Friday, July 31, 2009

Depression in old age

Depression in old age. Depressive disorders. Timely diagnosis and adequate treatment of depression.
Depression in old age, there very often. We can say that people over 55 years, the most common ailment. According to the World Health Organization, depressive symptoms occur in 40 - 45% of elderly patients, a doctor in connection with various diseases.

The main reason for the development of depressive disorders in this age is the situation of their own aging - increasing physical infirmity, the difficulties of self, difficulty in communicating due to pronounced weakening of eyesight and hearing, loneliness. In addition, aging is rich in various losses such as grief over the death of a loved one, possible illness of spouse, separation from children, deprivation and loss of social status.

Developing depression, usually slowly. Gradually increasing oppression, unfounded or exaggerated fears for their health, family status, material well-being. Older people are immersed in thoughts about the loss in the past, the present insolvency and irrelevance. They are absorbed by the internal work of the body, convinced that they have severe disease. Everything that is happening in the outside world to be minor and uninteresting. Attempts to support, reassure, that person seems insincere, stupid, empty, and often give the opposite effect.

Most older person's mood may be normal and natural. Offer psychological assistance to or receiving antidepressants these people categorically rejected. The relatives are surprised when they reported that such a painful condition can be interpreted as depressive disorder.

Depression in old age is characterized by a combination of anxiety and depression. Replete with vague feelings of apprehension, waiting for all the misfortunes. Especially they are amplified in the evening and night hours. Sick sob, wail, stonut, nervous look around, stupid, or wander mechutsya on the premises. Alarmingly, dreary state is combined with slow toneless speech, lethargy, sedentary.

Old people sure hopelessness of their situation, it seems that the sad state will last forever, life has never been and will not be another (there are not happy do not enjoy). A typical complaint of painful feeling of emptiness today. The greater part of the day patients spent in bed, not interested in going around and ignore the rules of personal hygiene. Often such patients are saying: I torment their home, they would be better off without me.

In these cases, especially high risk of suicide associated with the ideas of self, a sense of hopelessness, despair and loneliness. The most frequent suicidal thoughts occur in older people with depression combined with severe chronic bodily ailment.

When depression is always disturbed sleep, dominated by intermittent night sleep and early awakening to feel unwell in the mornings. Contrary to popular myth, the elderly need to sleep as much as they slept at a younger age, if not more.

Often, when a late depression to the forefront of a complaint to make a bad memory, disorientation, difficulty concentrating. However, these violations are not a sign of dementia and are reversible.

Timely diagnosis and adequate treatment to cope with later depression. Apart from the compulsory treatment of patients with antidepressants need psychological help. In the course of treatment is gradually returned to the desire to live, to be useful, something to help their loved ones, to enjoy life.

Thursday, July 30, 2009

Suicide and Depression


There is only one of a truly serious philosophical
problem - the problem of suicide.
A. Camus (1990. Pp. 24 - 25)

Suicide and depression. Depressive and psychopathological states. Prevention of suicide and depressive disorders.
One of the important medico-social problems of modern society the World Health Organization identifies the problem of suicide. In many countries, suicide is among the top 10 causes of death among adolescents and youth population is the third. Every year, from his own hands kills nearly half a million people, and these data will certainly diminish.

Only in the last decade in Russia an increase in the incidence of suicide to 45-56 cases per 100 thousand people per year, and in some regions and population groups - up to 90 or more, that is combined with a parallel increase in the frequency of depression and alcohol abuse.

Depression - the reason 70% of all committed suicide. Many authors agree that a large number of suicides, which we are linked to inadequate treatment of depression. Depressive disorders, in turn, is one of the most frequent psychopathological states. Approximately every tenth inhabitant of the planet moves throughout their lives from depression, and every twentieth is repeated.

Thus, for the prevention of suicide, it is necessary to conduct adequate early diagnostic interventions aimed at early detection and treatment of depressive disorders.

Wednesday, July 29, 2009

Depression through the eyes of a psychologist

Depression through the eyes of a psychologist. The treatment of depression. Light and heavy depression. Depression and manifestations.
Autumn. Days are becoming shorter, the sun is smaller and sometimes we are sad. And let's try to answer as we are sad. Try to include the following allegations:

• I feel the oppression, suppression.
• I recently changed my appetite and weight.
• I feel anxiety and can not find a place.
• I have a lot of crying.
• I feel tired without apparent reason.
• I do not get pleasure from your favorite courses.
• My thoughts are not as clear as before.
• My future seems bleak to me.
• I do not feel that my life is help people.
• I believe that others would be better if I died / is dead.

And if more than 5 allegations suits you, then you may have depression. Depression can manifest itself very differently. Possible forms variruruyutsya from weak leadership and a little oppressed, fatigue, sleep disturbance and depression, headaches, violations of appetite, constipation, loss of balance in life and, finally, to complete apathy. Specific manifestations of depression are diverse and so unique that it is difficult to put the appropriate diagnosis and often the disease is not recognized in time. Medicine There are three types of depression:

*
Depression caused by organic disease such as myocardial infarction, heart failure, hormonal disorders, trauma.
*
Endogenous depression. This form of depression comes from within, as a consequence of mental predisposition rights. «Endogenous» - measured depth, internal processes (including biochemical). This brings particular suffering depression because the patient does not feel capable of not only the joy, love and interest, but also grief, anger, compassion. Accordingly, such a depression is especially important time to recognize, as it is well kupiruetsya modern antidepressants.
*
Psychogenic depression. It arises from the subjective unportable experiences in connection with psihotravmiruyuschimi situations, the emotions are so intense that they need to suppress (depression - suppression). And for different people, people with a different type of personality that psihotravmoy can be totally different in strength, content, duration of the event.

Common also to all depression is to change samootnosheniya, a change in the perception of its past and future, as well as around the world, when everything starts to see the pessimistic tone.

In particular, are prone to depression, older people suffering from loneliness after the death of a spouse, loss of peers, previously surrounding rights, changes in habits, the restrictions imposed by frequent illnesses.

Depression deprives a person related to future targets for the future. Psihotravma deprives people of hope and strength to see tomorrow, when the prospects offered only disadvantage, the expected suffering, failure, pain, despair, frustration beginnings. To each his own trauma - divorce, separation, difficulties at work, financial difficulties, the suffering of homeless dogs. You better know how it happens to you. In cases of depression caused by the traumatic events of the effectiveness of drugs is minimal. It especially shows psychotherapy aimed at awareness unsuccessful strategies, the search for resources, internal and external awareness of the real problems and causes of depression, consisting in the suppression of important human needs. Depression shows that there is something depressing and demanding that he remove this.

The man under the yoke of depression are not satisfied with themselves, do not trust yourself, do not want to see reality, it loses its depth.

Depression can often be linked to the disease, traditionally called psychosomatic.

Importantly, the «lightweight» Depression is perfectly normal, if they occur after periods of great stress, because they allow the body to relax. But if they delayed it - evidence of distress. Do not make any sense to persuade the patient to relax in the gay community, travel to distant countries to claim that everything is not so bad, and soon will be meaningless to tell that you are, the demand from the patient, that he took himself in hand and not fall ignore the possibility of suicide and the signs of preparation for it. It makes sense to show the patient that his love, that it carefully, want to help. Be prepared for mood, gently help him back to himself, to become himself, to help the suffering to study the history of his life, and together with him to find the true causes of mental disorders. Optimal when such assistance is provided by a qualified psychiatrist.

Paradoxically, in some cases, to recover one must not fight against depression, but instead of falling into it, only in the depths of his life might oppose themselves to the fact that for so long dominated. «I fall to the bottom of the well». To the east of the depression is sometimes considered a gift of the Gods, as it allows and even compels reflection on the meaning of life, to seek answers to the question «Who I am», «Why», and to be updated and re-open the joys and sorrows of this world. And if you go through a depression with a guide, plunge into it, this trip will help give meaning to these difficult experiences, life again twinkle paints, which may have long forgotten.

Tuesday, July 28, 2009

Treatment of depression with light

Light Treatment of depression for more than twenty years trying to make with the help of the world, hoping to change the disturbed biological rhythms of a patient man.

Experimentally it was shown that changes in biological rhythms in the human body occurs when it is illuminated by the light source of high intensity. Attempts were made to prevent the seasonal exacerbation of depression by "lengthening days days" with the help of artificial lighting and sleep deprivation.

It is assumed that the bright light and duration of exposure influence the circadian rhythm centers, inhibits in the epiphysis (glands of internal secretion, in part, regulates the activity of other organs of the endocrine system), the secretion of melatonin, causes changes in the concentration of cortisol in the blood and AKTG patient alters the synthesis of catecholamines, has simpatikotonicheskim and parasimpatikotonicheskim (due to thermal effects) of action. Ultimately, these changes lead to treatment for depression.

For therapeutic effect lighting is needed at least 2600 and not more than 8000 lux.

Coverage achieved by the use of incandescent lamps, located on the ceiling of the House at an altitude of about 2.5 meters. Usually used 27 incandescent lamps of 200 Watts. It is noted that the effectiveness of treatment increases with the light color therapy rooms in the white or green, as well as the maximum (25%), naked body. Before the start of light therapy the patient carefully examined. Treatment of depression with light can be conducted at any time of day, as every day, and with two - three-day intervals. During the therapy session, patients are asked to not only turn a blind eye can move freely around the room.

The majority of the positive effect of light therapy associates with increased regulatory functions of the brain cortex, as well as the normalization of activity of the vegetative system. Interesting to note the sensitivity to light therapy in patients with manifestations of anxiety. To a lesser extent in this type of therapy, patients reacted with symptoms of depression and apathy. Speaking about the mechanism of therapeutic effect of this therapy should be noted, and the thermal effect of light. Common contraindications to the treatment of depression and other mental disorders are the light of oncological diseases and pathology of the eye. Currently, treatment for depression using light special desktop devices.

Monday, July 27, 2009

Psychotherapy of depression

Psychotherapy of depression. Pharmacological treatment of depression. Pharmacotherapy and antidepressants in the treatment of depression.
Depression should not be treated with psychotherapy, and patients themselves to seek this form of medical and psychological assistance. They have not solved a long time to accept drug use as starting receiving antidepressants, often quickly cease medication. Because of helplessness and constant doubt, patients usually suggestibility, and reading the annotations on these or other drugs, it is easy to find in their side effects are already in the first days of treatment. In addition, patients suffering from depression have a functional disorder of internal organs, and because of this really sensitive to side effects of drugs. Many patients have a false alarm with regard to permanent dependence on antidepressants. A significant portion of patients suffering from depression related to a placebo - the reactor, ie people responsive to receiving even "empty pill" does not contain any - or the active drug substance. All of the above determines the increasing interest of patients to psychotherapy.

