Antidepressants

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.

Causes of depression

Without going into details, interesting only to specialists, all causes of depression can be divided into two groups: reactive and endogenous. I must say that this is a very simplified classification, which can be supplemented by depression of the elderly, alcohol and drug depression and some others. But nevertheless, basically it is true and for the purposes of our discussion is sufficient.

Reactive depressions are caused by some external traumatic situation, such as the death of a loved one, loss of a workplace, parting with a loved one(s). Endogenous depressions are based on genetic predisposition and are caused by metabolic disorders of special substances of the brain-neurotransmitters. Neurotransmitters are responsible for the transmission of nerve impulses, for the correct formation and coordinated work of the processes of inhibition and excitation in the brain.

In fact, both of these reasons are interrelated, it is obvious that different people can react differently to the same traumatic situation. A person with initially low levels of neurotransmitters is more likely to get depression than a more fortunate individual. At the same time, if you create a hypothetical situation with the absence of all external traumatic stimuli, there is a high probability that a person even with a very burdened heredity will never know what depression is.

So, regardless of the cause that caused the depression, its biochemical basis is a violation of the exchange of brain mediators, namely serotonin, norepinephrine and dopamine.

Why is it important to know?

Because the drug therapy of depression is based on the alignment of this imbalance, and it should be understood exactly how the lack of a mediator to choose the right drug for treatment. It is quite rare to find a disease in which the exchange of all three mediators is disturbed equally, as there is no ideal antidepressant, equally affecting the exchange of all these conductors of the nerve impulse.

With a lack of serotonin, anxiety depression can develop, in which a low mood is mixed with causeless anxiety, anxiety for insignificant reasons. A deficit of norepinephrine manifests itself by lack of energy, lack of energy, fatigue, and dopamine is responsible for a person receiving pleasure from something, and, accordingly, in violation of his exchange occurs hedonia (loss of sense of pleasure), the food seems tasteless, unfunny jokes, uninteresting reading.

What kind of drugs affect the balance of these neurotransmitters, will be described in the Chapter “Antidepressants“, now it is enough to just remember this information and listen to your feelings, try to understand what symptoms you have expressed to a greater extent.

It is also important to understand the following. External causes of depression do not always lie on the surface, can not always be realized by man. In this respect, the sometimes used term “causeless depression” is not quite correct, it would be more correct to say”depression, the causes of which are not understood”. In practice, this means the existence of mental material, forced into the subconscious of a person, traumatic situation from the distant past, perhaps from early childhood. The psyche of a person at this age is not completely formed and sufficiently stable, that an adult is a trifle, for a child can have the scale of a universal catastrophe. The child is simply unable to exist in the presence of such a situation, and then the protective mechanism of the psyche triggers, causing displacement and external forgetting of the traumatic episode.

I deliberately write “external”, because in fact the situation has not gone away, it has remained unresolved, suppressed psychic energy continues to exist in the subconscious and bombard from there the psyche of an adult, to influence his actions, beliefs, perception of certain life situations.

To understand this, it is easiest to imagine a psychoanalytic model of the human psyche, consisting of three parts: consciousness, the pre-conscious and the unconscious. Consciousness is a set of thoughts, feelings, experiences of a person that are in his perception here and now. The area of the pre-conscious is the experience, which, although not realized at this moment, but can recover, go into consciousness either spontaneously or under the influence of external influence. The unconscious is a receptacle of instincts that exist on the principle of pleasure and are a source of mental strength and energy of man. Such a division of the psyche is not present in the child initially, and appears as his socialization, education, training standards of behavior adopted in society.

That is, the child is explained that some of his desires are unacceptable and even shameful, as a result, over time, he develops an internal censor, a kind of conscience that monitors the prevention and rejection of such aspirations. But the instinctive impulses are very strong, and so easy to give them up does not work, as a result in the human psyche is a constant struggle between the requirements of society and their own desires. Every mental act and human act, according to Freud, is the result of this struggle.

