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Active Ingredient: Amitriptyline

Elavil is a brand name for Amitriptyline renowned for treating depression. Anti-depressants are increasing in demand by day among people of all ages. Today, almost everyone is experiencing stress due to domestic or professional issues. The world is in consistent pressure hence the need for such drugs. Amitriptyline exists as a generic drug in the United States after several years in the market with different manufacturers. Besides its effectiveness in dealing with depression, its popularity is attributed to the extended time in the market.

Amitriptilin

Clinico-pharmacological group

Antidepressant

Release form, composition and packaging

Tablets from white to white with a slightly yellowish shade of color, flat-cylindrical shape, with a chamfer; light marbling is allowed.

Amitriptyline hydrochloride 1 tab./11.32 mg, which corresponds to the content of amitriptyline 1 tab./10 mg

Excipients: microcrystalline cellulose - 40 mg, lactose monohydrate (milk sugar) - 40 mg, pregelatinized starch - 25.88 mg, colloidal silicon dioxide (aerosil) - 400 μg, talc - 1.2 mg, magnesium stearate - 1.2 mg.

  • 10 pieces. - Contour cell packages (1) - cardboard packs.
  • 10 pieces. - Contour cell packages (2) - cardboard packs.
  • 10 pieces. - Contour cell packages (3) - cardboard packs.
  • 10 pieces. - Contour cell packages (4) - cardboard packs.
  • 10 pieces. - Contoured cell packs (5) - cardboard packs.
  • 100 pieces. - polymer cans (1) - cardboard packs.

Tablets from white to white with a slightly yellowish shade of color, flat-cylindrical shape, with a facet and a risk; light marbling is allowed.

Amitriptyline hydrochloride 1 tab./28.3 mg,which corresponds to the content of amitriptyline 1 tab./25 mg

Excipients: microcrystalline cellulose - 100 mg, lactose monohydrate (milk sugar) - 100 mg, pregelatinized starch - 64.7 mg, colloidal silicon dioxide (aerosil) - 1 mg, talc - 3 mg, magnesium stearate - 3 mg.

  • 10 pieces. - Contour cell packages (1) - cardboard packs.
  • 10 pieces. - Contour cell packages (2) - cardboard packs.
  • 10 pieces. - Contour cell packages (3) - cardboard packs.
  • 10 pieces. - Contour cell packages (4) - cardboard packs.
  • 10 pieces. - Contoured cell packs (5) - cardboard packs.
  • 100 pieces. - polymer cans (1) - cardboard packs.

Pharmachologic effect

Antidepressant (tricyclic antidepressant). It also provides some analgesic (central genesis), antiserotonin effect, helps to eliminate bed-wetting and reduces appetite.

It has a strong peripheral and central anticholinergic action due to its high affinity for m-cholinergic receptors; strong sedative effect associated with affinity for the H1-histamine receptors, and alpha-adreno-blocking action.

It has the properties of an antiarrhythmic drug class IA, like quinidine in therapeutic doses it slows down ventricular conductivity (in case of overdose it can cause severe intraventricular blockade).

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The mechanism of antidepressant action is associated with an increase in the concentration of norepinephrine and / or serotonin in the central nervous system (CNS) (a decrease in their reabsorption).

The accumulation of these neurotransmitters occurs as a result of inhibition of their reuptake by the membranes of presynaptic neurons. With prolonged use reduces the functional activity of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems, disturbed in depressive states. In anxiety and depressive states, it reduces anxiety, agitation and depressive manifestations.

The mechanism of anti-ulcer action is due to the ability to have a sedative and m-anticholinergic action. Efficacy in nocturnal urinary incontinence is apparently due to anticholinergic activity leading to an increase in bladder's ability to stretch, direct beta-adrenergic stimulation, alpha adrenergic agonist activity, accompanied by an increase in sphincter tone, and a central blockade of serotonin uptake. It has a central analgesic effect, which is believed to be associated with changes in the concentration of monoamines in the central nervous system, especially serotonin, and the effect on endogenous opioid systems.

