Drugs that are effective in relieving depression are

At present, the first-line drug for relieving depression that has the most sufficient clinical evidence in the world and is the most widely used is a selective serotonin reuptake inhibitor (SSRI). However, there is no "panacea" that is 100% effective for all patients. The effect of the drug is affected by multiple factors such as individual gene metabolism characteristics, depression classification, comorbidities, and medication compliance. Adaptability is far more important than "fame".

I have been working hard in psychiatric clinics for 8 years. I have seen postpartum mothers who took sertraline for 2 weeks and their desire to have sex disappeared for half a year. I have also seen high school sophomores who changed to 3 kinds of first-line drugs and added two boosters before they could finally go to work normally. After staying in this field for a long time, the last thing I dare to say is "a certain drug will definitely work for you."

The "Five Golden Flowers of Antidepressants" that everyone often hears belong to the SSRI category, which are fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram. The advantage of this type of drug is that the side effects are relatively mild, and the common problems of severe dry mouth and orthostatic hypotension that are common with older drugs are rare. The safety of long-term use has also been clinically verified for decades. Of course, different drugs are suitable for different groups. For example, sertraline is safer for teenagers and is the first choice drug for depression in many children and teenagers. ； Fluoxetine has a long half-life, so even if you miss a dose occasionally, there won’t be much reaction. It is suitable for office workers with poor memory and frequent business trips. ； Paroxetine has a strong anti-anxiety effect and is more suitable for depressed patients with obvious anxiety symptoms. However, its withdrawal reaction is relatively obvious. When stopping the drug, it must be tapered slowly and cannot be stopped immediately.

Many veteran doctors who hold a classic psychopharmacological perspective will mention that if the diagnosis is endogenous depression, with obvious symptoms of slow thinking and slow movement, the effect of tricyclic antidepressants is more direct than that of SSRIs. However, these drugs have more side effects and are now mostly considered only when first-line drugs are ineffective. If the patient is also accompanied by obvious symptoms of physical pain and fatigue, the doctor may prescribe SNRIs (serotonin and norepinephrine reuptake inhibitors), such as venlafaxine and duloxetine. These drugs can act on two neurotransmitters at the same time and improve physical symptoms better than SSRIs. However, some studies have pointed out that they have a slight risk of raising blood pressure, so patients with underlying hypertension are generally not preferred. I previously treated a 42-year-old middle-level man from a state-owned enterprise. He had been depressed and had chronic back pain for almost 2 years. He took sertraline for half a year and his mood improved for the most part, but the back pain was not relieved at all. He switched to duloxetine and came back for a follow-up consultation after 3 weeks. He said that the back pain has been reduced by 70%, and he even stopped taking the painkillers he had been taking all year round.

Oh, by the way, there is another drug that young patients particularly like to ask about, called bupropion. It hardly causes weight gain and has much less impact on sexual function than other antidepressants. Many young girls who are afraid of gaining weight will ask if they can prescribe it when they come to the clinic. However, its effect on depressed patients with obvious anxiety and insomnia is only average, and it may even aggravate anxiety, so it is not suitable for everyone.

Speaking of this, some people will definitely ask, is it better to take medicine or undergo psychological treatment? This is actually a point that has been discussed in the academic community: Most counselors in the CBT (cognitive behavioral therapy) school believe that if you have mild to moderate depression without obvious physical symptoms or suicide risk, you can try systematic psychological intervention first, and you don’t necessarily have to take medicine. After all, medicine only helps you bring your neurotransmitters back to normal levels. If your cognitive model is not adjusted, you will still be easily trapped in stressful events. ； However, the general consensus among our psychiatrists is that patients with moderate or above depression, especially those who have thoughts of self-harm or suicide and cannot even sit down and have a good chat for 10 minutes, must first stabilize their state with medication, otherwise psychological intervention will not be carried out at all and treatment will be delayed.

Last week, a junior girl came to me and asked me to prescribe fluoxetine with a list of "top 3 antidepressants" I searched online. I checked her case. In addition to depression, she also suffered from severe sleep disorders. She often stayed up until 4 o'clock in the morning and couldn't fall asleep. So I prescribed her a small dose of mirtazapine. This drug has a strong sedative effect and can not only improve her mood but also help adjust her sleep. She took it for a week and came back for a follow-up visit. She said that she was finally able to fall asleep before 12 o'clock, and her whole mood became much more relaxed. If she had complied with her request and prescribed fluoxetine, the early activation reaction of the drug might have aggravated her insomnia. At that time, she would have felt that "the drug was useless" and stopped taking it directly.

To put it bluntly, choosing antidepressants is really similar to buying shoes. No matter how comfortable others are wearing, it is useless for you to wear them. Don’t just search for information on your own and buy random medicines, and don’t just follow the trend when people around you tell you which one works best. All antidepressants are prescription drugs, and you need to find a regular psychiatrist for a comprehensive evaluation before prescribing them. You may experience some side effects of nausea and dizziness in the first 1-2 weeks of taking them, but most of them can be tolerated. Regular follow-up visits and medication adjustments are much more reliable than worrying about which "miracle drug" to choose.