Generic Zoloft

Treatment with antidepressants

2009-08-06T07:43:00.000-07:00

Antidepressants. The effectiveness of treatment with antidepressants. The symptoms and manifestations of depression. Treatment of anxiety disorder - phobias, panic attacks, obsessive thoughts and actions.
It is now widely used by several dozen major antidepressants. At the same time between the drugs there are many differences in the effectiveness of exposure, adverse reactions, and many other indicators.

One of the main indications for the appointment of antidepressants - depression. The effectiveness of antidepressants in addressing the symptoms of depression was established half a century ago. Later it was found that antidepressants are effective in treating not only depressive manifestations but also in the prevention of recurrent attacks of depression.

Selecting the most appropriate drug, identification of optimal dose and the determination of the necessary duration of treatment depends on the characteristics of depression for each individual patient - the main reason for its occurrence, clinical manifestations of depression, duration of illness, presence of concomitant therapy of disease. The effect of antidepressants with depression never develops immediately. Although the improvement of individual manifestations of the depressed state may occur in the first days of treatment, the full therapeutic effect is achieved no earlier than 4-6 weeks of therapy. Even with the full elimination of all symptoms of depression should continue to receive antidepressant for at least 6 months. This helps reinforce the effect of treatment and prevent the deterioration of the future.

Depression - is not the only disease which was discovered the effectiveness of antidepressants. They are successfully used in the treatment of anxiety disorder, the main manifestations of which are phobias, panic attacks, obsessive thoughts and actions of the state of constant tension and high anxiety. The use of antidepressants in combination with psychotherapy - the most effective method of treating anxiety disorder. The effectiveness of various antidepressants with anxiety disorder varies. As with depression, for the effectiveness of therapy requires careful monitoring of the process of treatment to choose the right dose and to determine the optimal duration of therapy.

We prove the effectiveness of antidepressants in the treatment of diseases and characterized by the emergence of a variety of pain and unpleasant sensations in the body, variations in blood pressure, heart beat, dysfunction of the gastrointestinal tract, have heat or chill, and other violations of bodily functions, as well as changing the overall physical well-being with a sense of weakness broken, increased fatigue. With careful examination did not reveal the pathology, the causes of these symptoms - psychological. When treating these patients, medical therapy is always done in conjunction with psychotherapy.

Antidepressants are also used in complex therapy and other mental disorders - schizophrenia, organic brain disease, old age dementia, pathological reactions to stress factors, alcohol and drug abuse.

How to cope with depression?

2009-08-05T07:41:00.000-07:00

Quiet solitude. How to cope with depression? Inferiority complex, and vague malaise.
Modern man, especially living in the megalopolis, idols of their careers, success, life table, where each step of each working day, a visit to the doctor, trips to the gym, calls and meetings with friends and relatives and all other components of our lives literally painted on the minutes.

We learned a short talk on mobile phones: only the most important, only the basic "on the case, in fact." Even our holidays are often planned zagodya and it, too, there is the schedule. We nesemsya in frenzied pace, winning the right to rest and happiness, sometimes losing their sense of himself, depriving himself of pleasure just to live. At one point, "the joy of life" becomes the prize, which can be obtained only at the cost of immense effort and sustained determination.

We are going to deny yourself of all, download a prohibitive, not to have fear. The success of our career is growing rapidly, the outer often affect the magnitude of the achievement, but we are all stronger gryzet an inferiority complex, and vague malaise. But perhaps somewhere in the program has failed? And the key to the joy of the most immediate - is it getting? In our everyday life language the word "hedonism" and "fun" has almost become abusive. In the meantime, the old (which was probably wiser than us) were able to enjoy life and appreciate its pleasures.

Also, is not accidental tendency of people in difficulty and stress to find a means to break and escape. But it is important that the minutes of pleasure were not overloaded with unrealistic expectations or provoke a feeling of despair, as they degrade it, causing a decrease in feelings of guilt and self-esteem, and is simply subjecting the body of excessive unexpected though pleasant load (because the month of fasting can not, then time to eat a whole cake). Therefore, it is necessary dose of fun, practice regularly, do they rule your life, rather than try to squeeze in painted on the clock one week "holiday."
And to make the first step the simplest approach, and even free things:

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Find a park bench, sit down and watch life.
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Lying in a hammock, contemplate the starry sky.
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Awash in the ocean.
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Go where the eye face.
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In complete silence, read a book.
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Take a nap in the sun.
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Take a bath with candles.
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Sleep, sleep and sleep until exhaustion.
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Watch the French film director.
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Pomassirovat feet.
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Deal with love in the rain.
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Dance dirty dancing.
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Sit in silence.
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Unrestrainedly laugh.

Prevention of depression

2009-08-04T07:41:00.000-07:00

Preventing re-depression. ffektivnost antidepressants with depression. Depressive manifestations. New and old antidepressants.
Depression - a disease which can be repeated. The risk of depression following the re moved first depressive episode is 50-70%. It is therefore an important prerequisite for effective treatment of depression is the prevention of repeated attacks. One of the most effective methods of prevention of depression - a long appointment antidepressants.

Antidepressants - drugs designed to treat depression. Efficiency of antidepressant drugs, with depression associated with the normalization of the exchange in the brain of two biologically active substances - serotonin and norepinephrine. These substances are the regulators of mood and their exchange is broken when depressions. The first antidepressants were developed back in the 50-60-ies of XX century. This group of antidepressants includes such well-known drugs like amitriptyline, melipramin, anafranil, and is termed "tricyclic antidepressants. These drugs have proved highly effective in addressing the manifestations of depression. However, their prolonged use is limited to high risk of side effects, which include sleepiness during the day, dizziness, lowering of blood pressure, muscle weakness, dry mouth, constipation, memory impairment and attention, etc. In addition, with long-term use of these antidepressants may impair the function of heart, which is especially dangerous in people with cardiovascular disease and the elderly.

New antidepressants, developed and implemented in practice for the past 20 years, have a number of advantages compared with tricyclic drugs. The number of new antidepressants is constantly growing and now amounts to several dozens. Most other applicable Paksi, zoloft, fevarin, tsipraleks, remeron, lerivon, auroriks, koaksil, iksel, simbalta. An important advantage is the portability of the best. New antidepressants do not cause daytime sleepiness, did not affect blood pressure and heart function. Therefore, they are safe in the long-term use.

Choosing the most effective and safe antidepressant for each individual patient - no easy task and can take only a doctor. Prolonged use of these drugs should be under constant medical supervision. The most important condition for the effectiveness of preventive therapy is the correct selection of dosage, careful adherence to the regime taking over quite a long time, compatibility with other antidepressant drugs, used by the patient.

Cancel antidepressive therapy in achieving strong improvement in the status of a progressively. The duration of prophylactic therapy is at least 1-5 years depending on the characteristics of affective illness.

Prevalence of depression

2009-08-03T07:40:00.000-07:00

Depression and the prevalence of mental illness. The emergence and development of depression. Depressive syndromes.
The risk of falling ill from depression every single person over a lifetime is about 20%. According to researchers, this is due to urban growth and the multitude of stressors events awaiting modern man is literally at every turn, migration and other social trends of our society.

It must be stressed that the emergence and development of depression involves a number of adverse effects of both medical and social order.

Depression, like any other mental illness at risk of suicide - one of the most tragic outcomes, leading to premature death 15% of patients suffering from depression. Depression greatly affects the quality of life and human adaptive capacity, thereby violating the usual way of life. Reduced working capacity, which can lead to loss of work, it forced a change and lastly, to the total disability.

The incidence of depressive syndrome in general medicine (studied in patients attending clinics) is 22-33% and exceeds the frequency of common diseases such as hypertension. Coming one day, burdening of depression, exacerbated over, worsens prognosis bodily infirmity and complicates treatment. On the other hand somatic illness, such as hypothyroidism, coronary heart disease, atherosclerosis of brain vessels, etc. may cause depression. Finally, the defeat of the internal organs (cancer, myocardial infarction) may be the psychological trauma resulting in feelings of depression.

Timely diagnosis of depressive disorders in many cases becomes a crucial prerequisite for successful medical treatment, and mental disturbances undue, underestimated, even when depressive symptoms may be interpreted as psychologically understandable. In such a "trap" the doctor can get, for example, when depression is considered as a "life situation". This is especially true when examining elderly people who have depressive disorders could be interpreted as a sign of "natural" tired of life, or for young people with the separation, change, care of a spouse, loss of a loved one, etc. when depression is viewed as "adequate" response to life's turmoil. In any of these cases you need advice and assistance to professionals working with depressed state.

Seasonal Depression

2009-08-02T07:40:00.000-07:00

Seasonal depression. Symptoms and treatments of seasonal (recurrent) depression.
Seasonal depression - the option of repeated (recurrent) depression. To include seasonal depression that developed during the autumn-winter season with some regularity - every year for at least 3 years.

Seasonal depression can manifest the same symptoms as depression, are not associated with specific seasons: low mood with a sense of longing or anxiety, a decline of interest in the environment, apathy, a sense of grim, hopelessness. Often these symptoms more pronounced in the first half of the day, while in the evening condition was improving.

More specific to seasonal depression are other symptoms. Patients suffering from seasonal depression, along with low mood, feelings of anxiety and a decrease in activity, experiencing sleepiness during the day and increasing appetite. During the Depression, they consume more foods rich in carbohydrates, added weight. Typically, decreasing the overall tone, there is a weakness, a variety of unpleasant sensations in the body.

Asthenic symptoms of seasonal depression following: feeling weak, weak, broken, general physical ailments. There are a variety of pain and unpleasant sensations in the body, reduces mental performance, deteriorating memory and attention. Characteristically, the severity of these symptoms almost do not depend on external pressure and are often more pronounced in the morning hours after awakening.

In the development of seasonal depression primary metabolic role of serotonin - biologically active substance to regulate mood. Experimental studies have shown that winter in the brain serotonin content is lower than in summer. An important regulator of the exchange of serotonin is melatonin - the active ingredient, the formulation of which depends on the amount of light.

The classic method for the treatment of seasonal depression is light. In addition, we prove the high efficacy of antidepressants with a specific effect on the exchange of serotonin in the brain. Prolonged use of these products allows us not only to cure the depression had already developed, but also to prevent their development in the future. As with other depressions, an important element of effective treatment is psychotherapy.

Depression in old age

2009-08-01T07:39:00.000-07:00

Depression in old age. The reasons for the emergence of depression in old age.
Depression in old age occur very often. It was found that depression affects 15-20% of people older than 60 years, and in patients with severe disease therapy, this figure reaches 40-60%. Not all depressed patients are senile age receive adequate therapy. Depression in old age is not always easily recognizable. Reduced background mood, pessimism, disbelief in the future, fear of near death, anxiety, decrease in activity and loss of former interests, complaints of impotence, a variety of pain, poor appetite, disturbed sleep, patients themselves, their relatives, and sometimes the doctors viewed as the natural manifestations of aging with its concomitant limitation of physical and social opportunities. Frequent manifestation of depression in old age is changing the nature and behavior of patients. They become irritable, captious, selfish, focused on their illness. These changes in mood and behavior-being of older people indicate the presence of serious illness - depression.