Such a struggle can wear down the psyche, and to deprive people of the opportunity to exist in society, to prevent this mentality produced a number of protective mechanisms to protect the mind from the ravages of primitive impulses. These include suppression, rejection, displacement, sublimation, projection, rationalization. The presence of these protective mechanisms ensures the preservation of the psyche in a stable state, maintaining the integrity and identity of the individual, in a constant conflict of psychological attitudes.

We are interested in the mechanism of suppression in this case. He is in enforced exile from consciousness of disturbing a person’s memories, causing anxiety, fear, tension. This memory is sent to the storeroom of the unconscious and ideally, if it is not very emotionally charged, should no longer cause a person significant anxiety, finding a way out through any harmless habits, patterns of behavior, mental attitudes.

But in some cases, the traumatic situation has such a strong emotional impact on the child that it continues to manifest itself in the form of externally unmotivated anxiety and sadness. It is in such cases that the patient cannot identify the source of his suffering and speaks of “causeless” depression.

But there is another situation. The cause of depression seems to lie on the surface and is associated with some specific episode from the recent past or present. Over time, the traumatic situation is resolved, it would seem, with it should go away and depression, but very often this does not happen.

The reason is that the realized situation from the present serves as a kind of associative trigger and touches the spiritual strings associated with a similar past negative experience, forced into the unconscious. For example, having received at work a scolding from the chief, a person suffers not only from this fact, but also from the painful unconscious anguish, which can be caused by a simple resemblance of the color of the tie of the head and the father of the patient, who hit him in childhood for some fault.

As a result, a person can change his place of work, completely change his current circumstances, but he does not get better. This small conflict episode served only as a push, the trigger which lifted the muddy Deposit from the bottom of his unconscious. Over time, perhaps, this precipitate will calm down, but with a high degree of probability it is possible to predict the repetition of a depressive episode, if a person once again finds himself in a similar situation in the future. And now imagine how much repressed pain we have accumulated in our entire lives, and you will realize that in fact we all walk on a minefield, risking their daily peace of mind.

How to deal with this? There are several fundamental approaches: you can suppress the painful memories of taking psychotropic drugs, cutting off part of yourself and continuing to pressurize the boiling pot of your unconscious, you can work out your current problems with a psychotherapist and learn to live with these problems, and you can try to throw out the accumulated pain and find true liberation, and with it the integrity of your personality.

Needless to say, the latter is the only way.

How to break out of a black hole Part 2

First, some statistics:

The world health organization (who) compares depression with an epidemic that has engulfed all of humanity: depression has already come to the first place in the world among the causes of absenteeism, the second – among the diseases that lead to disability.

Every year about 150 million people in the world lose their ability to work due to depression. Only the us economy, it causes annual damage of more than 50 billion dollars. This amount includes the cost of 290 million lost working days, psychotherapy and disability.

According to who forecasts, by 2020 depression will come out on the first place in the world among all diseases, having overtaken today’s leaders – infectious and cardiovascular diseases. Already today it is the most common disease that affects women.

According to studies conducted in the United States, people prone to depression are twice as likely to die from other diseases.

50 % of those suffering from depression do not seek medical care, and of the remaining only 25-30% get an appointment with a psychiatrist.

Unipolar depression is the leading cause of disability in the United States among children over 5 years.

Special studies have shown that 60 % of patients applying to clinics, detect depressive disorders of varying severity. Meanwhile, as a result of diagnosis by traditional medical methods, which are used in clinics, depression is determined only in 5% of all patients applying there depressive.

Depression is diagnosed in 22-33 % of hospitalized patients, 38 % of cancer patients, 47% of stroke patients, 45 % – myocardial infarction, 39 % – parkinsonism.

Not so long ago, the peak of depression was between the ages of 30 and 40 years, but today depression is sharply “younger”, and it often affects people under 25 years. Among those who were born before 1940, the number of people with depression before the age of 25 is 2.5%. Among those born in 1940-1959, this figure is already 10%. There is no accurate data for later years, but this trend continues to grow.

From 45 to 60% of all suicides on the planet are committed by patients with depression. According to forecasts, in 2020, depression will be the killer number 1.

