood, listlessness, social withdrawal or sleep disorders. Today, there are various approaches and methods to treat depression. One should always bear in mind that depression is a serious illness and the appropriate therapy for one’s own form of depression should be selected with the treating psychiatrist or psychotherapist, taking into account the severity of the illness.
Synonyms
- Depressive symptoms
- Depressions,
- Melancholy
Therapy
Basically, one differentiates between drug therapy and non-drug therapy. A so-called antidepressant, i.e. a drug that is typically used to treat depression, is understood to be a drug from a whole group of drugs, some of which have very different mechanisms of action, but whose goal is always the same. These are: Brightening, i.e. improving mood and increasing drive.
It is important to note here that even the most modern antidepressant usually does not begin to work until two to four weeks later. Some of the therapy discontinuations are based on the assumption that a drug which has not produced a significant improvement after three days cannot be a good or effective drug. In the human brain, different communications take place between the many billions of cells.
The “transmitters” of these messages from one cell to another are called “transmitters”. The release of these transmitters triggers a reaction in the cell directly following the transmission. When this reaction has been triggered, the transmitter substances are absorbed into the cells again.
As an example, if two houses are facing each other and the inhabitants of one want to give a signal to the other, they hang a certain number and arrangement of flags in the window. But what happens if either too few flags are available, or if the flags are retrieved too early? The most likely thing is that the people in the house opposite do not really know what they have to do…
If you apply this theory to the cellular level, it explains how most antidepressants work. They make sure that the transmitters (messenger substances) either remain longer in the gap between the cells or, alternatively, they can prevent the premature degradation or reabsorption of the transmitters into the cell. The names of the transmitters that play a superficial role in the treatment of depression are serotonin and norepinephrine (and, to a lesser extent, dopamine).
The antidepressants used today can be divided into the following groups: and antidepressant drugs
- Herbal preparations (St. John’s wort)
- Tri- and tetracyclic antidepressants
- SSRI (selective serotonin reuptake inhibitors)
- SNRI (Selective Noradrenaline Recovery Inhibitors)
- SSNRI (Selective Serotonin and Norepinephrine Recovery Inhibitors)
- MAO – Inhibitor (MAO stands for Monoaminooxidase, an enzyme that breaks down transmitters)
SSRIs are the first-line treatment for depression today. They have thus replaced tricyclic antidepressants. The abbreviation SSRI is English and means serotonin reuptake inhibitor.
In contrast to tricyclic antidepressants, which unselectively inhibit the absorption of various neurotransmitters, SSRIs achieve the targeted reuptake inhibition of a messenger substance: serotonin. In addition to the treatment of depression, SSRIs are also used in anxiety disorders and obsessive-compulsive disorders. Typical representatives of this group are sertraline, citalopram and fluoxetine.
For patients who are suffering from depression for the first time, citalopram or sertraline are most frequently used as monotherapy (single therapy, i.e. only one drug is taken). SSRIs have fewer side effects than tricyclic antidepressants. The most common side effects affect the gastrointestinal tract; loss of appetite, nausea, vomiting and diarrhea may occur.
Sexual dysfunction also occurs. Especially in the beginning, the (usually desired) stimulant effect can lead to states of arousal, restlessness and insomnia.If painkillers from the group of non-steroidal anti-inflammatory drugs (e.g. ibuprofen or diclofenac) or blood thinners (aspirin, falithrome, etc.) are taken in addition to SSRIs, the risk of bleeding in the gastrointestinal tract is increased, so that the additional intake of stomach protection tablets should be considered here.
Switching to a different antidepressant substance may also be considered here. Tricyclic antidepressants are among the oldest drugs used to treat depression. They are called tricyclic because they have three ring structures in their chemical compound.
Tricyclic antidepressants work by inhibiting the reuptake of various neurotransmitters. These include serotonin, noradrenaline and dopamine. In the case of depression, there appears to be a deficiency of these neurotransmitters, which the reuptake inhibition of the tricyclic antidepressants is intended to compensate for.
They have a mood-lifting effect and often boost the drive. However, there are also some members of the group who have a rather drive-inhibiting effect. Nowadays, tricyclic antidepressants are no longer among the first-choice drugs for treating a depressive disorder.
This is partly due to their side effect profile. Typical are so-called anticholinergic side effects such as dry mouth, impaired vision, constipation and difficulty urinating. Weight gain is also relatively common and can be very stressful for patients.
If an overdose is taken, this can lead to life-threatening cardiac arrhythmia. The group of tricyclic antidepressants includes amitriptyline, opipramol and doxepin. A word in advance: the side effects listed below are real and it is not uncommon for part of the typical side effect profile to occur before the actual therapeutic effect.
Nevertheless, especially the newer antidepressants have few side effects. The stress and pain of depression is usually out of proportion to the side effects of antidepressant therapy. Given the multitude of mechanisms of action mentioned above, it is not possible to draw up “a” typical side effect profile for antidepressants.
However, it is possible to show the so-called main side effects of a drug therapy for depression. These usually occur at the beginning of treatment. “Beginning” here means a period between one and four weeks.
- Tiredness and dizziness – if this symptom is perceived as a clear limitation, it could be discussed with the prescribing doctor (and only that one!) about postponing the intake until the evening, in which case there could be an improvement in alertness during the day and a deeper night’s sleep.
- Weight gain – this is a very frequently complained about problem, but it is also no less frequently feared. First, a correction: the tablets as such do not make you fat.
In a not inconsiderable number of patients, they can lead to an increase in appetite, which can ultimately lead to weight gain. It is therefore important to make sure right at the beginning of a treatment that you observe yourself critically and, if necessary, seek nutritional advice.
- Sexual dysfunction – In the course of treatment, it can lead not only to a loss of libido, but also to erection or ejaculation problems in men. As already mentioned under the chapter on depression, the distinction between depression and a possible side effect can be very difficult.
- Visual disorders in the sense of “focusing” (accommodation disorders)
- Dry mouth due to lower saliva production
- Bladder emptying disorders and constipation
- In very rare cases, epileptic seizures can also occur
- Position-dependent drop in blood pressure (orthostasis).
In this case, especially when getting up, the blood in the legs “sinks” for a short time, which can lead to dizziness, which in turn can lead to falls.
- Cardiac conduction disorders (cardiac dysrhythmia). This side effect applies especially to the “old” tricyclic drugs. Caution should be exercised in the case of known previous heart diseases.
- States of unrest.
In particular, the serotonin and noradrenalin/serotonin reuptake inhibitors can lead to massive restlessness, which can lead to sleep disorders, especially at night.
Lithium is a chemical element found in the periodic table of the elements. Some lithium salts are used as medicines. The drug called lithium is therefore actually a lithium salt.
Lithium has been used as a drug in psychiatry for about 70 years. It belongs to the group of mood stabilizing drugs, also known as mood stabilizer. There is only a relatively narrow therapeutic scope for treatment with lithium.
This means that the dose that is effective but not toxic is only slightly lower than the dose that is toxic. For this reason, the lithium level in the blood must be checked regularly during lithium therapy to avoid under- or overdoses. Lithium plays a particularly important role in the treatment of bipolar disorder, also known as manic-depressive disorder.
However, it can also be used in cases of pure depression. Antidepressants are primarily used to treat pure (unipolar) depression. If the depression is resistant to treatment, i.e. the symptoms do not disappear, lithium can be used.
This is then referred to as augmentation therapy. This means that an antidepressant and lithium are combined (augmentation). This often leads to a significant improvement in effectiveness. Lithium is therefore more of a reserve drug in depression, but as such it has relatively high potential.
