Effective medicine for relieving depression

Currently, there is no "miracle drug" that is suitable for all patients with depression. The two major categories of prescription drugs that have been certified by multinational guidelines and have the most sufficient evidence of their effectiveness in relieving depressive symptoms are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). The specific effects have strong individual differences, and all medications must be taken under the guidance of a regular psychiatrist.

Don't think I'm being too general. It's really not that I don't want to be precise. Last year, I accompanied my cousin to a psychiatric clinic for a follow-up visit. In the waiting area, I met a boy who had just entered his junior year in college. He was holding his cell phone and arguing with the attending doctor, saying why some netizens on the Internet became "normal" after taking fluoxetine for two weeks, while he took fluoxetine for a whole month and still sat in bed and cried for half an hour every day after he woke up. The doctor looked through his hormone test report and was very helpless: Your norepinephrine level is so obviously low. You are more suitable for SNRI venlafaxine. Of course, if the drug is not right, the effect will be slow. The physical constitution and pathogenesis of human beings are sometimes much different than those of humans and cats, so it’s really impossible to generalize.

Among the first-line drugs commonly used in clinical practice, most of the side effects of SSRIs such as sertraline, fluoxetine, and paroxetine are milder, and they are suitable for patients with first-time onset of symptoms whose main symptoms are depression. If they are accompanied by obvious physical pain and loss of motivation, SNRIs such as venlafaxine and duloxetine are often more effective. There are also many patients with severe insomnia. Doctors will prescribe mirtazapine, which has a strong sedative effect and makes them sleepy half an hour after eating. This can just solve the pain of many people who cannot sleep for half a month. However, some people will have a sudden increase in appetite and gain weight quickly after taking it. Patients who are concerned about their weight may need to change medicine.

The most controversial thing in recent years is the esketamine nasal spray, which has just been approved in China. It is aimed at refractory depression that has failed to respond to more than three first-line drugs. Many people can feel that the stone pressing on their chests is much lighter after using it for a few hours. I have seen several patients with suicidal tendencies take the initiative to tell the nurse that they "want to eat" for the first time after using it. However, opposition voices have not stopped: some people think that it has a high risk of addiction, and some say that the effects of long-term use are not supported by enough research. Now it is basically only used as a second-line auxiliary drug and will not be prescribed to patients as soon as it is introduced.

There are also many practitioners of traditional Chinese medicine who do not agree with the idea of ​​​​relying solely on western medicine intervention. They believe that mild depression does not need to take psychiatric prescription drugs. It can be improved through Chinese patent medicines that soothe the liver and relieve depression, acupuncture and rest adjustment. I do have a friend who is a designer. He was suffering from mild depression and did not want to take western medicine for fear of affecting his creative inspiration. So he consulted a doctor at a regular traditional Chinese medicine hospital and prescribed Xiaoyao Powder plus or minus, combined with acupuncture twice a week. After more than three months of adjustment, his previous condition of losing hair every day and not wanting to go to work has indeed been alleviated a lot. However, it should be noted that this idea is only suitable for patients with mild symptoms and clear syndrome differentiation. For moderate to severe depression, priority should be given to using western medicine to intervene according to the doctor's instructions. Don't delay treatment.

Many people are afraid to take antidepressants when they see the dozens of side effects listed in the instructions. When my cousin first started taking sertraline, she was so nauseous that she vomited after drinking water for the first three days. She also felt that she couldn't do anything and was even more numb than when she didn't take the medicine. At that time, she smashed the pill box and wanted to stop taking the medicine, but I stopped her and called the doctor. The doctor said that this was a normal adaptation period and it would be over after another week. Sure enough, by the eighth day, the nausea was completely gone, and when I woke up in the morning, my first reaction was not "I have to endure another day today." Those who say that taking antidepressants will make you stupid are even more misunderstood. The temporary slow response is just a transient symptom during the adaptation period. When the drug concentration stabilizes, you will find that the previous feeling of a layer of paste in your brain slowly subsides, and you can focus instead.

Oh, by the way, don’t think of medicine as a panacea. I met a girl who worked in Internet operations before. After taking medicine for half a year, her mood became much more stable, but she broke down as soon as she talked to her parents on the phone. After more than three months of family therapy, she talked to her parents about the grievances she had accumulated over the years, and she slowly got better. Many people say that "antidepressants are useless", but in fact they regard them as life-saving straws and ignore all the practical conflicts that should be resolved and the psychological problems that should be unblocked. Even if the medicine can help you bring your mood to a passing level, you will still not be able to get better if you are immersed in a negative environment every day.

I was chatting with a psychiatrist I know well before, and he said that many patients now ask "Is there the best antidepressant?" as the first question when they sit down. He has to explain to people every time that the best one is the best for you. After all, you are a living person, not a standardized list of symptoms. Find and adjust slowly, and you will always find a suitable rhythm, right?