The term «antidepressant» speaks for itself. It is a group of drugs to treat depression. However, antidepressants usage domain is much broader than it might seem. Besides depression, they are able to deal with melancholy, anxiety and fears, relieve emotional stress, and normalize sleep and appetite. Some of them are even able to help treat smoking addiction and nocturnal enuresis. And quite often antidepressants are used as painkillers for chronic pain. Currently, there are a significant number of drugs that are referred to antidepressants, and the list is steadily increasing. In this article, we gathered information about the most common and frequently used antidepressants Zoloft and Prozac.
Antidepressants have an impact on brain neurotransmitter system through various mechanisms. Neurotransmitters are special substances by means of which a variety of «information» between nerve cells is transferred. Neurotransmitters content and correlation influences not only on patient’s mood and emotional background, but also almost all nervous activity.
Main neurotransmitters, disbalance or deficiency of which is connected with depression, are considered to be serotonin, noradrenaline, dopamine. Antidepressants contribute to neurotransmitters number and correlation normalization, thereby eliminating clinical manifestations of depression. Thus, they have an only regulatory effect, but not substitutional, so they do not build up a tolerance (on the contrary to prevailing opinion).
Yet there is no antidepressant which effect is noticeable from the first administrated pill. Most of the drugs need quite a long time to show their effectiveness. This is often the cause of independent withdrawal. Because they want unpleasant symptoms to disappear as if by magic. Unfortunately, such «golden» antidepressant is not synthesized yet. Search for new drugs is caused not only by a desire to speed up antidepressant effect but also by the need to get rid of unwanted side effects, decrease contraindications number.
Worldwide antidepressants are usually divided into groups according to their chemical structure. For health professionals, such division also means drugs mechanism of action.
From this position, several groups of drugs are identified:
Monoamine oxidase inhibitors:
Non-selective neurotransmitters reuptake inhibitors (i. e., drugs that block all neurotransmitters inhibition by neurons without exception):
Selective neurotransmitters reuptake inhibitors:
A selective neurotransmitters reuptake inhibitors subgroup is currently the most frequently used worldwide. This is due to relatively good tolerability, a small number of contraindications and wide possibilities for use not only for depression.
From a clinical point of view, often antidepressants are divided into drugs with predominantly sedative (calming), activating (stimulating) and harmonizing (balanced) effect. The latter classification is convenient for doctors and patients, as it reflects basic drug effects, in addition to antidepressive. Although, it should be said that it is not always possible to clearly distinguish between products according to this principle.
Antidepressants require in most cases gradual dosage increase until individual effectiveness, i. e. in each case drug dosage will be individual. After reaching necessary effect the drug is taken for some time and then withdrawn as gradually as in the beginning. This mode allows avoiding side effects occurrence and disease recurrence at abrupt cancellation.
Antidepressants with immediate action do not exist. It is impossible to get rid of depression during 1 – 2 days. So antidepressants are prescribed for long-term use and the effect appears after 1 – 2 weeks (and even later). Only if after a month of application there will be no improvements, the drug is replaced by another.
Almost all antidepressants can’t be used during pregnancy and lactation period. They are not compatible with alcohol.
Another feature of antidepressants application is the earlier occurrence of sedative or activating action than directly antidepressive. Sometimes this quality becomes the basis for choice.
Almost all antidepressants have an unpleasant side effect manifesting in sexual dysfunction. It may be decreased in sexual desire, anorgasmia, and erectile dysfunction. Of course, these complications of antidepressant treatment does not occur in all patients, and, although this issue is very sensitive matter, this shouldn’t be ignored. In any case, sexual dysfunction is fully transient.
Each group of drugs has its advantages and disadvantages. For example, tricyclic antidepressants have a good and fairly rapid antidepressant action, quite cheap (as compared to other groups), but cause tachycardia, urine retention and ocular hypertension, decreased cognitive (mental) functions. Because of these side effects people with prostate adenoma, glaucoma and problems with heart rate, which is quite often cased in elderly age, can’t take these drugs. But the selective neurotransmitters reuptake inhibitors group has no such side effects, but its main purpose they begin to perform after 2 or even 3 weeks after therapy beginning, and their price category is quite high. In addition, there is less information about their clinical efficacy in severe depression.
To summarize everything said above, it turns out that antidepressant choice should be maximally personalized. As many as different factors possible must be taken into account at drug appointment. And certainly, in this case, patients should not follow «neighbor» rule: what helped one person – can harm another.
This is perhaps one of the most popular drugs of the latest generation. Preference is given to it by both doctors and patients. Doctors – for high efficiency, patients – for ease of application and tolerability. Prozac is manufactured in the UK, so it is a quite expensive drug, especially if consider its long-term use.
The only disadvantage to be considered is, perhaps, delayed antidepressive effect. Usually, persistent improvement appears in 2 – 3 weeks of application. The drug is taken in 20-80 mg/day dosage, besides different schemes may be used (in the morning or twice a day). For older people, the maximal daily dose is not more than 60 mg. Food consumption has no effect on drug absorption.
The drug can be used safely by people with cardiovascular and urological disorders.
Although Prozac rarely causes side effects, they still exist:
The drug is contraindicated only in case of idiosyncrasy.
The main component of this drug is sertraline (its second name). Also, drug composition includes:
This mixture is not only able to treat all sorts of phobias, anxiety and depression but also presents a whole bunch of side reactions that occur in each case individually. Zoloft has pros and cons. Psychiatrists reviews in this regard are also unclear. For this reason, this drug is often first taken in minimal dosage and then dosage is gradually increased, if the body is more or less accepts it.
Zoloft is prescribed for ordinary cases of nervous disorders and for severe depressive states. As an antidepressant, this drug has a two-way characteristic, that is, its effect has both pros and cons. It is able to relieve symptoms, which are currently a troubling patient, but as a consequence, another disease may occur. For example, sertraline relieves anxiety and emotional pain that arise from the loss of a loved one, but patient obtains insomnia after a course of treatment.
The main rule when using this drug – stability and regularity. If an effect is acceptable and patient state is really improving – drug application should be continued in accordance with doctor’s prescription. It should also be noted that when the patient has a variety of phobias and compulsive ideas doctors also prescribe Zoloft.
Essentially, there is no perfect antidepressant. Each drug has its own advantages and disadvantages. And individual sensitivity is also a major factor in the effectiveness of the particular antidepressant. And although it is not always possible at the first attempt to defeat depression, one drug is sure to be salvation for the patient. The patient will overcome depression, it is only necessary to be patient.