The causes of depression in old age is varied. Depression in old age may develop as a reaction to severe life events - the loss of loved ones, loneliness, changes in lifestyle due to retirement, the emergence of therapeutic conditions. Depression in old age may be the result of hereditary predisposition to the occurrence. Age-related changes in the body and external circumstances psihotravmiruyuschie support the identification of the hereditary predisposition, even if during the life of any manifestations of depression were observed. Finally, depression in old age may be one of the first manifestations of organic brain disease associated with vascular lesion of the brain or the development of senile dementia. More rarely, the development of depression in old age is associated with certain diseases, such as endocrine, or use of certain drugs.

Manifestations of depression in old age has its own characteristics in each case, and an accurate diagnosis could only doctor. Currently, there are a large number of effective drugs, as well as non-methods for the treatment of depression in old age.

Depression in old age

2009-07-31T07:38:00.000-07:00

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.

Suicide and Depression

2009-07-30T07:38:00.000-07:00

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.

Depression through the eyes of a psychologist

2009-07-29T07:37:00.000-07:00

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:

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Depression caused by organic disease such as myocardial infarction, heart failure, hormonal disorders, trauma.
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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.
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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.

Treatment of depression with light

2009-07-28T07:37:00.000-07:00

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.

Psychotherapy of depression

2009-07-27T07:36:00.000-07:00

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.

Depression in women

2009-07-26T07:35:00.000-07:00

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.

No Do you have depression?

2009-07-25T07:34:00.000-07:00

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.

All about the treatment of depression

2009-07-24T07:33:00.000-07:00

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.

What is depression?

2009-07-23T07:33:00.000-07:00

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.
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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.
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Try to stimulate the patient's breathing.
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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.

HELP WITH Depression

2009-07-22T07:32:00.000-07:00

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

2009-07-22T07:31:00.000-07:00

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.

Depression - a disease of our time.

2009-07-21T07:31:00.000-07:00

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.

Sinequan (Doxepin)

2009-07-20T07:25:00.000-07:00

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.

Amitriptyline

2009-07-19T07:23:00.000-07:00

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.

Venlafaxine

2009-07-18T07:21:00.000-07:00

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.

Citalopram

2009-07-17T07:18:00.000-07:00

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.

Fluoxetine

2009-07-16T07:16:00.000-07:00

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.

Sertralin (Sertraline)

2009-07-14T07:09:00.000-07:00

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.

Paroxetine (Paroxetine)

2009-07-13T07:06:00.000-07:00

Trade names

Pax. Paroxetine. Reksetin.

Subgroup

Selective serotonin inhibitors reverse the seizure.

Action

The main components of psychotropic activity profile is antidepressive and protivotrevozhnoe operation with moderate catalytic (catalytic) effect. The effect is manifested after 10 days.

Mechanism of Action

Inhibits reverse the seizure of serotonin neurons, increases serotoninergicheskuyu transmission in the CNS.

Pharmacokinetics

Completely absorbed in ZHKT. Time achieve Cmax in the blood - 5,2 h. Relationship to plasma proteins - 95%. Intensively metabolized, metabolites do not show pharmacological activity. Approximately 64% ekskretiruetsya the urine and 36% - through ZHKT (unchanged - 2% and 1% respectively). T1 / 2 - 21 am-equilibrium concentration is reached after about 10 days, with daily intake of 30 mg.

Indications

* Depression varying etiology;
* Obsessive-compulsive disorder;
* Panic disorder with agoraphobic and without it;
* Social anxiety disorder / social phobia;
* Generalized anxiety disorder;
* Post-traumatic stress disorder.

Contraindications

* Simultaneously receiving MAO inhibitors, and the period of 14 days after the repeal;
* Simultaneous reception tioridazina;
* Simultaneous administration of drugs containing tryptophan;
* Pregnancy;
* The period of lactation (breastfeeding);
* Childhood and adolescence to 18 years;
* Hypersensitivity to paroxetine and other components of the drug.

Side Effects

Drowsiness or insomnia, tremor, nervousness, increased excitability of central nervous system, the violation of concentration, emotional lability, amnesia, dizziness, paresis of accommodation, the expansion of the pupil, and pain in the eyes, noise and pain in the ears, raising or lowering of blood pressure, syncope, tachycardia or bradycardia, Violations of cardiac conduction, and peripheral blood circulation, cough, rhinitis, dipnoe, tahipnoe, nausea, decreased appetite, indigestion, increased activity of hepatic transaminases, stomatitis, arthralgia, arthritis, dizuriya, poliuriya, urinary incontinence, delayed urination, amenorrhea, dysmenorrhea, miscarriage, breast , violation of ejaculation, reduction of libido and potency, peripheral edema, decrease or an increase in body mass, anemia, leukopenia, allergic reaction (itching, rash, chills).

Rarely - violations of thinking akineziya, ataxia, seizures, hallucinations, giperkineziya, manic or paranoid reactions, deliry, euphoria, big epileptic seizures, aggressiveness, nystagmus, stupor, autism, a decline of visual acuity, cataract, conjunctivitis, glaucoma, exophthalmos, angina, myocardial infarction, disturbance of cerebral circulation, a violation of heart rate, eosinophilia, leukocytosis, limfotsitoz, monotsitoz, gematuriya, nefrourolitiaz, the violation of renal function, dermatitis, nodular erythema, depigmentatsiya.

Interaction

Absorption and pharmacokinetics of the drug did not change at all or changes only partially influenced by food, antacids, digoxin, propranolol, and ethanol.

Combined therapy with lithium preparations should be undertaken with caution and under the control of the concentration of lithium in the blood, because of combined experience in the use of paroxetine and lithium restricted.

Metabolism and pharmacokinetic parameters can be changed while the application of drugs that induce or inhibit the metabolism of protein. With simultaneous application of paroxetine with drugs inhibiting the metabolism of enzymes (tsimetidin) applied dose should be limited to the lower boundary of the normal level. When combined with the use of drugs, inducing metabolism enzymes (carbamazepine, phenytoin, valproat sodium) do not want to change the initial dose paroksetinaa. Follow correct dose should be carried out depending on the clinical effect.

With simultaneous application of paroxetine with drugs metabolized system cytochrome P450 CYP2D6 (tricyclic antidepressants (amitriptyline, nortriptilin, imipramine, dezipramin) fenotiazinovye neuroleptics (tioridazin, perfenazin) and antiaritmicheskie class IC drugs (propafenon, flekainid) and metoprolol), there is increasing their concentrations in blood plasma. The combination of paroxetine with terfenadinom and other drugs that are substrate for the CYP3A4 isoenzyme, does not cause unwanted reactions.

The simultaneous use of paroxetine with MAO inhibitors, may cause the development of tryptophanyl serotoninovogo syndrome evident agitation, anxiety disorders from ZHKT, including diarrhea.

Daily Appointment paroxetine significantly increased the level of protsiklidina plasma. If there are symptoms antiholinergicheskih protsiklidina dose should be reduced.

Interaction paroxetine with warfarin may increase bleeding time when prothrombin time unchanged.

Unlike antidepressants, which inhibit the seizure of norepinephrine, paroxetine inhibits much weaker antihypertensive effect guanetidina.

Dosing and Administration in Adults

Inside, 1 time per day, morning, along with eating - 20 mg. Tablets should be down entirely, not razzhevyvaya, zapivaya water. In poor effect may increase dose to 10 mg / day at intervals of not less than 1 week (maximum dose - 50 mg / day). Older depleted patients, as well as in violation of the functions of the kidneys and liver of the starting dose - 10 mg / day, maximum - 40 mg / day.

Dosing and Administration in pediatric practice

The use of medication in children (under 18) is not recommended, since safety and efficacy of its use in children has not been established.
Pregnancy and lactation

Safety of use in pregnancy has not been studied, so it should not be used during pregnancy and during lactation (breastfeeding), except with the medical point of view of the potential benefits of treatment exceed the possible risks associated with taking the medication. In appointing the drug during lactation is necessary to give up breastfeeding.

Overdosage
Symptoms: increased above-described side effects, as well as vomiting, headache, broadening pupils, fever, changes in blood pressure, involuntary muscle contraction, excitation, anxiety, tachycardia. Patients usually do not develop serious complications, even with the admission of up to 200 mg of paroxetine. Sometimes coma develops and changes in the EEG, it is rarely fatal, with the combined use of paroxetine with psychotropic drugs with alcohol or without it.

Treatment: standard events are used for overdose antidepressants (catharsis through simulated vomiting or washing, the appointment of 20-30 mg of activated charcoal every 4-6 hours during the first days after the overdose). The specific antidote is not known. There is a need for close observation and monitoring of vital functions.

Cautions

The drug should be used with caution with hepatic insufficiency, renal insufficiency, zakrytougolnoy glaucoma, prostate hyperplasia, maniyah, heart disorders, epilepsy, convulsive states, in the presence of risk factors for increased bleeding and predisposing to the disease, in combination with elektroimpulsnoy therapy with oral anticoagulants .

With a sharp lifting may develop symptoms such as dizziness, paresthesia, insomnia, agitation, anxiety, nausea and sweating.

If observed on the background of the treatment increased hepatic enzymes remains a long time, receiving the drug should be discontinued.

Pax does not potentiator effect of alcohol on psychomotor functions, however, patients are encouraged to abstain from alcohol.

It is cognitive or psychomotor retardation violations. Nevertheless, as in the treatment of any psychotropic drugs, patients should be careful when driving a car and work with moving machinery.

Buy Luvox

2009-07-12T06:57:00.000-07:00

Drug form:
tablets coated with film-coated, with a separation groove for the reception inside.

Composition

* The active substances: luvox maleate 50 or 100 mg.
* Other components of matter: mannitol, corn starch, pre starch, sodium stearila fumarat, anhydrous colloidal silicon dioxide, metilgidroksipropiltsellyuloza, polyethylene 6000, talc, titanium dioxide (E171).
* The product does not contain any lactose or sugar (E121).

Pharmacodynamics

Mechanism of action Luvox associated with selective inhibition of a seizure of serotonin neurons of brain and is characterized by a minimum impact on noradrenergicheskuyu transfer. Luvox has ulterior ability to communicate with a-adrenergic, b-adrenergic, gistaminergicheskimi, muskarinovymi cholinergic, dofaminergicheskimi or serotoninergicheskimi receptors.

Pharmacokinetics

After ingestion Luvox completely absorbed from the gastrointestinal tract. The maximum concentration of drug in plasma observed after 3-8 hours after injection. The average half of the blood plasma of a single dose for 13-15 hours, some increases in the multiple admission (17-22 hours), and equilibrium concentrations in blood plasma (steady-state), usually achieved through a 10-14 days.

Luvox biotransformiruetsya in the liver (mainly through oxidative demethylation) to at least nine metabolites that appear through the kidneys. Two major metabolite have negligible pharmacological activity. Other pharmacologically inactive metabolites. Degree Luvox bind to proteins of human blood plasma is about 80% (in vitro).

Indications

Treatment and prevention of depressive disorders. Treatment of the symptoms of obsessive compulsive disorder.

