Modern new generation antidepressants without side effects

Expert: Natalya Shneider

*Review of the best according to the editors of expertology.ru. About the selection criteria. This material is subjective in nature, does not constitute advertising and does not serve as a purchase guide. Before purchasing, consultation with a specialist is required.

We have already presented readers with a rating of sedatives, including both prescription and over-the-counter medications. But when it comes to antidepressants, we have to warn you: all of these drugs are prescription.

. Some of them require not just a piece of paper stamped and signed by a doctor, but must be written out on a special form, and after purchase the prescription remains in the pharmacy, where it is stored for three months. Therefore, you won’t be able to prescribe yourself an antidepressant just based on an article from the Internet (and we should note – fortunately). To do this, you will have to visit a doctor - a neurologist or psychiatrist, who will write a prescription based on his own ideas about which remedy is most suitable for a particular patient. Therefore, the review of modern antidepressants is for informational purposes only and should in no case become a guide to self-medication.

What are antidepressants and when are they prescribed?

The functioning of our brain, including the general background of mood and emotions, depends on the content of special substances in it - neurotransmitters. One of these substances, serotonin, is called the hormone of joy. It maintains a good mood and creates a feeling of happiness. In people with depression, serotonin levels decrease.

These are purely biochemical processes, and telling a person suffering from depression due to low serotonin levels to “just pull yourself together and start moving” is about as productive as telling a patient with diabetes to maintain the desired sugar level through willpower.

Antidepressants increase the amount of serotonin in the body, restoring a person’s “normal” state.

By the way, they are prescribed not only to lift your mood. Another common area for the use of antidepressants is chronic pain (back pain, headaches, fibromyalgia, irritable bowel syndrome pain, etc.). Against the background of constant pain, the synthesis of the body’s own painkillers is disrupted; doctors call this dysfunction of the antinociceptive system. Antidepressants restore natural pain suppression mechanisms. Moreover, if their main effect - improving mood - takes 2-3 weeks, then the analgesic effect appears literally with 1-2 tablets.

Antidepressants are also recommended for anxiety disorders, premenstrual and premenopausal syndromes, urinary and fecal incontinence, and other pathologies.

St. John's wort - down with depression

Since depression is based on a violation of the exchange of brain mediators, it is advisable to resort to the help of specialized drugs - antidepressants. This is a group of drugs that activate the activity of brain structures (Reshetnyak V.K., Kukushkin M.L., 2004), and are designed to improve mood, restore cheerfulness and energy. In addition, it is necessary to take into account that with depression a person is already depressed, and his activity is reduced, therefore taking sedatives can in some cases increase the severity of depression (Damulin I.V., 2005).

Treatment for depression is usually long-term - about 2 months. Therefore, when choosing a drug, the safety profile and tolerability of the drugs used are of particular importance. In this regard, interest in antidepressants based on components of plant origin is significantly increasing. In addition, the preferences of the patients themselves played an important role in this matter. Thus, according to WHO data, the use of herbal medicines is preferred by up to 80% of the world's population. In such a situation, it is difficult to overestimate the importance of the patient’s trust in the drug.

In this context, medicines based on St. John's wort extract attract attention, for example, the German-made drug LIFE 900, which is represented on the domestic pharmaceutical market. The drug LIFE 900 contains a specially developed standardized extract of St. John's wort STW 3-V1 (Khaustova E.A., 2012). LIFE 900 has over-the-counter status, so it can be recommended by a pharmacist.

The effectiveness in the treatment of depressive disorders and the safety profile of drugs based on St. John's wort extract have been well studied. St. John's wort preparations are superior in their effectiveness to some classical antidepressants.

During the study of the effectiveness of LIFE 900, positive dynamics in the patients’ condition was noted already by the 14th day of therapy, and on the 42nd day of treatment, the majority of patients recorded a complete restoration of background mood, energy, activity, ability to concentrate and concentrate attention, they began to show interest and enjoy ordinary things.