A major argument against the role of psychotherapy in treating depression, are the experimental data, which speak of the importance of psychological factors in shaping the sustainability of therapeutic drugs for depression. An effective course of psychotherapy in the long term, possibly more useful than the drug because it teaches the patient. The latter acquired the skills to overcome depression, learning to recognize its approach, to prevent the development of its recurrence. The results of many studies, the normalization of endocrine indices in the treatment of depression is achieved not only during treatment with antidepressants, but also in psychotherapy. Moreover, the impact of psychotherapy on endocrine indicators observed in the case of combination therapy with psihofarmakologicheskoy, and in the case of using it as the sole method of treatment.

In some cases, psychotherapy allows patients to adjust to real life, with the continuing violations of affective sphere of thinking and attitudes. Having an independent therapeutic effect, psychotherapy promotes optimal patient and physician collaboration, improves efficiency of medical treatment, and improves family relationships and the professional status of the patient.

Frequent start of depression after acute trauma or prolonged stress leads to a persistent search for the psychological reasons for its occurrence. This fact reinforces the desire of patients to psychological care. However, excessive overestimation of its possibilities, unfortunately, can lead to a complete rejection of psychotropic substances, the formation of resistant variants and the protracted course of depression, the emergence of early exacerbations.

From the standpoint of medical psychotherapy of depression should be primarily aimed at addressing its symptoms. Some of them are more sensitive to psychotherapy and other relatively hard to its effects. Understand that in severe depression psychotherapy opportunities are more limited than in cases of lung disease.

As a target in the mental health impact of depression distinguish disorders of mood, thinking, behavior, motivation and physiological symptoms. Among the affective symptoms - sadness, guilt and shame and anxiety in particular are especially sensitive to psychotherapeutic influence.

There are a number of general principles of the psychotherapist with patients suffering from depression. It is important for the doctor's control own feelings in relation to the patient because you may experience the feeling of emptiness, anger, sympathy, and excessive fatigue. Psychotherapy not only sympathy for the patient, but also closely watched him, keeping a certain distance. In the process of therapy is necessary to strictly regulate the time to communicate with patients, to maintain the structure of the momentum of recovery. The active production of targeted issues, confidence in diagnosis, providing real hope to apply the basic rules of treatment of depression. Studies have shown that from the doctors hope retrospectively evaluated the patients as an important aid in the process of overcoming depression.

A feature of the psychotherapist with patients depression is not so much empathy, understanding how much of the state and, in particular, the possibility of adverse changes of mood episodes. Often the patient is seeking «paralyze» psychotherapist its infinite expectation of assistance, and the latter admits a mistake, putting in the search for theoretical explanations and psychological causes of depression. In fact, the psychotherapist should aim to ensure that the patient drew attention to himself and seek an adequate perception of their situation. Especially desirable conversation with the patient about the symptoms of his condition, much more important to emphasize the dependence of their expression of different situations, to talk about the features and relationships with other people. Compassion psychotherapist usually increases the patient waiting for assistance, an attempt to ease the severity of symptoms leading to their strengthening, consolation - for inconsolable. It is important to bring the patient to the appropriate self-help, not to comfort him, show him the importance of the adoption of a way it is.

For the treatment of depression have been proposed various methods of psychotherapy:

* Psychoanalysis.
* Client-centered therapy.
* Existential therapy.
* Interpersonal therapy.
* Cognitive Therapy.
* Therapy memories.
* Changing the projection in time.
* Relaxation training.
* Therapy to address the social problems and other methods of psychotherapy.
* Includes its mixed or eclectic options.

According to most researchers is most effective in the treatment of depression, cognitive therapy, focusing on correcting thinking features of patients with depression.

Sunday, July 26, 2009

Depression in women

Depression in women. The symptoms of depressive illness. The frequency of manifestations of depression.
"Female character or predisposition to a particular disease?
Depression is called a painful condition that is manifested typical symptoms.

Depression is in no way an expression of weakness. This is a serious disease that is accompanied by violations of all mental and even physical (sleep, appetite, body weight, etc.) functions of man. Loss or reduction of strong-willed qualities - one of the symptoms of depressive illness. Therefore, should not advise a person with depression, "get yourself in the hands" - he will not be able to overcome the disease without medical help. Depression significantly affects the efficiency, education, social life, relationships with others, including loved ones.
Is there a relationship of depression to the female sex?
Doctors are well aware that women suffer from depression more often than men. This is reliably confirmed by the results of numerous large epidemiological studies in different countries, including in Russia. The frequency of depression in women is 2-3 times higher than among men. In modern medicine female gender of the factors predisposing to the development of depression.
Why is women's predisposition to depression?
Depression is largely associated with changes in hormonal background, which occur in the female body in child-bearing age. The so-called reproductive (genital) cycle takes place a number of stages, beginning with the appearance of menses and ending their disappearance: menstruation, pregnancy, childbirth, and pre menopause. At each of these stages in the composition and amount of hormones significant changes, which are accompanied by changes in physiological functions of the female body, including the mental sphere. Therefore, these hormonal changes in the background associated with increased risk for depression.
As evident depression in women?
As already mentioned, the risk of depression increases in each of the phases of the reproductive cycle. In clinical medicine provided different options (syndromes) of depression, specific to each of the phases of the reproductive cycle - premenstrual syndrome, depressive syndrome pregnant, the syndrome "sadness mothers, postnatal depression and depression in pre and menopause.

Manifestations of depression may be different. Depressed mood may be manifested as oppression, suppression and apathy, as well as increased irritability, maudlin, anxiety, a sense of internal tension. The change of mood is usually accompanied by a decrease in activity, a sense of loss of energy, increased fatigue, distraction of attention. Depression in women is often accompanied by a variety of somatic disorders: the changes of sleep (insomnia or increased sleepiness), appetite (decreased appetite or increase). May appear unpleasant feelings of stress and a sense of pain in the mammary glands, headaches, pain in joints and muscles, heart pain and occasional feelings of heart, weak in body, fluctuations in blood pressure, etc.

Duration of depression associated with the reproductive cycle may be different. Premenstrual depressive syndrome are usually short, approximately 2 weeks (1 week before and 1 week after the menstrual period), but has a recurrent character with the corresponding monthly menstrual cycle aggravation. Post-natal depression and depression menopause may be more prolonged and continue for several weeks and even months.
How can you treat depression?
Depression - curable diseases. With the correct selection of the appropriate drug and dose may complete freedom from symptoms of depression.

Treatment of depression is carried out only with the help of special medicines, which are called antidepressants.

Treatment of depression should target only the doctor. We should remember that every person has depression, especially as related to the degree of severity of illness, and with its clinical manifestations. The correct choice of treatment in each case requires an assessment of the many features of the patient. Correctly identify, evaluate and classify such features can only be a doctor. Do not resort to the advice of relatives or friends or choose a means of self-treatment, based on the fact that a drug has helped someone who you know.

This rule must be observed, especially if the change of mood is accompanied by marked changes in the overall state of health, human bodily functions and pain, the most characteristic of depression associated with reproductive cycle. In such cases, only a doctor can properly assess the nature of the symptoms, to determine the actual state of internal organs and select drugs that will not only effective but also safe. Strongly advised to take antidepressants during pregnancy and lactation.

To date, there are many antidepressants. All current drugs of this class are effective and safe means. However, each drug has its own distinctive features associated with therapeutic effects, and ways of receiving, dispensing.

Treatment of depression takes time. Do not wait for the full treatment in the first days of taking the medication. It must be remembered that all modern antidepressants for depression begin no earlier than 1 -2 weeks after starting treatment. During this period also being the selection of the required dosage.

Cancel antidepressant, as well as his appointment should only be a doctor. Even after the complete disappearance of all symptoms of depression should continue to receive antidepressant for a period of time. This is because the risk of worsening of depression in the case of premature lifting of therapy is very high - up to 60-80%. Moreover, worsening of depression associated with premature discontinuation of treatment is usually more difficult to care. The duration of such an additional period of treatment, the purpose of which - the prevention of escalation, determines only a doctor by individual characteristics of each patient.

Keep in mind that if you decide to stop treatment before the deadline, which has identified the physician must be sure to consult with him.

Saturday, July 25, 2009

No Do you have depression?

Check whether you have depression? Mental disorders, bad mood, boredom and indecision on the soul. Symptoms of depression and depressive disorder.
Currently, the depression ahead of all other mental disorders to the extent of the damage to work and, consequently, on the percentage of years lost to a full life. A large proportion of patients with depressive disorders seek help from obschesomaticheskuyu network. In doing so, only 10-30% of cases depression is detected in time. This test symptoms of depression and evaluation of its gravity in line with the criteria of the International Classification of Diseases 10 th revision (ICD-10), but filled with specific content of our private medical practice.


Typical (main) symptoms of depression:

* A bad mood, depression, black, dark, oppressive, shabby, upadnicheskoe, dreary, "nothing good", "boredom at heart, all gray to me."
* "There is no traction to the case: you may defer implementation of any plans or status, or a long set himself to carry them out. There is no desire to unravel the business problem, the contents of an important conversation - you know that it needs to be done, but not doing. Manufacturing solutions, business acquaintances also defers to the "tomorrow." Nothing interesting, do not want to do anything, but you know what to do here. Joy is not like before - "Everything was as it still." It has long been forgotten, when something happy.
* Get tired right away, even after minor physical effort, or the evening after returning from work or to not have enough forces. Perhaps the feeling of constant fatigue. It seems that never rested. I would like to shed the responsibilities at home, at work - to rest, gain strength. However, short-rest does not improve the status and entertainment quickly lose its appeal.