Contraindications

Luvox pill contraindicated use in combination with inhibitors monoaminoksidazy (MAO inhibitors). The interval between the cancellation of the irreversible MAO inhibitor action and the start of treatment Luvoxom shall not be less than two weeks. Luvoxom treatment can be started the next day following the lifting of reversible inhibitor of MAO activity (eg, moklobemida). In principle, the interval between the cancellation and the start of treatment Luvox any MAO inhibitor should not be less than one week.

In addition, Luvox contraindicated in patients with known hypersensitivity to fluvoksamina maleate, or to one of the fillers that make up the drug, as well as patients with marked liver disorders.

Children up to age 8 years.

The use during pregnancy and lactation period

Studies on reproduction in laboratory animals that received high doses of Luvox, revealed no reduction in fertility, sexual behavior and violations of teratogenic effects in their offspring. Nevertheless, it is necessary to observe the usual precautions regarding the use of any drugs during pregnancy. Luvox penetrate in small quantities in breast milk. In this regard, it is not applicable to the period of lactation.

Precautions and warnings

In patients with depression is typically a high likelihood of suicide attempts, which may be retained until a sufficient remission.

Treatment of patients suffering from hepatic or renal failure should start with low doses of Luvox under strict medical supervision. In rare cases, treatment Luvoxom can lead to an increase of enzyme activity of the liver, often accompanied by relevant clinical symptoms. In these cases Luvox should be abolished. Despite the fact that studies on laboratory animals fluvoksamin not cause convulsive activity, caution must be exercised in the appointment of the drug to patients with a history of seizures. Luvoxom Treatment should be discontinued in case of an epileptic seizure. Data obtained in the treatment of patients older and younger patients showed that there was no clinically significant differences between generally applicable to them daily doses. However, increasing doses of the drug in elderly patients should always be done slowly and with greater caution.

Luvox can lead to modest reductions in heart rate (by 2-6 beats per minute).

Due to the lack of clinical experience Luvox is not recommended for the treatment of depression in children.

There have been reports of such abnormal intradermal hemorrhages as ekhimoz and purpura observed in applying the election serotonin inhibitors reverse the seizure. There is a need for caution in designating these medicines, especially in the case of patients receiving both drugs acting on the function of platelets (eg, atypical antipsychotic, and means fenotiaziny, many tricyclic antidepressants, aspirin, non-steroidal anti-inflammatory drugs), as well as patients with a history of bleeding.

Interaction with other drugs

Luvox can not be used in combination with MAO inhibitors. Luvox may prolong the elimination of drugs, metaboliziruemyh by oxidation in the liver. Perhaps the clinically significant interactions with drugs, characterized by a narrow dose-effect "(eg, warfarin, phenytoin, teofillin, klozapin and carbamazepine).

Against the background of the application Luvox may be a slight increase in plasma concentrations of benzodiazepines, metaboliziruemyh in the liver by oxidation.

If you are applying Luvox previously observed increase of the stable levels of tricyclic antidepressants. In this regard, it is not advisable to appoint Luvox in combination with these drugs.

In studies of interactions Luvox indicated increasing concentrations of propranolol after the introduction of Luvox. In this regard, it is possible to recommend lowering doses of propranolol in the event of additional appointments Luvox.

In applying Luvox in combination with warfarin for two weeks, there was a significant increase of concentrations of warfarin in blood plasma, and prothrombin time prolongation. Thus, in patients receiving anticoagulants and inside Luvox should monitor the prothrombin time, and to select doses of anticoagulants.

Luvox does not interact with digoxin and atenolol.

Luvox used in combination with medications for the treatment of severe lithium patients responding poorly to drug therapy. It should be noted that lithium (and possibly tryptophan) enhances serotoninergicheskie Luvox effects, and therefore this kind of combination drug therapy should be undertaken with caution.

As with the use of other psychotropic drugs during treatment Luvoxom not advisable to consume alcohol.

Effects on ability to driving a car or in the management of machines and mechanisms

Luvox, appointed by the healthy volunteers in doses up to 150 mg, no effect on psychomotor functions related to driving a car or with the management of machines and mechanisms. At the same time, there are reports of sleepiness, observed during the treatment Luvoxom. In this regard, it is recommended to be cautious until the final determination of individual responses to medicine.

Dosing and Administration

Depression

The recommended starting dose is 50 or 100 mg (one-time, evening). We recommend a gradual increase starting dose to effective dose. The effective daily dose, usually 100 mg, selected individually depending on patient response to treatment. The daily dose can be as high as 300 mg. Daily intake of more than 150 mg should be distributed on multiple devices.

In accordance with official recommendations of the WHO treatment with antidepressants should be continued for at least 6 months after cure depressive episode.

To prevent a recurrence of depression are recommended to take 100 mg Luvox once a day.

Obsessive compulsive disorder.

We recommend that you start with a dose of 50 mg Luvox a day for 3-4 days. The effective daily dose is usually between 100 and 300 mg. Doses should increase gradually until an effective daily dose should not exceed 300 mg in adults. Doses up to 150 mg can be taken as a single dose, preferably at night. Daily intake of more than 150 mg is recommended to allocate up to 2 or 3 steps.

Doses for children over 8 years and adolescents:

Initial dose is 25 mg / day at a time. Maintenance dose of 50-200 mg / day. The daily dose should not exceed 200 mg. Daily intakes above 100 mg is recommended to allocate up to 2 or 3 steps.

When a good response to drug treatment may be continued by means of individually selected daily dose. If improvement is not achieved after 10 weeks of treatment, fluvoksamin should be repealed. Until now, there was no organized system of research that could answer the question about how long the treatment can be conducted fluvoksaminom, however, obsessive compulsive disorders are chronic in nature, and therefore can be considered a useful extension Luvoxom treatment beyond 10 weeks in patients with good responses to this drug. Selection of the minimum effective maintenance dose should be done with caution on an individual basis. Some clinicians recommend the concomitant psychotherapy in patients responding well to drug therapy.

Treatment of patients suffering from hepatic or renal failure should start with the lowest dose under strict medical supervision.

Tablets Luvox should not zapivaya razzhevyvaya and little water.

Adverse effects

The most frequent symptom, associated with the use of Luvox is nausea, sometimes accompanied by vomiting. This side effect, usually disappears in the first two weeks of treatment.

Other side effects observed in controlled clinical trials of more than 1% of patients and there is more often than with placebo were as follows:

* Central nervous system: drowsiness, dizziness, headache, insomnia, anxiety, psychomotor agitation, anxiety, tremor;
* Digestive tract: constipation, anorexia, dyspepsia, diarrhea, unpleasant sensations in the epigastrium, dry mouth, feeling of discomfort;
* Skin: increased sweating;
* Other: asthenia, palpitation, tachycardia.

As with the application of other polling serotonin inhibitors reverse capture rarely observed transient hyponatremia, terminated after the abolition of Luvox. In some cases it may be due to syndrome of inappropriate secretion antidiureticheskogo hormone. Most reports were associated with the treatment of patients with senile age.

Hemorrhage: See "Safety precautions and warnings."

Sometimes there may be an increase or decrease in body weight.

In rare cases, symptoms such as headache, nausea, dizziness and anxiety, there were sharply after the abolition of Luvox.

Some of the above-mentioned undesirable phenomena can be symptoms of depression and do not necessarily caused by Luvoxom.

Overdosage

Symptoms

The most characteristic symptoms include gastrointestinal disturbances (nausea, vomiting and diarrhea), drowsiness and dizziness. In addition, there are reports of violations of cardiac (tachycardia, bradycardia, arterial hypotension), liver dysfunction, convulsions and even coma.

So far received over 300 reported cases of intentional overdose Luvox. The highest recorded dose Luvox received one patient was 10 000 mg; this patient was cured as a result of a purely symptomatic treatment. More serious complications were observed in cases of intentional overdose Luvox on the background of concomitant pharmacotherapy.

Treatment

There is no specific antidote. If overdose is recommended gastric lavage, which should take place as soon as possible after taking the medication, and symptomatic treatment. In addition, it is recommended that multiple receive activated charcoal. Enhanced diuresis or dialysis seem unreasonable.

Composition

Tablets, coated with film-coated, with a separation groove in the blisters, packed in cardboard packaging of 15 tablets of 50 mg fluvoksamina maleate, or in cardboard packaging of 15 tablets of 100 mg fluvoksamina maleate.

Storage conditions

Luvox tablets should be stored in a dry place inaccessible to children, protecting from direct sunlight at a temperature no higher than 250 ° C.

Keep the medicine out of reach of children!

Shelf life

3 years, subject to store undamaged in original packaging.

The drug can not be applied at the end of life.

Terms of leave from pharmacies

Prescription physician.

Treatment of depression

2009-07-11T07:35:00.000-07:00

The treatment of depression. Definition and typical symptoms of depression. Test and scale to detect depression.
Definition of depression
Depression - an illness that can bring people out of emotional balance for a long time, and significantly impair quality of life (activity, personal relationships, leisure, etc.).

Depression can occur as a response to previous trauma or adverse event (death of a loved one, dismissal from work, etc.), but it often develops without apparent cause.

It is important to know that:

*
Depression is well to treatment, resulting in full recovery occurs.
*
Talking about your problem - then do the first step toward recovery from depression.

Typical symptoms of depression:

*
Tosca, sadness, anxiety or irritability.
*
Difficulty falling asleep, repeated awakening at night or awakening too early.
*
Loss of interest in work, eating, sex life.
*
The sense of guilt and his own inferiority, hopelessness about the future.
*
Difficulty concentrating and constant tiredness.
*
Loss of weight or, conversely, an increase in weight.
*
Headaches, pain in the heart, the back (without organic causes).
*
Excessive concern about their health.
*
Thoughts about suicide and death.

Men's Depression
Depression in men often is detected with difficulty. This is because, on the one hand, the widespread erroneous perception that telling others about their problems and do not know how to handle himself with them - a sign of human weakness, but on the other hand, the fact that men often hide their depression of aggressive behavior and / or for alcohol abuse.

Alcohol - is not the only means available to try to alleviate depression or disguise it. Care to head to work, an active sport or hobby of such species that are associated with the risk or extreme events, as well as gambling - all this may be indicative of depression in men.

Typical symptoms of depression in men:

*
Reducing the resistance to stress.
*
Soyavlenie uncertainty in decision-making.
*
Aggressive and hostile behavior.
*
Alcohol abuse, alcohol dependence.
*
Syndrome «peregoraniya».
*
Manifestation of impetuous behavior.
*
A passion for extreme sports, intentional excessive physical activity.
*
Thoughts about suicide and death.

Trazodon (Trazodone)

2009-07-11T07:12:00.000-07:00

Trade names

Azona. Trittiko. Trazodon.

Action

Pharmacological Effects - antidepressive, sedative. The therapeutic effect of half of the patients seen after 3-7 days, with 3 / 4 - at the end of the 2 nd week and 1 / 4 - 2-4 weeks. Antidepressive (timolepticheskoe) effect combined with anxiolytic and trankviliziruyuschim (effective for the expression of anxiety and severe insomnia).

Mechanism of Action

Selective serotonin inhibits seizure sinaptosomami brain potentiator and behavioral change, induced by serotonin precursor 5-gidroksitriptofanom, blocking alpha-adrenergic receptors.

