Month: December 2018


It is generally recognized that the combination of psychotherapy with drug therapy is more effective than the use of each of these methods separately. They are not alternatives to solving the problem, but, on the contrary, complement each other perfectly. When conducting psychotherapy is of great importance the activity of the patient, his involvement in the process. Active participation of the patient allows him to develop certain behavioral skills and mechanisms of self-regulation, which teach to cope effectively with difficult life situations and increase the chances of a person not to fall into repeated depression in the future.

The most common currently and effective in the treatment of depressive disorders are three types of psychotherapy: psychodynamic, based on the work of Freud and his followers and the methods of psychoanalysis developed by them, behavioral therapy and cognitive psychotherapy.

According to the psychoanalytic concept, the cause of depression is unresolved and suppressed unconscious conflicts. This approach was most detailed in Freud’s book “Sadness and melancholy”. According to his ideas, the basis of depression is laid in infancy, when the child is taken from the mother’s breast. The resulting mental trauma and lack of adequate compensation cause a state of dissatisfaction and the development of self-esteem disorders, leading ultimately to the development of depression in adulthood. The views of Freud on depression was developed in the works of Melanie Klein and Donald Winnicott.

The merit of the psychoanalytic school is a detailed study of the core of depression and a correct indication of the role of unconscious factors in its development. The task of the therapist in the conduct of psychoanalysis is the discovery of repressed traumatic situation, the awareness of her patient, re-experiencing and healing. At the same time, the psychodynamic school pays insufficient attention to other sources of unconscious conflicts that are not directly related to the traumatic removal from the mother’s breast. Its big drawback is also the neglect of social factors and traumatic situations from the present, which can lead to the development of a depressive episode. Psychoanalysis is a long process, sometimes treatment can be delayed for many years, which limits the widespread use of this method in successful therapy of depression.

Behavioral psychotherapy appeared in the Arsenal of psychotherapists relatively recently, finally formed into a whole doctrine, it was only in the 50s of the last century, after which it quickly gained popularity and developed in several directions. Common to all types of behavioral therapy is the idea of human behavior as a result of training, which radically distinguishes it from psychodynamic concepts. Behavioral therapy is aimed at solving the current problems of the patient by changing behavioral patterns, passivity, rejection of pleasure, isolation from the environment.

The Creator of cognitive therapy is Aaron Beck, who has tried to combine the best of both approaches. Cognitive psychotherapy combines the work with the actual problems of the patient, and with his deep beliefs and perceptions. Beck believes that the cause of the depressive disorder is inherent in the patient’s worldview and interpretation of the events happening to him. The aim of cognitive therapy is to change the patient’s negative thinking to positive by careful individual work and detection of cognitive, mental errors in the patient’s reasoning.

Currently, the last two methods are often combined into one called “cognitive-behavioral therapy”. From the name it is clear that in this way an attempt is made to combine both approaches, correction and behavioral and mental errors. Perhaps it is no exaggeration to say that cognitive-behavioral therapy is the most common type of psychotherapy now. Its popularity is explained by the relative brevity, especially in comparison with psychodynamic therapy, in which treatment can last for years, and the resulting relative cheapness, a large number of empirical (experimental) data confirming its effectiveness.

On average, ten to twenty psychotherapeutic sessions are required to achieve some result. In my case, it took more than fifty. I visited a therapist for a year and a half, once a week, each session lasted about an hour. During the sessions, we discussed the situations that concern me from today’s life, possible options for their development and what effect they can have on my life.

In favor of cognitive-behavioral therapy, I can say that first of all, some effect is achieved due to the fact of communication with the therapist. If the latter manages to establish reliable contact with the patient, to create a trusting relationship, the very expression of accumulated fears, the opportunity to share them with someone in a safe environment, “pour out the soul” already leads to some subjective changes in the emotional status of the patient. In my case, it happened that way, after a short period of rubbing, I quickly opened up to the therapist and immediately felt some relief. Passing sessions after that was no longer a burden, on the contrary, I was looking forward to them. Also, therapy really helped me to deal with some hypertrophied fears, to realize that their consequences may not be as severe as I initially thought.

The thing is that, being in a depressed state, you do not delve into the essence of your problem, it scares and disarms you so much that you continue to engage in its mental chewing on a superficial level, do not take the next step, just feel that it will continue to be bad and scary. The role of the therapist is to take you by the hand and mentally go through this path, critically evaluate it, do what the patient is not able to do on their own. It is important to avoid any pressure on the part of the therapist, it should only help you to understand the hypertrophy of the problem by asking questions, offering to evaluate the possible variants of development of events.

As a result, your problem does not disappear, but its value, significance, if very roughly, decreases.cognitive-behavioral therapy does not eliminate the source of your pain, but teaches you to live with it. Well, that might be justified, too. Such therapy did not cure me, and I did not take less drugs, but in some situations I began to feel more confident, less fixated on certain problems that worried me at that time.