Other symptoms of depression:

* Hard to concentrate in the presence of an irritant (for example, a TV, radio, talking in the next room), because of the "parallel" thinking - "I read and think about the other." In the communication has been difficult to choose words to capture the conversation thread, reading books, journals, business records hardly captured the meaning of reading, had to re-reread the page.
* There is unusual for you indecisiveness, persistent doubts about the performance of everyday household and familiar professional duties, after the decision. Lost self-confidence - "Suddenly, not as I say, not do."
* Can a critical evaluation of the whole past life - "Everything that was in the past, drifter, it was necessary to engage others." You have a sad feeling of "burden" in the family, "superfluous man" at work. Reproaches himself for his irresponsible attitude towards filial responsibilities, or a child, insufficient attention to other close relatives.
* You conquered the dark thoughts that you - "loser" in life can not solve their problems, finding a full professional bankruptcy, the finish (I completed their life "). Dark and pessimistic vision of the future can be filled out and very specific domestic circumstances.
* Sometimes there are thoughts - "It may be easier to withdraw from life, as all bad, bad, bad ...", desperate, no prospects and, in general, life for you ceased to be something meaningful, has lost its meaning.
* Sleep problems is diverse. This is a difficult time falling asleep, a reduction of hours of night sleep due to frequent awakening, awakening in the 3-4 o'clock in the morning or 5 o'clock in the morning, followed by insomnia. In all variants of disorders of sleep after the final morning awakening there is no feeling of freshness (rest).
* Decreased appetite ( "I can limit daily glass of tea"), or no appetite at all, perhaps even in disgust to the sight and smell of food.

Depression Self-diagnostics
In case you do not dial 3 any symptoms (main and supplementary list), you do not have a depressive mood disorder, according to the criteria of ICD-10.
Easy depressive disorder
The presence of 2-all typical symptoms of depression and at least 2 symptoms from a list of "a-g". You are concerned about their condition. Experiencing some difficulty in carrying out normal work and social activity.
Moderate depressive disorder
The presence of 2-all typical symptoms of depression and at least 3 (preferably 4) of the list of "a-g". There are considerable difficulties in fulfilling social responsibilities, home affairs and the continuation of professional work.
Heavy depressive disorder
The presence of all 3 of typical depressive symptoms, and 4 or more from the list of "a-g". Social and domestic activities can be very limited and its implementation is unlikely.
If you have a depressive mood disorder in accordance with the criteria of your condition may be exacerbated by a number of additional painful manifestations:

* You want to be the one (one), all insulate oneself; feel like "zapolzti as a snail in a shell - that no one touched you, did not respond to questions."
* Close to notice that you have been unusually silent, vanished from the face smiling.
* Relationship with relatives in the family, the staff at work compounded extrinsical you previously increased irritability, sometimes amounting to aggression.
* The feeling of heaviness in the chest ( "Like a stone on the heart," "How come an elephant) or a nagging pain in the left half of the chest or burning sensation in the sternum.
* There was inappropriate you slowness in movements, or, conversely, motor agitation, anxiety, neusidchivost ( "Can not find a place").
* During the period of depression significantly reduced libido - "How to cut, do not even think about it"
* Especially bad you feel in the morning and afternoon. By the evening feeling slightly better (a typical diurnal rhythm of depressive mood disorders.
* An attempt to improve their health, remove the spiritual discomfort receiving alcohol had only a temporary and unstable effect.

If you find a host or a member of his family foundation for self-depressive mood disorders should seek psychological help.

Friday, July 24, 2009

All about the treatment of depression

All about the treatment of depression. Methods of treatment of depression. Mental health care. Biological treatment and psychotherapy.
Unfortunately, most people with depression do not understand that they are sick, and therefore did not consider it necessary to seek medical attention for depression, and suffer the issue: how to get rid of depression?

How to effectively treat depression, are not known to many inhabitants. However, treatment of the first signs of depression are not only worried about them. Efficient help with depression remains a challenge not only to psychiatrists, doctors, and psychotherapists. The successful treatment of depression is necessary to include a biological therapy, psychotherapy and social interventions aimed at improving the status of the patient.

Spontaneous healing in the protracted course of depression was rarely and is about 10% of all cases, the return of depression when it happens over the next 2-4 years.

The effectiveness of the treatment of depression depends on its clinical picture and the adequacy of therapeutic interventions. Biological treatment of depression primarily consists of pharmacological therapy. At the same time for the biological treatment of depression may be used: Electro-therapy, sleep deprivation, phototherapy, diet therapy, therapy with medicinal herbs, efferent sorption technique and other biological effects on the body means a patient man. Among the pharmacotherapeutic treatment of depression most commonly used antidepressants, but the treatment of this disease, are also used and other drugs: tranquilizers, neuroleptics, vitamins, hormones, antioxidants, salts of lithium, drugs that improve the metabolism of brain cells, affecting the immune system and other medicinal means.

It should be noted that antidepressants could also be effective in the treatment of anxiety, fear, obsessions states, migraine, bulimia, autonomic crisis and even the removal of pain of different origin, since antidepressants generally increase the threshold of pain sensitivity. Treatment can be signs of depression through psychotherapy. To get rid of depression, patients have to seek this form of medical and psychological assistance. Patient long-term depression is not solved by resorting to receive drugs and start receiving antidepressants, often quickly terminate drug treatment of depression.

Because of helplessness and constant doubt, patients usually suggestibility, and reading the annotations on these or other drugs, it is easy to find in their side effects are already in the first days of treatment. In addition, patients suffering from depression have a functional disorder of internal organs, and because of this really sensitive to side effects of drugs. Many patients have a false alarm with regard to permanent dependence on antidepressants. A significant portion of patients suffering from depression related to a placebo - the reactor, ie people are easily reactive to receive even the «empty pill», does not contain any active drug substance. All of the above determines the increasing interest of patients to psychotherapy.

A major argument against the role of psychotherapy in treating depression, are the experimental data, which speak of the importance of psychological factors in shaping the sustainability of therapeutic drugs for depression. An effective course of psychotherapy in the long term, possibly more useful than the drug because it teaches the patient. The latter acquired the skills to overcome depression, learning to recognize its approach, to prevent the development of its recurrence. The results of many studies, the normalization of endocrine indices in the treatment of depression is achieved not only during treatment with antidepressants, but also in psychotherapy. Moreover, the impact of psychotherapy on endocrine indicators observed in the case of combination therapy with psihofarmakologicheskoy, and in the case of using it as the sole method of treatment.

In some cases, psychotherapy allows patients to adjust to real life. Having an independent therapeutic effect, psychotherapy promotes optimal patient and physician collaboration, improves efficiency of medical treatment, and improves family relationships and the professional status of the patient.

Frequent start of depression after acute trauma or prolonged stress leads to a persistent search for the psychological reasons for its occurrence. This fact reinforces the desire for psychological care of patients with depression. However, excessive overestimation of its possibilities, unfortunately, can lead to a complete rejection of psychotropic substances, the formation of resistant variants and the protracted course of depression, the emergence of early exacerbations. Question: how to treat a patient for depression remains an open question.

From the standpoint of medical psychotherapy of depression should be primarily directed towards the elimination of, signs of depression. Some of them are more sensitive to psychotherapy and other relatively hard to its effects. Understand that in severe depression psychotherapy opportunities are more limited than in cases of lung disease. As the impact of mental health targets in the treatment of depression provide disorders of mood, thinking, behavior, motivation and physiological symptoms. Among the affective symptoms - sadness, guilt and shame and anxiety in particular are especially sensitive to psychotherapeutic influence.

Thursday, July 23, 2009

What is depression?

Depression - a mental illness characterized by mood disorder


What are the symptoms of depression?

The most common symptoms of depression are:

*
Bleak, depression, loss of sensation of pleasure.
*
The lack of interest.
*
Inability to concentrate, memory.
*
Failure to take action, obsessive return to the same issues.
*
Fear (to everyday life or indeterminate), inner restlessness, anxiety.
*
The sense of fatigue, lack of energy.
*
Sleep Disorders.
*
Loss of appetite, reducing weight.
*
Lack of sexual interest.
*
The sense of pressure, heaviness in the abdomen and chest.
*
Vegetative symptoms (dry mouth, constipation, sweating, etc.).

What if depression is suffering people close to you?

*
We should not ignore the complaints and to prohibit a patient from depression.
*
Do not let the flat and comforting remark or trivial podbadrivany.
*
Do not attempt to liven up the patient.
*
Stress short-term depressive state, warned the hope for an end to depression.
*
Do not call for expressions of the will of the patient, do not talk to him: «You must commit itself to the hand», you could if you wanted to », etc.
*
Do not make the patient feel helpless and guilty man.
*
Do not call for such virtues as faith, or sense of responsibility.
*
To release the depressed patient from having to make decisions, especially important.
*
Keep yourself with the patient calm, smoothly and confidently.
*
Organize themselves coming to the doctor and accompany the patient
*
Relieve the patient against his or her personal and business contacts.
*
Do not change the fundamental habits of the patient.
*
Do not insist on sick leave, especially if there are no signs of pronounced depression.
*
Show your sympathy and understanding, keep the patient in the discharge of his own immediate and real problems.
*
Pay attention to the patient at all that it can be done, do not let yourself with triumphant intonations.
*
Watch for regular compliance with the patient, measured the distribution of cases in the daily
*
Do not allow the patient to lie in the morning in bed, lay down to sleep early and stayed one.
*
Make sure that patient care.
*
Avoid factitious gaiety.
*
Do not blame, and comments.
*
Try to stimulate the patient's breathing.
*
Not to refer to the past successes of the patient.
*
Do not self sick, contact your specialist psychiatrists.

How to treat depression?
Modern treatment of depression includes:

*
Use of biological methods of therapy (primarily drug psihofarmakologicheskimi). A prerequisite for effective treatment is the cooperation with your doctor: strict adherence to the prescribed regime of treatment, frequency of visits to the doctor, a detailed, frank account of his condition and life difficulties.
*
Psychotherapy (individual, group and family) is not an option, but an important addition to the medical treatment of depression. In contrast to the pharmacological treatment of psychotherapy involves a more active role in patient care. Psychotherapy helps patients develop skills for emotional self-regulation in the future to better cope with the crisis, not plunging into depression.

What usually prevents the treatment of psihoterapevticheskroy help?

*
Low awareness of people about what psychotherapy.
*
Fear of initiation of foreign rights in the personal, intimate experience.
*
Skepticism that the "conversations" can provide significant therapeutic effect.
*
The notion that psychological problems have to handle yourself in a reference to another person is a sign of weakness.

Help closest people to overcome depression.
Support for relatives of people, even when the patient does not express interest in it is very important to overcome depression.
In this regard, you can give the following advice to relatives of patients:

*
Remember, depression - a disease in which you want sympathy, but neither koem if you can not dive into the disease along with patients, sharing his pessimism and despair. You need to be able to maintain a certain emotional distance, all the time reminding themselves and the patient that depression - this is a transient emotional state.
*
Studies have shown that depression has adversely especially in those families where they do a lot of criticism of the patient. Try to understand the patient that his condition - it is not his fault, and the trouble that he needs the help and treatment.
*
Try not to focus on the illness of a person and bring positive emotions in their life and family life. If possible, try to involve the patient in some useful activity, but did not remove him from the case.