Pharmacokinetics
Quickly and completely absorbed from the ZHKT. Time achieving Cmax is approximately 1 hour (increasing after meals). Passes through gistogematicheskie barriers, including GEB. Penetrates the tissue and ekzosekret (bile, saliva, milk, etc.). In livers subjected to transformations. Eliminations are diphasic nature. T1 / 2 of the first phase of 3-6 h, 5-9 h later; possible accumulation. Ekskretiruetsya (together with metabolites), mainly from urine.

Indications

Various forms of depression (endogenous, neurotic, somatogennye) with anxiety and tension, depression in elderly patients with organic diseases of the central nervous system.

Contraindications

Hypersensitivity, start-up period after myocardial infarction, disturbance of heart rhythm expressed disorders of liver and kidney function, pregnancy, breast-feeding (at the time of treatment excluded).

Limitations to the use of

With caution (when continuous monitoring of cardiac rhythm) designate, with heart disease, hypertension (because of the high-risk hypotensive reactions may require the reduction of doses of antihypertensive drugs).

Side Effects
Changes in vision, eye irritation, mortgaged nose, constipation, diarrhea, dry and bitter taste in the mouth, nausea, vomiting, dizziness, drowsiness, fatigue, headache, mialgii, discoordination, paresthesia, disorientation, blackout, tremor, a violation of heart rate and conductivity , bradycardia, atrial fibrillation, arterial hypotension with elements of orthostatic hypotension and sinkopalnymi conditions, leukopenia, neutropenia (usually small), priapizm, allergic edema, skin allergic reactions.

Interaction

Modifies the effect of warfarin (increases or decreases), potentiator effect of drugs, oppressive central nervous system, including barbiturates, alcohol. Antihypertensive funds increases the risk of orthostatic hypotension. Decreases hypotension caused by clonidine. Increases plasma concentrations of digoxin and phenytoin.

Dosing and Administration in Adults

Inside, after the meal. As antidepressant - 50 mg 3 times a day, then, depending on the type and severity of depression, the dose gradually (50 mg every 3-4 days) increased to 300-500 mg / day (less than 600 mg), maintenance dose also be selected individually. The main part of the daily dose is recommended to take before bedtime.

As - 25 mg 3 times a day. B / B and V / m - 50 mg for.

Pregnancy and lactation

Not recommended during pregnancy and lactation period.

Overdosage

Symptoms: nausea, drowsiness, priapizm, stop breathing, epileptiformnye seizures, changes in ECG, frequency and Enhancement of side reactions.

Treatment: gastric lavage and forced diuresis in order to accelerate the elimination of, the maintenance of vital functions.

Cautions

It should not be used concurrently with MAO inhibitors.

Do not combine with electric shocks. Patients should be warned men about the need for immediate treatment to the doctor (to stop taking trazodona) if there are lengthy and inadequate erection. Because until a remission may be maintained suicidal tendencies, the patient should prescribe the drug in the minimum required amounts.

Before the operation under general anesthesia is required early lifting trazodona. During the period of treatment is not recommended to receive alcoholic beverages (trazodon may increase the effects of alcohol). With carefully applied during the drivers of vehicles and people, a profession which is related to increased concentration.

Antidepressants

2009-07-11T06:56:00.000-07:00

The first antidepressant introduced in the late 1950's. In 1957 were discovered by iproniazid and imipramine. The first group was the ancestor of antidepressants, MAO inhibitors, on the basis of the second were synthesized tricyclic antidepressants.

In accordance with modern ideas, with depression decreasing serotoninergicheskaya noradrenergicheskaya and synaptic transmission. It is therefore an important link in the mechanism of action of antidepressants is considered to be caused by the accumulation of brain norepinephrine and serotonin.

MAO inhibitors block monoaminoksidazu - the enzyme that causes oxidative desamidization and inactivation monoanines. There are currently two known forms of MAO - type A and type B, differing in the substrate, are subjected to their operation. MAO type A resulting in desamidization noradrenaline, adrenaline, dofamina, serotonin, tiramina and MAO type B - desamidization feniletilamina and some other amines. There are competitive and non-inhibition, reversible and irreversible. It can be observed substrate specificity of the drug, ie, predominant influence on the different desamidization monoanines. All this greatly affects the therapeutic and pharmacological properties of different MAO inhibitors. For example, iproniazid, nialamid, fenelzin, traniltsipromin irreversibly blocking MAO type A. At the same time pirlindol, tetrindol, metralindol, eprobemid, moklobemid, etc. (which belong to a new generation of antidepressants, MAO ignibitorov) - have on monoaminoksidazu reversible and selective influence .

Tricyclic antidepressants are known thanks to its characteristic trehtsiklicheskoy structure. The mechanism of action due to a seizure of oppression NEUROMEDIATOR monoanines presinapticheskimi the nerve endings, which leads to the accumulation of mediators in the synaptic gap and the activation of synaptic transmission. Most tricyclic antidepressants at the same time reduce the capture of different NEUROMEDIATOR monoanines (norepinephrine, serotonin, dofamina).

Recently created antidepressants that selectively block the reverse capture serotonin (fluvoksamin, fluoxetin, sertralin, etc.).

In addition, there are a number of so-called "atypical" antidepressants, distinct from "typical" how to structure and mechanism of action. There are bi-products and chetyrehtsiklicheskoy structure, which did not reveal any pronounced influence on the activity of either MAO or to capture neuromediators (mianserin, etc.).

Common property of all antidepressants - they timolepticheskoe (antidepressive) effects, ie a positive impact on the emotional (affective), the scope of the patient, with the overall mental state and, in particular, better mood.

Various antidepressants differ, however, the amount of pharmacological properties. So, for imipramine and MAO inhibitors, along with antidepressive, characterized by a catalytic effect, for amitriptyline, pipofezina, fluatsizina, clomipramine, and trimipramina doksepina - on the contrary, sedative. Maprotilin has trankviliziruyuschimi properties pirlindol - nootropnymi, etc.

Many antidepressants are used not only in the psychiatric practice but also in the treatment of a number of (psycho) somatic diseases, vegetative disorders, chronic pain syndromes, etc.

The therapeutic effect of antidepressants develops gradually and can be seen, usually through a 3-10 or more days after the treatment. This is because the development of antidepressive action due to the gradual accumulation of neuromediators in nerve endings and slowly emerging changes in the adaptation cycle neuromediators, and the sensitivity of receptors to the brain.

Tranquilizers

2009-07-11T06:53:00.000-07:00

Tranquilizers (from Lat. Tranquillo - calm), or anksiolitiki (from Lat. Anxietas - anxiety, fear + gr. Lytikos - capable of dissolving, weakening), or ataraktiki (from Greek. Ataraxia - imperturbability) - psychotropic drugs, which reduce the severity or suppress anxiety, fear, anxiety, emotional tension.

First tranquilizers (gidroksizin, meprobamat) were synthesized in 50-ies of the XX century. Widely used in medical practice, tranquilizers were from 60-ies of XX century. When the first benzodiazepinovye anksiolitiki - hlordiazepoksid and diazepam.

Tranquilizers have a wide range of pharmacological actions. They have not only anxiolytic effect, but also have sedative, hypnotic, miorelaksiruyuschee, anticonvulsant, and amnesticheskoe vegetostabiliziruyuschee operation.

The main effect of tranquilizers is anxiolytic (protivotrevozhny). Anxiolytic effect is manifested in the reduction of anxiety, fear (antifobicheskoe effect), the emotional tension.

Sedative (calming) effect is to reduce psychomotor excitability, daily activity, a decrease of concentration, slow reactions, etc.

Hypnotic (hypnotic) effect manifests itself in facilitating the onset of sleep and an increase in its duration. Depressant effect of tranquilizers on the central nervous system leads to mutual reinforcement of the effects of sleeping-pills, anesthesia and analgetics funds.

Miorelaksiruyuschy effect (relaxing the skeletal muscles) in the application of tranquilizers tended to be a positive factor for the withdrawal of voltage excitation, including motor. However, this effect may limit the use of drugs in patients whose work requires quick mental and physical reactions. It should also be borne in mind that miorelaksiruyuschee operation can take the feeling of drowsiness, weakness, etc.

Anticonvulsant effect is to suppress the proliferation of epileptogennoy activity, resulting in epileptogennyh pockets.

Amnesticheskoe action (ability to cause amnesia) is manifested mainly in the parenteral (injection) application. The mechanism of this effect is not yet clear.

In the spectrum of certain tranquilizers emit vegetostabiliziruyuschy effect (normalization of functional activity of the autonomous nervous system). Clinically, this effect can occur decreases autonomic manifestations of anxiety (tachycardia, hypertension, sweating, a violation of the functions of the digestive system, etc.).

The clinical use of tranquilizers is related mainly to their protivotrevozhnym action. Tranquilizers are used in all types of anxiety disorder, in addition, they can be used to treat anxiety or to short-term symptoms of anxiety.

Although tranquilizers may exercise all the characteristics for this group of pharmacological properties, expression, and the ratio of the effects of different drugs may be different, hence the features of their clinical application.

It should be remembered that the treatment of tranquilizers can be carried out only under medical supervision, since the use of tranquilizers can lead to habituation (reduction in the long admission), as well as to the formation of drug dependence (physical and / or mental) and a syndrome cancel. The risk of dependence increases with prolonged use. Because of the higher risk of dependence use tranquilizers in children and adolescents under the age of 18 is justified only in exceptional cases, a clear evidence-based, with the duration of treatment should be minimal.

In connection with the weakening of concentration and slowing down of psychomotor reactions should appoint tranquilizers outpatient care, particularly for patients whose work requires high concentration and rapid mental and physical reactions (drivers, dispatchers, etc.).

When you receive tranquilizers is not alcohol, because alcohol increases the depressant effects of drugs of this group in the central nervous system that may be accompanied by a danger to the life of heavy side effects, including loss of consciousness and respiratory depression.

In the appointment of tranquilizers for the treatment of anxiety disorder should observe the principle of gradual dose increase - from minimally effective for up to an optimal therapeutic effect (apart from a severe condition). The treatment should be as short as possible, and then must re-evaluation of the patient to decide on the need for continued therapy.

In connection with the possibility of development of drug dependence and addictive Conciliation Commission, WHO (1996) is not recommended to use tranquilizers benzodiazepinovogo number continuously for more than 2-3 weeks. If you need long-term treatment (several months) course is recommended that the discontinuous method, discontinue receiving the drug for several days, followed by the appointment of the same individually tailored doses. To reduce the risk of developing the syndrome lifting, with the lifting of the drug dose is recommended to decrease gradually.

Antidepressants

2009-04-06T07:22:00.001-07:00

Antidepressants - that drugs that facilitate or prevent depression. Prior to the opening of antidepressants to treat depression is actively used substances with exciting effects that can cause a state of euphoria (opium and other opiates, caffeine, ginseng).

To reduce anxiety and excitability using, also used a salt bromine. But the real coup was the discovery in psychopharmacology antidepressants in the early 50's. Since then, for over half a century, these drugs are the principal means to combat depression.

Despite the fact that the era of antidepressants has started recently, it has already had its "creation myths."