As for psychoanalysis, I have only a brief experience of this procedure, which I interrupted after several sessions, and I still believe that I did the right thing. For all the fidelity of the theoretical basis of the method, to its practical results, I am extremely skeptical. First, it repels the duration and cost of the process. Secondly, the method is extremely subjective, very much depends on the personality of the psychoanalyst, his ability to correctly interpret the signs that your subconscious mind gives.

I also have strong doubts about the treatment of the depressive disorder itself by psychoanalytic methods. It seems to me that psychoanalysis can be effective in cases where the cause of neurotic disorder is reduced to some one suppressed root episode. This occurs in the pathogenesis of various phobias and obsessive-compulsive conditions. If the therapist manages to get to the displaced episode and help the patient to realize and relive it, then there is a recovery or a marked reduction in symptoms. To illustrate, we can consider the example given by Freud in lectures on the introduction to psychoanalysis, I will allow myself to give this passage as a whole:

“Nineteen-year-old blooming gifted girl, the only child of her parents, whom she surpasses in education and intellectual activity, was an unruly and playful child, and in recent years without apparent external causes has turned into a nervous. She is very irritable, especially against her mother, always unhappy, depressed, prone to indecision and doubt, and finally admits that she is not able to walk alone in the squares and large streets. We will not deal with her difficult painful condition, requiring at least two diagnoses, agoraphobia and neurosis of obsessive-compulsive conditions, but will focus only on the fact that this girl has also developed a ceremonial bedtime, from which she makes her parents suffer. We can say that in a sense, any normal person has his own ceremonial laying down to sleep or requires compliance with certain conditions, the failure of which prevents him from falling asleep; he clothed the transition from a state of wakefulness to sleep in certain forms, which he repeats in the same way every evening. But anything that requires a healthy sleep environment can be rationally understood, and if external circumstances cause the necessary changes, then it is easily obeyed. But the pathological ceremonial is uncompromising, it is able to achieve the price of the biggest victims, and it is in the same way covered by the rational justification and at superficial consideration it seems different from normal only by some exaggerated carefulness. But if you look closer, you can see that the veil of rationality is too short, that the ceremonial includes requirements that go far beyond rational justification, and others that directly contradict it. Our patient as a motive for their night precautions leads to the fact that she needs to sleep and it should eliminate all sources of noise. To this end, she acts in two ways: she stops the big clock in her room, all the other clocks are removed from the room, she does not tolerate even the presence of her tiny clock on the bracelet in the nightstand. Flower pots and vases are made on the Desk so that they could not fall at night, break and disturb her in her sleep. She knows that all these measures can only have a seeming justification for demanding peace, the ticking of a small clock can not be heard, even if they remained on the bedside table, and we all know from experience that the uniform ticking of a clock with a pendulum never interferes with sleep, but rather acts sleepy. She also recognizes that the fear that flower pots and vases left in their place at night can fall and break themselves is unlikely. For other requirements of the ceremony she no longer refers to the need of rest. Indeed, the requirement that the door between her room and her parents ‘ bedroom remain half-open, the fulfillment of which she achieves by inserting various objects into the half-open door, it seems, on the contrary, can become a source of disturbing noise. But the most important requirements apply to the bed itself. The pillow at the head of the bed should not touch the wooden headboard. A small pillow for the head can lie on a large pillow only as forming a rhombus; head then she puts exactly along the long diagonal of the rhombus. The feather bed (”Duchent”, as we say in Austria), before it can be covered, must be whipped so that its edge at the feet became quite thick, but then it will not miss the opportunity to smooth this accumulation of feathers again.

Let me go around the other, often very small details of this ceremony; they would not teach us anything new and would take us too far from our goals. Do not lose sight, however, that all this is not so smooth. At the same time, it does not leave the fear that not everything is done properly; everything must be checked, repeated, the doubt arises about one or the other precaution, and as a result, it takes about two hours, during which the girl herself can not sleep and does not allow frightened parents to sleep.

The analysis of these torments was not as simple as in the case of the obsessive action of our first patient. I had a girl to do suggestive hints and propose interpretations, which every time she was rejected with a resounding “no” or accepted with contemptuous doubt. But this first negative reaction was followed by a period when she herself was engaged in the possible interpretations proposed to her, selected the appropriate thoughts, reproduced memories, established connections, until, on the basis of her own work, she accepted all these interpretations. As it happened, it is also more inferior in the performance of the obsessive precautions and before the end of treatment declined from just ceremonial. You should also know that the analytical work, as we now do, directly excludes the sequential processing of a single symptom until its final clarification. Moreover, sometimes you have to constantly leave one topic in full confidence that you will return to it again in another connection. The interpretation of the symptom that I am about to tell you is thus a synthesis of results that, interrupted by other work, take weeks and months to produce.

