According to statistics, about 15% of Americans suffer from one or another form of depression, and it costs the nation 89 billion dollars every year (it includes not only cost for treatment and medicines, but also production loss, work absences and suicidal thoughts). Each year in the U.S. occur about 30 thousand attempted suicides, resulting in the death of a considerable number of people. Depression – is one of the main reasons of employability’s lost among people aged 15-44. Doctors called it «emotional cancer», the same malignant disease disposed to relapses.

Nowadays they used more than two tens of antidepressants with different mechanisms of action. Some of them are not so efficacious as it was expected. Others had tendency to suicidal actions by teenagers, and perhaps by adults.

Today the most popular are medicines which belong to the group of selective serotonin reuptake inhibitor (SSRI). The reason – is simplicity of application (one pill per day).

Some time ago, with a help of government budgeting, there was a wide trial after the medicine called Celexa (citalopram). The studies included 3 thousands of patients suffering from depression, from which this antidepressant has helped only a third people, despite the fact that they were given in higher doses than usual.

The next stage of research were conducted with those people who are not helped Celexa. Among those patients were people who suffered from depression more than one year. These patients were prescribed other antidepressants of different classes – Zoloft (from the same group as Celexa), Wellbutrin (other class than SSRI), or Effexor (which has another point of application in brain). It turned out that such simple medicine change has helped at least a quarter of patients do not experience depression attacks during 3-4 months.

Another group of similar patients have continued to give Celexa, but in addition was appointed a Wellbutrin or sedative BuSpar. Among these patients, one third had a calm period during the same term, however, the combination with Wellbutrin was more effective.

The doctors were very interested in these studies, consider it as a new hope for people suffering from depression. Indeed, such a simple procedure, like substitution one medicine with another or addition of a new therapeutic agent allows you to help more patients, especially with severe and long-term recurrent forms of depression. But it is known that the suicidal inducements often occur with a medicine change, so patients and their surroundings should be especially attentive during these periods, to avoid trouble.

Very often depression is accompanied by chronic diseases. It is considered, that one third of all patients with serious medical problems suffers from a depression. Thus after infarction it is observed by 40 – 65% of the patients, by ischemic disease – 20%, after the stroke – from 10 to 27%, by diabetes and rheumatoid arthritis – from 20 to 30 %.

It is natural, that chronic diseases cause the disturbance of daily routine, especially if there is no possibility to continue the work. In this case symptoms` appearance may be imperceptible for others and patient itself, that’s why it is necessary to know such symptoms in order to take appropriate measures. There are some of them.

• The constant state of depression, sadness, anxiety, nervousness or indifference.
• The inability to enjoy life or its positive moments.
• Loss of weight and appetite
• Insomnia, early awakening or on the contrary, drowse in the morning
• Impatience
• Reduction of vital power and chronic tiredness
• Feeling of helplessness and pessimism
• Feeling of own otioseness and unjustified guilt
• Difficulties with concentration, memory and with taking decisions
• Recurrent suicidal thoughts

If you notice some of these symptoms by your relatives, discuss with a doctor what measures can be taken. The specialist in fundamental illness (for example in diabetes or arthritis) can not often to diagnose the depression himself, but he should connect the patient with a psychiatrist. In many cases qualified treatment of depression can relieve clinical the course of arthritis or recover health after infarction.

In case of unimportant depression doctors recommend psychotherapy like a first stage of the treatment. Among them the most efficient is Cognitive Behavioral Therapy, CBT. It helps the patient to recognize negative ideas and some behavioral reactions and replace them with positive. Usually the course of treatment is not very long – about 10-20 weeks, and is defrayed by medical insurance. Quite often psychotherapy goes with drug therapy, which yields tangible results, especially by acute form of a depression.

The most commonly are used the class of selective serotonin reuptake inhibitors (SSRI). This group includes:

• citalopram (Celexa)
• escitalopram (Lexapro)
• fluvoxamine (Luvox)
• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)

An other class of antidepressants (SNRI) is also connected with a heightened content of serotonin and norepinephrine in the brain – venlafaxine (Effexor) and duloxetine (Cymbalta). So-called tricyclic antidepressant, previously widely used for depression treatment, now are not recommended for people elder 65 because of their side effects, particularly their abilities to cause cardiac arrhythmias.

Antidepressants are conditionally divided into groups in accordance with the chemical agents which they affect (pharmacodynamic principle). There are several different types of antidepressants, including:


1. Selective serotonin reuptake inhibitors (SSRIs)

• Citalopram (brand name Celexa)
• Escitalopram (brand name Lexapro)
• Fluoxetine (brand name Prozac)
• Paroxetine (brand name Paxil, Pexeva)
• Sertraline (brand name Zoloft)

Side Effects of SSRI’s

Compared with side effects of others antidepressants, the side effects of these medicines are insignificant. These are some side effect of selective serotonin reuptake inhibitors:

• dry mouth
• sickness
• nervousness
• sleeplessness
• sexual disorders
• headache

2. Tricyclic antidepressants (TCAs)

• Amitriptyline (brand name Elavil)
• Desipramine (brand name Norpramin)
• Imipraminum (brand name Tofranil)
• Nortriptilin (brand name Aventyl, Pamelor)

Side effects of tricyclic antidepressants

The most common side effects of tricyclic antidepressants:

• dry mouth
• loss of one’s eyesight
• diarrhea
• painful feeling by urination
• exacerbation of glaucoma
• disorder of thought process and rapid fatigability.

These antidepressants also affect blood pressure and heart rate.


3. Serotonin-norepinephrine reuptake inhibitors (SNRI)

• Venlafaxine (brand name Effexor)
• Duloxetine (brand name Cymbalta)

The most common side effects of Serotonin-norepinephrine reuptake inhibitor:

• sickness
• appetite loss
• anxiety and nervousness
• headache
• sleeplessness and rapid fatigability

Such effects like dry mouth, diarrhea, weight loss, sexual disorders, heart-rate acceleration and increase of blood cholesterol level are also possible.


4. Norepinephrine and dopamine reuptake inhibitors

• Bupropion (brand name Wellbutrin)

The most common side effects of norepinephrine and dopamine reuptake inhibitors:

• anxious excitement
• sickness
• headache
• appetite loss
• sleeplessness.

Some people can have rise of blood pressure.


5. Combined reuptake inhibitors and receptor blockers

• Trazodone (brand mark Desyrel)
• Nefazodone (brand name Serzone)
• Maprotiline
• Mirtazapine (brand name Remeron)

The most common side effects of combined reuptake inhibitors and receptor blockers: drowse, dry mouth, sickness and giddiness. Nefazodone is counter-indicative for people with kidney diseases. Maprotiline is counter-indicative for epileptics.


6. Monoamine oxidase inhibitors

• Isocarboxazid (brand name Marplan)
• Fenelzin (brand name Nardil)
• Tranylcypromine (brand name Parnate)

Monoamine oxidase inhibitors are less widespread as compared with others antidepressants. They also can have serious side effects, including weakness, giddiness, headache and tremor. The combination of monoamine oxidase inhibitors with others antidepressants or flu medicines, which are dispensed without prescription, can cause dangerous reaction. Prescribing antidepressant, a doctor must tell, which food and spirits can not be taken with monoamine oxidase inhibitors. You can take this medicine only if you are ready to respect doctor’s recommendations. If you take monoamine oxidase inhibitors and your attending physician wants to change or prescribe another antidepressant, then at first you should stop take the first one and only after a time you can take the second one. This time is required for completely leaving of monoamine oxidase inhibitor out from an organism.