Drugs to relieve depression

Currently, the drugs that are clinically recognized as effective in relieving depression mainly include three categories: new antidepressants, traditional antidepressants, and auxiliary synergists. All drugs must be evaluated by a psychiatrist before being used according to the doctor's instructions. There is no "magic drug" that applies to everyone. Only a plan that matches the individual's condition and tolerance is the best choice.

Last week I went with a friend who was diagnosed with moderate depression for a follow-up visit. She took sertraline for the first time last year. She felt nauseous every day for the first week and vomited everything she ate. She also always said that she was like an emotionless robot and couldn't cry or laugh. I read a lot of online posts at that time and almost stopped taking the medicine privately. Fortunately, I went to the doctor to adjust the dosage, from half a tablet to a quarter tablet, slowly increasing it, and then switched to venlafaxine. Now three months later, last week he took us to a camping trip in the countryside, and he even complained to us about the weird request of the leader last week while holding a skewer.

Many people are exposed to antidepressants for the first time. The first ones they hear about are SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine and sertraline, which are often referred to as the "Five Golden Flowers". The side effects of these drugs are indeed small, and most people will not feel too much discomfort after taking them, so many doctors will give priority to these drugs for initial administration. But it is not suitable for everyone. I have met a sales patient before who needs to run around for work and suffers from shoulder and neck pain all year round. After taking sertraline for three months, his mood improved a lot, but the shoulder and neck pain did not relieve at all. Later, the doctor changed him to SNRI (serotonin and norepinephrine reuptake inhibitor) duloxetine. Not only did his mood stabilize, but the pain problem was also solved.

Of course, this does not mean that old drugs are not good. Nowadays, many experienced experts will consider using old tricyclic drugs when they encounter severe depression patients who have become numb and unable to eat. They are more effective and cheaper than new drugs. However, the side effects are greater, and dry mouth and constipation are more common, so they are suitable for patients with good tolerance.

I would also like to say here that there is actually a lot of controversy in the academic community about the timing of medication. One school of thought believes that mild to moderate depression can be treated with 8-12 weeks of cognitive behavioral intervention first, without rushing to take medicine. After all, medicine is only three parts poisonous; but the clinical data of the other school are also very clear: patients who intervene early and take medication have about 30% less chance of recurrence later than those who take medication. Especially for patients who have already suffered from sleep disorders, decreased appetite, and are unable to work and study normally, the longer the delay, the worse the prognosis.

By the way, here’s another question that’s been asked a lot: Are antidepressants addictive? To be honest, regular antidepressants are not addictive. Many people say that stopping the drug is uncomfortable. In fact, it is a withdrawal reaction, such as dizziness and a little panic. As long as you slowly reduce it according to the doctor's instructions, from one tablet to half and then to a quarter, give the brain time to adapt. Basically, you will not have too strong a feeling. Don't be frightened by those posts on the Internet that "you can't stop taking it".

There are also many people who have been taking medicine for a long time but have no effect. The doctor will add some synergistic medicine, such as a small dose of atypical antipsychotics or thyroxine. Don't panic when you see "antipsychotics". Small doses are used here just to enhance the effect of antidepressants. It does not mean that you have mental illness. I have seen many patients with refractory depression who have seen significant improvement in half a month after adding a small dose of aripiprazole.

However, there are indeed great differences in the academic circles regarding the use of depression medication in adolescents. When I attended an industry seminar last month, an old professor of child psychiatry said that many children are now casually prescribed antidepressants due to mood swings in adolescence and high academic pressure, which may interfere with normal neurological development. However, some young doctors refuted the data and said that among a dozen suicidal teenage depression patients treated last year, the risk of suicide was reduced by 80% after timely medication. Saving lives is obviously more important than possible side effects.

Of course, it must be made clear that antidepressants are not a panacea. I have seen many patients who are taking the medicine without any problem, but they stay up until two or three o'clock every day to watch short videos, which are all negative content. Their family members still say "you just think too much" around them every day, so no matter how good the medicine is, it is useless. To use an inappropriate metaphor, antidepressants are like the crutches you use when you break your leg. They can help you walk, but if you use crutches every day and jump into puddles, your leg will definitely not heal. When your legs grow well, you can naturally throw away the crutches. You don’t need to feel that taking medicine is something to be ashamed of, and you don’t need to feel that taking medicine will mean you can’t live without it for the rest of your life.

In the final analysis, there is no standard answer to relieving depression. Some people can just rely on exercise and psychological counseling without taking medicine. Some people take several medicines before they find the one that suits them. Some people may need to take medicine for a long time to maintain it. The most important thing is not to think about it on your own. Either seek a regular doctor for evaluation or find a reliable psychological counselor. Don't buy so-called "antidepressant miracle drugs" on the Internet, and don't hold on to them and refuse to seek help. Whatever makes you feel better is fine.