Drugs to relieve depression

Currently, the drugs that are clinically recognized as effective in relieving pathological depression mainly include new antidepressants, traditional antidepressants, and symptomatic auxiliary drugs. However, all drugs must be prescribed and used after evaluation by a psychiatrist. There is no "magic drug" that applies to everyone, and drugs are not the only option for relieving depression.

Last week, I met a 27-year-old Internet operator girl in the outpatient clinic. She came in with a post on her cell phone that read "Fluoxetine is the magic drug for happiness." As soon as she sat down, she said she would prescribe this medicine. I checked her assessment scale and found that her depression score had just reached the mild borderline. I asked her about the situation. She only worked overtime for a month in a row and had a quarrel with her boyfriend. In the past week, she had not been able to be energetic. She had neither woken up early nor had a loss of appetite. In the end, I did not prescribe her any medicine. I only suggested that she take three days off and take half an hour to run every day. When she came here for a review this week, she had mostly recovered. Many people's misunderstandings about depressive drugs come from this fragmented information. They always think that taking them will make them happy immediately. In fact, this is not the case at all.

Fluoxetine, sertraline, and paroxetine, which everyone often hears called the "Five Golden Flowers," are SSRI antidepressants and are the most commonly used first-line drugs in clinical practice. To put it bluntly, they help you retain 5-hydroxytryptamine in your brain, which is responsible for pleasure. They do not create happiness out of thin air, but replenish your "happiness reserve" that has been almost leaked. I have seen many patients report that after taking it for two weeks, they didn't suddenly laugh out loud, but the unmovable stone that was pressing on their chest suddenly became lighter. They were able to stand up and pour a glass of water, and they were able to listen to what their friends said. Of course, side effects do exist. Many people will feel a little nauseous and slightly drowsy in the first week of taking it, and even feel more irritable in the first few days. Most of them can get over it. If you really can't stand it, just ask a doctor to adjust the dosage. Don't force yourself to do it, and don't just stop taking it.

If you still feel pain in your body all the time, feel as tired as carrying a heavy shell every day, and can't relieve it even if you lie down, the doctor will most likely prescribe SNRI for you. Duloxetine and venlafaxine belong to this category. The depressive effect on combined physical symptoms is more obvious than SSRI. Many people have had headaches and stomachaches that have been checked by orthopedics and gastroenterologists for half a year but have not been able to find the problem. After taking it for half a month, the headaches and stomachaches gradually subsided. There are also people who suffer from severe insomnia when they are depressed. The doctor may prescribe a small dose of quetiapine or mirtazapine. Don’t panic when you see it is an antipsychotic. A small dose only helps you adjust your sleep and stabilize your mood. It does not mean that you have a more serious disease. Don’t scare yourself.

Earlier traditional antidepressants such as tricyclics and monoamine oxidase inhibitors are now rarely used as first-line drugs. They have relatively serious side effects. They are prone to dry mouth, constipation, and fast heartbeat after taking them. However, they are not completely eliminated. Some patients with refractory depression have tried several new drugs to no avail, but the old drugs are more effective. There is no absolute good or bad clinical medication, only whether it is suitable or not.

There are actually differences in the academic circles on the timing of medication for depression. Some evidence-based studies show that if patients with mild to moderate depression can insist on aerobic exercise for 30 minutes or more three times a week, and at the same time cooperate with cognitive behavioral therapy once a week, the effect is not significantly different from taking antidepressants. Therefore, many doctors in the psychosomatic medicine department will recommend that patients with mild to moderate depression have no obvious biological symptoms. Patients with symptoms should first try non-pharmacological intervention; however, some psychiatrists believe that if you have woken up early for more than two consecutive weeks, lost more than 5% of your weight, completely lost interest in everything, or even have thoughts of self-harm, you must intervene with medication as soon as possible to avoid further worsening of symptoms. Both views are actually supported by clinical data, and the core depends on the specific status of the patient.

I once met a junior boy who was diagnosed with moderate depression at the beginning and refused to take medicine. He said, "Taking medicine is proof of my weakness." He endured it for three months. He could only sleep for one hour a day for a month and failed all the final exams. Finally, accompanied by a counselor, he came to the clinic again. He took sertraline for two months as prescribed by the doctor before he could slowly sit down and read books. He is already preparing for the postgraduate entrance examination this year. Of course, there are also patients who took the first medicine and had too many side effects, so they switched to the third type before finding a suitable one. There are also people who took the medicine and felt that their emotions were "dull" and could not feel happy or sad. They stopped taking the medicine and relied on psychological consultation to slowly adjust and get better. There is no unified standard answer.

Finally, I have to mention, don’t blindly buy medicines for yourself, and don’t just follow what your relatives and friends take to see if they are effective. Everyone’s metabolism and symptoms are different. Some people are prone to insomnia after taking fluoxetine, so it is suitable to take it in the morning. Some people are prone to sleepiness after taking mirtazapine, so it is suitable to take it at night. These are doctors. It needs to be adjusted according to your situation, and don't believe in the "antidepressant probiotics" or "natural antidepressants" sold online. The only herb with clear antidepressant effects is St. John's wort, but it will interact with many commonly used drugs such as birth control pills and anticoagulants. Taking it by yourself may cause problems.

In fact, depression is like a cold and a fever. Some people are in good health and can pass it off in two days. Some people can easily develop pneumonia if they don’t take antipyretics when their fever reaches 39 degrees. There is no right or wrong medicine in itself. If your knees hurt, you will put on plaster, if you have a cold, you will take granules. If you have an emotional problem, use some medicine to help yourself. There is really nothing to be ashamed of.