Wednesday, July 22, 2009

HELP WITH Depression

Modern approach to treatment of depression involves a combination of different methods - a biological therapy (medication and non medication) and psychotherapy.

Medication.
Appointed patients with mild, moderate and severe forms of depression. A prerequisite for effective treatment is the cooperation with your doctor: strict adherence to the prescribed regime of treatment, frequency of visits to the doctor, a detailed, frank account of his condition and life difficulties.

Antidepressants.
Proper treatment makes it possible in most cases, completely eliminate the symptoms of depression. Depression requires treatment by specialists. The major class of drugs for the treatment of depression is antidepressant medication. Currently, there are various medications of the group, including tricyclic aptidepressanty (amitriptyline, melipramin) and used since the late 50's. In recent years, the number of antidepressant drugs has increased significantly.

The main advantages of new generation antidepressants are to improve portability, reduction of side effects, reduction of toxicity and high safety in overdose. New fluoxetin include antidepressants (Prozac, profluzak) sertralin (zoloft), tsitalopram (tsipramil), paroxetine (Paksi) fluvoksamin (fevarin) tianeptin (koaksil), mianserin (lerivon) moklobemid (auroriks) milnatsipran (iksel) , mirtazapin (remeron) and other antidepressants are a safe class of psychotropic drugs, when properly applied according to recommendations of a doctor. Dose is determined individually for each patient. You must know that the therapeutic effects of antidepressants may occur slowly and gradually, so it is important to positively set up and wait for his appearance.

Antidepressants are not addictive and the development of the syndrome, as opposed to the abolition of the class of drugs benzodiazeninovyh tranquilizers (fenazepam, relanium, elenium, tazepam and others) and is widely used in our country korvalola, valokordina. In addition, benzodiazepinovye tranquilizers and phenobarbital, are part of korvalola and valokordina with long-term use reduces the sensitivity to other psihofarmakologicheskim means.

The main stages of therapy.

* Definition of treatment: the choice of antidepressant in the light of the major symptoms of depression for each patient, the selection of adequate doses of medication and individual treatment
* Implementation of the basic course of therapy aimed at reducing symptoms of depression up to their disappearance, the restoration of the former characteristic of patient activity
* Carrying out maintenance treatment for 4-6 months or more after the normalization of the state. This phase is aimed at preventing the worsening of the disease

What usually prevents the holding of medical treatment:

* Misconceptions about the nature of depression and the role of medication
* A common misconception about the harm of all unconditional psychotropic drugs: the emergence of dependence, a negative effect on internal organs. Many patients believe that it is better to suffer from depression than taking antidepressants
* Many patients interrupt reception in the absence of a rapid effect, or occasionally taking drugs

It is important to remember that numerous studies confirm the high efficacy and safety of modern antidepressants. Damage caused by depression and emotional well-being, according to the severity nesopostavim small and easily removable side effects that sometimes occur when using antidepressants. It should be remembered that the therapeutic effects of antidepressants is often only 2-4 weeks after the start of the reception.

Psychotherapy.
Psychotherapy is not an option, but an important addition to the medical treatment of depression. In contrast to the pharmacological treatment of psychotherapy involves a more active role in patient care. Psychotherapy helps patients develop skills for emotional self-regulation in the future to better cope with the crisis, not plunging into depression.

In the treatment of depression as the most effective and science-based approach proved to three: psychodynamic psychotherapy, cognitive behavioral psychotherapy, and psychotherapy.

According to psychodynamic therapy, psychological basis of depression is the internal unconscious conflicts. For example, the desire to be independent and simultaneous desire to receive a large amount of support, assistance and care from other people. Another characteristic is the presence of intense conflict of anger, resentment on others, combined with the need to always be kind and good and to keep the location of loved ones. The sources of these conflicts lie in the history of the patient's life, which becomes the subject of analysis in psychodynamic therapy. In each individual case may be its unique content of conflicting emotions, and therefore require individual psychotherapeutic work. The aim of therapy - awareness of the conflict and in its constructive resolution: to learn how to balance independence and closeness, to develop the ability to constructively express their feelings and to keep that relationship with people. Behavioral Psychotherapy is aimed at resolving the current problems of the patient withdrawal, and behavioral symptoms: passivity, denial of pleasure, monotonous way of life, isolation from the others, the inability to plan and engage in purposeful activity.

Cognitive psychotherapy is a synthesis of both the above approaches, and combines their advantages. It combines work with the current life difficulties and behavioral symptoms of depression and work with their internal psychological sources (depth and beliefs). The main psychological mechanism of depression in cognitive psychotherapy is considered the so-called negative thinking, which is reflected in the tendency of depressed patients to consider all that happens to them in a negative light. Changes of this kind of thinking requires a careful individual work, which aims at developing a more realistic and optimistic look at ourselves in the world and in the future.

Additional forms of psychotherapy of depression are marital counseling and group therapy (but not all, but specially designed to help depressive patients). Their involvement can be of great assistance in treatment and rehabilitation.

What usually prevents the treatment of psychological help?

* Low awareness of people about what psychotherapy
* Fear of initiation of foreign rights in the personal, intimate experience
* Skepticism that «talk» can provide significant therapeutic effect
* The notion that psychological problems have to handle yourself in a reference to another person is a sign of weakness

In modern society, psychotherapy is a recognized, effective way to help with various mental disorders. Thus, the rate of cognitive psychotherapy significantly reduces the risk of recurrence of depression. Modern methods of psychotherapy focus on short-term (10-30 sessions, depending on the severity of condition) effectively. All information received by a psychotherapist in session is strictly confidential and remains confidential. A professional psychologist trained to work with heavy feelings and difficult life situations of others, he knows how to respect and assist in coping with them. Every person in life there are situations (such as illness), with whom he could not cope alone. The ability to ask for help and accept it is a sign of maturity and rationality, rather than weakness.

Assistance to relatives of people in overcoming depression
Support for relatives of people, even when the patient does not express interest in it is very important to overcome depression.
In this regard, you can give the following advice to relatives of patients:

* Remember, depression - a disease in which you want sympathy, but neither koem if you can not dive into the disease along with patients, sharing his pessimism and despair. You need to be able to maintain a certain emotional distance, all the time reminding themselves and the patient that depression - this is a transient emotional state
* Studies have shown that depression has adversely especially in those families where they do a lot of criticism of the patient. Try to understand the patient that his condition - it is not his fault, and the trouble that he needs the help and treatment
* Try not to focus on the illness of a person and bring positive emotions in their life and family life. If possible, try to involve the patient in some useful activity, but not remove it from the cases

Scientific knowledge Depression

The main types of depression
Often depression is emerging against the backdrop of existing long-term stress, or severe traumatic situations. Sometimes they occur for no apparent reason. Depression can accompany systemic diseases (cardiovascular, gastrointestinal, endocrine, etc.). In such cases it is substantially burdening the main course and prognosis of somatic diseases. However, early detection and treatment of depression observed rapid improvement in mental and physical well-being.

Depression can occur in a single, different severity of episodes of disease or take a long time in the form of repeated exacerbations.

In some patients the depression is chronic - can last many years without reaching a significant gravity.

Sometimes depression is limited mainly bodily symptoms without distinct emotional expressions. In doing so, clinical and laboratory tests could not detect any organic changes. In such cases the advice of psychiatrists.

Modern ideas about the causes of depression
Bio-psycho-social model of depression.
Modern science considers depression as an illness, the origins of which contribute to different causes or factors - biological, psychological and social.
Biology of Depression.

To biological factors of depression include, above all, the specific violations of neurochemical processes (exchange neuromediators, such as serotonin, noradrenalin, acetylcholine, etc.). These violations, in turn, may be hereditarily conditioned.

Psychology Depression.
The research revealed the following psychological factors of depression:

* A special way of thinking, the so-called negative thinking, which is characterized by fixation on the negative aspects of life and their own personality, the tendency to see in a negative light surrounding the life and its future
* The particular style of communication in a family with a high level of criticism increased conflict
* Increased the number of stressors of life events in personal life (separation, divorce, alcoholisation loved ones, death of loved ones)
* Social exclusion from a small number of warm, trusting contacts that could serve as a source of emotional support

Social context of depression.
Growth depression in modern civilization is associated with a high tempo of life, raising her stressors: a highly competitive modern society, social instability - a high level of migration, the difficult economic conditions, uncertainty about the future. In modern society, cultivated a range of values, starvation of the rights of permanent dissatisfaction with each other - and the personality cult of physical perfection, the cult of power, of superiority over other people and personal well-being. It makes people hard to survive and to hide their problems and failures, depriving them of their emotional support and condemned to solitude.

Tuesday, July 21, 2009

Depression - a disease of our time.

Studies worldwide show: Depression, like cardiovascular disease, has become the most prevalent disease of our time. This is a common disorder that affects millions of people. According to various researchers, they are suffering up to 20% of the population in developed countries.

Depression - a serious disease that dramatically reduces the work and brings suffering to the patient as well and his family. Unfortunately, very few people are aware of the typical manifestations and consequences of depression, so many patients are assisted, when the state takes a protracted and severe, and sometimes - and is not provided. Virtually all developed countries, health services are concerned with the situation and put its efforts to disseminate information about depression and its treatment modalities.

Depression - disease of the body. Typical signs of depression
The manifestations of depression are diverse and vary depending on the form of the disease. The most common symptoms of this disorder:

Emotional expression

* Tosca, suffering, distress, gloom, despair
* Anxiety, a sense of internal tension, waiting for trouble
* Irritability
* A sense of guilt, frequent self -
* The frustration is, the reduction of self-confidence, self-reduction
* Reduction or loss of ability to experience pleasure from previously enjoyable classes
* Decreased interest in the world
* Loss of ability to feel any sense (in cases of deep depression)
* Depression is often combined with anxiety about health and the fate of loved ones, as well as with fear seem untenable in public places

Physiological manifestations

* Sleep disorders (insomnia, drowsiness)
* Changes in appetite (loss or overeating)
* Violation of bowel function (constipation)
* Decreased sexual
* Decreased energy, increased fatigue in normal physical and intellectual conditions, the weakness
* Pain and a variety of unpleasant sensations in the body (for example, in the heart of the stomach muscle)

Behavioral manifestations

* Passivity, difficulty engaging in purposeful activity
* Avoiding contact (propensity for solitude, loss of interest in other people)
* Waiver of entertainment
* Alcoholisation and substance abuse, giving temporary relief

The thought of

* Difficulty concentrating, focusing
* The difficulty of the decision-making
* The preponderance of dark, negative thoughts about themselves, about their life on the world as a whole
* Dark, pessimistic vision of the future with a lack of perspective, irrational thoughts about life
* Thoughts of suicide (in severe cases of depression)
* Availability of thinking about their own useless, insignificant, helpless
* Slow thinking

For diagnosis «depression» it is necessary that some of the symptoms persisted for at least two weeks.

