Depression, also known as depressive disorder, is a common mental illness.
Manifestations of depression
Persistent poor mood, depressed mood, reduced interest, pessimism, slow thinking activity, lazy speech, lack of initiative, lack of energy, self-blame, poor appetite, poor sleep quality. They may worry that they are suffering from various diseases, feel uncomfortable in many places but cannot point out the specific place, often accompanied by cognitive or psychomotor disorders or physical symptoms. In severe cases, suicidal thoughts and behaviors may occur, often accompanied by certain physical or biological symptoms, such as depression, anxiety, suspicion, autonomic disorders, increased or decreased heart rate, numbness in the limbs, chills in the limbs, sweating, dizziness, headache, fatigue, loss of appetite, joint pain, constipation, diarrhea, etc.
Depression is generally divided into reactive depression, endogenous depression and bipolar depression.
Non-pharmacological treatment of depression
Mild depression can be treated with non-pharmacological methods. Such as psychotherapy, music therapy, food therapy, sports therapy, light therapy, cognitive therapy, etc. Outdoor exercise or taking a long trip is a good therapy for mild depression.
The drug treatment of depression
1. Tricyclic antidepressants
They are named after a heterocyclic ring containing seven elements, each connected to a benzene ring. There are promethazine, clomipramine, trimipramine, amitriptyline, doxepin, protirelin, etc.
1, Promethazine has a strong antidepressant effect, but the excitatory effect is not obvious, and the sedative and anticholinergic effects are moderate. It is effective in endogenous depression, reactive depression and menopausal depression, but the efficacy is slow to appear, usually taking more than 2 weeks. It is almost ineffective or has poor efficacy in depressive states associated with schizophrenia.
2, Clomipramine has good efficacy in obsessive-compulsive neurosis.
3, Amitriptyline is a commonly used clinical antidepressant with good efficacy in endogenous depression and menopausal depression, and is also effective in reactive depression and depressive states of neurosis. It is more effective than promethazine in patients with both anxiety and depressive symptoms.
4, Doxepin is a strong sedative antidepressant with weaker antidepressant effects than promethazine, and is used in patients with significant anxiety and depressive symptoms, as well as for sedation and hypnosis.
5, Protirelin acts similarly to amitriptyline, but has a stronger psychostimulant effect and a weaker sedative effect, and is used for the treatment of depression with emotional indifference and withdrawn personality.
2. Monoamine oxidase inhibitors
Representative drugs are moriclofenamide, toloxadone, etc.
Moclobemide is a new generation antidepressant. It is used for endogenous depression, neurofunctional depression, psychotic and reactive depression. It is also indicated in geriatric depression and has no effect on psychomotor and recognition functions. It is also effective in sleep disorders.
Selective 5-hydroxytryptamine reuptake inhibitors
The representative drugs are fluoxetine, fluvoxamine, sertraline, citalopram, escitalopram and so on. Among them, citalopram and escitalopram are the antidepressants with very high clinical use rate at present.
1, Fluvoxamine, which has the advantage of neither excitatory nor sedative effects, nor anticholinergic or antihistamine effects, has no effect on the cardiovascular system and does not cause upright hypotension. It is used for the treatment of all types of depression, especially persistent depressive symptoms and patients at high risk of suicide.
2, Citalopram is highly selective and effective in both endogenous and non-endogenous depression, with a rapid onset of antidepressant action, usually after 2-4 weeks. It does not affect the cardiac system and blood pressure, especially in elderly patients, nor does it affect the blood, liver and renal systems.
3, Escitalopram, the levo-enantiomer of citalopram, is 5 to 7 times more potent than citalopram in the body. It is suitable for major depressive disorder.
4. Selective norepinephrine reuptake inhibitors
The representative drugs are Maprotiline, Amoxapine, Reboxetine, etc.
1, Maprotiline has antidepressant effect and anxiolytic effect, while sedative, anticholinergic and blood pressure lowering effects are light. It is used for the treatment of endogenous, reactive and menopausal depression, and also for postpartum depression.
2, Amoxapine has strong antidepressant and euphoric effects. Compared with promethazine, the antidepressant effect is similar, but the onset of action is rapid, the cardiotoxicity is low, and the anticholinergic and sedative effects are weaker.
3, Reboxetine is rapidly absorbed orally, with high bioavailability, characterized by its repeated administration without accumulation. However, it can cross the placenta and enter into breast milk. Used for depression in adults.
5. Selective 5-hydroxytryptamine and norepinephrine reuptake inhibitors
Representative drugs are venlafaxine, duloxetine.
1, Venlafaxine is indicated for the treatment of various types of depression and generalized anxiety disorder.
2, Duloxetine has relatively few adverse effects and is well tolerated by patients. It is used for the treatment of major depressive disorder.
The above drugs are prescription drugs, purchased with prescription, and should be used under the guidance of a physician or pharmacist.