Our patient is beginning to gradually realize that during her sleep preparations, she removed the clock as a symbol of the female genitals. Watches, which can be symbolically interpreted in a different way, acquire this genital role due to the periodicity of processes and the correct intervals. A woman can boast that her menstruation occurs with the correct clockwork. But especially our patient was afraid that the ticking of the clock would interfere with sleep. The ticking of the clock can be compared to the pulsation of the clitoris during sexual arousal. Because of this unpleasant feeling she really woke up repeatedly, and now this fear of erection was expressed in the requirement to remove from herself at night running hours. Flower pots and vases, like all vessels, are also female symbols. The precaution that they do not fall and not break, therefore, not devoid of meaning. We know a common custom to break a vessel or plate during the engagement. Each one present takes a shard that we should understand how the waiver of claims for the bride from the point of view of the marriage custom to monogamy. Regarding this part of the ceremony the girls got a memory and some thoughts. Once as a child, she fell with a glass or clay vessel, cut her fingers, and was bleeding heavily. When she grew up and learned the facts of sex life, she had a frightening thought that on the wedding night she would not bleed and she would not be a virgin. Her precaution against the fact that the vase did not break, means, thus, the denial of the entire complex, associated with virginity and bleeding at the first intercourse, as well as the denial of the fear of bleeding and opposite to him the fear of] not to have bleeding. To prevent the noise for which it took these measures, they had only a remote relationship.

The main meaning of her ceremony, she guessed one day, when she suddenly realized the order that the pillow did not touch the headboard. Pillow for her has always been a woman, she said, and the vertical wooden backrest – man. Thus she wanted – by magic, I might add – to share a man and a woman, i.e. to separate the parents to prevent them before the marital act. This same goal she tried to achieve before, until the introduction of ceremonial, more direct way. She feigned fear, or used existing tendency to fear in order not to give close the door between the bedroom and the nursery. This requirement still remains in her present ceremonial. Thus she created itself opportunity eavesdrop on for parents, but, using this opportunity, she once acquired insomnia, which lasted months. Not quite pleased with the opportunity to interfere with her parents in this way, she sometimes made sure that she slept in the marital bed between her father and mother. Then the “pillow” and”headboard” really couldn’t connect.”

From this example, it becomes clear that the success of the interpretation of painful symptoms in psychoanalysis is very dependent on the professionalism of the therapist, requires patient work and really helps in a number of disorders lead to recovery. The problem is that in the case of depression, it is rarely possible to identify any one episode from the patient’s past, which served as the direct cause of the disease. There are many such episodes, they are superimposed on each other, increase internal tension, until it finds a way out in the symptoms of the disease. Obviously, a lot of work needs to be done to identify and work out, one after another, each such traumatic event. And of course, psychodynamic therapy does not help the patient to solve his problems with real events occurring in the present.

Data on the effectiveness of psychoanalysis in depression are contradictory and, at least for me, unconvincing. Effective and reliable tools for detecting suppressed unconscious material in the Arsenal of psychoanalysts today I do not see. But they existed and were actively used in the 60s of the last century. Such tools were psychedelic drugs.



My first antidepressant was Prozac.

I do not know why I decided to appoint him to Cromwell Hospital. Once considered revolutionary, the drug is currently not the antidepressant of choice, there are significantly more effective analogues. In addition, in my case, I needed a drug of a completely different group. But first, let's talk a little bit about the history of antidepressants and their classification.

Nerve cells are connected to each other by means of special contacts, called synapses and consisting of the ends of the connected nerve processes, separated by synaptic or interneuronal gap. When a nerve impulse is transmitted from the end of one of the processes, neurotransmitters are released, which we have already mentioned above, and, migrating through the interneuronal gap, reach the receptor of the cell that perceives the impulse.

All antidepressants, regardless of the mechanism of action, have a therapeutic effect, increasing the concentration in the synaptic gap between the neurons of the brain of one or more neurotransmitters at once – serotonin, norepinephrine and dopamine.

The history of antidepressants, like many other drugs, began by accident, with the discovery in 1957 of antidepressant properties in a number of anti-TB drugs and the proposal to use these side effects in the treatment of patients with depression. The first such drug was iproniazid.

Iproniazid, as well as its analogues, refers to the so-called non-selective and irreversible inhibitors of monoamine oxidase (MAO), the enzyme responsible for the destruction of brain-secreted mediators. It is clear that when it is suppressed, the concentration of mediators increases, which leads to a positive therapeutic effect. Other drugs of this series include imipramine, isocarboxazid, nialamide, as well as derivatives of amphetamine – tranilcipromin, pargyline. A big disadvantage of MAO inhibitors is their toxicity and the need to follow a special diet during their use in order to avoid the development of “serotonin syndrome”, poisoning the body with an excess of serotonin.

In particular, while taking MAO inhibitors should avoid eating foods such as cheeses, smoked meats, marinades, bananas, sauerkraut, legumes, yeast extracts and brewer’s yeast, red wine, beer, chocolate, caffeine, dairy products. The fact that these products in the human body do some special amino acids: tyramine, its metabolic precursor Terezin and tryptophan. Tyramine, as well as serotonin, is cleaved by monoamine oxidase and has the ability to increase blood pressure; accordingly, its excessive accumulation can lead to the development of hypertensive crises. Tryptophan also serves as a source for the production of serotonin in the body.