Depression should be treated.
Depression is often perceived as a very sick, and others as an expression of bad character, laziness and selfishness, promiscuity or natural pessimism. It should be remembered that depression - not simply a bad mood (see expression above), a disease which requires the intervention of specialists and well enough to treat. The earlier put the correct diagnosis and proper treatment initiated, the greater the chances for a swift recovery, the fact that depression does not recur again and did not take severe form, accompanied by a desire to commit suicide.

What usually prevents people ask for help about depression?

Often people are afraid to turn to specialist mental disorders because of the alleged negative effects:

* The potential social restrictions (of registration, a ban on driving motor vehicles, and travel abroad)
* Conviction in the case, if someone learns that a patient is treated with a psychiatrist
* The fear of negative influence of medication, which is based on the widespread, but not the correct understanding of the harm of psychotropic substances

Often people do not have the necessary information and properly understand the nature of his condition. They think that if their condition is linked to the understandable difficulties in life, it is not a depression, a normal human reaction to take place independently. Often happens that the physiological manifestations of depression contributed to a belief that there were serious systemic diseases. This is an opportunity for treatment to a medical practitioner.

80% of patients with depression first seek help from general practitioners, and the correct diagnosis is established about 5% of them. Adequate therapy gets even smaller number of patients. Unfortunately, the usual admission clinic is not always possible to delineate the physiological manifestations of depression and the presence of a true systemic diseases, which leads to production of false diagnosis. Patients appoint symptomatic therapy (medication «for the heart», «to the stomach», «of a headache»), but the improvement does not occur. Having thought about the hard, unrecognized systemic diseases, the mechanism that leads to a vicious circle Enhancement depression. Patients spend a lot of time on clinical and laboratory tests, and usually get to a psychiatrist from the severe, chronic forms of depression.

Monday, July 20, 2009

Sinequan (Doxepin)




Trade names

Sinequan.

Subgroup

Antidepressant tricyclic structures derived.

Action

Pharmacological Effects:

* Antidepressive,
* Anxiolytic,
* Sedative,
* Protivoyazvennoe,
* Antiholinergicheskoe,
* Antiserotoninovoe,
* Antihistaminic,
* Spasmolytic,
* Vasorelaxant (moderate peripheral)
* Miorelaksiruyuschee,
* Anticonvulsant.

Distinct antidepressive effect develops after 2-3 weeks of treatment. It stimulates the central nervous system, does not inhibit MAO.

Mechanism of Action

The mechanism of action associated with an effect on adrenergic transmission in the central nervous system, in particular, to reverse the blockade of neuronal noradrenaline capture.

Pharmacokinetics

Quickly and completely absorbed in ZHKT, metabolized in the liver, with the participation of cytochrome P450 2D6 to the pharmacologically active dimethyl-Sinequana further glyukuronidiruetsya and ekskretiruetsya with urine, T1 / 2 - 28-52 h; distributed throughout the tissue is found, particularly in the lungs, heart, brain and liver.

Indications

Depression and / or anxiety in the neuroses, alcoholism, organic diseases of the CNS, psychosis (including involutional depression and manic-depressive).

In practice obscheterapevticheskoy - duodenal ulcer, dumping syndrome, premenstrual syndrome, chronic pain in cancer patients, itchy skin, chronic idiopathic urticaria.

Contraindications

* Hypersensitivity to Sinequanu,
* Zakrytougolnaya glaucoma,
* AV blockade
* Adenoma of the prostate and the tendency to delay the urine,
* Pregnancy
* Breast-feeding (should abandon breastfeeding)
* Children age (under 12).

Side Effects

Cuhost mouth, nausea, vomiting, anorexia, disturbance of taste sensation, diarrhea, constipation, thrush, delayed urine, jaundice. Reduced body weight, increased sweating, chills, general weakness, feeling tide of blood-to-face.

Dizziness, the noise in the ears, headache, visual impairment, drowsiness, disorientation, hallucinations, paresthesia, ataxia, ekstrapiramidnye violation, convulsions, diskineziya tardive, tremor, arterial hypotension, hypertension, tachycardia.

Allergic reactions - skin rash, itching, photosensitization, angionevrotichesky edema, eosinophilia.

Aggravation of the flow of bronchial asthma.

Rarely - leukopenia, agranulocytosis, thrombocytopenia.

Increase or decrease in libido, swelling of testicles, ginekomastiya (men), an increase in the mammary glands, galaktoreya (women). Hypo-or hyperglycemia, syndrome of inappropriate secretion antidiureticheskogo hormones, alopecia.

Dependence syndrome and the abolition of

With sudden cessation of treatment may cancel the development of the syndrome (nausea, headache, general weakness).

Interaction

Tsimetidin Sinequana increases the concentration in plasma, and enhances its main side effect. Patients with diabetes with co-application with tolazamidom may develop pronounced hypoglycemia. If you are applying Sinequana with chlorpromazine developed giperpireksiya.

Dosing and Administration in Adults

When moderately expressed, and the degree of depression or anxiety Sinequan initial dose, with ingestion of 75 mg / day. In the future, gradually picked up individually effective dose (usually 75-150 mg / day).

When the degree of depression and / or anxiety Sinequana effective dose can be as high as 300 mg / day. In patients with a minimally effective dose expressed violations - 25-50 mg / day.

Take inside 1-2 times / day (with a single admission in the course of the day dose Sinequana should not exceed 150 mg).

In most of the disorders of sleep daily dose taken at night.

Dosing and Administration in pediatric practice

Suitable for children over 12 years.

Pregnancy and lactation

Pregnancy and lactation are contraindications.

Overdosage

Drowsiness, stupor, hallucinations, visual impairment, the expansion of pupils, dry mouth, nausea, respiratory depression, severe arterial hypotension, coma, convulsions, muscle rigidity, tachycardia, arrhythmias, typical of the tricyclic antidepressant intoxication ECG changes (especially the QRS).

Cautions

When treating Sinequanom should not engage in activities that require high concentration and rapid psychomotor reactions, increased rate of mental and motor responses.

During the period of treatment is not allowed alcohol, use of MAO inhibitors.

Sunday, July 19, 2009

Amitriptyline




Trade names

Amizol. Amineurin. Amirol. Amiton. Amitriptyline. Amitriptyline hydrochloride. Apo-Amitriptyline. Probability Amitriptyline. Damilya maleinat. Novo-Triptin. Saroten. Saroten retard. Triptizol. Elivel.

Subgroup

Tricyclic antidepressant, a derivative dibenzotsiklogeptadina.

Action

* Antidepressive (developing within 2-3 weeks after starting treatment);
* Anxiolytic, sedative;
* Analgesic;
* Antidizuricheskoe (antidiureticheskoe);
* Antiholinergicheskoe (blocks m-choline receptors of central nervous system);
* Antihistaminic (gistaminovye blocks the receptors of central nervous system).

Mechanism of Action

Antidepressive effect of Amitriptyline is associated with adrenergic stimulation and serotoninergicheskih mechanisms in the brain by reverse neuronal capture of oppression mediators.

Antidiureticheskoe effect attributed antiholinergicheskoy activity.

Analgesic effect, which is associated with changes in the concentration monoanines in the central nervous system, especially serotonin, and the influence of Amitriptyline on the endogenous opioid system.

Pharmacokinetics

Rapidly and well absorbed from the ZHKT. Bioavailability Amitriptyline at different ways to the introduction of 30-61%, its metabolite - nortriptilina - 46-70%. The volume of distribution - 5-10 L / kg. Cmax in the blood after ingestion is achieved through 2,0-7,7 h. The therapeutic concentration in the blood for Amitriptyline - 50-250 ng / ml for nortriptilina - 50-150 ng / ml. Binding to plasma proteins was 82-96%.'s Easy to pass, as nortriptilin through gistogematicheskie barriers, including GEB, placental, penetrate into breast milk. T1 / 2 of 31-46 h.

Metabolized in the liver (demethylation, hydroxylation, N-oxidation) to form the active - nortriptilin, 10-hydroxy-Amitriptyline, and inactive metabolites. Derive mainly kidneys, mainly as metabolites, within a few days.

Indications

* Depressive syndrome (Depression: endogenous, involutional, reactive, neurotic, with organic brain damage, medical)
* Schizophrenic psychosis,
* Disturbing-depressive state of different genesis,
* Mixed emotional distress and breach of conduct,
* Psychogenic anorexia, bulimia;
* Night enuresis (excluding children with hypotonic bladder),
* Chronic pain syndrome.

Contraindications

* Hypersensitivity,
* Glaucoma,
* Hypertrophy of the prostate,
* Bladder atony,
* Paralytic ileus,
* Pilorostenoz,
* Epilepsy,
* The early recovery period after myocardial infarction,
* The use of MAO inhibitors in the preceding 2 weeks,
* Pregnancy, lactation,
* Children age (6 years).

Limitations to the use of

With careful use, with ischemic heart disease, arrhythmia, congestive heart failure.

Side Effects

From CNS: drowsiness, disorientation, excitation, hallucinations, ekstrapiramidnye disorders, dizziness, trembling, tremor, fatigue, rare - anxiety.

On the part of the cardiovascular system: tilt hypotension, tachycardia, hypertension, conduction, ECG changes (especially the QRS)

On the part of the digestive system: sour-bitter taste in the mouth, nausea, vomiting, stomatitis, rarely - cholestatic jaundice.

On the part of the reproductive system: potential violations, or delay ejaculation, reduction of potency, changes in libido.

From the Endocrine System: rare - hyperglycemia, glyukozuriya, violations of glucose tolerance, diabetes, syndrome of inappropriate secretion of ADG.

On the part of metabolism: an increase in body weight.

Allergic reactions: skin rash, itching.

Effects due to blockade of peripheral M-holinoretseptorov: dry mouth, disturbance of accommodation, poor vision, increased intraocular pressure, delayed urination, constipation, increased sweating.

Dependence syndrome and the abolition of

At the reception following the sudden cessation of long-term treatment may develop the syndrome cancel.

