There are several types of depressive spectrum disorders. They include neurotic depression and dysthymic disorders. For depression, tranquilizers, antidepressants, psychotherapy, drugs that affect the somatic state are prescribed. Therapy depends on the pathogenesis of the disease, the characteristics of the patient’s personality. Medications act on the symptoms of depression, psychotherapy – on the restoration of interpersonal relationships.
The criterion for choosing an antidepressant is the severity of psychopathology, the degree of damage to mental activity. Modern thymoanaleptic drugs act on the altered affect, that is, on the neurotic or psychotic level. Classic antidepressants (amitriptyline, clomipramine , imipramine ) are used for severe affects. These drugs are called “big” antidepressants. Selective serotonin reuptake inhibitors, as well as tianeptine , trazodont , mianserin are effective in depression with less affect of a neurotic, reactive, somatogenic, vascular nature. They are classified as minor antidepressants. If depression is classic, then tricyclic antidepressants are effective. In the treatment of such depression, a positive result is observed in 60-80% of patients, and a placebo effect is observed in 30-40%.
In severe depression, it is necessary to prescribe “large” antidepressants with a strong thymoanaleptic effect with parenteral administration ( imipramine , clomipramine , amitriptyline, maprotiline ). The main principle in choosing an antidepressant is to verify the leading psychopathological syndrome. Prescribing an antidepressant is carried out in accordance with the Kilholz principle . Anxiolytic and sedative drugs are prescribed for depression accompanied by anxiety. With inhibited apathetic anergic states, stimulating, activating antidepressants are used. Failure to follow the Kilholz rule can reduce the effectiveness of therapy and lead to worsening symptoms.
Thus, the appointment of stimulating antidepressants for anxiety and depression with delusional syndrome can increase fear, sleep disturbance, agitation, anxiety.
There is a group of antidepressants intermediate between sedative antidepressants and stimulant antidepressants. These drugs are called balanced drugs.
Amitriptyline, mianserin , doxelin , trimipramine belong to the group of sedative antidepressants . Stimulant antidepressants include fluoxetine , moclobemide , milnatsepran , desipramine , nialamide . The intermediate group includes sertalin , venlafaxine , and citalopram . These drugs have a strong thymoanaleptic property, therefore they are effective in polymorphic, fuzzy forms of depression, when it is not possible to detect the main depressive affect (anxious-melancholy version of depression).
There is a group of drugs that do not have sedative properties, but have a strong anxiolytic effect (SSRI group). A number of drugs have been shown to reduce phobic disorders. The effectiveness of thymoanaleptic treatment depends on the monomorphic structure of depression. If the affect is bright and typical, the therapy is more successful. When psycho-like , delusional, organic symptoms are added to the clinical picture , the effectiveness of antidepressants decreases. Therefore, it is necessary to conduct a psychopathological analysis of the structure of depression with the isolation of the leading affect (apathy, anxiety, melancholy) or symptoms of depersonalization, asthenia, paranoid , hypochondria. This will allow you to choose a treatment regimen in accordance with the properties of the antidepressant.