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While some believe that it is possible to resort to antidepressants at the slightest stress, others demonize pills and refuse to take them even with a serious diagnosis. Where is the truth? Let’s deal with psychiatrists.
Antidepressants are one of the most used drugs in the world. There is an opinion that they are used only to combat depression, but this group of drugs helps with a wide range of disorders: anxiety-phobic disorders, panic attacks, irritable bowel syndrome, chronic pain and migraines.
What else is important to know about them? Experts say.
Alina Evdokimova, psychiatrist:
1. How and when did antidepressants appear?
In 1951, clinical trials of anti-tuberculosis drugs were conducted in New York. Researchers soon noticed that patients taking these drugs began to experience mild arousal and excess energy, and some of them even began to disturb the peace.
In 1952, the French psychiatrist Jean Delay reported the effectiveness of these drugs in the treatment of depression. This study was repeated by American psychiatrists — it was then in 1953 that Max Lurie and Harry Salzer called these drugs «antidepressants.»
2. Do antidepressants of the new time differ from their former counterparts?
They are characterized by fewer side effects with high efficiency rates. New antidepressants act on the receptors of the brain «more targeted», their action is selective. In addition, many new antidepressants act not only on serotonin receptors, but also on norepinephrine and dopamine receptors.
3. Why do antidepressants have so many side effects?
In fact, it is a myth that there are so many of them. Antidepressants have on average as many side effects as the well-known analgin.
Side effects of antidepressants are due to their effect on the amount of serotonin, norepinephrine, dopamine, as well as on histamine receptors, adrenoreceptors and cholinergic receptors in the brain. Let me give you my favorite example about serotonin. Everyone thinks that this hormone is contained in the brain. But in fact, only 5% of the body’s total serotonin is in the brain! It is mainly found in some nerve cells of the gastrointestinal tract, in platelets, in some immune cells.
Naturally, when taking antidepressants, the content of serotonin increases not only in the brain, but also in the body as a whole. Therefore, in the first days of admission, nausea and abdominal discomfort are possible. Also, serotonin is responsible not only for the mood and resistance of the nervous system to external stimuli, but also is an inhibitory neurotransmitter, hence, for example, side effects in the form of a possible decrease in libido.
It usually takes about one week for the body to adapt to the changed serotonin content.
4. Is it possible to become addicted to antidepressants?
Substances that cause addiction have a number of characteristic features:
uncontrollable cravings for substance use
development of tolerance to the substance (a constant increase in dosage is required to obtain the effect),
the presence of withdrawal symptoms (withdrawal, hangover).
All this is not characteristic of antidepressants. They do not cause an increase in mood, do not change consciousness, thinking. However, often the course of treatment with antidepressants is quite long, therefore, if treatment is interrupted ahead of time, the painful symptoms are likely to return again. Often it is because of this that ordinary people believe that antidepressants are addictive.
Anastasia Ermilova, psychiatrist:
5. How do antidepressants work?
There are several groups of antidepressants. The principles of their work are based on the regulation of brain neurotransmitters — for example, serotonin, dopamine, norepinephrine.
So, the most «popular» group of antidepressants — SSRIs (selective serotonin reuptake inhibitors) — increase the amount of serotonin in the synaptic cleft. At the same time, antidepressants contribute to a smooth normalization of the mood background, but do not cause euphoria.
The second important mechanism of action is the activation of neuronal growth factors. Antidepressants help form new connections in the brain, but this process is very slow — hence the duration of taking these drugs.
6. Do antidepressants really cure or are they only effective for the period of use?
The antidepressant effect occurs only from 2-4 weeks of admission and smoothly stabilizes the mood. Treatment of the first episode of the disorder is carried out until the symptoms disappear, then relapse is prevented for at least six months — that is, the formation of those very neural connections that “know how to live without depression and anxiety.”
With repeated episodes of depression, the duration of treatment may increase, but not because of the formation of dependence on the antidepressant, but because of the characteristics of the course of the disease, the risks of relapse and the need for longer use of the “crutch” for recovery.
At the end of the course of treatment, the doctor will gradually reduce the dosage of the antidepressant to avoid withdrawal syndrome and allow the biochemical processes in the brain to adapt to the lack of a «crutch». So, if you do not stop treatment ahead of time, then you will not need to resort to antidepressants again.
7. What happens if you drink alcohol while taking antidepressants?
First of all, it should be remembered that alcohol has the opposite effect, namely «depressive». In the instructions for all antidepressants, it is recommended to abandon alcohol due to the lack of reliable data on the interaction of these substances.
In simple terms: no one will definitely give you an answer and any guarantees to the question “is it possible to have a glass of wine for a holiday?” It can be very bad for someone with a combination of a glass of wine and minimal doses of antidepressants, and someone goes into a binge during treatment with thoughts “maybe it will carry it this time” — and it does carry it (but this is not accurate).
What could be the consequences? Pressure surges, increased side effects, hallucinations. So it’s better to play it safe!
Oleg Olshansky, psychiatrist:
8. Can antidepressants cause real harm?
I would change the word «bring» to «call». Yes, they can — after all, there are side effects and contraindications. Antidepressants are prescribed for good and justified reasons. And this is done by a doctor who is responsible for the health of the patient: both legal and moral.
I will not list what can be caused by taking antidepressants — just open the instructions and read it carefully. It will even be written there what percentage of people have this or that adverse reaction and under what conditions it is absolutely impossible to take them.
The most important thing when prescribing AD therapy is to correctly assess the condition of a person. Any drug can be harmful. Individual tolerance, the quality of the drug itself and a well-diagnosed diagnosis play a role here.
9. Why are antidepressants prescribed not only for depression, but also for other mental disorders?
There are a number of theories about the causes of depression. The most popular of them is based on the fact that a person has a deficiency of monoamines (neurotransmitters) — serotonin, dopamine and norepinephrine. But the same system of monoamines plays a leading role in the development of other disorders.
10. Can you take antidepressants if you don’t have depression, but just a difficult period in your life?
It depends on what state this “difficult period” has brought a person to. It’s all about how he feels. And then a doctor comes to the rescue, who can check and assess the patient’s condition. A difficult period can drag on and lower to the very “bottom”. And antidepressants can help you swim. However, this is not a magic pill. Changing your life is not always easy. Either way, you don’t need to self-diagnose.