Interaction

With simultaneous application of Amitriptyline:

* With other drugs, have a depressing effect on the central nervous system, as well as the significant increase in ethanol may act on the central nervous system depressant, hypotensive action, oppression of breathing;
* With other drugs that have antiholinergicheskoy activity - strengthening antiholinergicheskih effects;
* A sympathomimetic means - may enhance their action on the cardiovascular system and increase the risk of heart rhythm irregularities, tachycardia, severe hypertension;
* With clonidine, guanetidinom - may reduce their antihypertensive effects;
* With barbiturates, carbamazepine - reducing the Amitriptyline because of its metabolism and reducing concentrations in the blood plasma;
* With quinidine - perhaps slowing metabolism Amitriptyline;
* With tsimetidinom - perhaps slowing metabolism Amitriptyline, increasing its concentration in blood plasma and the development of toxic effects.

Incompatible with MAO inhibitors.

Dosing and Administration in Adults

For admission into the starting dose is 25-50 mg per night (not razzhevyvaya, after meals). Then, within 5-6 days to increase the individual dose of 150-200 mg / day (most of the dose taken at night). If, during the second week did not come to improve, increasing the daily dose of 300 mg. With the disappearance of signs of depression, the dose is reduced to 50-100 mg / day and continue such therapy for at least 3 months.

V / m - initial dose of 50-100 mg / day in 2-4 introduction. If necessary, the dose can be gradually increased to 300 mg / day, in exceptional cases - up to 400 mg / day.

In old age, with light violations, which are treated with outpatient, dose is 50-100 mg / day, usually 1 time per day at night. The maximum dose for outpatient treatment - up to 150 mg / day in the hospital - up to 300 mg / d in elderly patients - up to 100 mg / day.

Dosing and Administration in pediatric practice

Children as antidepressant: 6 to 12 years - 10-30 mg or 1-5 mg / kg / d fractional, as a teenager - 10 mg 3 times a day (if necessary, up to 100 mg / day)

For the treatment of night enuresis for children under 6 years - 10 mg at night, 6-10 years - 10-20 mg / day, 11-16 years old - by 25-50 mg / day.

Pregnancy and lactation

Contraindicated in pregnancy, especially in I and III terms, except in cases of extreme necessity.

At the time of treatment should stop breastfeeding.

Adequate and well controlled clinical studies safety of Amitriptyline in pregnancy have been conducted.

In experimental studies Amitriptyline has teratogenic effects in doses many times the clinical dose.

Overdosage

Symptoms: hallucinations, convulsions, deliry, coma, cardiac conduction violation, extrasystoles, ventricular arrhythmia, hypothermia, etc.

Treatment: gastric lavage, receiving suspensions of activated charcoal, laxatives, maintaining body temperature, and monitoring functions of the cardiovascular system is not less than 5 days, with heavy holinoliticheskih symptoms (hypotension, arrhythmia, coma) - 0,5-2 g in fizostigmina / m or in / in. Hemodialysis and forced diuresis are not effective.

Cautions

Receive Amitriptyline is possible not earlier than 14 days after the lifting of MAO inhibitors.

Older children and recommended a reduced dose.

You should not assign manic patients and patients with suicidal tendencies.

It should not be used in conjunction with sympathomimetic means, including with epinephrine, ephedrine, izoprenalinom, norepinephrine, fenilefrinom, fenilpropanolaminom.

With caution used in conjunction with other drugs that provide antiholinergicheskoe operation.

During the reception of Amitriptyline is not allowed alcohol.

During the period of treatment should refrain from potentially hazardous activities requiring increased attention and rapid psychomotor reactions.

Saturday, July 18, 2009

Venlafaxine




Trade names

Venlafaxine. Efektin. Efektin Depot.

Subgroup

Inhibitors of reverse serotonin and noradrenaline capture.

Action

Pharmacological Effects - antidepressive.

Mechanism of Action

Venlafaxinea antidepressive effect in humans due to increased activity in the CNS NEUROMEDIATOR. In preclinical studies showed that Venlafaxine and its active metabolite - O-dezmetilVenlafaxine (ODV) are powerful inhibitors of reverse neuronal capture of serotonin and norepinephrine, and weak inhibitors of reverse capture dofamina. Venlafaxine and EFA in vitro had no significant affinity to muskarinovym, gistaminergicheskim, alfa1-adrenergic receptors, did not have the ability to inhibit MAO.

Pharmacokinetics

After ingestion Venlafaxine well absorbed and extensively metabolized in the liver. After receiving the single dose is absorbed by at least 92%, absolute bioavailability is approximately 45% (due presistemnogo metabolism). Eating does not have a significant influence on the absorption and biotransformation Venlafaxinea.

Metabolized primarily to the formation of a single pharmacologically active metabolite (EFA), as well as a number of inactive - N-dezmetilVenlafaxine, N, O-didezmetilVenlafaxine etc.

Equilibrium concentrations in plasma as Venlafaxinea, and EFA is achieved within 3 days of repeated admission. Pharmacokinetics Venlafaxinea and EFA is linear in the range of daily doses of 75-450 mg / day (while taking every 8 h). Plasma clearance, T1 / 2 and volume of distribution in the equilibrium condition was unchanged for Venlafaxinea, and for the EFA, after receiving multiple doses. In the equilibrium state of the plasma clearance Venlafaxinea and EFA was 1,3 ± 0,6 l / h / kg and 0,4 ± 0,2 l / h / kg, T1 / 2 - 5 ± 2 h and 11 ± 2 h, the volume distribution - 7,5 ± 3,7 l / kg and 5,7 ± 1,8 l / kg, respectively.

Derive predominantly kidney: about 87% of dose derived from the urine within 48 h (5% - unchanged, 29% - in the form of nekonyugirovannogo EFA, 26% - in the form of conjugated EFA, 27% - in other inactive metabolites).

Indications

Venlafaxinea hydrochloride in the form of tablets with immediate release is indicated for the treatment of depression.

Venlafaxinea hydrochloride in the form of modified release capsules is indicated for the treatment of depression, generalized anxiety disorder and social phobias.

Contraindications

Hypersensitivity, simultaneously receiving MAO inhibitors.

Limitations to the use of

Recently transferred myocardial infarction and unstable angina, changes in blood pressure, increased intraocular pressure and glaucoma zakrytougolnaya, manic state in history, the initially low body weight, kidney / liver failure, up to age 18 (safety and efficacy of the application is not installed).

Side Effects

The most frequent side effects while taking Venlafaxinea hydrochloride were asthenia, sweating, nausea, constipation, anorexia, vomiting, drowsiness, dry mouth, dizziness, nervousness, anxiety, tremors, lack of clarity of view, the violation of ejaculation / orgasm and impotence in men.

The most common effects associated with receiving Venlafaxinea in the form of capsules with a modified release, were insomniya and nervousness.

Dependence syndrome and the abolition of

It was found that the sharp Venlafaxinea stopping or reducing its dose (at different doses) associated with the appearance of symptoms, the frequency of which increased with increasing dose and duration of treatment. Reported symptoms included the following: agitation, anorexia, anxiety, confusion, violation of coordination, diarrhea, dizziness, dry mouth, dysphoria, fastsikulyarnye jumps, fatigue, headache, gipomaniya, insomniya, nausea, nervousness, nightmares, convulsions, a violation of the sensitivity (including a feeling of shock electrocution), drowsiness, sweating, tremor, vertigo, vomiting.

In this regard, the abolition of Venlafaxinea should be carried out gradually, by reducing the dose to reduce the risk of reactions cancel, you are advised to monitor the condition of the patient. The time period may depend on the lifting of dose, duration of therapy and individual characteristics of the patient. When treating Venlafaxineom for 6 weeks or more during the lifting of the drug must be at least 2 weeks.

Interaction

Incompatible with MAO inhibitors. Venlafaxineom treatment should start no earlier than 14 days after receiving MAO inhibitors, in turn, treated MAO inhibitors can be started no earlier than 7 days after the lifting Venlafaxinea. If you are receiving Venlafaxinea and MAO inhibitors may develop severe adverse reactions (including tremor, mioklonus, copious sweating, nausea, vomiting, flush-to-face, dizziness, hyperthermia with features similar to neyrolepticheskim malignant syndrome, seizures, up to death).

Dosing and Administration in Adults

Inside, along with the eating, the starting dose - 75 mg / day (tablets - daily dose is divided into 2-3 reception capsules - 1 times / day, approximately at the same time of day - morning or evening). For some patients it may be desirable starting dose of 37.5 mg / day (within 4-7 days). If necessary, possibly increasing dose (slowly, at 75 mg / day, 1 every 4 days or more) to 225 mg / day (the recommended dose, with an average degree of severity of depression), in the hospital (in severe depression) may increase dose to the maximum -- 375 mg / day.

In patients with liver dysfunction of moderate and severe degree of reduction of required daily intake of 50% or more. Against the background of violations of kidney function (glomerular filtration rate - 10-70 ml / min) needed dose reduction to 25-50%, with dialysis - at 50%, the drug should be taken after dialysis. Patients older special dose adjustment is required, but care should be taken in treating this category of patients, especially with increasing dose.

Dosing and Administration in pediatric practice

In the age of 18 safety and efficacy of the application is not installed.

Pregnancy and lactation

If pregnancy can only use when absolutely necessary (adequate and strictly controlled studies safety of pregnant women are not held).

Venlafaxine and its active metabolite EFA penetrate the breast milk of women. Given the potential risk of serious side effects in children who are breastfed, breastfeeding women should stop or breastfeeding, or drug treatment.

Overdosage

Symptoms: ECG changes (prolongation of interval QT, block feet beam Gisa, the expansion of QRS complex, etc.), sinus and ventricular tachycardia, bradycardia, hypotension, dizziness, mental blankness of varying degrees of expression (from drowsiness to coma), convulsions, until the fatal outcome.

Treatment: the use of activated charcoal, induction of vomiting, gastric lavage (to reduce absorption). Maintain adequate airway to ensure adequate ventilation and oxygenation. We recommend close observation and monitoring of heart rate and other vital signs, symptomatic and supportive therapy. The effectiveness of such measures as forced diuresis, dialysis, gemoperfuziya and exchange blood transfusions is unlikely. No specific antidote. In cases of overdose postmarketingovyh studies were mainly Venlafaxinea while receiving alcohol and / or other drugs.

Cautions

It should be noted that against the backdrop of Venlafaxinea may develop hyponatremia and syndrome of inappropriate secretion antidiureticheskogo hormone, especially in patients with hypovolemia, dehydration in the elderly, as well as while receiving diuretics.

