Medications to relieve depression

Serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and specific serotonergic antidepressants (NaSSAs), in addition to traditional drugs such as tricyclics and monoamine oxidase inhibitors, as well as rapid antidepressant preparations such as esketamine nasal spray that have been approved in recent years. All antidepressants are prescription psychiatric drugs and must be used according to medical advice after evaluation by a regular psychiatrist. There is no "optimal" or "no side effects" that is suitable for everyone. Individual suitability is the core criterion for drug selection.

Last week, I accompanied my friend to Beiliu for a follow-up consultation. She had been taking sertraline for three weeks. She was still so groggy for the first two weeks that she couldn't even get out of bed. When she walked in the door that day, she dragged me and shook her: "Look, I steamed three vegetable buns this morning!" I even went downstairs to feed the stray cats! ”Sertraline is one of the most commonly used SSRIs, and is often referred to as one of the “Five Golden Flowers.” The same type includes fluoxetine, paroxetine, fluvoxamine, and citalopram, and is the first choice for most newly diagnosed patients. There are a lot of controversies about this type of medicine on the Internet. Some people feel nauseated and nauseated after taking it for three days and say, "This medicine is harmful to people. The more they take it, the stupider they become." There are also people who suffer from severe insomnia and trembling hands and refuse to seek medical advice. They say, "The side effects are temporary and must be overcome." In fact, clinical practice is not so black and white at all. Gastrointestinal reactions and drowsiness in the first 1-2 weeks are mostly normal manifestations of the tolerance period. However, if it has affected normal school and work, you can ask your doctor to adjust the dosage or switch to other varieties of the same type. There is no need to force it, let alone stop taking the medicine directly. The withdrawal reaction is much more uncomfortable than the side effects.

Oh, yes, I met a sophomore boy in the outpatient clinic last month. When he first came here, he was hunched over. He said that his back felt like a piece of water-soaked cotton wool, and the pain was so bad that he could not even sit through the 45-minute class. He had taken sertraline for two months and his mood improved, but the physical pain did not go away at all. The doctor gave him SNRIs venlafaxine. This time he was able to play badminton with his roommate for half an hour. This type of drug has more norepinephrine regulatory effect than SSRIs, and is particularly effective for depressed patients with physical pain and fatigue. However, the disadvantage is that some people will increase their blood pressure after taking it, and patients with a history of hypertension are generally not given priority.

There is also Mirtazapine, which everyone loves but fears, and belongs to the NaSSAs category. Some people complain that it is a "magic drug for weight gain" and gained eight pounds after taking it for half a month. Others regard it as a savior. They used to keep their eyes open all night long until dawn, and slept for seven hours on the first night after taking it. Its characteristic is that it can quickly improve sleep and appetite. It is especially friendly to patients with weight loss and severe insomnia. However, if you have a need to lose weight or are prone to drowsiness during the day, the doctor will most likely not prescribe this to you.

Many people think that traditional tricyclic antidepressants have been eliminated, but this is not the case. Last month, there was an aunt in her 60s. She went to several hospitals and tried four first-line drugs, but none of them had any effect. The doctor prescribed her doxepin, which costs a few yuan and costs 100 tablets. After taking it for a month, she came back and said she could finally go square dancing with her old sisters. However, this type of medicine has relatively large side effects, such as dry mouth and constipation, and is also cardiotoxic when used in large doses, so it is not the first choice. However, when used in treatment-resistant depression programs, it can often work unexpectedly.

The most controversial thing is the esketamine nasal spray that has been approved in recent years. Some people tout it as an "antidepressant miracle drug" and say that you will not want to commit suicide within a few hours after spraying it. Others call it a "drug" and fear that you will become addicted after using it. In fact, it is a second-class controlled drug that can only be prescribed by regular hospitals. It is specially used for patients with severe depression who have strong thoughts of self-harm or suicide, or patients with refractory depression for whom conventional drugs are ineffective. It is usually used in combination with oral medications and will not be used alone for a long time. As long as it is used according to the doctor's instructions, the risk of addiction is extremely low. It can indeed save lives at critical moments. However, if you have problems with high blood pressure or increased intracranial pressure, you must not use it.

I have been working as an administrative assistant in a psychiatric department for almost five years. I have seen too many patients shouting "Prescribe me the best antidepressant" as soon as they come in. How can there be any best? There is an Internet person with a monthly salary of 30,000 yuan who has no response after taking a new medicine that costs several thousand yuan per box, but he gets better after changing to an old medicine that costs dozens of yuan. ； There are also students who have tight living expenses, so there is no need to choose expensive imported drugs. The efficacy of affordable domestic generic drugs is not much different. Using medicine is really like choosing shoes. No matter how expensive the co-branded shoe is, it is useless. The doctor has to understand your core symptoms, whether you have underlying diseases, your previous medication history, and even your financial situation before you can choose the most suitable pair.

Oh, by the way, don’t believe what is said on the Internet, “Taking antidepressants will make you stupid and dependent.” The slow response and poor memory during the first period of taking the medicine are mostly temporary side effects. They will fade away once you are able to tolerate them, and they will not really affect your IQ.； As long as the drug is slowly tapered off under the guidance of a doctor, there will be no so-called "dependence". Those who experience dizziness and emotional rebound after stopping the drug are mostly withdrawal reactions caused by stopping the drug privately, which is not the same thing as dependence at all.

Last week, my friend who makes steamed buns just saw a doctor to reduce her intake. She told me that before, everything looked like a layer of dust, but now she can finally feel the coolness of the wind on her face and the fragrance of the magnolia flowers downstairs. In fact, antidepressants are never an elixir that can make people happy immediately. They just pull you from the quagmire that sinks into your chest to flat ground. You still have to walk the rest of the way slowly by yourself.