Drugs to relieve depression

There are currently more than ten types of prescription drugs that are clinically recognized as effective in relieving depressive symptoms. They can be roughly divided into three categories: traditional antidepressants, new antidepressants, and auxiliary synergists. All drugs are prescription drugs. There is no "optimal solution" that applies to everyone. The effects and adverse reactions vary greatly among individuals. They must be used under the guidance of a licensed psychiatrist. It is strictly prohibited to purchase drugs by yourself.

When I was a clinical trainee in the psychiatry department, I met a girl who was in her second year of college. She squatted in the corridor and read the Little Red Book for 40 minutes before entering the clinic. The first thing she said when she sat down was, "Doctor, can I not take medicine? They said that if I take it, I will become stupid and gain weight." I encounter this kind of question almost a dozen times a week. Many people’s understanding of drugs that relieve depression is either “just take the miracle pill of happiness” or “take the poison and it will be useless.” In fact, these are too far.

The most commonly used antidepressants in clinical practice are the SSRIs, which are commonly known as the "Five Golden Flowers": fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram. The principle of this type of drug is to adjust the concentration of serotonin in the brain, and the side effects are much milder than older drugs. Many patients with first-episode mild to moderate depression use this type of drug for the first time. But it is not suitable for everyone. I have seen patients who took fluoxetine wake up at 3 a.m. every day for the first week and kept their eyes open until dawn. They could just switch to taking trazodone before going to bed. There was also a girl who took sertraline who vomited everything she ate in the first half of the month and lost 4 pounds. She had no reaction after switching to escitalopram.

There have been different opinions in the industry regarding "should you take medicine when you are depressed?" Most counselors who do cognitive behavioral therapy (CBT) will suggest that if it is mild to moderate depression caused by real-life events and there are no obvious physical symptoms, 8-12 weeks of psychological intervention may be able to alleviate it. I have met a young man who works in operations before. He just fell out of love and failed to meet the KPI target for three consecutive months. He was found to be mildly depressed. He did CBT once a week, ran 3 kilometers every day after get off work, and took no medicine. After more than two months, the score on the review scale was completely normal. However, most doctors who study biological psychiatry will hold a different view: if there has been a severe physical reaction - such as sleeping only 2 hours a day for a week, being unable to eat and even walking a few steps until tired, or having thoughts of self-harm, then you must first take medicine to suppress the symptoms, otherwise the patient will not even have the energy to sit down and chat with a counselor for 10 minutes, and psychological intervention will be empty talk.

Older tricyclics and monoamine oxidase inhibitors are rarely used now, but they are not completely eliminated. When I was outpatients, I saw an almost 70-year-old expert prescribing amitriptyline to patients with severe endogenous depression. The effect was better than new drugs, but the side effects are indeed obvious, such as dry mouth, constipation, and blurred vision. Many young patients cannot bear it, so now it is mostly used as an alternative for treatment-resistant depression. What many people don’t know is that some depressive episodes are actually the depressive phase of bipolar disorder. In this case, antidepressants alone cannot be used directly, as it can easily induce a manic episode. There was a boy who had just started working. He took a scale online and said he was depressed. He secretly bought fluoxetine and took it for a week. He didn’t sleep for three days and three nights in a row. He talked to his friends all night long about his "business plan". Finally, his family took him to the doctor, where he was diagnosed with bipolar. He adjusted his mood stabilizer and stabilized.

As for the side effects that everyone is most afraid of, they do exist, but they are not as exaggerated as what is reported online. For example, taking mirtazapine makes you hungry, and many patients get up in the middle of the night to look for bread. It is common for them to gain 7 or 8 pounds in two or three months. However, switching to bupropion may suppress appetite and even help control weight. Some people who suddenly stop taking paroxetine will feel an "electric shock" and feel dizzy and nauseated for several days. Therefore, you must slow down the medication. If the doctor tells you to take half a pill and half a pill, don't try to save trouble and stop directly. You will suffer. As for what many people are afraid of: "taking it will make you sluggish", it is actually due to the sedative effect of some drugs in the early stages of taking them. Most of them will be relieved after a two-week adaptation period and will not really affect IQ.

After all, antidepressants are never magic pills that can make all your worries go away. They are more like the stick someone else hands you when you fall into a puddle - it can help you stand up, but it still depends on you whether you want to reach out and grab it, and whether you want to walk to a dry place after standing up. Don't treat it like a scourge. You insist on not taking it when you should take it. If it gets serious, it will be more troublesome. Don't make random diagnoses and buy medicines for yourself when you shouldn't take it. Find a psychiatrist in a regular hospital to make a good evaluation and follow the doctor's advice to slowly adjust it. It will be more reliable than reading a hundred netizens' "medicine experience".