As reported on developments in the treatment of midriaza Venlafaxineom, you must use them with caution in patients with elevated intraocular pressure or risk of an acute attack of glaucoma zakrytougolnoy.

Although Venlafaxine do not increase the impact of ethanol on psychomotor reaction from volunteers, should be avoided while receiving Venlafaxinea and alcohol.

In studies on healthy volunteers has not been observed clinically meaningful reduction of thinking and psychomotor speed of reaction on the background Venlafaxinea. However, since any psychoactive drug may affect the CNS, patients should be warned of the need to observe caution when working with potentially dangerous machinery and when driving a car.

Friday, July 17, 2009

Citalopram




Trade names

Citalopram.

Subgroup

Selective serotonin inhibitors reverse the seizure.

Action

Antidepressive effect usually develops within 2-4 weeks of therapy. Almost did not have, or have little ability to bind to a variety of receptors, including gistaminovye, m-and holinoretseptory adrenoceptor. Sedative effect is absent.

Mechanism of Action

Selectively inhibits the reverse neuronal capture of serotonin in the brain. In a very small extent inhibits cytochrome P450 IID6, therefore, does not interact with drugs metabolized this isoenzyme. Not affect the conductive system of the heart and blood pressure did not alter haematological indices, liver and kidney, no increase in body weight.

Pharmacokinetics

If ingestion Cmax is determined within 2-4 h. Bioavailability - 80% binding to plasma proteins - less than 80%. Changes in plasma concentration are linear. After 1-2 weeks of therapy in the plasma concentration equilibrium is established. In blood plasma Citalopram is largely unchanged. Metabolized by demethylation, deamination and oxidation. T1 / 2 was 1.5 days. Return via the kidneys and intestines. Antidepressive effect develops within 2-4 weeks. treatment.

Indications

* Depression of varying etiology and structure (in adults);
* Panic disorder with or without agoraphobia;
* Obsessive-compulsive disorder (ROC).

Contraindications

Hypersensitivity, pregnancy, lactation (the period of treatment stop breast-feeding).

Side Effects

Drowsiness, dry mouth, nausea, increased sweating, tremors, convulsive seizures, bradycardia (with initially reduced HR).

Interaction

Enhances effects sumatriptana etc. serotoninergicheskih drugs; tsimetidin increases the equilibrium concentration in the blood. If you are receiving with MAO inhibitors may hypertonic crisis (serotoninovy syndrome).

Dosing and Administration in Adults

Inside, on one occasion, at any time of day, regardless of the meal. Initial dose - 20 mg per day, maximum - 60 mg / day. Older - 20 mg daily dose, maximum - 40 mg / day. When liver failure is recommended to use the minimum dose.

Overdosage

Symptoms: drowsiness, disturbance of articulation, coma, occasionally - great convulsive seizures, increased sweating, sinus tachycardia, cyanosis, lung hyperventilation, nausea, vomiting.

Treatment: gastric lavage, maintenance of vital functions.

Cautions

Precautions: Be wary appoint persons working with potentially dangerous machinery or driving vehicles (reduced ability to focus and increased reaction time).

Do not combine with MAO inhibitors or designate within the first two weeks after their withdrawal.

With the development of manic state should stop taking.

Thursday, July 16, 2009

Fluoxetine




Trade names

Apo-Fluoxetine. Bioksetin. Depreks. Deprenon. Portal. Prodep. Prozac. Profluzak. Flokset. Fluval. Fluksonil. Flunat. Fluoxetine. Flyudak. Frameks.

Subgroup

Selective serotonin inhibitors reverse the seizure.

Action

Pharmacological Effects - antidepressive. Promotes the improvement of mood, reduces anxiety and stress, eliminates dysphoria. It is sedative effect. Persistent clinical effect occurs within 1-2 weeks of treatment.

Mechanism of Action

The mechanism of action is related to selective blockade of reverse neuronal capture of serotonin in the central nervous system. Fluoxetine is a weak antagonist of choline-, adreno-and gistaminovyh receptors. Unlike most antidepressants, Fluoxetine, apparently, does not cause decline in functional activity postsinapticheskih b-adrenoretseptorov.Pri admission to secondary therapeutic doses virtually no effect on the function of the cardiovascular and other systems.

Pharmacokinetics

After a single injection 40 mg into the Cmax in plasma observed after 6-8 h and is 15-55 ng / ml. The capsules and aqueous solution of the drug bioequivalent, eating does not affect the bioavailability. At concentrations up to 1000 ng / ml Fluoxetine to 94.5% associated with blood proteins, including albumin and alfa1-glycoprotein. Both enantiomeric forms ekvieffektivny, but S-Fluoxetine displayed slower and dominates over the R-form, with the equilibrium concentration. In the liver enantiomers demetiliruyutsya to norfluoksetina. T1 / 2 Fluoxetine is 1-3 days after a single application and 4-6 days after reaching the equilibrium concentration. T1 / 2 norfluoksetina - 4-16 days in both cases, causing significant cumulation of reactive, slow achievement of equilibrium levels in plasma and prolonged presence in the body after the repeal. In patients with hepatic cirrhosis T1 / 2 extended by 3-4 times.

Indications

* Depression
* Obsessive-compulsive state
* Bulimia, anorexia

Contraindications

Glaucoma, urinary bladder atony, severe violations of kidney function, benign prostate hyperplasia, the simultaneous appointment of MAO inhibitors, spastic syndrome of different genesis, epilepsy, pregnancy, lactation, hypersensitivity to Fluoxetine.

Side Effects

Anxiety, nervousness, lethargy, insomnia, rapid fatigue, headache, dizziness, tremors, convulsive status, reduction of libido, anorexia, weight loss, nausea, vomiting, dyspepsia, dry mouth, diarrhea, increased salivation, rash, urticaria, which is often accompanied by systemic violations of the lung, kidney or liver vaskulity.

Interaction

If you are applying Fluoxetine with drugs which have a depressing effect on the central nervous system, as well as possibly significant increase in ethanol depressant actions in the CNS, as well as increasing the chance of seizures.

When applied simultaneously with drugs that possess a high degree of binding to proteins, especially with anticoagulants or digitoksinom may increase the concentration in the blood plasma of free (unbound) drugs and increased risk of adverse effects, with medication lithium - may increase the concentration of lithium, and development of toxic effects; with phenytoin - increasing its concentration in blood plasma and the development of toxic effects, with tryptophanyl - may strengthen the agitation, motor disturbance, misconduct by ZHKT.

When applied simultaneously with MAO inhibitors (eg selegiline or moklobemidom), due to increased content of serotonin and the suppression of a seizure, there is a significant increase in the number of serotonin in the synapse - serotoninovy syndrome "in which there are hyperthermia, muscle rigidity, mioklonus, as well as manifestations of mental instability and physiological state of the body until death.

Dosing and Administration in Adults

Inside. When depression - 20 mg in the morning to rise no more than 80 mg in 2-3 reception, with bulimia - 60 mg in 3 admission, with obsessive-compulsive states - 20-60 mg / day.

Pregnancy and lactation

Not applicable.

Overdosage

Symptoms: nausea, vomiting, central nervous system excitation, gipomaniya, convulsions.

Treatment: induction of vomiting or gastric lavage, the appointment of activated charcoal, symptomatic and supportive therapy.

Cautions

With great care used in patients with disorders of liver and kidney function, with a history of seizures, cardio-vascular diseases. Patients with diabetes may change in the level of glucose in the blood, which requires correction gipoglikemicheskih drug dosing regime. When using a weakened patients receiving Fluoxetine increases the likelihood of development of epileptic seizures. If you are applying Fluoxetine and Electro-therapy may develop prolonged epileptic seizures. Fluoxetine can be applied not earlier than 14 days after the lifting of MAO inhibitors. The period after the abolition of Fluoxetine prior to the start of therapy MAO inhibitors should not be less than 5 weeks. Patients older require correction dosing regime. Safety Fluoxetine application in children has not been established. During the period of treatment to avoid alcohol. Impact on ability to driving a car, and management arrangements in the period of treatment should refrain from potentially hazardous activities requiring increased attention and rapid psychomotor reactions.

Tuesday, July 14, 2009

Sertralin (Sertraline)




Trade names

Asentra. Zoloft. Serlift. Sertralin. Stimuloton. Torino.

Composition

50 mg and 100 mg.

Subgroup

Selective serotonin inhibitors reverse the seizure.

Action

Pharmacological Effects - antidepressive. It provides stimulating, sedative or antiholinergicheskogo action and no cardiotoxicity in animals. In tests the drug in healthy volunteers did not have sedative effects and do not modify the psychomotor function. Unlike tricyclic antidepressants, in treating depression or obsessive-compulsive disorders (obsessive state) sertralinom increase in body weight does not happen, in some cases it even decreases.

Mechanism of Action

Selectively blocks the reverse capture presinapticheskoy membrane serotonin neurons of brain and platelets, slightly affects the level of others neuromediators (noradrenaline and dofamina) in the synaptic fissure. It reinforces kateholaminergicheskuyu activity. It has affinity to muskarinovym holinoretseptoram, serotoninovym, dopaminovym, gistaminovym, GABA, benzodiazepinovym and adrenergic receptors. With long-term use reduces the number of adrenergic receptors in the CNS, have a similar effect of other clinically effective antidepressive drugs and antiobsessivnye.

Pharmacokinetics
The man in the treatment of sertralinom in a dose of 50 to 200 mg 1 time per day within 14 days, Cmax was achieved after 4.5-8.4 h after administration. Consequently, T1 / 2 (young and older men and women is 22-36 h) is approximately double accumulation of the drug to achieve Css after 1 week of treatment (receiving doses of 1 times / day). Eating does not have a significant influence on the bioavailability sertralina tablets. Binding to plasma proteins is about 98%. Sertralin actively biotransformiruetsya in the first passage through the liver. The main metabolite found in plasma, - N-desmetilsertralin - significantly less activity sertralinu (approximately 20-fold) in vitro, and in fact is not active in models of depression in vivo. The average T1 / 2 sertralina in young and elderly men and women is 22-36 h. T1 / 2 N-desmetilsertralina the range of 62-104 h. Sertralin and N-desmetilsertralin actively biotransformiruyutsya in humans, occurring metabolites derived from faeces and urine in equal amounts. Only a small fraction of the drug (less than 0.2%) derived from the urine in unchanged form.

Indications

* Treatment of depressive states (including the accompanying feelings of anxiety) in the presence and absence of mania in history;
* Treatment of obsessive-compulsive disorder (ROC) in children and adults;
* Treatment of panic disorder, accompanied or not by agoraphobic;
* Post-traumatic stress disorder (PTSD).