A depressed person is 35 times more likely to commit suicide than someone outside of it. 50 % of people with endogenous depression and 20% with psychogenic commit suicide attempt. Every sixth it is possible.

The annual catalogue of new antidepressants reaches a thickness of 3 cm.

With a single episode of depression, the probability of relapse is 50 %, with the second – 70 %, with the third – already 90 %.

With depressive disorder, at least one of the spouses divorces occur 10 times more often than in ordinary families.

This book does not claim the status of scientific research, I will not describe in detail the causes and biochemical reactions behind the development of depression, complex mechanisms of action of psychotropic drugs used for its treatment. This is a look at depression from the inside, an attempt to tell about what a person feels, being in such a state, and, most importantly, that you can get out of depression, I did it, and therefore, you should get it.

This is not an easy way, there is no universal method or pill, drinking which could regain mental health. But, if you are among the people described by the soulless statistics in the above quote, the fight against depression should be your most important task, the meaning of life here and now, a goal without which you can hardly expect to achieve all the others.

Believe me, I know what I’m writing. I studied medicine for seven years at the Institute and had to spend another six years studying the problem of depression and methods of its treatment. You will not read this information in medical textbooks and drug instructions, your doctor will not tell you about it either. I am not bound by any shop obligations and am not going to defend my point of view before the ossified medical establishment. I recognize only one criterion-the result and ready for this criterion to withstand any tests and checks. Everything that is written here, I tried on myself, except psychedelics and electroshock, the first – in view of their illegality and absence of the psychotherapists having experience with them, the electric shock simply wasn’t necessary to me, I managed to jump off the train before arrival to this station.

Most of the therapeutic methods used for the treatment of depression, has a varying degree of effectiveness, and to achieve the optimal result requires a combination of them. Any psychiatrist will tell you that taking antidepressants should be combined with psychotherapy sessions. Unfortunately, this knowledge and recommendations of most specialists and limited. Rarely any psychiatrist will advise you to engage in meditation or gymnastics qigong. Even fewer specialists are familiar with the techniques of neurolinguistic programming, and almost no one in Russia knows about the primary therapy of Dr. Arthur Yanov.

There is no need to be afraid of the number of practices offered by me, there is no point in practicing them all. Some of them are described in order to avoid them and not to repeat my mistakes. The basis of my technique is the Primary therapy (primal therapy), developed by Arthur Yanov. I am convinced that without serious study of unconscious material it is very difficult to get rid of the true causes of depression, and I believe that Dr. Yanov’s methods are the most effective at the moment to achieve this goal.

This book describes my personal experience of getting out of depression, and I really hope that it will be useful for someone else. I know that you find it hard to believe that deliverance might know how tired you advice others to “pull themselves together”, the replica “you’re the man!”or “you’re a mother!”, “think about the children/parents/colleagues/interests of the company”, believe me, I went through all this nightmare.

But I would like to warn you. If you suffer from depression, you in any case should not engage in self-medication and perceive this book as an alternative to drug therapy and psychotherapy, on the contrary, the earlier you start treatment prescribed by a specialist, the more chances you will have to get rid of your problem forever. Another thing is that the book can help you in choosing a doctor, to understand the cause of your suffering, to save time and money that you could spend on all sorts of near-medical charlatans and, I very much hope to make the final step, to make a breakthrough to the final recovery.

I give practical advice and exercises that helped me get out of the black hole of depression.

If you, as well as I, unsuccessfully motalis from one specialist to another, if you are treated for all possible diseases in the world, until the present diagnosis, if you go to the pharmacy more often than the supermarket, if the number and color of the tablets already dazzled – this book is for you.

Remember-there is a way out.

Depression. How to break out of a black hole PART I

Depression is like a lady in black. If she came, do not drive her away, and invite to the table as a guest, and listen to what she intends to say.

