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With so many antidepressants, how do you choose?

Time:2022-09-26 01:55:52 source:psychiatricethics.com author:Prevent anxiety Read:753次
With so many antidepressants, how do you choose?

For patients with depression, especially those who have taken multiple antidepressants, what is the difference between so many antidepressants is a practical issue that everyone is very concerned about. Today, I will introduce to you the commonly used antidepressants. There are currently five major classes of antidepressants in clinical use: monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors. Uptake inhibitors (SNRIs), noradrenergic and specific 5-HT receptor antagonists (NASSA). 1. Monoamine oxidase inhibitors (MAOIs) MAOIs are the first antidepressants discovered in the 1950s and have been widely used. Mainly used to treat endogenous depression, deep or chronic non-endogenous depression. By increasing the levels of norepinephrine, dopamine and 5-HT in the brain, it can improve the patient's mood, increase interest in things, and achieve antidepressant effects. However, MAOIs are potentially dangerous in combination with a variety of drugs, so they are gradually replaced by tricyclic antidepressants. 2. Tricyclic antidepressants (TCAs) Tricyclic antidepressants have been used in the treatment of depression since the 1960s, and commonly used varieties include amitriptyline, imipramine, chlorpromazine, doxepin and clomiphene Clomipramine is currently the most widely used. TCAs have obvious antidepressant effects, but the dosage is too large and there are many side effects, including dry mouth, constipation, difficulty urinating, blurred vision, dizziness, drowsiness, etc., so they are used less and less. 3. Selective serotonin reuptake inhibitor (SSRI) SSRI is a new type of antidepressant with more clinical applications. There are 5 commonly used drugs: fluoxetine, paroxetine, sertraline, citalopram and fluvoxa Ming, commonly known as "five golden flowers". Fluoxetine: It is suitable for the treatment of various depressions, especially senile depression, obsessive-compulsive disorder, phobias and anxiety symptoms of depression, and can also be used for anorexia nervosa. Paroxetine: It has a wide range of effects and can be used to treat depression in patients who have failed other SSRI drugs. It is also very effective in the treatment of anxiety disorders. It is the only FDA-approved drug for all 5 major anxiety disorders. Sertraline: for depression, including depression with anxiety, with or without a history of mania, and obsessive-compulsive disorder, can significantly improve the symptoms of post-stroke depression, for women (except pregnant and lactating women) and the elderly Depressed patients are also more suitable. Citalopram: It can be used for various depressions, especially for patients with physical illness complicated by depression and requiring a combination of drugs, such as post-stroke depression. Fluvoxamine: It is suitable for the treatment of various types of depression and related symptoms and obsessive-compulsive disorder. It can also be used to treat anxiety, irritability, and insomnia. 4. Serotonin and norepinephrine reuptake inhibitors (SNRIs) These drugs exert antidepressant effects by inhibiting the reuptake of serotonin and norepinephrine, also known as "dual channel blockers", representing The medicines are venlafaxine and duloxetine. Venlafaxine: indicated for the treatment of various types of depression (including depression with anxiety), generalized anxiety disorder, and obsessive-compulsive disorder. It can also treat post-stroke depression, which is conducive to the recovery of patients' neurological function, improvement of living ability, and reduction of complications. Duloxetine: It can be used to treat depression, including major depressive disorder, and somatic pain, cognitive impairment and anxiety caused by depression. It also has a good therapeutic effect on generalized anxiety disorder and obsessive-compulsive disorder. 5. The main mechanism of action of noradrenergic and specific 5-HT receptor antagonists (NASSA) is to antagonize presynaptic α2 autoreceptors and presynaptic α2 heteroreceptors and increase norepinephrine, 5- HT level, strengthen the nerve function of noradrenergic and 5-HT, and specifically block 5-HT2A, 5-HT2C and 5-HT3 receptors, and also have a certain degree of antagonism to histamine receptor H1. The representative drug is mirtazapine. This mechanism of action determines that, in addition to antidepressant effects, mirtazapine also has anti-anxiety and sleep aid effects, and can avoid adverse reactions such as nausea and sexual dysfunction. The above summarizes the main functions of several commonly used antidepressants. Do you have a preliminary understanding of these drugs? However, the most important thing about how to take medicine is to follow the advice of a professional doctor. If you have any questions during taking the medicine, remember to communicate with the doctor at any time, and do not take medicine by yourself.

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