What are the drugs to relieve depression?

Currently, the two main categories of antidepressant prescription drugs commonly used in domestic psychiatric clinics are SSRI (selective serotonin reuptake inhibitor) and SNRI (serotonin and norepinephrine reuptake inhibitor). In addition, there are traditional drugs such as tricyclics and monoamine oxidase inhibitors, as well as atypical antidepressants such as bupropion and agomelatine. Some patients with complex symptoms also use mood stabilizers and atypical antipsychotics as auxiliary drugs. All of these drugs are strictly prescription drugs and must be prescribed after evaluation by a psychiatrist. It is absolutely not recommended to check the information yourself, buy them and consume them randomly.

Over the years when I have been doing psychological counseling, many patients who have come into contact with me for the first time ask for Prozac. They say that I read online that other people have taken it and it has good effects. In fact, this is not the case. Take the most commonly used SSRIs, for example, which include fluoxetine (also commonly known as Prozac), sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. Different drugs are suitable for different groups of people. For example, sertraline is relatively safer for teenagers. Doctors will give it priority to many underage patients who are taking the drug for the first time. I came for a follow-up last month. A sophomore girl was taking Sertraline. She felt slightly nauseous and easily drowsy in the afternoons in the first week. She thought the side effects were too great and she couldn't bear it. I asked her to stick with it for another two weeks. By the third week, she said that the "heavy feeling" on her chest was much lighter. Before, she didn't even have the strength to get out of bed and wash her face. During that follow-up visit, she was able to take the subway for half an hour with her roommate and buy a cup of milk tea along the way.

If the effect of SSRI is not obvious after taking enough courses of treatment, or the patient is accompanied by obvious symptoms of physical pain and fatigue, doctors will generally consider switching to SNRI, such as venlafaxine and duloxetine. In addition to regulating 5-hydroxytryptamine, it can also act on energy and pain. Regarding norepinephrine, there was a male patient in his 40s who worked as a designer. He had been depressed for more than three years and suffered from shoulder and back pain that made him unable to sit for more than half an hour. He switched to duloxetine and took it for less than half a year. Not only did his mood stabilize a lot, but the frequency of shoulder and back pain episodes was also reduced by 70%. Now he can return to work normally.

As for antidepressants such as tricyclics and monoamine oxidase inhibitors, which have been on the market for a long time, they are indeed used less now because the side effects are relatively more obvious, such as dry mouth, constipation, and drowsiness. However, they are not completely eliminated. Some patients with refractory depression have used several new drugs to no avail, but switching to old drugs can be effective. Individual differences are really obvious in psychiatric drugs.

Of course, there is a lot of controversy over the use of antidepressants in the industry. Research data shows that about 30% of depressed patients can experience symptom relief after taking a placebo. Many scholars believe that for mild depression, you can try psychological intervention first, without rushing to take medicine. There is no unified conclusion yet. So if it is the first time you are diagnosed with mild depression, you can talk to your doctor to see whether taking medicine first, a period of psychological counseling first, or a combination of the two is more suitable for you.

There is another common misunderstanding that I would like to mention. Many people think that antidepressants can be "addictive" or "stupid". At least half of the patients I have contacted had this concern when they first got the medicine. In fact, the current mainstream new antidepressants are not addictive. The initial drowsiness and slow reaction are mostly transient side effects, which usually disappear in 2 to 4 weeks and will not affect long-term cognitive function. I have seen many people feel better after taking it for a month or two, and then stop taking the medicine privately. As a result, within a week, they develop dizziness, mood rebound, and feel worse than before. When stopping the medicine, you must follow the doctor's rhythm and gradually reduce it. Even if you want to stop, it usually takes a few weeks to several months to gradually reduce it to be safe.

After all, there is no so-called "best antidepressant". Just like some people take ibuprofen to treat headaches, while others take acetaminophen. The one that suits you is the right one. Don't just follow the online experience and try randomly. Follow the doctor's advice always first.