Antidepressants are frequently used in cases such as depression and anxiety disorder. So do we know enough about antidepressants?
At the beginning of the 20th century, lobotomy (surgical intervention from the eye socket to the frontal lobe) method was applied in Europe, while the first antidepressant with chlorpromazine active ingredient was launched in the USA in 1955. Side effects such as dizziness, dry mouth, and constipation were common in the first generation antidepressants. In the 1980s, second-generation antidepressants emerged. Although it is claimed that these side effects are alleviated in new generation drugs, side effects such as weight gain or weight loss, insomnia or drowsiness, suicide were included in the prospectus of almost every antidepressant.
Antidepressants are not only used in the treatment of depression, some may have more anxiety or obsessive relief effect. However, generally these drugs are in the antidepressant group. Generally, the most common side effects of antidepressants: weight gain, lack of sexual desire, drowsiness.
At first, residual symptoms were tried to be eliminated
Depression has certain diagnostic criteria. Many medicines have been produced to relieve depression symptoms such as reluctance, malaise, not enjoying life, and thoughts of death. According to experts, even though these symptoms were relieved with only these antidepressants it was noticed that the functionality and quality of life of the patient did not increase. Efforts were made to eliminate the negativities called residual symptoms. At first, eliminating the symptoms of depression such as the death wish of the patient was in the foreground and was considered sufficient.
Antidepressants were mostly described according to their active ingredients in the first years. Double-acting antidepressants emerged after the classic antidepressants. Then strains such as serotonin, noradrenaline, reuptake inhibitors were also marketed in the antidepressant group.
Knowing the patient is important
Experts say that listening to the patient’s history is very important when making a diagnosis. There are many depression tests on the internet, and most patients fill in these tests and decide to go to the doctor saying “I am depressed.” It is necessary to evaluate the patient as a whole with his personality structure, defense and coping mechanisms and conditions. If you ignore them, even if you start treatment, you will not get a positive result or the patient will only have a temporary well-being. People change drugs by saying “This drug is not good for me” or the things that are suppressed while using the drug can continue after they stop.
A medicine that is good for one patient may not be good for another
While drugs have an effect on us called as pharmacodynamics, there is also an interaction of us with the drug called as drug’s pharmacokinetics. Therefore, a medicine that is good for you may not be good for someone else. While the drug acts on neurotransmitters, hormones, the body takes the drug, metabolizes it, breaks it down, liver enzymes determine what your body will do with the drug, how much benefit you will or will not see. For this reason, some drugs may be very good for someone, but may not affect another person at all or too many side effects can be seen.
How long should we take antidepressants?
While the drug needs to reach a certain blood concentration to be effective, this time varies from person to person. The effect of the drug can take up to two or three weeks, and in some cases up to eight weeks. The standard for the minimum duration of use of the drug is six months after starting treatment. These processes are now a bit protracted because our experience has shown that patients with depression or anxiety disorder start to come back with second episodes when they stop taking the drug after six months. We recommend using it for 6-12 months after it starts to heal; In the meantime, if their well-being is very short, it may be necessary to extend this period up to two years.
How do antidepressants work?
Antidepressants in different groups have different mechanisms of action. For example, serotonin, which is found in SSRIs and known as the happiness hormone, does not only manage mood. It also affects many functions such as our perception of pain and our hunger state. SSRIs increase serotonin concentration in the synaptic gap between nerve cells. While the receptors in the synaptic space are damaged in disorders such as depression; The amount and function of serotonin is impaired. SSRIs allow serotonin to stay in the synaptic space for a long time. It needs to be used for 6-12 months as it repairs the broken system here. After taking antidepressants, people have a temporary state of well-being that lasts one to two weeks because serotonin has increased in the synaptic interval. In the next period, there will be fluctuations for a few weeks. In that period, during the transition from temporary effect to permanent effect, the serotonin level decreases and there is a feeling of discomfort again. As the repair begins after the third and fourth week, well-being lasts longer because neurons are the hardest to heal cells.
Drug withdrawal process
When we start to reduce the dose, we measure the response, if there is no excessive effect, we understand that the person is ready to stop the drug if the body tolerates that low dose. At this point, the following questions need to be examined: “Is the patient experiencing side effects due to lowering the dose, or is the source of the problem still continuing and only suppressed with medication?