Serotonin syndrome is a dangerous condition, manifested by agitation and confusion, trembling limbs, respiratory failure, fever. In severe cases, it can lead to the death of the patient. MAO inhibitors are also incompatible with a range of medications, such as psychostimulants, antidepressants of another chemical group, cough medicines containing sympathomimetics, and many others.

Work to eliminate these deficiencies of the first antidepressants led to the synthesis of selective Mao inhibitors, the next generation of agents that require less restrictions on their appointment. These include Moclobemide, Pirlindola (Pirazidol) Eprobemide and Metralindol. However, due to the current presence of antidepressants with fewer side effects, MAO inhibitors are now rarely used for special indications. In particular, they are well established in the treatment of atypical depression.

The next group of antidepressants on the market were tricyclic antidepressants. They had less side effects and did not require a special diet. Tricycles are also compatible with a large number of other drugs. These include amitriptyline, nortriptyline, imipramine, anafranil, trimipramine and others.

Part of the tricyclic antidepressants, along with the actual antidepressant, also has an anti-anxiety and sedative effect, this group includes, for example, amitriptyline and trimipramine. In the action of others, such as imipramine and nortriptyline, expressed, on the contrary, the stimulating effect.

In General, tricyclic antidepressants are quite effective drugs for the treatment of depression, they affect the exchange of several mediators and are characterized by a relatively fast time of therapeutic effect, compared with drugs of other groups. Their great disadvantage is the indiscriminate effects and the presence of serious side effects – lethargy, drowsiness, dry mouth, constipation, inhibition of libido and erection.

Selective serotonin reuptake inhibitors (SSRIs) became the latest class of antidepressants, which gained huge popularity due to the selectivity of action and the presence of fewer side effects. As the name implies, the drugs of this series inhibit the reuptake of nerve endings already isolated in the intersynaptic gap of serotonin, which leads to an increase in its concentration and enhance its inherent effects. The first drug of this series was the famous Prozac. With his appearance, many predicted the beginning of a revolution in the treatment of depression, the final solution to the problem. This of course did not happen. SSRIs are really convenient to use and less poison the patient’s life with side effects, but the price for this is their lower efficiency, compared to tricyclics and MAO inhibitors.

In addition to Prozac (fluoxetine), this group includes sertraline (zoloft), paroxetine (paxil), fluvoxamine (Luvox), estsitalopram (Cipralex), citalopram (CELEX). Despite the lower frequency and severity of side effects, SSRIs are all the same from them is not free. The most common are insomnia or, conversely, drowsiness, headache, tremor, fatigue, sweating, nausea, libido and potency disorders, ejaculation delay.

Subsequently, selective drugs with the same mechanism of action as SSRIs acting on the exchange of other neurotransmitters were synthesized:

Selective norepinephrine reuptake inhibitors (SSRIS))

Reboxetine (Edronax), Atomoxetine (Straterra) are usually well tolerated and have a pronounced activity in melancholic depression.

Selective inhibitors of reverse takeover serotonin and noradrenalina (Sossin)

Venlafaxine (Effexor), DULOXETINE (Cymbalta), Milnacipran (Ixelles)

Modern antidepressants with small side effects, are more effective than SSRIs and SSRI, are approaching in this respect to tricyclic antidepressants. Proved to be effective in the treatment of severe depression.

Selective reuptake inhibitors of norepinephrine and dopamine (Cesnid)

Bupropion (Wellbutrin, Zyban)

A very interesting drug, has a pronounced energizing and stimulating effect, some researchers even treated previously to psychostimulants. It is effective in melancholic depression, has a disinhibiting effect on the libido, which distinguishes it from most other antidepressants that have the opposite effect. An interesting feature of Bupropion is to reduce the thrust to the use of nicotine, for use for this purpose it is produced under the commercial name “Zyban“.

Noradrenergic and specific serotonergic antidepressants (Nassa)

Mianserin (Lerivon, Bonseron) and Mirtazapine (Remeron)

Drugs in this group affect the metabolism of norepinephrine and serotonin, it is blocking the serotonin receptors responsible for the side effects at prima SSRIs, such as nausea, decreased libido, nervousness, insomnia. However, they have a pronounced sedative effect and contribute to weight gain, through the effect on insulin metabolism, increased appetite and water retention in the body.

Specific serotonergic antidepressants (SSA)

For drugs in this group include Trazodone (Desyrel, Trittico) and its newer derivative of Nefazodone (Serzon).

SSA, as well as Nyssa, block the “bad” receptors of serotonin and do not cause some side effects inherent in the classic SSRI. Trazodon, for example, has a stimulating effect on potency in men and can even lead to the development of priapism, painful long-term erection, requiring, approximately in every third case, surgery.

Nefazodon has a strong hepatotoxicity, which limits its use, it is currently banned for sale in the United States.