Since the beginning of the twentieth century, researchers have experimented with different substances in an attempt to synthesize the drug that facilitates the symptoms of depression, but the experiments failed. The first antidepressant was "opened" in 1957, quite by accident, when doctors called attention to the effect of iproniazida who applied for the treatment of tuberculosis. In addition to the main effect of the drug were observed and secondary, which was unusual in improving mood in patients with tuberculosis. Soon the drug was used to alleviate symptoms of depression, the more that, as a means of tuberculosis, the drug itself is not justified.

According to another version of the effect of opened Nathan Kline, and its opening was also more than a casual - he tried to help the drug to prove a theory about the location of the "ego". During psychoanalytic sessions, Klein noted that some patients to whom he gave the drug, suddenly ceased to agitate the problem over which they worked. Iproniazid has been placed on the market, but soon proved that it increases the risk of jaundice, and the sale of the drug was discontinued.

At the same time, Germany was opened by Ronald Kunom imipromin. Kuhn gave various drugs to their patients, to their reaction to the global classification of mental illness, which German psychiatrists of that time were literally obsessed. As in previous cases, the drug was "open" when the patient has to rise up. Unlike iproniazida, imipromin still included in the official list of drugs and WHO before prozac was the best selling antidepressants.

When the first antidepressants were discovered, no one could have imagined that just a few decades, treatment with antidepressants almost replace other types of treatment of depression, but in a survey conducted in the late 20 th century in the United States, the biggest opening of the last century will be recognized is not the theory of relativity and not the Internet, a small capsule prozac.

How to deal with depression: pleasant antidepressants

2009-04-06T07:19:00.000-07:00

Depression - from the Latin word «depressio» - means the suppression, oppression. A sense of inner emptiness, senselessness of life, sudden shifts of mood throughout the day, obsessive memories, sleep problems, unwillingness to work or do anything to do - these are some symptoms of depression. During this time feel the desire to retire. Hardships and daily responsibilities, and any, even the most minor problem out of equilibrium, and it seems impossible. But you can not give up, you need to live, because there is liability, there is a promise, and, generally, the life given to us once, and stupid to spend it on longing, sadness and gloom.

To begin with, listening to you, good specialist tells what to do in any given situation. Any problem can be solved.

First of all psychologists are advised to talk with a close person that oppresses you. Straight Talk provide some relief.

Do not place a unattainable goal. Realistically assess their capabilities and skills.

Do not stay alone with them. Try to be among people, nice to you, and communicate with those who trust. Walk to the cinema, theater or a visit.

Most rest. Fresh air, books, fragrant baths, shopping trip - whatever gives you pleasure.

Psychologists argue that if you have depression and you want to get rid of it, all in your hands. To get out of depression, the man himself should so wish. Of course, you can «jam» depression pills. By the way, a very important point: to take pills for depression should be only on the advice of a doctor. Uncontrolled receiving these drugs can cause addiction and lead to chronic depression.

There are many good antidepressants, which can be used.

One of the nice tools that will help with depression - it is taking care of themselves. Buy yourself something new clothing. Relax and rest. Massage, a new hairdo, manicure, pedicure - all this does not only result in the order of appearance, but also help raise the status of your own perception and in the eyes of others.

Sports help to no worse than pills. In the human body starts out in a very important hormone - a hormone of happiness and mood - serotonin. So do not ленитесь! Fitness, aerobics, swimming pool, cycling, rollerblading or even dvadtsatiminutnaya scamper - all at your choice.

Sex also helps reduce tension, to forget about problems. During the sex hormone produced joy - endorfin - indispensable in the fight against depression. Besides classes love relax, normalize the nervous system, increase immunity.

The withdrawal of the depressed state of music is very helpful. The best action has on the psyche of our classical music. But if the word «classic» makes you melancholy and sadness, you can try the classics in modern or light rhythmic dance music - click on your taste.

Find a hobby. Embroidery, painting, razgadyvanie crossword puzzles, dance, books - just a lot of things you can do yourself and try to emerge from depression and despondency. By the way, read the light and funny piece. For example: Zoshchenko, Darrell, Averchenko.

Travel and vacation in nature will give you a feeling of newness of life. New impressions, fresh air, contact with nature, the harmony will help you reconcile with yourself and feel part of the universe.

Everyone wants to be happy. But happiness - was a relative concept. In life, we are upset by trifles, we are outraged actions of others, and if something does not succeed, give up and allow discouragement to capture our minds. But persevere and work always bring success. Sense of humor and a philosophical attitude to life and defeat the problems of failure.

Change your attitude towards life, a rearrangement of priorities, and it is quite possible that life will appear in a different light.

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Signs of depression. How to fight depression.

2009-03-17T05:03:00.000-07:00

In the U.S., one in three adults suffers from depression. Depression worsens the quality of life, adversely affect relationships with friends, colleagues, reduces the effectiveness of rights at work. It should be noted that if the prior for help to a doctor, a counselor asked predominantly intellectual and economic elite of society, aware of the importance of full active life, in recent years has increased the number of people of all walks of life, preferring to use the professional psychological help.

How to understand that you or your loved ones is not just a bad mood, and depression, in which you want to seek the assistance of a physician-therapist?

Any depression is composed of three components - mood disorders, autonomic disturbances and fatigue.

The first component of depression is related to changes in mood - sad gloom lasts more than two weeks. When depression appears dim perception of the world, everything seems gray and uninteresting. There are changes in mood during the day - morning, the mood may be good, but worse in the evening. Alternatively, the mood is bad in the morning, and several razveivaetsya in the evening. Some people may not be the daily fluctuations of mood - but it is sad, sad, dismal and wet.

Gloom is in different shades. Sometimes it's gloom with a touch of longing, with a tinge of anxiety, with a tinge of desperation, as well as indifference or irritability. Sometimes people may not realize its a sad mood, but feel the so-called physical manifestations of depression. With depression, you may receive a strong feeling the heat in the chest, «heavy stone pressing on the heart». Less depression manifests itself as a chronic feeling of pain in any part of the body, while physicians of other specialties are not to organic causes of pain.

Very often the situation long-term stress man reacts with a touch of anxiety depression. Anxiety people feel in different ways. It can manifest itself in the fear of falling asleep, nightmare dreams, and in constant fear and imagination that with friends and family, something terrible will happen. Sometimes people describe anxiety as anxiety and inability to usidet in one place. Constant feeling of anxiety does not allow you to relax, for example, a person can not sit quietly on a chair for more than two or three minutes - «fidget in his chair, then jumps and starts to walk around the room».

Very severe anxiety (57 points on the scale of Shihan or more) occurs on a background of depression developed, and manifests itself in the form of panic attacks (feeling the shortage of air, heart rate, trembling in the body, feeling the heat). If you are having severe anxiety, it is said that a person has formed a huge underwater part of the iceberg of depression and anxiety disorder is the pinnacle of the iceberg of depression.

If the alarming depression people could not usidet on the ground, then when the other forms of depression, he, on the contrary, it becomes harder to move. If a person sleeps for 12 -14 hours a day, he had no sense of cheerfulness in the mornings, but everyday activities - cooking the soup, clean the apartment using a vacuum cleaner - it seems to be prohibitive, or meaningless, it may be a manifestation of apaticheskoy depression.

The processes of inhibition in the depression, covering the entire body - the person becomes more difficult to think he had a significant negative impact on memory and attention, which significantly affects the efficiency. Difficulty with concentration is that people get tired of watching TV, or short of reading a few pages of interesting books. Or, for example, a person may be a long sit in front of the computer, but unable to concentrate at work.

The second component of depression include vegetative disorders (of vegetovascular vascular dystonia). If a cardiologist and internist excluded relevant organic disease, then hurried urination, the urge false, headaches, dizziness, fluctuation of blood pressure and temperature are treated as additional vegetative signs of depression.

In the gastrointestinal tract depression affects as follows: a person has lost appetite, constipation observed in 4-5 days. Considerably less, in the form of atypical depression, a man noted an increased appetite, diarrhea or false urge.

Depression is not true, and sexual systems. As a result of developing depression in men and women caught in sexual feelings. Much less depression manifests itself in the form of obsessive masturbation, or in the form of flight in many chaotic communication. Men often appear problems with potency. Women with depression may be a delay of regular menses in 10 - 14 days to six months or more.

The third component of depression - asthenic include fatigue, sensitivity to weather changes, irritability. Irritation causes loud sounds, bright lights and sudden touching strangers (for example, when a person accidentally pushed on the subway or on the street). Sometimes, after the outbreak of internal irritations appear tears.

When there are various depression disorders of sleep: difficulty in filling up, superficial restless sleep with frequent awakening or early awakening with a simultaneous desire and inability to sleep.

Depression has its own laws of development. There are signs that indicate the severity of depression. Symptom of depression were significantly greater reflection on the senselessness of life and even suicide. Thus, the general sense of reluctance to live, thinking about the senselessness and aimlessness of life, as well as more distinct suicidal thoughts, intentions or plans appear consistent with severe depression. The appearance of these symptoms you or your loved ones is an indication for urgent treatment to a doctor, a counselor. In this state, it is important to as quickly as possible to begin drug treatment of depression in an adequate dose.

Drug treatment of depression is appointed, if the level of depression on a scale Dung equals or exceeds 48 points. The effect is due to the influence of drugs on the serotonin system (hormone of happiness and pleasure), norepinephrine, etc. Against the background of a stable mood is much easier to resolve psychological problems, to allow the conflict situation.

Many people are afraid to take antidepressants, because believe that the alleged resistance to the growing habit (drug dependence). But it does not, to antidepressants addictive (dependence on drugs) does not develop. The addiction causes strong sedatives and sleeping pills from the group of tranquilizers (benzodiazepines). Depression is treated with a drug - with antidepressants.

Depending on the hue gloom physician psychotherapist appoints different antidepressants. There are antidepressants that treat depression, with a touch of anxiety. There are medications to treat depression, with a touch of apathy, indifference, etc. If you choose the right dose of medication within three to four weeks, the depression begins to undergo reverse development - disappear suicidal thoughts, anxiety, a desire to act in stabilizing mood.

Antidepressants become effective at the end of the second - the third week. Having improved, most people already at the fourth week, dropping out of receiving antidepressant, and as a consequence, in a few weeks, the depression returned. To completely cure the depression, it is important to bear the entire course of treatment of depression, a doctor, a psychotherapist.

The duration of treatment with antidepressants doctor determines an individual psychotherapist in each particular case. But as a rule, treatment with antidepressants may take from 4 months to a year, sometimes longer. Sometimes the doctor-psychotherapist after the main course of treatment may designate a course maintenance, to secure the effect of treatment of depression. Easiest to treat depression lasting less than six months. If a person defers treatment for two or three years, or even eight - ten years, the treatment significantly increases and can reach up to half a year and a half years of maintenance therapy.

Psychotherapy of depression should be treated as a high temperature in the practice of common diseases. The high temperature is not a diagnosis, it shows corporal trouble. When a person has fever, he is drawn to the doctor and specialist deals - this flu, appendicitis or something else. Thus depression and said that, at heart a bad man, and he needed psychiatric help. The doctor-psychotherapist appoints «febrifuge» - antidepressant, and further using the methods of psychotherapy helps a person deal with the problem, which was the cause of depression.