The mechanism of action in bulimia nervosa is unclear (may be similar to that in depression). A distinct effect of the drug in case of bulimia in patients with and without depression is shown, and a decrease in bulimia may occur without a concomitant weakening of the depression itself.

When conducting general anesthesia, lowers blood pressure and body temperature. Does not inhibit monoamine oxidase (MAO).

Antidepressant effect develops within 2-3 weeks after the start of the application.

Pharmacokinetics

Absorption is high.

Bioavailability of amitriptyline is 30-60%, its active metabolite nortriptyline is 46-70%. The time to reach Cmax after ingestion is 2.0-7.7 hours. Vd 5-10 l / kg. Effective therapeutic blood concentrations for amitriptyline - 50-250 ng / ml, for nortriptyline 50-150 ng / ml.

Cmax 0.04-0.16 µg / ml. Passes (including nortriptyline) through histohematogenous barriers, including the blood-brain barrier, placental barrier, penetrates into breast milk. Communication with plasma proteins - 96%.

Metabolized in the liver with the participation of CYP2C19, CYP2D6 isoenzymes, has the effect of "first pass" (by demethylation, hydroxylation) with the formation of active metabolites - nortriptyline, 10-hydroxy-amitriptyline, and inactive metabolites. T1 / 2 from blood plasma - 10-26 hours for amitriptyline and 18-44 hours for nortriptyline. Excreted by the kidneys (mainly in the form of metabolites) - 80% in 2 weeks, partly with bile.

Indications

Depression (especially with anxiety, agitation and sleep disorders, including in children, endogenous, involutional, reactive, neurotic, drug, with organic brain lesions).

As part of complex therapy, it is used for mixed emotional disorders, psychosis in schizophrenia, alcohol withdrawal, behavioral disorders (activity and attention), nocturnal enuresis (except for patients with bladder hypotension), bulimia nervosa, chronic pain syndrome (chronic pain in cancer patients, migraine, rheumatic diseases, atypical pains in the face, postherpetic neuralgia, post-traumatic neuropathy, diabetic or other peripheral neuropathy), headache, migraine and (prevention) of gastric ulcer and duodenal ulcer.

Contraindications

Hypersensitivity, use in conjunction with MAO inhibitors and 2 weeks before the start of treatment, myocardial infarction (acute and subacute periods), acute alcohol intoxication, acute intoxication with hypnotic, analgesic and psychoactive drugs, angle-closure glaucoma, severe AV disturbances and intragastric closures bundle His, AV blockade II Art.), the lactation period, children under 6 years.

In connection with the content in the tablets of lactose monohydrate (milk sugar) the drug should not be taken by patients with rare hereditary diseases, such as galactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Carefully. Amitriptyline should be used with caution in persons with alcoholism, with bronchial asthma, schizophrenia (activation of psychosis is possible), bipolar disorder, epilepsy, with the oppression of bone marrow hematopoiesis, cardiovascular diseases (CVD) (stenocardia, arrhythmia, heart block, chronical heart failure, myocardial infarction, arterial hypertension), intraocular hypertension, stroke, reduced motor function of the gastrointestinal tract (GIT) (the risk of paralytic intestinal impassability u), liver and / or kidney failure, hyperthyroidism, prostatic hyperplasia, urinary retention, hypotension, bladder, pregnancy (especially I term), in the elderly.

Dosage

Assign inside, without chewing, immediately after eating (to reduce irritation of the gastric mucosa).