During such a long-term use of LIFE 900, no complaints, adverse reactions, complications or phenomena of drug intolerance were identified, and tolerability was assessed as good in all patients (Yavdak I.A., 2013).

Precautions when taking antidepressants

Modern drugs do not cause addiction, but in order for the body to adapt to biochemical changes, it is necessary to start and stop taking them gradually. Doctors usually recommend taking a quarter of the normal dosage in the first two days, then taking half a tablet for several days, and only then taking the full dose. You need to complete the course in reverse order.

When starting to use medications, you need to keep in mind that the desired effect occurs no earlier than after two weeks, and the minimum recommended course duration by WHO is six months (except for situations where the medicine is not prescribed for the treatment of depression). You can't take breaks, so you need to schedule appointments with your doctor in advance to renew your prescription.

New generations of anti-anxiety drugs and daytime tranquilizers

Recently, successful attempts have been made to develop new anxiolytics that do not belong to the class of benzodiazepines. The properties of some old compounds are also being re-examined. This is due to the fact that many doctors are not satisfied with the shortcomings of traditional tranquilizers, which make them unsuitable for constant use. The result of the researchers' activities was the emergence of a group of so-called daytime tranquilizers. This name is not accidental. Most of the drugs on the list of daytime anxiolytics do not cause daytime lethargy and drowsiness in patients and do not lead to a slowdown in reactions. This means that daytime tranquilizers can be used to treat people leading an active lifestyle, those who drive a car. Daytime tranquilizers also do not cause drug dependence or addiction in the patient.

Main names of daytime tranquilizers:

• tofisopam (Grandaxin),
• alprazolam,
• tazepam,
• buspirone,
• Afobazol.

Review of “neutral” antidepressants

These drugs do not have a pronounced sedative or active tonic effect. Such antidepressants are considered safer, since they do not grossly change the “settings” of the nervous system, regulating the general emotional background.

Sertraline

Popularity rating*: 4.9

Trade names: Zoloft, Stipuloton, Serenata, Sirlift, Asentra.

One of the safest antidepressants with a relatively quick (about a week) onset of action. Approved for use by children and during pregnancy, subject to an assessment of the possible risk-benefit ratio. Not recommended for nursing mothers as it passes into breast milk.

The instructions do not indicate incompatibility with alcohol, however, this does not mean that you need to take vodka tablets.

Despite the available generics, the average cost of the medicine is relatively high: from 800 rubles per month of use (as of early April 2019).

Advantages

• low likelihood of side effects,
• you can drive
• Can be taken by pregnant women and children.

Venlafaxine

Popularity rating*: 4.8

Trade names: Velaxin, Velafax, Venlaxor.

This antidepressant has long been well known in the world, and its patent protection, which was valid for 20 years from the date of registration of the molecule, has already been lifted. But for our country this drug is relatively new. It regulates not only the exchange of serotonin, but also norepinephrine and dopamine, which also affect the overall emotional status of the body.

It becomes effective quite quickly: by the end of the first week, but subject to a rapid (5 days) increase in dosage from the minimum - 75 mg per day - to the maximum daily dose of 375 mg. It has shown itself to be effective in the treatment of resistant depression (by the way, in approximately ⅓ of cases, the initially prescribed antidepressant turns out to be ineffective and the drug has to be changed). Improves attention, memory, normalizes sleep.

Side effects when taking venlafaxine are not uncommon: approximately 10% of all cases. On the other hand, they are safe for life: nausea, weight loss, unusual vivid dreams, sweating. May increase blood pressure. Adverse effects are dose-dependent: if you reduce the dosage of the drug, the severity of side effects decreases.

When the medication is abruptly discontinued, extremely unpleasant paresthesia appears - a feeling as if a current discharge is passing through the nerves.

Not approved for use by pregnant women and children under 18 years of age.

Advantages

• acts quickly if the dosage is rapidly increased;
• adverse events are not life-threatening,
• There are many generics, you can find an inexpensive one.

Flaws

• does not combine with alcohol,
• discomfort when stopping the drug.