2009-03-15T07:30:00.001-07:00

Generic Zoloft.

Currently, one of the most common painful conditions is depression. In doing so, increasingly there is a situation where the first doctor in charge patients with symptoms of depression is not a psychiatrist, and the precinct a doctor - a physician, neurologist, cardiologist or other specialists, clinics or hospitals.

Especially in patients with depression can be found on the admission of the neurologist. In neurological patients of depression most often associated with Parkinson's disease, multiple sclerosis, intracranial tumors, especially in the temporal lobe, atherosclerosis of brain vessels.

More than two-thirds of patients with depression revealed the pain of varying intensity [Bair MJ, 2004], and severe pain associated with a higher degree of depressive symptoms [Katon W., 1994].

This has meant that the tools used not only to psychiatrists but also to neurologists, cardiologists, physicians, surgeons, dermatology and others, have also include antidepressant drugs. However, the lack of awareness about modern antidepressant leads to the predominant use of general practitioners, only long types of drugs amitriptyline, melipramina etc.

These drugs are powerful antidepressants, so far widely used in the psychiatric clinic, while deployed, a deep depression. In the same out-patient conditions, which mainly refers to the atypical, erased versions of depression occurring against the backdrop of somato-autonomic disorders, these drugs are relatively side effect, may have negative consequences.

In addition, traditional antidepressants (amitriptyline, etc.) because of poor tolerance of side effects may compromise the meaning of the treatment of depressive disorders in patients obschemeditsinskoy practice. Given what is particularly important to inform general practitioners about antidepressants, have a milder effect and without any marked side effects.

One of the modern drugs that can be recommended for use in obschemeditsinskoy practice is sertralin (INN: Sertraline), which belongs to the class of selective serotonin inhibitors reverse capture (SIOZS).

This product was originally developed by «Pfizer» and is registered in Russia under the brand name «Zoloft». Sertralin Generic Zoloft has a high efficiency, comparable to the effectiveness of the treatment of tricyclic antidepressants, but there has been much better portability and a high profile security [Casey DE, 1994].
Mechanism of Action

Sertralin inhibits reverse the seizure of serotonin (5-HT) neurons in the central nervous system, and superior in this respect amitriptyline in 100-200 times fluvoksamin 9 times, fluoxetin 5 times and 2 times clomipramine [Koe BK, 1990]. As a result of increased content of serotonin in the synapses, which link the antidepressive effect and antitrevozhny Setralin.

This sertralin has very little effect on the reverse capture norepinephrine and dofamina. Sertralin not inhibited monoaminooksidazu. Selectivity Setralin against serotonin and low affinity for adrenergic, cholinergic, GABA, DOPAMINE, gistaminovym, serotoninovym and benzodiazepinovym receptors leads to a lower frequency of cardiovascular, antiholinergicheskih and sedative side effects such as xerostomia, mist, an increase in body weight, constipation, orthostatic hypotension and sedation, often resulting in the treatment of tricyclic antidepressants.

Some positive sertralin properties associated with the peculiarities of its pharmacokinetics. The latter are also key differences from other Setralin SIOZS. When the 14-day application Setralin at a dose of 50-200 mg once daily maximum concentration of drug in plasma are achieved within 4,5-8,5 hours.

The half of the plasma is 26 hours, which is sufficient to receive a single daily dose, but eliminates the risk of cumulative drug dose and side effects (unlike fluoxetin, where the half life of 2-3 days). Regular admission at the doses of 50-200 mg once a day equilibrium state is achieved within approximately 1 week. In equilibrium condition the rate of absorption Setralin equal to the speed of its ascent, so the levels of the drug remained virtually constant.

Sertralin subjected to metabolism in the first passage through the liver. After the cessation of therapy sertralin 95% out of the body (otmyvochny period) for 1 week.
Comparative studies SIOZS and other antidepressants.

There are a large number of meta-analysis of antidepressants compared. According to these studies, SIOZS generally do not concede on the effectiveness of tricyclic antidepressants. This portability SIOZS much better than the portability of the tricyclic antidepressants . Profile of side effects also varies among SIOZS. Application SIOZS accompanied by significantly fewer antimuskarinovyh effects, with the increasingly common gastrointestinal effects and psihostimuliruyuschie.

Indications for use Generic Zoloft

The drug sertralin Generic Zoloft was developed (designed) as a drug for a psychiatric practice. Therefore, in testimony to the applicability of the depression, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder (PTSD) and social phobia.

There are a large number of studies have confirmed the effectiveness of Setralin Generic Zoloft when those violations. Currently, however, the use of drugs had gone beyond psychiatry.

This was largely due to the high prevalence of depression in obschemeditsinskoy practice. Thus, approximately 60-80% of patients with depression do not fall within the field of mental health treatment and medical internist, because they predominate among patients with mild forms of atypical depression.

A large proportion of these patients is found in the practice of neurologists. Milder effects Setralin Generic Zoloft and a favorable safety profile make it possible to apply it more widely by doctors of various specialties. In addition, recent studies have demonstrated high efficiency of application Setralin Generic Zoloft and with various chronic pain syndromes
.
Application Setralin Generic Zoloft with depression and anxiety
There is a lot of experience applying Setralin Generic Zoloft with a broad spectrum of depressive violations as endogenous and exogenous nature. Sertralin Generic Zoloft, can be used to treat high depressive disorder. Its effectiveness in the episode of major depression was established in 6-8-week controlled study in outpatients [Khouzam HR et al. 2003].
A separate mention should be made of the effectiveness of Setralin Generic Zoloft in the treatment of masked depression, which manifests itself in different neurological and somatic symptoms (including chronic pain syndromes).

These patients are usually reluctant to accept and carry bad tricyclic antidepressants. Monthly treatment sertralinom Generic Zoloft successfully resolves itself as a manifestation of depression, and worrying, and somato-vegetative symptoms, contributing to the normalization of sleep and the elimination of pain syndrome, regardless of the clinical picture of the prevalence of those or other somatic manifestations.

Recently, we investigate the effectiveness of sertralin Generic Zoloft in the depressions in the organic neurological disease. In neurological practice, very often, and with unfavorable prognostic point of view is the development of depression in patients suffering from Parkinson's disease.

Effectiveness sertralin Generic Zoloft in this situation is not inferior to amitriptyline. This application sertralin Generic Zoloft, but not amitriptyline significantly improves the quality of life of these patients.

Recent research has proved highly effective Setralin Generic Zoloft in the treatment of depression in Alzheimer's disease in combination with high portability, which allows to speak of sertraline Generic Zoloft as the drug of choice in this situation.

There is work that showed the high efficiency sertralin Generic Zoloft with postnatal depression and postmenopauzalnyh. Epperson et al. (1997) presented the results of 6-week placebo-controlled double-blind study the effectiveness of Setralin Generic Zoloft with this pathology. Of the 13 women received a full course of 6, 4 out of 6 completed the study were evaluated responderami, 3 of them were sertralin Generic Zoloft.

The authors come to conclusion on the effectiveness of Setralin Generic Zoloft in the treatment of postnatal depression. Stowe et al. [1997] investigated the influence of Setralin Generic Zoloft with depression in 26 patients. Was the standard dose (50-200 mg / day).. The entire 8-week course of therapy was 21 women, all marked improvement from 2 nd week of treatment. In 14 patients after the course has been recorded complete remission. Sertralin Generic Zoloft is well tolerated, side effects were minor and completely reduced by correcting the dose. Breast-feeding during treatment continued to 6 women that did not impact on children. However, it is unknown which may have influenced breast-feeding mothers taking drugs, for newborn babies in the long run. Therefore, the decision to use antidepressants for postpartum depression at kupirovaniya nursing mothers must be very balanced.

About 75% of women experiencing unpleasant feelings during the menstrual period in the form of headaches, worsening of mood according to epidemiological studies. In doing so, only in 3-8% of women, these and several other violations very seriously and expressed dezadaptiruyut women. In DSM-IV classification was introduced a special term for this condition - «perimenstrualnoe disforicheskoe disorder». Etiology of the violations are not clear. It is assumed that the physiological fluctuations in hormones rather than a violation of the ratio of the hormones are provocateurs of clinical manifestations perimenstrualnogo disforicheskogo disorder. Serotoninergicheskaya system is in close reciprocal relationship with sex hormones and is the most reasonable target for intervention. Of the drugs for this category of patients were the most effective drugs SIOZS group. In several randomized, placebo-controlled studies have shown drugs SIOZS high efficiency and minimal side effects. Recently, another study showed that even an effective periodic (only during perimenstrualnogo period) receiving the drug serotoninergicheskogo.

Application Setralin Generic Zoloft with obsessive-compulsive
disorder (ROC)

Sertralin Generic Zoloft is used to treat obsessy and kompulsy patients with ROC. ROC is characterized by intrusive ideas, thoughts, beliefs or the way (obsessiyami), which are distonicheskimi and / or repetitive, purposeful and intentional action (kompulsiyami) that a person sees as excessive or unreasonable. Effectiveness Setralin Generic Zoloft was set at 12-week and 52-week studies in outpatients diagnosed with ROC [Koran LM, 2002], and currently use Zolofta with ROC recommended American Psychiatric Association (2007).
Application Setralin Generic Zoloft in children and adolescents

Application Setralin Generic Zoloft are allowed to have children (6-12 years) and adolescents (13-17 years) only if ROC. Alderman J. et al. (2006) demonstrated the efficacy and safety of long-term therapy, even sertralinom Generic Zoloft in children with the ROC.

However, children treated with antidepressants should be undertaken with caution, given the increased risk of suicidal attempts in children and adolescents taking antidepressants [Cheung A., 2007]. Therefore, in the appointment of any antidepressant to children or adolescents should carefully weigh the risk ratio and the clinical feasibility of (harm and benefit), as well as closely monitor the mood and behavior of patients who have decided to appoint a drug.
Treatment sertralinom Generic Zoloft, panic disorder Panic disorder (PR) is a chronic condition, which is characterized by sudden re-emergence of panic attacks.

Panic attacks is a dramatic episode of fear or discomfort, which suddenly appear palpitations or increased heart rate, sweating, tremors or chills, feeling the shortage of air, asthma, pain or discomfort in the chest, nausea or indigestion, dizziness, fainting, or volatility, derealizatsiya (feeling not practical) and Depersonalization (loss of my own), a sense of loss of control, fear of death, paresthesia, chills or hot flushes.

Panic disorder is usually accompanied by distress and dizadaptatsiey due to disturbing the expectation of new attacks, concern about their effects and / or significant changes in behavior associated with panic attacks. These patients have high consumption of health services and pronounced decline in the quality of life. They are often found in the doctor in the clinic. They make numerous somatic complaints, such as chest pain, nausea, dizziness.

PR is often combined with depression, alcohol or other substances, as well as other disturbing irregularities, including the social fobiyu, generalized anxiety disorder, PTSD and the ROC. There are different medicinal and nelekarstvennye methods to successfully cope with the treatment of panic disorder. This SIOZS are drugs of choice (first line), with pharmacotherapy OL. Among SIOZS sertralin Generic Zoloft is different in that it is effective not only for improving the symptoms of panic.

