Tricyclic antidepressants are used to treat depression. But there are a number of points that limit their use.
Elderly people have metabolic disorders, changes in receptors, and side effects associated with cholinergic action occur very often.
The use of one or another drug from the group of tricyclic antidepressants depends on the somatic and neurological condition of the patient, the presence of concomitant diseases and the intake of other drugs. Therefore, it is necessary to select the optimal dosage of the drug, thereby avoiding negative consequences. Treatment with antidepressants should be careful in case of heart, kidney, liver disease. Since this changes the metabolism and the effect of the drug on the target organs.
There are contraindications to the use of tricyclic antidepressants and MAO inhibitors:
- hypertrophy of the prostate;
- angle – closure glaucoma;
- violation of blood circulation in the vessels of the brain;
- diseases of the hematopoietic organs;
- heart defects in a decompensated phase;
- epileptic seizures.
More detailed contraindications are set out in the instructions for the drug.
When prescribing treatment, it is necessary to examine the patient using laboratory and instrumental diagnostic methods. During therapy, it is necessary to monitor the concentration of the drug in the blood and adjust its dosage or change the drug. Also, the doctor needs to understand the strategy of therapy, that is, to clearly understand the goal of each stage of treatment and the possibility of prevention.
With an integrated approach in the treatment of depression, it is necessary to isolate three phases of therapy:
- stopping treatment – begins from the moment the patient first visits and ends with the onset of remission. Duration 6-12 weeks;
- stabilizing therapy — begins from the moment of remission until the end of the depressive episode. With unipolar depression, it lasts 5-9 months, with bipolar depression, 3-4 months. At this stage, follow-up treatment for dysthymia and affective disorders is carried out;
- preventive treatment aims to prevent the development of new episodes, determined by the frequency of the phases. The duration is 1 year.
For unipolar depression, carbamazepine or antidepressants are used, for bipolar depression, valproate , lamotrigine , and lithium salts are used.
The phase symptoms of depression play a role in the choice of therapy. Asthenic, energetic, visceral manifestations of depression initially respond well to treatment with a wide range of antidepressants. But when symptoms of major depression are present, many drugs become ineffective. Early stages of depression need to be effectively treated, but they are usually not recognized in time, leading to protracted treatment. If one drug is ineffective within 3-4 weeks, it is necessary to change the drug to a drug with a different mechanism of action or a different chemical structure. When using drugs that affect serotonin metabolism, you need to wait 6-8 weeks for the effect.
In the absence of laboratory control of the effectiveness of the drug, it should be changed after 3-4 weeks in the absence of a decrease in symptoms. If there is any progress, then you need to wait up to 8-12 weeks. Changing the medication has a positive effect in 30-50% of patients.
Discontinuation of treatment should be carried out on the basis of a treatment plan, so a decrease in symptoms does not indicate the end of the phase. Recurrent depression requires active treatment for 6-9 months. Bipolar depression – 3-4 months. With reactive and neurotic depressions, treatment can be stopped immediately.
Withdrawal of drugs should be gradual, as withdrawal syndrome may occur.
Monitoring the effectiveness of treatment must be carried out by laboratory and instrumental methods, and not rely only on clinical signs of the disease. It is very difficult to identify the clinical picture for a long time in the existing system of outpatient and inpatient treatment. Therefore, objectification of the patient’s condition is a necessary step for psychiatric practice.