Medications to relieve depression

Currently, the drugs that are clinically recognized as effective in relieving depression are mainly divided into two categories: traditional antidepressants and new antidepressants. There is no "optimal drug" that applies to everyone. All drugs must be used under the evaluation and guidance of a regular psychiatrist. Purchasing and taking drugs by yourself carries extremely high health risks.

Last week, I accompanied a friend who had relapsed into depression to the city Jingwei Center for a follow-up consultation. There were more than 20 people sitting in the waiting area, half of them holding prescription slips with unfamiliar drug names in their hands, and two little girls in school uniforms gathered together and whispered: "Will you feel sleepy after taking that sertraline?" The first three days I took Prozac, I felt like throwing up at breakfast.” The ones everyone is talking about are basically the new antidepressants of choice in clinical practice. The most commonly used ones are the SSRIs (selective serotonin reuptake inhibitors) known as the "Five Golden Flowers", including fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram. Compared with the old drugs decades ago, their side effects are much milder. Most people will only experience mild gastrointestinal reactions and mild insomnia in the first week or two of taking the medicine, and basically feel nothing after the body tolerates it. I once met a sophomore girl majoring in advertising. After she was diagnosed with moderate depression, the doctor prescribed paroxetine. In the first week, even her favorite mango pancake felt like chewing wax when she bit it into her mouth. She was so scared that she almost stopped taking the medicine privately. During the follow-up visit, the doctor adjusted the dosage from 20mg to 10mg and asked her to take half a tablet first and slowly increase the dosage. When she went back for the third week, she could already sit there and complain to the doctor about how outrageous the new client's brief was.

However, different doctors have different considerations regarding which one to choose. For example, when it comes to adolescent patients under the age of 18, many doctors will give priority to prescribing sertraline. After all, minors have the most evidence-based evidence and the side effects are milder.； However, if the patient also has severe sleep disorders, counting the ceiling with his eyes open at three o'clock in the morning, many doctors will combine it with a little mirtazapine in the early stage, which can not only help sleep but also improve the mood. The only disadvantage is that he will get hungry easily after eating. Many patients have reported that they gained five or six pounds in the first month, and little girls who love beauty often have to struggle for a long time. In recent years, there is also Vortioxetine, which has a faster metabolism and fewer side effects. In addition to improving mood, it can also alleviate cognitive problems such as memory loss and slow response caused by depression. Many patients who have to go to work or go to school are willing to choose it, but the price is a bit expensive. Without medical insurance, it will cost 700 to 800 yuan a month, which is indeed a big burden for many student parties.

It’s quite interesting to say that many young doctors now prefer new drugs when prescribing drugs. However, an old director I know who has worked at the Jingwei Center for almost 30 years encountered several patients with refractory depression who had tried three or four new drugs but had no improvement. He prescribed amitriptyline, which cost a hundred dollars, and after taking it for two months, they slowly recovered. These traditional antidepressants, such as tricyclics and monoamine oxidase inhibitors, are rarely used as first-line drugs now, not because they are not effective, but because they have serious side effects. Dry mouth, constipation, and dizziness when standing are common. People with underlying heart diseases should be more cautious. However, for some special patients, they are the most cost-effective choice.

The biggest concern many people have about taking antidepressants is whether they will be addictive. This issue has been popularized many times in the industry: antidepressants themselves are not addictive. The reason why we are required to slowly reduce the medication and gradually stop taking the medication is to avoid the withdrawal reactions caused by sudden withdrawal of the medication - such as dizziness, insomnia, and temporary low mood. Many people regard these reactions as "addicted and unable to quit", but they are actually two completely different concepts. However, some doctors will tell the truth: If you have more than three depressive episodes, or the symptoms of each episode are particularly severe, you may indeed need to take long-term or even lifelong medication, just like patients with high blood pressure who need to take antihypertensive drugs for a long time. It is not a "dependence", but a need for the condition. If you insist on not taking it, it will be more likely to relapse, and the treatment will be more difficult.

Don’t buy medicine randomly. It’s really not to scare people. Last year, I read about a netizen who saw that other people took venlafaxine and secretly bought a few boxes online. After taking it for three days, his blood pressure soared to 160. He was so dizzy that he couldn’t stand and went to the emergency room. He himself has hereditary hypertension. Venlafaxine has an impact on blood pressure and is not suitable for him at all. Everyone’s condition, physical condition, and tolerance are different. Someone else’s panacea may be poison to you.

When I accompanied my friend for a follow-up visit last time, her attending doctor said something very true: "Antidepressants are crutches to help you stand up, not a wheelchair to help you walk." If you take medicine along with regular exercise and psychological counseling, your recovery will be much faster. Don’t think of it as a magic medicine that will make you happy immediately after taking it, nor as a scourge that will destroy your body. Find a reliable doctor and slowly adjust according to the plan, and you will always get better.