Carl Gustav Jung

Best day of my life

Probably, it would be easier to throw out at once these two huge plastic bags stuffed to the eyeballs with all kinds of psychotropic drugs available in the post-Soviet space. But it was a special pleasure for me to get one multi-colored boxes, each of which meant a certain milestone, a stage in my six-year struggle with depression, to carefully consider them, to cause associated memories and ruthlessly send them to the trash, along with all the pain, fear, suffering that they meant to me.

“Prozac”, Cromwell Hospital, London, obese doctor with unhealthy shortness of breath, first told me “you are depressed“; “Remeron”, ajibedam hospital, Istanbul, $ 800, spent on meaningless tests; “Lerivon”, Moscow, 10 kilograms of excess weight, gained over three months…

Six years. Erased from life, from the most active period of my life, six years of unrealized opportunities, rejected career proposals, ruined personal life, hopeless vegetations.

I deserve this day. Definitely deserved it.

Introduction

Hi.

My name is Anar, I am a doctor, I am 38 years old.

The last 6 of them were stolen by depression.

I have suffered from depressive disorder, generalized anxiety and panic attacks since August 2002. At the peak of the disease, I took three types of antidepressants at the same time, visited a psychotherapist, engaged in various practices from the field of alternative medicine. Despite this, most of every day I spent in a depressed state, panic attacks happened 3-4 times a day, I shuddered from every phone call and appeal to me by name.

At some point I decided to accept it. I decided that I was destined to spend the rest of my days on antidepressants, which though I did not feel good, but which at least gave me the strength to get up every morning from bed and go to work, somehow communicate with the people around me, to perform their social functions.

In the end, it stopped working. I lost my job, my personal life was ruined, I didn’t see any sense in my future existence.

But six months ago, the situation began to change. Now in my life everything is different, I do not take antidepressants, do not feel anxiety and panic attacks, most of the day I am in a calm and positive state. I have a new job that gives me satisfaction, and a girl with whom I plan to connect my life and which is better for me there is no one in this world.

Not so much, you say?

Well, really, a lot of people around you have the same thing and don’t write books about it.

But if you are reading this book, perhaps your life is not so rosy. As a doctor, I have encountered depressive patients in my practice, some of them reached such a stage that they saw no other way out for themselves than suicide.

Then I still did not suffer from depression myself and I can responsibly say: never a person who has not been in this skin, will not understand that he is experiencing a depressed patient, for whom there is no greater happiness, a greater dream than to return to his pre-painful state, to live a normal life, to love and be loved, to enjoy the little joys that healthy people are so familiar that they do not cause any emotions.

So what happened six months ago?

There was no miracle, I did not find a wonderful pill that cured me, did not read any book that recommends “change your attitude to depression” and “think positively“, after which all my problems were resolved.

There are no miracles. There will be no them and in your case-to get rid of depression, it is necessary to work. But my example shows that the reward for work can be huge if you know exactly what to do. It took me 6 years to figure it out, you can get this knowledge in a few hours spent reading this book.

As a doctor, I was well aware of the underlying mechanism of depression, but as a patient, I could not find an effective solution that would stop this ruthless mechanism.

Now I know how to do it. I spent 6 years and over $ 50,000 on medication, psychotherapy, and various spiritual practices. Everything I know, including the only effective way out of depression that I know, I have summarized in a book that I have the honor to offer to your attention.

Just remember that reading the book will not cure you, the technique will have to practice. It is not difficult, does not take much time, and the effect you will feel after the first successful session. Each time it will increase, and, I assure you, the classes will not only not burden you, but, on the contrary, once you feel the effect, you will strive for them with impatience.

The basis of my methodology is based on the theory of primal therapy, Dr. Arthur Janov and methods of neuro-linguistic programming, originally developed by John Grinder and Richard Bandler.

I underwent three weeks of intensive therapy at the primary center in Los Angeles in January 2009, and this experience changed my whole life. I finally figured out how to get to the forgotten childhood memories and the repressed pain they continue to cause us.

It remained to find a method to work with psychological trauma from the present and recent past. This proved to be easier, NLP methods in this regard have shown themselves to be very effective.