In General, there are several common stereotypes about antidepressants. Some patients believe that taking psychotropic drugs or even a consultation with a psychiatrist are equal to recognizing themselves as crazy and continue to endure their suffering, hoping that everything will resolve itself. This is self-deception, and self-deception is very dangerous. In any case, it is impossible to allow the chronification of the process, the earlier adequate treatment is prescribed, the more likely the positive outcome of the disease. It should be understood that depression is the same disease as hypertension or gastric ulcer, and requires appropriate therapy, the disease can not be anything shameful.

Another common opinion is the hypertrophied danger of taking antidepressants, an exaggeration of the degree of harm they cause to the body. Many people think that a serious dependence develops to antidepressants, almost as to drugs, and, having hooked on them once, it will be almost impossible to get off. This is certainly not the case. Antidepressants are designed for long-term use, and most of them do not cause any undesirable effects after completion of treatment and discontinuation of their use. There are some exceptions to this rule, which I will discuss later in this Chapter.

There are also concerns, mainly from creative professionals, about the possible negative impact of psychotropic drugs on creativity. What can we say about this? Yes, a number of drugs (not all!) has a sedative effect and enhances the braking processes in the brain. But if you suffer from depression, your creativity will be weakened in any case, and it is in your best interest to get out of this state as soon as possible. Antidepressants, with all their shortcomings, make it possible to bring your mind in order in the shortest possible time, compared to other treatments. In addition, the positive effect of their reception in most cases overlaps the negative and creative abilities can even improve on the background of taking drugs, compared with the same abilities in the absence of adequate treatment.

A big disadvantage of almost all antidepressants is the slowness of the effect, in most cases it takes at least 2-4 weeks to start the actual antidepressant action. Anti-anxiety or, on the contrary, a stimulating effect, may develop earlier. This feature causes certain difficulties in the selection of the drug for the treatment of a particular patient.

First of all, the doctor should evaluate the type of depressive disorder and prescribe an antidepressant to the patient, which has the necessary characteristics to combat this type of disease. For example, in case of anxiety depression should choose a drug with a sedative component of the impact, with inhibited, on the contrary, with stimulating.

Specific drugs are selected depending on the degree of disease. With mild depression, it is even possible to dispense with the appointment of herbal preparations based on St. John’s wort, which have moderate antidepressant activity.

St. John’s wort has practically no side effects, except for the phenomena of photosensitization, increasing the sensitivity of the skin to ultraviolet radiation: during its reception, it is contraindicated to sunbathe and visit the Solarium.

At an average, and in some cases of mild depression the drugs of choice are inhibitors of reuptake neurotransmitters, the SSRI, NARI, Sossin, Sioned. In severe depression, large doses of tricyclic antidepressants are prescribed, combined with drugs of another group. MAO inhibitors have proven themselves in the treatment of atypical depression, in which the symptoms of classical depressive disease are not expressed, vegetative disorders, anxiety prevail, the reverse cycle of daily mood fluctuations is characteristic, in the morning the emotional state is better than in the evening.

Two important factors should be taken into account when assessing the effectiveness of antidepressant action on a particular patient. It’s time and dosage. To develop the effect, it is necessary to give the drug a time of at least a month, after which, depending on the results, you can adjust the dosage upward or downward. If the result is unsatisfactory and after adjustments, which may be several, the doctor should either change the drug, or Supplement its effect with the appointment of another antidepressant.

It is clear that the selection of the drug occurs by trial and error, it may take many months before it is possible to determine the optimal scheme of drug treatment. The General rule of drug therapy for depression is to achieve the disappearance of all its symptoms, after which treatment continues for at least six months, after which a gradual decrease in dosage begins, until the complete abolition of the antidepressants used.

Unfortunately, this tactic is not always effective. Antidepressants do not treat the cause of depression, they only remove its symptoms, and if during treatment nothing has changed in the patient’s life, the traumatic factors have not gone or have not been worked out, the likelihood of relapse is very high.

It is important to keep in mind that antidepressants are incompatible with alcohol. First, there may be a cumulative sedative effect from the simultaneous intake of alcohol and a number of antidepressants used to treat anxiety depression. Can develop serious poisoning of the body, up to the suppression of the respiratory center and death. Secondly, alcohol further enhances the processes of inhibition in the brain of patients with melancholic depression. And thirdly, the interaction of alcohol and a number of psychotropic drugs has not yet been fully studied and the neurotoxic effect on the brain tissue of their metabolic products is not excluded.

As I said above, most antidepressants are not addictive and addictive. Antidepressants are designed for long-term, in some cases even life-long use. Very many of them do not cause any withdrawal syndrome. But for some drugs, there are certain difficulties associated with discontinuation of their use. Of those antidepressants that I have taken, these include Paxil and Effexor (Venlaflaxine).

The paxil by itself, the drug is very effective. It belongs to the SSRI, inhibits the reuptake of serotonin in the synaptic cleft and is in this respect stronger than Prozac and Zoloft. An additional advantage of Paxil is its positive effect on the treatment of social phobia, patients become more sociable, social activities frighten them to a lesser extent. At the same time, Paxil has a short half-life from the body, and therefore the risk of withdrawal syndrome at the termination of its reception is quite high.