Escitalopram

Popularity rating*: 4.7

Trade names: Cipralex, Selectra, Elitseya, Lenuksin.

A little “softer” than Zoloft, it also rarely causes adverse events. Effective for anxiety disorders, panic attacks.

Some patients complain that escitalopram increases cravings for sweets.

Not indicated for children under 18 years of age. During pregnancy, the instructions recommend assessing the balance of risk and benefit, but according to post-marketing studies, newborns often required hospitalization and resuscitation measures due to breathing problems, vomiting, low blood pressure and other symptoms, possibly associated with an abrupt cessation of drug intake.

It does not enhance the effects of alcohol; however, combining the use of an antidepressant with alcohol is not recommended.

Can anti-anxiety medications be sold without a prescription?

Anxiolytics are not sold in pharmacies without a prescription. The only exception is Afobazole, which belongs to the group of mild tranquilizers. Almost all tranquilizers belong to the category of psychoactive substances. Therefore, according to the law, they must be dispensed by prescription. Over-the-counter sedatives may be a definite substitute for prescription anti-anxiety medications:

• Corvalol;
• Validol;
• herbal preparations and dietary supplements based on motherwort, St. John's wort, valerian and other medicinal plants;
• vitamin complexes containing zinc and magnesium.

Particular attention should be paid to herbal medicines:

Most of them, when used regularly, can help with mild anxiety and mild stress.

Review of antidepressants with an “invigorating” effect

Depression can manifest itself in different ways. Maybe - anxiety, nervousness, obsessive thoughts about how “bad everything is.” Then it is better to use “sedative” antidepressants. But depression often causes apathy: a state in which crawling out of bed and walking to the kitchen for breakfast becomes a real feat. It is precisely these patients who literally have no strength for anything that need “invigorating” antidepressants.

Fluoxetine

Popularity rating*: 4.5

Trade names: Prozac, Profluzac, Deprex.

One of the first non-addictive antidepressants. Over several decades of active use, it has demonstrated both strengths and weaknesses. Causes a surge of activity and lifts the mood. But if the chosen dosage is too high, increased activity can result in an inappropriately elevated mood, psycho-emotional agitation, excessive thirst for activity, and even a complete loss of contact with reality. Hypomania or mania, agitation are common side effects.

Another side effect is loss of appetite (anorexia). Because of this, fluoxetine was and remains popular among visitors to “weight loss” public pages and forums. Just like with elevated mood, the line between the expected effect and the side effect is quite thin. It is precisely because of such nuances that antidepressants (and not only fluoxetine) should be taken only under the supervision of a doctor.

Since the medicine has been known for a long time, there are many generics (products with different trade names but the same active ingredient). Therefore, there is always the opportunity to choose a drug within your means.

Fluoxetine is contraindicated in children under 18 years of age, pregnant and lactating women.

Advantages

• causes a surge of activity
• eliminates sleep problems,
• affordable price.

Flaws

• not compatible with alcohol,
• may change the reaction speed, so it is not recommended for those who drive.

Paroxetine

Popularity rating*: 4.4

Trade names: Paxil, Rexetine, Adepress, Plizil.

It has not only a stimulating effect, but also a pronounced anti-anxiety effect. Especially recommended for patients with compulsive-obsessive disorders and panic attacks. It has a more selective effect than fluoxetine, meaning it is less likely to cause side effects. On the other hand, the stimulating effect of paroxetine is less pronounced.

Like many antidepressants, it enhances the toxic effect of alcohol, so you should not drink alcohol during therapy.

The instructions for use of the drug stipulate that it does not affect the speed of decision-making and intellectual functions, while manufacturers still recommend not to drive a car or work with mechanisms that require a quick reaction during therapy. It is difficult to say to what extent this reservation is a manifestation of the usual caution for a drug manufacturer. It is best to discuss this with the attending physician, who can assess the condition of a particular patient and has experience in using the medicine, and, therefore, some statistics.

Cannot be used by pregnant women, breastfeeding women or children (no safety studies available).

Advantages

• more selective action.