Sertralin Generic Zoloft reduces the expectation of an alarming new attacks, and significantly improves (various aspects), the quality of life for the patient. In the study, Pollack MH, Marzol PC (2000) showed that sertralin Generic Zoloft was effective even in patients with poor prognosis of disease outcome (agoraphobia, komorbidnaya depression, personality disorder, high duration of disease, female sex).

Panic disorder is a chronic disease, so that the patient responsible for medical treatment, appropriate to continue therapy. This should match the minimum effective dose, and periodically evaluate the appropriateness of the continuation of maintenance therapy.
Treatment sertralinom Generic Zoloft posttraumatic stress disorder

In connection with emergencies in the modern world, a growing number of violations, known as «post-traumatic stress disorder» (PTSD). PTSD (according to the criteria DSM-III-R/IV) develops in response to travmatiziruyuschee event that involves threat of death or serious injury, threat of physical damage to the person or other people and the response of intense fear, helplessness or horror.

Symptoms resulting from travmatiziruyuschego events include re-experience the events in the form of intrusive thoughts, dreams, or flashes, intense physiological distress, and physiological reactions to memories of the event, avoidance of situations reminiscent of travmatiziruyuschem event, inability to recall the details and / or reduction general reactivity in the form of reduced interest in the important cases, alienation from others, restricted affect, or feeling a lack of future, the initiation of vegetative symptoms, including insomnia, increased skittishness, the violation of concentration, irritability, or an outbreak of anger. The diagnosis of PTSD requires persistence of symptoms for at least a month and the presence of significant distress or violation of social, occupational or other activity.

Sertralin Generic Zoloft is used for the treatment of PTSD. The effectiveness of the drug with PTSD has been established in several placebo-controlled studies [Brady K et all, 2000]. When maintenance therapy should periodically assess the appropriateness of its continuation.

Application Setralin Generic Zoloft elderly and patients with somatic Pharmacotherapy in the elderly is a great difficulty in mind the high risk of developing complications from the treatment. The use of antidepressants in this category of patients requires special caution.

The high profile security Setralin Generic Zoloft makes it attractive for use in gerontology. Comparative studies Setralin Generic Zoloft with amitriptyline, nortriptilinom fluoxetin and demonstrated its high efficacy and relative safety of this category of patients [Thompson C., 1992].

In recent years certralin Generic Zoloft have been applied in obschesomaticheskih disorders, in particular, in patients post-myocardial infarction.

More recently, patients with cardiovascular disorders excluded from any study antidepressants because of their cardiotoxicity and the potential risk of undesirable interactions of antidepressants and kardiotropnyh drugs.

Sertralin Generic Zoloft has proved safe in this regard and are well tolerated by these patients. Most revealing in this regard is the study SADHART [Glassman A., 2002], which studied patients with severe depression and myocardial infarction in the acute period (30 days) or post-attack of coronary disease.

The study was multicentered placebo-controlled, double-blind and lasted 24 weeks. The average age of patients was 57 years old, dose - 50-200 mg / day. Sertralin Generic Zoloft had 186 patients a placebo - 183. Almost all patients received the usual set of kardiotropnyh drugs. The study showed that sertralin Generic Zoloft was significantly more effective than placebo. At the same side effects in both groups hardly differed in frequency and severity of manifestations. In patients receiving sertralin Generic Zoloft, from the side effects are diarrhea was presented. The authors conclude on the efficacy and safety Setralin Generic Zoloft for cardiac patients with depression.

Another study examined the effectiveness of Setralin Generic Zoloft in 38 depressed patients post myocardial infarction. Patients received 50 mg Zolofta day. 27 patients completed the study, and none of them have not seen any side effects. The authors confirmed the assumption that sertralin Generic Zoloft contributed to the restoration of cardiac function in depressed patients after a heart attack [Parissis, 2007].

Effectiveness and safety Setralin Generic Zoloft was demonstrated in the study of Rasmussen et al [2003], which applied sertralin Generic Zoloft for the purpose of preventing the development of depression in patients with stroke. 138 patients were studied for 12 months. Sertralin Generic Zoloft has demonstrated a significant advantage over placebo in this component of the study, as well as positively influence the improvement of cognitive functions of patients.

In the group of patients who received sertralin Generic Zoloft, there were lower numbers of blood pressure, decreased tachycardia.

Application Setralin Generic Zoloft in chronic pain Antidepressants are effective means kupirovaniya chronic pain of different origin and have not only analgetics action, but also significantly reduce the accompanying emotional (affective) reaction, ie facilitate the experience of pain and suffering to the patient.

Indeed, following the reduction in pain usually appears clear and psychotropic effect: improved mood, enhanced performance, recover interest disappears fobicheskaya symptoms (worrying anticipation of pain). Changing the very perception of pain and attitudes towards it - it becomes more efficient, eliminates its affective saturation. There is a gradual distancing from the identity of pain, which allows to increase its protective mechanisms and adaptive capacity.

Antinotseptivnye properties of the antidepressants were discovered almost immediately after its introduction into psychiatric practice. During the 40-year history of their use was to do a large number of open and controlled studies proving their effectiveness, with chronic, organic pain syndromes of different etiologies, including those resistant to conventional analgetics funds.

Theoretically antinotseptivny antidepressants may have an effect on the three main mechanisms: redutsiruya depression, potentsiruya Effects of exogenous or endogenous analgetics substances because of their own analgetics properties. The latter fact is confirmed by data obtained in the experimental study in animals and in humans, indicating that antidepressants increase the threshold of pain sensitivity and have antinotseptivny effect of direct exposure to the opiate receptors.

However, it remains unclear whether the stimulation of opiate receptors primarily or indirectly, through activation noradrenergicheskih and serotoninergicheskih neurons. Modern theories of endogenous pain control require involvement of the two systems NEUROMEDIATOR (noradrenergicheskoy and serotoninergicheskoy).

Therefore, for treatment of chronic pain used primarily tricyclic antidepressants or SIOZSN. However, in some cases, a good effect can be achieved with the use of drugs that affect mainly to serotoninergicheskuyu system. Operations were performed, which showed high efficiency Setralin Generic Zoloft in the treatment of tension headache, pain dysfunction syndrome temporomandibular mandibular joint with the muscular-fascial pain syndrome, with pain in women in the pelvic area and even in the diabetic polineyropatii [Gustaw K. , 2000; Engel CC Jr, 1998; Goodnick P.J., 1997].
Application certralina Generic Zoloft can be seen especially in cases where the patient is not receiving transfers, or the effect of amitriptyline previous therapy (including amitriptyline) was insufficient.
However, recommendations for the use of Zolofta with pain syndromes in the general medical practice requires additional, more extensive studies that have confirmed the effectiveness of certralina found in chronic pain.
Other uses
certralina Generic Zoloft
Violation of ejaculation is one of the most common sexual disorders among men. Missing data (controlled clinical research) that would prove the effectiveness of psychotherapy in the normalization of sexual function in these patients. Now there is increasing interest, both by doctors and pharmaceutical companies to the possible pharmacological treatment of this violation.

We know that one of the side effects certralina Generic Zoloft is delayed ejaculation. In the study, McMahon CG, Samali R. (1999) have shown that the use of certralina Generic Zoloft in men with premature ejaculation had a normalizing effect on sexual function. There is also a description of the successful application of certralina Generic Zoloft in a patient with frontal-temporal dysfunction, which manifests itself in an extremely sexual desire with the serious, aggressive sexual harassment to the wife. Receive certralina Generic Zoloft Normalized behavior and sexual function in this patient [Anneser JM, 2007].
Metering mode
Zoloft is available in tablets of 50 and 100 mg. Standard dose - 50 mg per day. Zoloft designate once a day - morning or evening. Depending on individual sensitivity to the drug and the other reading a range of doses in adults and adolescents can vary from 50 to 200 mg / day., In children from 6 to 12 years - from 25 to 200 mg / day.

In patients with dysfunction of the liver should reduce the dose or a multiplicity of use of the drug. Older people recommend the same dose as adults. However, given the frequent greater sensitivity of older people to drugs in general, it is advisable to initiate treatment with lower doses than in younger people.
Security.
Undesirable effects
As indicated above, the selectivity of action Zolofta to reverse the seizure of serotonin and the lack of affinity for adrenergic, cholinergic, and serotoninovym benzodiazepinovym postsinapticheskim receptors define a low frequency of development of certain undesirable events that may mediate these neuromediators. Nevertheless, it is necessary to know the possible complications that may arise when applying Zolofta to warn of the possibility of the emergence of the patient and take action to overcome them.
Unwanted effects in the application Zolofta may include:
• Violations of the autonomic nervous system (disorder ejaculation, dry mouth, sweating);
• Violations of the central and peripheral nervous system (somnolence, tremor);
• general (fatigue);
• gastrointestinal disorders (anorexia, constipation, diarrhea, or erratic stools, dyspepsia, nausea);
• psychiatric disorders (agitation, anxiety, insomnia, decrease in libido).

The children, moreover, when applying Zolofta may arise giperkineziya, tick fever, malaise, purpura, reducing body weight, a violation of concentration, manicheskie reaction, emotional lability, a breach of thinking, and bleeding from the nose.
What should the doctor tell
patients taking Zoloft?
Do not expect a rapid onset of effect of taking the medication. Symptoms of depression and a reduced interest in life is usually held within 4-6 weeks after the start of taking the medication. Reducing some of the somatic symptoms and normalization of sleep may occur earlier, within 1-2 weeks after the start of taking the medication before a measurable improvement in mood or interest in any activity. This may be an indication that the therapy will be effective.

Nevertheless, following a tangible improvement of therapy should be continued. Before you judge the effectiveness of the drug against depression, Zoloft should be taken at least 2 months. You can not stop the self, or alter the dose of medication. A sudden withdrawal of taking the medication could lead to one and / or more of the following symptoms lifting: irritability, nausea, dizziness, vomiting, nightmares, headaches, and paresthesia. Zoloft normally be taken 1 time a day. Tablets can be taken during meals. At the beginning of taking the medication may cause some side effects.

The most frequently increased sweating, drowsiness, nausea, diarrhea, tremor, dry mouth, loss of strength, headache, decrease, or a set of weight, dizziness and anxiety. These side effects are generally slight or moderate and usually go through 1-2 weeks while continuing taking the medication. It may be a worsening of sexual function when receiving Zolofta.
Thus, the emergence of a new class of antidepressants - SIOZS - the possibility of more widespread use of antidepressants, not only in mental health, but also obschemeditsinskoy practice. One of the members of this group is the drug sertralin Generic Zoloft, which has high efficiency with a broad spectrum of depressive violations, which are typical for a large number of patients seeking treatment to the doctor about somatic complaints. The high profile of security and ease of use of sertralin Generic Zoloft is an effective drug.

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Generic Zoloft Information

2009-03-09T21:56:00.000-07:00

Generic Zoloft Pharmacological Effects

Antidepressants, a specific inhibitor capture serotonin in neurons. Has very little effect on the reverse capture norepinephrine and dopamine.
In therapeutic doses it blocks the seizure of serotonin in human platelets. Generic Zoloft does not have a stimulating, sedative or antiholinergicheskogo act.
Through selective oppression capture, Generic Zoloft no increases adrenergic activity. Generic Zoloft has no affinity to muskarinovym holinoretseptoram, serotoninovym, dopaminovym, gistaminovym, and adrenergic receptors.
Generic Zoloft does not cause drug addiction, does not cause an increase in body weight during long-term admission.

