Depending on the duration and severity of the depression, drug therapy with antidepressants is carried out. Various drugs with different effects are available for this. Which ones are there, how they work, which side effects occur and how they should be taken.
- For severe depression, antidepressants, usually in combination with psychotherapy, make sense.
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Antidepressants are usually used for depression. Their effect is mood-enhancing and stimulating. They also have a positive effect on the physical symptoms of depression, such as sleep disorders. There are different mechanisms of action in the different groups of active ingredients. In the opinion of numerous experts, the use of antidepressants is indispensable for severe depression in order to enable the affected person to deal with psychological, interpersonal and social stress in psychotherapy in the first place.
At a glance:
Treating Depression: Help & Tips
Effect and types of antidepressants
There are many types of antidepressants. There are differences from active ingredient to active ingredient, which can be used individually depending on the indication. What they all have in common, however, is that they act on the metabolism in the brain and there on the neurotransmitters noradrenaline and serotonin (messenger substances for the transmission of nerve impulses) produced by the body, so that they regain their equilibrium.
A basic distinction is made between synthetic and herbal antidepressants. The herbal antidepressants with a mood-enhancing effect include, above all, St. John's wort, the effect of which has been proven, just as it has been with synthetically produced antidepressants. St. John's wort preparations are available from pharmacies without a prescription. All synthetic antidepressants, however, require a prescription.
Antidepressants are not addictive and do not change the personality of the person affected. This fear is still common.
What Antidepressants: Overview of Common Drugs
Tricyclic antidepressants
- Examples of active ingredients: Amitriptyline, clomipramine, doxepin, imipramine
- Effect of the drugs: strong effect, numerous side effects
- Annotation: They are among the older antidepressants and are usually prescribed when other groups of active substances, such as SSRIs, do not work sufficiently.
Tetracyclic antidepressants
- Examples of active ingredients: Maprotiline, mianserine, mirtazapine
- Effect of the drugs: strong effect, numerous side effects
- Annotation: They are also among the older antidepressants and are usually second-choice drugs.
Monoamine oxidase inhibitors (MAOIs)
- Examples of active ingredients: Moclobemide, tranylcypromine
- Effect of the drugs: strong effect, numerous side effects and interactions with other drugs
- Annotation: They also belong to the older antidepressants and are therefore also more of a second choice.
Selective Serotonin Reuptake Inhibitors (SSRI) / Selective Norepinephrine Reuptake Inhibitors (SNRI)
- Examples of active ingredients: Citalopram, duloxetine, escitalopram, fluoxetine, sertraline, venlafaxine
- Effect of the drugs: increase serotonin uptake in the brain and / or inhibit the reuptake of noradreanline; good effect despite fewer side effects and interactions than the older groups of active ingredients
- Annotation: Today they are most commonly prescribed for depression and anxiety disorders.
Selective norepinephrine reuptake inhibitors (NRIs)
- Example of active ingredient: Reboxetine
- Effect of the drugs: inhibit the reuptake of noradreanline; good effect despite fewer side effects and interactions than the older groups of active ingredients
- Annotation: Today they are most commonly prescribed for depression and anxiety disorders.
Noradrenergic and specifically serotonergic antidepressants (NASSA)
- Example of active ingredient: Mirtazapine
- Effect of the drugs: strengthens noradrenergic and serotonergic nerve stimulus transmission; good effect with relatively few side effects
- Annotation: Belong to the modern antidepressants that are prescribed more often today.
Taking and stopping antidepressants
The aim of acute therapy is to alleviate depressive symptoms. Most of the preparations start with a creeping in phase: the preparation is taken in half the dose for a while before switching to the full dose. Acute therapy usually lasts eight to twelve weeks. If the symptoms do not improve after three to four weeks, another preparation or even a different active ingredient should be used.
Stopping antidepressants should never be done on your own. If it is stopped too soon, it makes full recovery difficult and promotes depressive relapses. If the treatment is stopped as soon as the person appears to be feeling better, the depression will come back about 50 percent of the time. Therefore, after the obvious recovery from the depressive phase, a so-called stabilization phase is necessary for some time.
According to current guidelines, it is recommended to continue treatment with antidepressants at the same dose for at least four to six months, possibly twelve months, before starting the slow tapering (gradually lowering the dose). The risk of relapse seems to increase with impending or chronic stress. In such cases, a longer duration of treatment is often required.
The duration of the intake and when the right time to stop should always be discussed with the doctor or psychotherapist. Usually, antidepressants are tapered off slowly and not suddenly stopped.
Taking antidepressants properly
Only take medication after consulting your doctor.
Take medication regularly and as directed.
Tell your doctor about any symptoms you experience while taking it.
Clarify any uncertainties and questions with your doctor.
Do not stop taking the medication on your own, even if you feel better.
Only your doctor should change the dosage or replace it with another.
Side effects of the drugs
In general, modern antidepressants are well tolerated. But there are also possible side effects with antidepressants. Some side effects disappear after a certain period of use, others may persist, so that it may be necessary to switch to another preparation. The side effects can include, depending on the active ingredient group:
Those affected should definitely talk to the prescribing doctor about possible side effects and tell him about any changes they notice. In this way, the patient and the doctor can jointly consider what can be tolerated and when a switch to another antidepressant may be necessary.
Are antidepressants and alcohol compatible?
Like all medicines, antidepressants are best taken with a glass of tap water. Alcohol and antidepressants should not be combined as they can mutually reinforce their effects. In the worst case, this can lead to a coma or cardiac arrest, especially when consuming large amounts of alcohol.
