This is the 4029 article
of Medical Care
Churchill, once an extraordinary British political leader, an outstanding historian, writer, painter, and winner of the Nobel Prize in Literature, today is another side of him: Churchill There is a “black dog” who has accompanied him through the long years. This “black dog” is called depression. Churchill knew of its existence and called it “the black dog”, which also allows us to see the other side of the great Churchill – the same pressure and despair as ordinary people. Churchill once described his feelings this way: “When I was young, for about two or three years, all I saw was bleak. I went to work and sat in the House of Commons, but black melancholy enveloped me…” (I don’t like standing near the edge of a platform when an express train is passing through. I like to stand back and, if possible, get a pillar between me and the train. I don’t like to stand by the side of a ship and look down into the water. A second’s action would end everything. A few drops of desperation.”)
Today we’re going to talk about the “black dog” – depression and medication.
There are approximately 322 million people with depression worldwide, a prevalence rate of approximately 4.4%. The prevalence of depression in China is about 3% to 5%. The incidence is expected to continue to rise. Depressive disorder is mainly defined as a significant and persistent depression as the main symptom, which is related to genetic, neurobiological, psychosocial and cultural factors, and is a complex disorder formed by multiple mechanisms.
Drug therapy is an important means of depression treatment. In recent decades, a number of new antidepressant drugs have emerged with few side effects and good tolerance. Depression drugs mainly include the following:
1. Inhibition of monoamine oxidase activity
monoamine oxidase inhibitors (MAOIs)
2. Increase the concentration of intersynaptic transmitters
Tricyclic antidepressants (TCAs), including heterocyclic or tetracyclic antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin norepinephrine reuptake inhibitors (SNRIs)
Selective noradrenaline reuptake inhibitors (NRIs)
norepinephrine and dopamine reuptake inhibitors (NDRIs)
3. Blocking receptor related
serotonin antagonist and reuptake inhibitors (SARIs)
α2-adrenergic blockers or noradrenergic and specific serotonergic antidepressants (NaSSAs)
4. Other types of antidepressants
Flupentixine/Melitracen: patients with mild to moderate anxiety and depression, neurasthenia, somatic diseases with anxiety, menopausal anxiety and depression wait
Melatonin receptor agonists: agomelatine, MT1 and MT2 receptors, and antagonizes 5-HT2C, exerts antidepressant, anxiolytic, adjustment The role of sleep rhythm and biological clock; the onset is faster, and it can improve sleep quality and daytime function. There were no withdrawal reactions and did not affect sexual function, body weight, heart rate or blood pressure. Common side effects are headache, dizziness, drowsiness or insomnia, gastrointestinal reactions, and elevated transaminases
Multimodal drugs: vortioxetine, vilazodone
Others: Hypericum perforatum, Shugan Jieyu Capsules, Chaihu Shugan Pills, Xiaoyaosan, etc.
The names, dosages and precautions of the main treatment drugs for depression are summarized in the following tables.
Table 1 Selective serotonin reuptake inhibitors SSRIs
Table 2 Selective serotonin and norepinephrine reuptake inhibitors SNRIs
Table 3 Tricyclic Antidepressants TCAs
Explanation: TCAs are effective in treating severe depression, but are less tolerated than other novel antidepressants (such as SSRIs, NaSSAs, etc.) and lowering epilepsy threshold; associated with alcohol, anticoagulants, anticonvulsants, antihypertensives, antipsychotics, barbiturates, cimetidine, digoxin, morphine, methylphenidate, smoking Long-term treatment of drug interactions requires monitoring of heart and liver function, electrolytes, complete blood count, etc., and monitoring of blood drug concentrations is strongly recommended.
Drug therapy is an important and main means of fighting depression, but non-drug therapy is also an increasingly important means of treatment in recent years, such as patient education, psychotherapy, physical therapy (electroconvulsive/ modified electroconvulsive therapy) and so on. Whether it is drug therapy or non-drug therapy, the formulation of a treatment plan should fully consider the patient’s feelings and experiences, medical history, and individual patient conditions (comorbidities, mutual medication, age, family, etc.).
Treatment of depression is a long and relatively difficult process. The only one who can declare war on the inner “black dog” and save the quagmire is each patient himself. May every depressed patient face the “black dog” in his heart and drive it away optimistically.
References
Movie “Darkest Hour”
2016 NICE: Guidelines for the Recognition and Management of Depression in Adults
2016 ACP Clinical Practice Guidelines: Pharmacological versus Nonpharmacological Treatment of Major Depressive Disorder in Adults
2016 Chinese expert consensus on clinical practice of post-stroke depression
2016 CANMAT Clinical Guidelines: Management of Depression in Adults
2016 ICSI Guidelines for Healthcare: Primary Care Management of Depression (17th Edition)
2020 Japanese Expert Consensus: Drug Treatment of Depression
By: Neurology Clinical Pharmacist
Lu Jin