To understand why a combination of these methods has had the best effect, you need to be aware of the causes of depression. Any doctor will tell you that the basis of depression is a violation of the normal course of biochemical processes in the brain and the associated metabolic disorders of neurotransmitters – serotonin, norepinephrine and dopamine.

But that’s not what I mean.

Every depression has a reason. Sometimes it can lie on the surface and be realized by the individual, sometimes its causes are buried in childhood injuries and experiences. But most often, even almost always, there is a combination of these two factors, stress in the present causes pain from the past to life. You can read more about this in the Chapter “Causes of depression“.

Dr. Yanov had been in therapy at the time, many celebrities, including Elizabeth Taylor and Barbra Streisand. But his most famous patient was of course John Lennon. Below you can read the memoirs of Dr. Janov about John’s therapy, with which he shared in an interview with the magazine “Mojo”.

In my opinion, Dr. Yanov managed to get to the root of the problem. Primary therapy allows you to reach and throw out suppressed emotions that cause nervous disorders. This is very important, but not always enough. To get rid of depression, you also need to work through traumatic situations that are already in your mind, are recognized by you, but still continue to torment you.

I’m not going to teach you Primary therapy, you have to go to Los Angeles and get it at the Primary center. In this book I describe my experience, undoubtedly positive, and the method that I had to come up with to be able to continue to work with his subconscious to stop the three-week intensive at the Center.

Primary therapy, like any other, is long-term. It does not stop after the first three weeks, and it is quite justified: it is impossible to work out all the unconscious material in such a short time. But I had to interrupt my treatment at the Center, I could not continue to stay in Los Angeles, besides, having lost my job, I already in any case had nothing to pay for the continuation of therapy.

Fortunately, I now have the opportunity to practice my method at home, and I’m ready to share it with you. You will learn how to relive long-suppressed feelings, how to get rid of the pain that has accumulated in your mind for decades, how to get rid of daily stress and work out traumatic memories from the recent past.

I also described in detail my experience of medication and psychotherapy, as well as the experience of various spiritual practices. Some methods worked for me, some didn’t. After reading this book, you will learn how not to make my mistakes and not to waste time and money on useless techniques, learn about the side effects caused by various antidepressants, the exact, and not always harmless, the mechanism of their work.

Here's a partial list of what I've had to try in the last 6 years:

Antidepressants and other medications:

Prozac, Zoloft, Amitriptyline, Lerivon, Remeron, Venlafaxine, Desyrel, Wellbutrin, Paxil, Xanax, Diazepam.

Psychotherapy and body-oriented therapy:

Interpersonal therapy, psychoanalysis, cognitive-behavioral therapy, primary therapy, Rolfing.

Spiritual and meditative practices:

Self-hypnosis, qigong, Scientology, transcendental therapy, holotropic breathing, psychoanalysis, sleep deprivation.

I do not urge you to stop your current treatment, my method is compatible with medication and psychotherapy. There is a high risk of premature and abrupt discontinuation of antidepressants, and they should be taken only under supervision and in consultation with the attending physician. But, practicing my method, you will feel that over time you will no longer need for other types of treatment.

I wrote this book from two points of view – the doctor and the patient. As a doctor, I will tell you about the causes of depression, the mechanism of action and indications for the use of various types of therapy. From me, as a patient, you will learn about the effectiveness of a particular method, side effects of drugs and, finally, that eventually helped me cope with my long-term disease.

I feel better now than I did before my illness. Simultaneous work with suppressed and conscious material gave results that I could not even hope six months ago. But I’m not going to stop there, it’s not enough for me to be just a healthy person in the ordinary sense of the word. Now I have a powerful tool at my disposal, using which I am going to completely clear my mind of the mental debris that has been building up in it for decades. My goal is to return and comprehend my personality, my true self, free from artificially constructed by me or anyone who has ever had an influence on me, psychological barriers, old complexes and beliefs.

Change your life and you. Do not settle for vegetating and suffering for the rest of your life. I know, I know very well that it’s hard for you to believe this right now, but life can really be beautiful and amazing, filled with happiness and meaning. This goal is worth fighting for.

Don't give up, get your life back!