Generic Zoloft Indications

- Depression of varying etiology;
- Obsessive-compulsive disorder;
- Panic disorder;
- Post-traumatic stress disorder;
- Social phobia.
Generic Zoloft Metering mode

Generic Zoloft appoint 1 time / day morning or evening. Tablets of Generic Zoloft can be taken irrespective of food intake.
When depression and begin treatment with the dose of 50 mg / day - 150 mg/day.
Treatment of panic disorder, The use of Generic Zoloft under the scheme will reduce the frequency of unwanted effects of early treatment, which are typical for panic disorder.
With little effect Generic Zoloft application in patients in a dose of 50 mg / day daily dose can be increased.
Dose should be strengthened at intervals of not more than 1 time per week to a maximum recommended dose is 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.
In a long-term maintenance therapy medication designate the minimum effective dose, which subsequently changed depending on the clinical effect.
In children and adolescents aged 13-17 years, Generic Zoloftom treatment should begin with a dose of 50 mg / day.
In children aged 6-12 years old begin therapy with doses of 25 mg / day, after 1 week it increased to 50 mg / day.
Later, with little effect of the dose can be increased step by 50 mg / day to 200 mg / day as needed.
However, to avoid overdosing, with increasing doses over 50 mg should be taken Generic Zoloft 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 old age, drug use in the same doses as in younger patients.
In patients with liver disorders should use lower doses or increase the interval between taking the medication.
In patients with disorders of kidney function with the correct dose of light manifestation of renal failure is not required.

Generic Zoloft Side Effects

On the part of the central nervous system and peripheral nervous system: headache, dizziness, tremor, insomnia (rare - drowsiness), anxiety, agitation, gipomaniya, delusion, disturbance of gait, visual impairment,
ekstrapiramidnye disorders (diskinezii, akatiziya), paresthesia, convulsions.
Motor violations occurred more frequently in patients with indications for their existence in history or in the concomitant use of antipsychotic funds.
Upon the termination of treatment Generic Zoloftom describe rare cases of development of the syndrome cancel.
May appear paresthesia, gipostezii, symptoms of depression, hallucinations, aggressive reaction, psychomotor agitation, anxiety or psychotic symptoms that are indistinguishable from the core symptoms of the disease.
On the part of the body as a whole: increased sweating, decrease or increase in body mass, weakness.
On the part of the digestive system: decreased appetite (rare - increasing), until anorexia, dry mouth, dispepsicheskie disorders (flatulence, nausea, vomiting, diarrhea), abdominal pain.
On the sexual system: a violation of sexual function (ejaculation delay, reduction of libido, decrease in potency, anorgazmiya).
On the part of the cardiovascular system: reddening of the skin or the tides of blood to the face, bleeding (including nose), palpitation.
Allergic reactions: urticaria, pruritus.
Dermatological reaction: skin rash, rarely - Stevens-Johnson syndrome and epidermal nekroliz.
On the part of the endocrine system: a violation of the menstrual cycle, galaktoreya, giperprolaktinemiya.
From the laboratory performance: transient hyponatremia (typically develops in elderly patients, as well as when receiving diuretics or certain other medications. This side effect associated with the syndrome of inappropriate secretion of hormones antidiureticheskogo), rarely (if long-term use) - the symptomatic improvement of activity of transaminases in serum (lifting of the drug resulted in normalization of enzyme activity).

Generic Zoloft Contraindications

- Pregnancy;
- The period of lactation;
- Children up to age 6 years;
- Hypersensitivity to Generic Zoloft.

Be wary - with organic brain diseases or renal insufficiency, expressed by reduction of body weight.

Generic Zoloft Pregnancy and lactation

Controlled by the application of Generic Zoloft in pregnant women is not, therefore, to appoint Generic Zoloft during pregnancy only if the expected benefits to the mother outweighs the potential risk to the fetus.
Women of reproductive age during treatment Generic Zoloft should use effective methods of contraception.
Generic Zoloft found in breast milk, hence the use of Generic Zoloft in the period of lactation is not recommended.
No reliable data on the safety of its use in this case, no. If the designation of the drug needed, then breastfeeding should be discontinued.

Generic Zoloft Cautions

Generic Zoloft can be used no earlier than 14 days after the lifting. Inhibitors also can be used no earlier than 14 days after lifting Generic Zoloft.
You must be careful while appointing Generic Zoloft with other drugs. Such a joint appointment with the possibility should be excluded, given the likelihood of pharmacodynamic interactions.
With caution should be used Generic Zoloft to the drug, depressing the central nervous system. Use of alcoholic beverages and preparations containing ethanol during treatment Generic Zoloftom prohibited.
The experience of clinical research whose purpose was to determine the optimal time required to transfer patients from receiving other antidepressive and antiobsessivnyh funds for Generic Zoloft is limited.
You must be careful with such a transition, especially with long-acting drugs, such as fluoxetin. The required interval between the cancellation of a selective inhibitor of serotonin and a capture
start receiving a similar drug is not installed.
It should be noted that in patients exposed to Electro-therapy, an adequate and therefore sexperience of Generic Zoloft absent. . ThThe possible success or risk of such combination therapy is not understood.
No experience with the application Generic Zoloft in patients with convulsive syndromehould avoid its use in patients with unstable epilepsy and patients with controlled epilepsy should be carefully observed during treatment.
When a drug seizures should be abolished.
Patients suffering from depression are risk group in relation to suicide attempts. This risk persists until the development of remissionerefore, from the beginning of treatment and to achieve an optimal clinical effect in patients should be constant medical observation.
During clinical studies gipomaniya and mania occurred in about 0.4% of patients receiving Generic Zoloft. Cases activate mania / gipomanii described as a small portion of patients with manic-depressive recipients or other antidepressive antiobsessivnye funds.
Apply Generic Zoloft in patients with liver disease should be with caution, it is necessary to carry out correction of dosing regime.
Use in pediatrics
Safety and effectiveness Generic Zoloft installed with the ROC in children (aged 6 to 17 years).
Impact on ability to driving of vehicles and management mechanisms
Appointment Generic Zoloft are generally not accompanied by a breach of psychomotor functions. However, its use in conjunction with other drugs may lead to a breach of attention and coordination of movements. Therefore, during treatment Generic Zoloftom operate motor vehicles, special equipment or engage in activities associated with increased risk, not recommended.

Overdosage

Severe symptoms of overdose with Generic Zoloft not detected even when using the drug at high doses. However, while the introduction of other drugs or alcohol can be severe poisoning.
Symptoms: serotoninovogo manifestations of the syndrome: nausea, vomiting, drowsiness, tachycardia, agitation, dizziness, psychomotor agitation, diarrhea, increased perspiration, and mioklonus giperrefleksiya.
Treatment: No specific antidotes. Requires intensive maintenance therapy, and constant monitoring of vital functions of the organism. Induce vomiting is not recommended. Introduction of activated charcoal may be more effective than gastric lavage. It is necessary to maintain adequate airway. Do Generic Zoloft large volume of distribution, thus enhancing diuresis, a dialysis gemoperfuzii or blood transfusions may be inconclusive.

Drug interactions

In a joint application Generic Zoloft and pimozida been an increase in levels of pimozida when his single assignment to a low dose (2 mg). Increased levels of pimozida did not involve any changes in the ECG. Since the mechanism of this interaction is not known, but pimozid is a narrow therapeutic index, simultaneous reception pimozida and Generic Zoloft contraindicated.
There are severe complications, while the application Generic Zoloft and MAO inhibitors including selective effect (selegiline) and reversible type of action (moklobemid). Perhaps the development serotoninovogo syndrome: hyperthermia, rigidity, mioklonus, autonomic nervous system lability (rapid fluctuations in the parameters of respiratory and cardiovascular system), changes in mental status, including increased irritability, expressed excitement, confusion, which in some cases may go to state delirioznoe or to whom.
In a joint appointment with warfarin Generic Zoloftom noted a slight but statistically significant increase in prothrombin time - in these cases it is recommended to monitor the prothrombin time at the beginning of treatment Generic Zoloftom and after its repeal.
Pharmacokinetic interaction
Generic Zoloft binds to proteins of blood plasma. It is therefore necessary to take into account the possibility of its interaction with other drugs, have been linked to proteins (eg, diazepam and tolbutamidom).
The simultaneous use of tsimetidinom significantly reduces the clearance Generic Zoloft.
Prolonged treatment Generic Zoloftom dose of 50 mg / day increases the plasma concentration of both drugs in the metabolism which is involved isoenzyme CYP2D6 (tricyclic antidepressants, drugs antiaritmicheskie Class IC - propafenon, flekainid).
Experiments to study the interaction in vitro showed that the ongoing isoenzyme CYP3A3 / 4 betagidroksilirovanie endogenous cortisol, as well as the metabolism of carbamazepine and terfenadina with long-term appointment Generic Zoloft at a dose of 200 mg / day did not change.
The concentration in blood plasma tolbutamida, phenytoin and warfarin in the long-term appointment Generic Zoloft in the same dose also does not change. Thus, one can conclude that Generic Zoloft not inhibits isoenzyme CYP2S9.
However, while receiving Generic Zoloft reduces clearance tolbutamida - requires monitoring of blood glucose.
Generic Zoloft does not affect the concentration of diazepam in serum, suggesting a lack of inhibition of isoenzyme CYP2C19. According to the studies in vitro Generic Zoloft practically did not affect or minimally inhibits isoenzyme CYP1A2.
Pharmacokinetics of lithium does not change with the concomitant introduction Generic Zoloft. However, tremor occurs more often in their joint application. The joint application Generic Zoloft with drugs that affect the serotoninergicheskuyu transfer (eg, lithium), requires increased caution.
When replacing a single inhibitor of neuronal serotonin capture on the other there is no need for a "period of Money." But be careful if you want to change the course of treatment. Avoid joint appointment with tryptophan or fenfluramina Generic Zoloftom.
Generic Zoloft causes minimal induction of liver enzymes. Simultaneous Generic Zoloft appointment at a dose of 200 mg antipyrine and leads to a small (5%), but also significantly reduce antipyrine half.
When coupled with the introduction Generic Zoloft does not alter beta-adrenoblokiruyuschee action atenolol.
When you enter Generic Zoloft in a daily dose of 200 mg drug interactions with glibenklamidom and digoxin have been identified.
Prolonged use of Generic Zoloft at a dose of 200 mg / day does not have a clinically significant effect and did not suppress the metabolism of phenytoin. Despite this, it is recommended to closely monitor the level of phenytoin in the blood plasma of the designation Generic Zoloft and adjusted doses of phenytoin.
There are very few cases of weakness, enhanced tendon reflexes, confusion, anxiety and initiation in patients concurrently taking Generic Zoloft and sumatriptan. Recommended surveillance for patients who have appropriate clinical reason for the simultaneous reception and Generic Zoloft sumatriptana.

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