Flaws

• does not mix with alcohol.

Let’s “get to know” depression once or twice

How can you tell if a person is depressed and not just having a bad day in the morning? First, let's figure out what is meant by this term.

Depression is a condition characterized by a combination of depressed mood and reduced activity: a person is not interested in anything, he is inactive (Fedotova A.V., 2008).

There are two key signs to suspect depression. The first is decreased interest or lack of enjoyment in all or most activities. The second is a depressed mood most of the day, almost every day (Prikhodko V.Yu. et al., 2011). A person with depression experiences constant fatigue, he feels that he “has no strength,” “all his energy has gone,” he is “internally empty.”

In search of a solution to their problem, such patients often rush to the pharmacy for vitamins “to cheer up,” and sometimes for sedatives “for nerves.” How can you recognize a person who has become a victim of depression among the many visitors to a pharmacy, and most importantly, how to help him?

Review of “calming” antidepressants

These are antidepressants with a pronounced sedative effect. They are well suited for people with anxiety disorders, obsessive thoughts, and sleep disorders.

Fluvoxamine

Popularity rating*: 4.3

Trade name: Fevarin.

A modern drug that does not yet have generics. It perfectly restores sleep, which, however, can result in problems with awakening and drowsiness during the day. Approved for use in children, but only for the treatment of obsessive-compulsive disorders (obsessive states). And in principle, judging by the reviews of doctors, it is more effective for treating obsessive-compulsive disorders than depression. It also works well in the treatment of post-traumatic stress disorder.

Not recommended for pregnant and lactating women.

You can drive a car no earlier than 2 weeks from the start of taking the drug - when the absence of side effects in the form of drowsiness is obvious.

Due to the fact that there are no generic versions of this antidepressant, it is not cheap: about 1000 rubles for 15 tablets.

Advantages

• effective for obsessive states.

Trazodone

Popularity rating*: 4.2

Trade name: Trittiko.

Another relatively new antidepressant that does not yet have generics.

It normalizes sleep well and reduces anxiety. Unlike most antidepressants, it does not reduce sexual desire, but, on the contrary, enhances it.

Not recommended for children, pregnant or lactating women. May cause drowsiness, so you should only drive after several weeks of use, when the absence of side effects is obvious.

Advantages

• does not cause a decrease in libido.

Amitriptyline

Popularity rating*: 4.1

At first glance, this medicine has absolutely nothing to do in a review of antidepressants. The first generation medicine has many side effects, the mildest of which is constant drowsiness, which is addictive. But this is the only antidepressant that not only can, but also should be prescribed to people with suicidal tendencies. It is this state of “drowning”, which almost everyone who has taken amitriptyline complains about, that will save the patient from an irreparable step. Most often, the drug is recommended in combination with other antidepressants and gradually discontinued as the other drug begins to act effectively.

Advantages

• allowed for suicidal tendencies,
• effective for pain syndromes,
• cheap.

Age of Depression

Surprisingly, futurists have already dubbed our century the “century of depression,” and their opinion is shared by the scientific and medical community. Indeed, today depression ranks 1st in the world among the causes of absenteeism and 2nd among diseases leading to loss of ability to work. Every year, about 150 million people around the world are unable to work due to depression (WHO, 2001). Among patients who consult doctors about complaints not related to their psychological state, depression is diagnosed in 45–95% (Fedotova A.V., 2008).

Depression prevents us from realizing ourselves as individuals and as a professional, and significantly reduces the quality of life in general. Therefore, it is very important to provide adequate assistance in such a situation.

Unfortunately, in our society there is a stereotype that everyone is capable of coping with depression on their own, and a depressed state for a long time is supposedly not a reason to seek help from a doctor. In this case, many are ready to pour out their souls to anyone - parents, friends and even a random fellow traveler, but not a specialist.

Therefore, pharmaceutical care is of particular importance, because often it is the head of the hospital that the patient turns to for advice and help. If a pharmacy visitor has clearly expressed psychological symptoms, the pharmacist should pay special attention to this fact.