I took paxil for about two months and was dissatisfied with its effect, but trying to switch to another drug, experienced serious unpleasant effects, the mood has deteriorated, increased the frequency of panic attacks, I almost could not normally perform their social functions. I had to go back to him, given the fact that the second time to remove the drug is already under the supervision of a doctor and with great caution.

The effector did not come to me from the first days, I had difficulty sleeping, severe dizziness and stopped taking it less than a week after the start of the course. Personally, I didn’t have withdrawal syndrome, but I’ve met a few reviews online from people who have taken it significantly longer than I have, and for whom the rejection of the Effector has become a big problem.

Below I will briefly describe my experience of taking other antidepressants.

As I said, Prozac was my first psychotropic drug. I knew that the action of SSRIs, to which he belongs, develops slowly, but nevertheless laid great hopes on him, believing that bringing back to normal the disturbed balance of serotonin will eliminate all manifestations of my disease.

Prozac was released on the pharmacological market in the mid-80s of the last century and quickly gained immense popularity, becoming a cultural phenomenon, imprinted in several popular works of literature. With the advent of great hopes were linked, there were concerns about the decline of psychoanalysis, the uselessness of all the others that existed on the day of antidepressant drugs. Minimal, compared with MAO inhibitors and tricyclics, the number of side effects allowed to take it daily, without making significant changes in your lifestyle, a kind of lifestyle drug.

But it turned out that for better portability you have to pay less efficiency. I took Prozac for three months, initially 20 mg in the morning, then this dose was doubled. It was the most useless antidepressant I’ve ever been prescribed. It did not have any positive effect on me, these three months I add to the previous six, conducted without receiving adequate therapy.

As a result, I changed not only the antidepressant, but also the attending physician. The next in the list of my drugs was zoloft, the same SSRI, but more modern and considered more effective. I took it for a few months, and it had some antidepressant effects. Do zoloft stronger than Prozac, but the normalization of the exchange of serotonin for me was not enough, and I switched to Remeron.

The advantage of this drug is the effect on the metabolism of not only serotonin, but norepinephrine. Don’t know why, but it was in my case practically useless. In addition to some anti-anxiety action, I did not feel anything and two months later was transferred to the drug from the same group Lerivon (Mianserin).

Lerivon has a strong sedative effect, he removed the alarm, but with it eliminated any desire for any activity during the day. I had a feeling that I was wearing a helmet on my head, which protected my mind from any influence of the outside world, both negative and positive. On Lerivone I first felt a good antidepressant effect, in General, the drug for me was quite effective, and I took it for about six months. Its huge drawback is the water retention in the body and increased appetite, leading to rapid weight gain. For the first three months I added 10 kg, instead of 75 kg I began to weigh 85 kg. Before the therapy I did not think it was a big problem, but very quickly I realized that this weight strongly poisons my life. Dissatisfaction with my appearance and physical discomfort did not contribute to the improvement of my emotional state. In addition, the complete reduction of symptoms has not occurred, despite the constant increase in dosage.

As a result, I decided to turn to tricyclic antidepressants and started taking amitrip-Tylin. This is a very effective drug. With the right dosage, it can really eliminate all the symptoms of depression. In my case, this happened at 150 mg per day, which is not a very large, average dose. Amitriptyline affects the exchange of all three major mediators and has a pronounced sedative effect, in some sources indicate its stimulating, at a certain dosage, the effect, I did not notice.

Together with depression, amitriptyline cuts off all the emotions from a person, most of the day I was half asleep, slept for 10-12 hours a day. About any pleasure from life of the speech and could not be, I turned into the robot which did not test not only sufferings, but also in General more than anything. Besides, I have developed a normal weight for tricyclics, the side effects: constant thirst and dry mouth, severe urinary retention, confusion in thought and action, slow speech, almost totally killed libido and potency. The most unpleasant was the feeling of dullness, each thought had to be formulated with difficulty, suddenly the vocabulary became poor, writing a short e-mail became a big problem for me.

With all this, depression and anxiety was not, objectively, I no longer felt related to them of torment, the life of the vegetable was preferable to constant fear and depression. This went on for another 8 months, in full compliance with the existing medical doctrine, my doctor (the third in a row) and I achieved a complete reduction of symptoms in two months and waited another six months before the start of the dosage reduction.

With a decrease in the amount of amitriptyline taken, the symptoms began to return strictly in the same order in which they disappeared. I wasn’t just disappointed. I realized that drug treatment in my sense is simply meaningless without addressing the real causes of depression, which I still had a long time to understand. But this was still far away, and I had to think what to do next. I did not want to return to the previous dose of amitriptyline and drag out my former existence. All this time I was supported by the hope for a cure, the fact that in six months or a year everything will end and I have to endure this time, only temporarily live the life of a vegetable. The prospect of a permanent existence in this mode did not suit me.

I changed another psychiatrist. In fact, such throwing does not make much sense, in drug therapy of depression there is a certain pattern, which is followed by more or less versed in the subject of doctors. I see my behavior as another manifestation of illness, a break from reality, in the hope of finding a miraculous deliverance.

