Which medicines can help?
From a moderate to severe depression, so-called antidepressants are used. These substances intervene more or less specifically in the metabolism of messenger substances in the brain and therefore have various effects. What they have in common is an increase in the concentration of serotonin, the “mood hormone”, and of noradrenalin, the “drive hormone”.
These messenger substances have been shown to be reduced in depressed patients, which explains the low mood and lack of drive. The oldest of these antidepressant drugs are the so-called tricyclic antidepressants (named after their chemical structure), such as amitriptyline, which intervene in the metabolism of several signal substances and are therefore very effective, but unfortunately have many side effects. These include, among other things, sedation, which makes the patients feel tired and subdued, but this can be desirable in very anxious or suicidal patients.
More specific substances with a rather drive-enhancing effect are the SSRI (selective serotonin reuptake inhibitors), such as citalopram, or the SSNRI (selective serotonin noradrenalin reuptake inhibitors), such as venlafaxine. These drugs are the drugs of choice today. In addition, other preparations can be used to strengthen or prolong the effect of these antidepressants.
Unfortunately, the mood brightening effect of almost all common substances only occurs after 2-3 weeks, while side effects can occur immediately. This can discourage patients and they must therefore be well informed. Typical side effects of the classic tricyclics are for example weight gain, sexual disorders or impairments of the gastrointestinal tract and the cardiovascular system.
An overdose is also easily possible with these substances. The newer SSRI and SSNRI are better tolerated, but can also cause sexual and digestive problems, especially nausea and vomiting. Patients are therefore discontinued with the lowest still effective dose and the drug is changed in case of intolerance.
A combination of several antidepressants does not make sense, as only the side effects add up. St. John’s wort is particularly well-known and can be bought in pharmacies. It can help with mild depression, but it is virtually ineffective for severe depression and should not be taken because of the high risk of interaction with other drugs.
You can find out more about this topic at: Medication for depressionIf the depression is only mild, the antidepressant effect of current medications would be minimal, so drug treatment would not be necessary anyway. In this case, psychotherapy in the sense of behavioural therapy would be the first step. The patient learns to recognize and avoid typical triggers and stress factors.
In addition, he is shown how to actively fight against a depressive episode and how to apply strategies to overcome the negative thought spirals. These therapeutic approaches require cooperation, i.e. a certain degree of motivation on the part of the patient. Severely depressed people do not have this motivation and would not be able to take advantage of alternative therapies without medication.
Treatment without antidepressants is therefore possible, but only if the patient is motivated enough to work on himself. In cases of severe depression, it is therefore not advisable to do without medication. This could also be interesting for you: Winter Depression