Contraindications

* Joint appointment of MAO inhibitors;
* Hypersensitivity to the drug.

Side Effects

In controlled tests of the re-taking the medication at different doses compared to placebo sertralin often leads to the following adverse reactions:

On the part of the digestive system: nausea, diarrhea, unsteady stool, anorexia, dyspepsia, xerostomia. Asymptomatic increase of aminotransferase activity (AST and ALT) in the treatment of sertralinom met infrequently (approximately 0.8% of cases). These violations are usually observed during the first 1-9 weeks of treatment and rapidly disappeared after the abolition of the drug.

From CNS: tremor, dizziness, insomnia, drowsiness.

From the water-electrolyte balance: in some cases - hyponatremia (after cessation of treatment, sodium levels returned to normal) and in some cases, hyponatremia may have been linked to inadequate secretion antidiureticheskogo hormone. The reduction of sodium in most cases observed in patients with older age, as well as patients receiving diuretics and other medications.

On the part of blood clotting: transient thrombocytopenia, atypical bleeding and haemorrhagic rash, causal connection with the admission that the drug has not been established.

Other: increased sweating, violation of sexual function in men (mostly delayed ejaculation).

Profile of adverse events encountered during the double-blind placebo-controlled trials in patients with intrusive state, was similar to that in patients with depression.

After the introduction of the drug on the market before the records were the following side effects, which sometimes occurred when using the drug, but can not be associated with him: vomiting, abdominal pain, disturbance of motor activity (ekstrapiramidnye symptoms and violations of gait), convulsions, disturbance of menstrual cycle giperprolaktinemiya, galaktoreya, rash (including rare cases of erythema multiformnoy), rarely - pancreatitis and severe violations of the functions of the liver (including hepatitis, jaundice and liver failure). We describe the rare cases of the syndrome cancel. In rare cases, there were the following side effects, which could not be distinguished from the natural flow of the main manifestations of the disease: paresthesia, gipesteziya, symptoms of depression, hallucinations, aggressive reaction, agitation, anxiety and psychosis.

Dependence syndrome and the abolition of

Sertralin does not cause physical or psychological dependence.

Interaction

We describe cases of serious adverse reactions in patients receiving sertralin in combination with MAO inhibitors, including selective MAO inhibitors (selegiline) and reversible inhibitors of MAO (moklobemid). Symptoms of this collaboration include: hyperthermia, rigidity, muscle cramps, changes in mental status, which include confusion, irritability and excessive excitation to the development of deliriya and coma.

Simultaneous reception of the drug at a dose of 200 mg / day did not influence ethanol increases, carbamazepine, haloperidol or phenytoin on cognitive and psychomotor function in healthy people.

Sertralin associated with plasma proteins, so it is necessary to take into account the possibility of its interaction with other drugs, have been linked to proteins. However, during the 3 formal studies on interaction with diazepam, tolbutamidom and warfarin, a significant influence on the binding of drugs to proteins have been identified.

Simultaneous reception of the drug at a dose of 200 mg / day of diazepam or tolbutamidom led to a small but statistically significant change in some pharmacokinetic parameters. Tsimetidin caused a significant reduction in clearance sertralina co-application with the drug. If you are applying sertralin no effect on beta-adrenoblokiruyuschuyu activity of atenolol. Signs drug interactions 200 mg / day with glibenklamidom and digoxin were not found. If you are taking 200 mg / day with warfarin, there was a small but statistically significant increase in prothrombin time. In this regard, should closely monitor the rate of prothrombin time at the beginning of therapy sertralinom and after its repeal.

Many antidepressants, such as selective serotonin inhibitors reverse the seizure, including sertralin, and most tricyclic antidepressants, inhibit a biochemical activity of the enzyme, metabolized drugs - cytochrome P450 2D6 (debrizokvingidroksilaza) and thus may increase the plasma concentrations of other drugs that biotransformiruyutsya 2D6 and have a narrow therapeutic index, such as tricyclic antidepressants and drugs antiaritmicheskie class 1c (propafenon and flekainid). With simultaneous application of the drug, subjected to biotransformation P450 2D6, and sertralina first may need to assign to a lower dose than usual. In addition, when you cancel sertralina may require increased doses of other drugs.

In placebo-controlled trials in healthy volunteers sertralin do not affect the pharmacokinetics of lithium, but in comparison with placebo, increased tremor, indicating a possible pharmacodynamic interaction. In this regard, while treating sertralinom, like other selective serotonin inhibitors reverse the seizure, in combination with other drugs type of lithium, which may act through mechanisms serotoninergicheskie, be careful.

Dosing and Administration in Adults

Appoints 1 time / day morning or evening. Tablets can be taken irrespective of food intake. When depression and begin treatment with the ROC dose of 50 mg / day. When the effect of daily low dose can be increased gradually (50 mg), in a few weeks to a maximum dose of 200 mg / day. The initial effect may occur within 7 days after the start of treatment, but the full effect is usually achieved within 2-4 weeks.

Treatment of panic disorder and PTSD beginning with doses of 25 mg / day, which increased after 1 week to 50 mg / day. The use of drugs under the scheme will reduce the frequency of unwanted effects of early treatment, which are typical for panic disorder.

In a long-term maintenance therapy medication designate the minimum effective dose, which subsequently changed depending on the clinical effect. In old age, drug use in the same doses as in younger patients.

Dosing and Administration in pediatric practice

In children and adolescents aged 13-17 years suffering from ROC, treatment should begin with a dose of 50 mg / day. In children aged 6-12 years of therapy to begin with ROC dose 25 mg / day, after 1 week it increased to 50 mg / day. Later, with little effect of the dose can be increased in steps of 50 mg / day to 200 mg / day as needed. However, to avoid overdosing, with increasing doses over 50 mg should be taken into account the smaller body weight in children than adults. You may change the dose should be at intervals of not less than 1 week.

In completed and ongoing studies sertralin received more than 250 children with the ROC. Safety sertralina in these studies was comparable to that in studies of adult patients with ROC. Effectiveness sertralina with depression or panic disorder in children in controlled studies has not been established. The safety and efficacy sertralina in children aged less than 6 years of age are not proven.

Pregnancy and lactation

When pregnancy sertralin should be appointed only if the expected benefits outweigh the risks, because Adequate well-controlled testing of the drug in pregnant women.

Information about the intrusion sertralina in breast milk are not available and therefore is not recommended to assign the drug during lactation.

Women of childbearing age during treatment sertralinom must use appropriate methods of contraception.

In experimental studies, with the introduction sertralina rats and rabbits at doses approximately 20 and 10 times the maximum daily dose for humans (in mg / kg), signs of teratogenic action have been identified. Sertralin do not have mutagenic action. Nevertheless sertralin in doses of about 2.5-10 times the maximum daily dose for humans (in mg / kg) caused a delay of ossification of bone tissue fetus, possibly as a result of the impact on the parent species. When you enter sertralina at doses approximately 5 times the maximum dose for humans (in mg / kg), resulted in the decreased survival of newborns.

Overdosage

Toxicological studies in various animal species demonstrated good portability sertralina. Available data indicate a wide range of security sertralina with his overdose. Reported cases of overdose with sertralinom monotherapy at a dose of up to 13.5 g. There have been reports of fatal overdose sertralina when combined with other drugs and / or alcohol. In this regard, in all cases of overdose requires intensive treatment.

Treatment. Recommendations for specific therapy of drug overdoses, as well as specific antidotes are not available. There should be a normal adequate airway, oxygenation and ventilation of the lungs. Activated charcoal, which can be used in combination with sorbitol, may be even more effective than emesis or gastric lavage. Advisable to monitor the performance of the heart and other vital organs and the conduct symptomatic and supportive therapy. The use of forced diuresis and hemodialysis impractical because of the large volume of distribution of the drug.

Cautions

Sertralin can be used no earlier than 14 days after the lifting of MAO inhibitors. MAO inhibitors also can be used no earlier than 14 days after lifting sertralina.

You must be careful while appointing sertralina with other drugs, reinforcing serotoninergicheskuyu neyrotransmissiyu, such as tryptophan or fenfluramin. Pending receipt of additional data serotoninergicheskie funds should not be used in combination with sertralinom.

Experience of clinical trials aimed at determining optimal time required for transfer of patients to receive other funds to antidepressive sertralin is limited. You must be careful with such a transition, especially with long-acting drugs. The required interval between the cancellation of a selective inhibitor of serotonin and a capture start receiving a similar drug is not installed.

Sertralin exposed to an active metabolism in the liver. According to the pharmacokinetic study, with acute administration sertralina in patients with stable hepatic cirrhosis easy flow increase in T1 / 2 drug, and AUC (area under the curve concentration-time ") were compared with those in healthy people. Apply sertralin in patients with liver disease should be with caution, it is necessary to discuss the desirability of reducing the dose or increasing the interval between taking the medication. Sertralin unchanged output of urine in small amounts. In patients with primary and Moderate renal insufficiency (CC 20-50 ml / min) and patients with severe renal insufficiency (CC less than 20 ml / min) pharmacokinetic parameters at single sertralina his admission did not differ significantly from controls. However, pharmacokinetics sertralina in the equilibrium state of this category of patients studied is insufficient, therefore, in the treatment of patients with renal insufficiency should be careful.

In patients with convulsive syndrome certralina application is not examined, therefore, should avoid its use in unstable epilepsy and patients with controlled epilepsy require careful monitoring during treatment. If you have seizures in all cases, the drug should be abolished.

When testing sertralina gipomaniya and mania occurred in about 0.4% of patients receiving sertralin. Cases activate mania / gipomanii described as a small portion of patients with major depression who received other antidepressive or antiobsessivnye funds.

The risk or benefit of combined use of Electro-therapy and sertralina in clinical trials not been studied. Patients depression inherent propensity to attempt suicide, which persists until the onset of significant improvement in their condition as a result of treatment. In this regard, the early treatment of patients must be carefully monitored. In clinical studies on the effectiveness of sertralina in the elderly its effectiveness in patients of this group has been demonstrated in more than 700 patients over 65 years. Profile and frequency of adverse reactions in patients older and younger age were the same. Against the background of the reception sertralina not to drink alcohol.

Studies have shown that sertralin no effect on psychomotor function. Nevertheless, antidepressive or antiobsessivnye could impair mental or physical activity necessary to perform the functions of the type of potentially dangerous driving, or management arrangements, as necessary to warn the patient.