In this state, I began to combine drugs. Having reduced the dose of amitriptyline twice to feel something, I consistently added fluvoxamine, zoloft, paxil to it, without achieving a satisfactory result.

So here is a blind I picked up for myself an effective drug. They found Trazodone (Desyrel). These days, this antidepressant is not very popular, preference is usually given to serotonin drugs like Zoloft and Paxil, but I suddenly went very well. Expressed antidepressant effect I felt a few days after starting, which is unusual for most of these drugs. It was combined with a good anti-anxiety effect, due to the sedative nature of trazodone, but softer, not causing total dullness, as in the case of amitriptyline. Another advantage of trazodone was its positive effect on sexual function, as I wrote above, because of this effect, it is sometimes prescribed as an auxiliary drug for the treatment of erectile dysfunction, including that caused by taking other antidepressants.

In this combination, Amitriptyline + Trazodon, I lasted quite a long time. There was some compromise between depression and emotional stupidity, I was somewhere in the border area, not falling in any direction. Health is of course the name was not, moreover, such a therapeutic approach is wrong, because of incomplete reduction of the symptoms of depression leads to its stable of chronification. But what was I supposed to do?

The last time you start taking the drug in my case was Wellbutrin. Unfortunately, today it is not officially delivered to Russia and can be purchased only on Western websites. The drug is very interesting, and we can only regret that it is not available to most Russian patients. Its peculiarity is the effect on the exchange of dopamine and norepinephrine, as a result of Wellbutrin has a stimulating effect and is effective in the treatment of anhedonia, the inability to enjoy life. This is manifested in the disinhibiting effect on the libido, and in the General increase in human sensuality.

Wellbutrin suited me, I took the usual therapeutic dose, 150 mg every morning, combining it with trazodone and amitriptyline. The dosage of the latter varied depending on the effectiveness of other methods used by me at different times to combat the disease. For this cocktail I continued to hold on to the last two years. Manifestations of depression at the same time significantly reduced, but still not completely disappeared. I did not experience more panic attacks due to the sedative effect of trazodone and amitriptyline and could remain relatively active due to the stimulating effect of Wellbutrin. Actually tonight I took sadatoki to sleep, and stimulants to Wake up.

This regime is by no means universal, and the selection of antidepressants should be made individually in each case. But I hope that the information in this Chapter has given you some insight into the mechanism of action of various drugs and can help you in finding, together with your doctor, a suitable antidepressant or a combination of them.

Can antidepressants cure depression? In some cases. If the depressive episode occurred for the first time, was diagnosed in time and has not yet had time to be chronicled, if the correct treatment is prescribed from the beginning of the disease, and the traumatic situation was resolved during the course of therapy, then Yes, there is a chance that only drug therapy can defeat depression.

Unfortunately, this is not always the case. In most cases, antidepressants allow the patient to gain time, give a break, during which it is necessary, using psychotherapy and other methods, to cope with the cause of the disease, to deal with their own mental blocks and change the attitude to the traumatic situation.

To do this, it is important to undergo courses of psychotherapy.

Do you have depression?

Do you have depression?

Many people think that depression is a bad mood. This view is certainly wrong, if you are a living person, then you have inevitable periods of emotional decline and recovery. Depression begins when you lose the ability to cope with such downturns. If a healthy person is yelled at by the boss, his mood will certainly deteriorate, this is completely normal. Such a person will stay in a bad mood for some time, but then inevitably he will be distracted, will work this negative on an unconscious level and will live on. There may be situations when the" precipitate " will still remain for a long time (how to deal with this, I'll tell you below), but nevertheless this episode will not poison the rest of a healthy person's life.

When depression is different. The most common signs of its presence are causeless bad mood, loss of the ability to enjoy life and increased fatigue for at least two weeks. Under the wanton here refers to the lack of daily traumatisierung factor causing an emotional depression. It doesn’t mean that if you’re rude on the bus, you have a reason to fall into melancholy for the next two weeks.

It should also be borne in mind that depression can be masked, that is not manifested through bad mood, and any somatic factors, disorders at the level of organs and systems of the body. Such depression is also unpleasant because it is poorly diagnosed. This is exactly what happened in my case, six months I was treated for anything, but not for depression. During these six months, I managed to undergo treatment for thyroid insufficiency, gastroesophageal (gastro-esophageal) reflux, gastric erosion, irritable bowel syndrome, chronic myocarditis, giardium and a number of other diseases.

Fortunately, there are quite objective methods for diagnosing depression. To assess the presence and severity of the disease, specialists use several scales, such as the Hamilton, Beck or Gotland scale. All of them are a set of questions, for each of which there are several possible answers, estimated by a different number of points. It is believed that the assessment should be made by a psychiatrist, and this is correct. It is always easier for a specialist to objectively assess the accuracy of your answers, clarify unclear points, ask leading questions.

At the same time, if you suspect that you have a depressive disorder and think that you are able to answer the questions as honestly as possible, it makes sense to test yourself before you run headlong to a psychiatrist. A negative answer may not always be correct in the case of self-test, but a positive is a sufficient reason for a visit to a specialist.

For independent work more than others suitable scale Zang.

Zang scale for self-assessment of depression (ZDRS)

Zang scale for self-assessment of depression (The Zung self-rating depression scale) was first published in the UK and subsequently received international recognition. It is developed on the basis of diagnostic criteria of depression and the results of a survey of patients with this disorder. Assessment of the severity of depression on it is based on the patient’s self-assessment. The scale contains 20 questions, each of which gives an answer to the frequency of occurrence of a particular feature, ranked in four gradations: “rare”, “sometimes”, “often” and “most of the time or constantly.”

Method of application: before starting the procedure, the subject should be acquainted with the method of working with the scale. The scale is filled in by the subject, and the specialist does not take part in its filling. The time required to fill in takes a few minutes.

The total score is determined by the results of the answers to all 20 points.

How it all began

Analyzing now my past, trying to find the causes of depression, I understand that there is no one traumatic situation that led to the development of the disease. Undoubtedly, my childhood experiences played a huge role. I was quite a weak physically and sickly child, and although I’m still not fully aware of everything that scared and traumatized me in the deep past, the intensive therapy I went through at Dr. Janov Center in Los Angeles and months of practice of my method convinced me that the roots of the problem grow from childhood.

At the same time, in full accordance with the causes of depression, set out in one of the previous chapters, in my mind there were a lot of quite conscious traumatic episodes from the less distant past and even the present. All this tension grew like a snowball and did not find a way out, in the end the psyche had to not withstand such pressure and break. That is what happened in August 2002.

At that time, I only suffered from the flu and was still in the recovery period, was weakened physically, residual effects continued to manifest themselves. It so happened that in the same period I was under the influence of chronic stress associated with problems at work and difficult relationships with his girlfriend. Problems have not been resolved for several months, and if the complexity of the working order, I objectively could not have any significant impact, the solution to the problems in my personal life was not due to the blocks, beliefs, blinkers, if you like, that existed in my mind at that time. All this mental stuff accumulated for decades and did not allow me to breathe calmly and carefully analyze the emerging life situations.

One fine morning I woke up and was surprised to find that my heart was beating faster than usual, without any physical or intellectual stress. Without paying special attention to it, I went to work, by the end of the working day to heartbeat the expressed shortness of breath was added. This went on for a few days, but I was really worried when I started daily bursts and drops in body temperature, with nothing obvious associated and not following any sustainable pattern.

My medical education played a cruel joke on me. The emotional sphere at that time had not yet been touched, and I was looking for the cause of ill health in anything but a depressive disorder. By the third week, my condition began to bother me seriously, I developed severe asthenia, I was tired very quickly and could not concentrate on doing any, even the most simple work.

The trip to the therapist and the General examination revealed no abnormalities, except for palpitations. There was a suspicion of myocarditis, which was rejected after a special instrumental examination. The next stage was the elimination of hormonal disorders, a detailed analysis revealed a slightly reduced level of thyroid hormones, and the next stage of my epic began.

On the recommendation of an endocrinologist, I started taking thyroxine, the main product of the thyroid gland, with regular blood tests and monitoring of hormone levels. I must say that the process is not fast and we spent another month to fix the minimum violation that was found in me. Needless to say, it did not produce any results.

Since I did not receive adequate treatment, my condition continued to deteriorate, and now he added disorders of the digestive system. The first was a stable heartburn, after taking almost any food, it quickly led to the development of pain in the stomach and the emergence of erosion of the gastric wall. In addition to thyroid hormones, I started taking drugs to reduce the acidity of gastric juice and was treated with antibiotics for the eradication of Helicobacter pilory, a bacterium that causes stomach ulcers.

As soon as I heal one manifestation of the disease, as she found a way out in something else, now I had to deal with gastroesophageal reflux, an extremely unpleasant disease, manifested by the casting of undigested food and gastric juice from the stomach into the esophagus. Another series of examinations, unsuccessful drug therapy and the proposed surgery aimed at narrowing the diameter of the gastro-esophageal valve. All this against the background of continuous deterioration of the General state of health.

I understood that the operation would not solve anything and would not save me from suffering. It was necessary to find the root cause of the disease, and I went to London, for examination in Cromwell Hospital, one of the best private hospitals in the UK. By this time, I looked so depressed that, to the credit of my therapist, he didn’t have to exhaust me with numerous and unnecessary tests. First of all, looking at my hormonal tests and conducting an external examination, he immediately said that my thyroid is all right, and advised me to immediately throw out all my pills for hypothyroidism.

Then, after asking me in detail about the symptoms of the disease and the effect of the treatment (or rather, its absence), he was the first to utter the fatal word: “Depression”. In other circumstances, I would have been extremely upset by such a diagnosis, but by that time I was so exhausted that I was even glad to see him. Anything to get some certainty and the right treatment. I had no idea what was ahead of me. I was sick by this time for about six months.

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