Adults

Adults with depression, the initial dose - 25-50 mg at night, then gradually the dose can be increased, taking into account the effectiveness and tolerability of the drug to a maximum of 300 mg / day. in 3 doses (the largest part of the dose is taken at night). When a therapeutic effect is achieved, the dose can be gradually reduced to the minimum effective, depending on the condition of the patient. The duration of the course of treatment is determined by the patient's condition, the effectiveness and tolerability of the therapy being performed and can range from several months to 1 year, and, if necessary, even more. In old age, in cases of mild disorders, as well as in nervous boulemia, as part of complex therapy for mixed emotional disorders and behavioral disorders, psychosis in schizophrenia and alcohol withdrawal is prescribed in a dose of 25-100 mg / day. (at night), after reaching a therapeutic effect, switch to the minimum effective dose of 10-50 mg / day.

For the prevention of migraine, with chronic pain syndrome of a neurogenic nature (including prolonged headaches), as well as in the treatment of gastric ulcer and duodenal ulcer from 10-12.5-25 to 100 mg / day. (the maximum dose is taken at night).

Children

Children as an antidepressant: from 6 to 12 years old - 10-30 mg / day. or 1-5 mg / kg / day. fractionally, in adolescence - up to 100 mg / day.

With nocturnal enuresis in children 6-10 years old - 10-20 mg / day. for the night, 11-16 years - up to 50 mg / day.

Side effects

Associated with anticholinergic effects of the drug: blurred vision, accommodation paralysis, mydriasis, increased intraocular pressure (only in individuals with local anatomical predisposition - narrow anterior chamber angle), tachycardia, dry mouth, confusion (delirium or hallucination), constipation, paralytic intestinal obstruction, difficulty urinating.

On the part of the central nervous system: drowsiness, fainting, fatigue, irritability, anxiety, disorientation, hallucinations (especially in elderly patients and in patients with Parkinson’s disease), anxiety, psychomotor agitation, mania, hypomania, memory impairment, decreased ability to concentrate, insomnia, nightmares, asthenia; headache; dysarthria, tremor of small muscles, especially of the hands, hands, head and tongue, peripheral neuropathy (paresthesia), myasthenia gravis, myoclonus; ataxia, extrapyramidal syndrome, increased and increased seizures; changes on the electroencephalogram (EEG).

On the part of the cardiovascular system: tachycardia, feeling of palpitations, dizziness, orthostatic hypotension, nonspecific changes on the electrocardiogram (ECG) (S-T interval or T wave) in patients without heart disease; arrhythmia, lability of blood pressure (decrease or increase in blood pressure), violation of intraventricular conduction (expansion of the QRS complex, changes in the P-Q interval, blockade of the bundle of the His bundle).

On the part of the digestive tract: nausea, heartburn, gastralgia, hepatitis (including abnormal liver function and cholestatic jaundice), vomiting, increased appetite and body weight or decreased appetite and body weight, stomatitis, change in taste, diarrhea, darkening of the tongue.

On the part of the endocrine system: an increase in size (edema) of the testes, gynecomastia; increase in the size of the mammary glands, galactorrhea; decrease or increase in libido, decrease in potency, hypo-or hyperglycemia, hyponatremia (decrease in vasopressin production), syndrome of inadequate secretion of antidiuretic hormone (ADH). Allergic reactions: skin rash, pruritus, photosensitivity, angioedema, urticaria.

Other: hair loss, tinnitus, edema, hyperpyrexia, swollen lymph nodes, urinary retention, pollakiuria.

With prolonged treatment, especially in high doses, with its abrupt cessation, the development of withdrawal syndrome may occur: nausea, vomiting, diarrhea, headache, indisposition, sleep disturbances, unusual dreams, unusual agitation; with gradual cancellation after long-term treatment - irritability, motor restlessness, sleep disturbances, unusual dreams.

The connection with taking the drug has not been established: lupus-like syndrome (migratory arthritis, the appearance of antinuclear antibodies and a positive rheumatoid factor), abnormal liver function, agevziya.

Overdose

Symptoms

From the side of the central nervous system: drowsiness, stupor, coma, ataxia, hallucinations, anxiety, psychomotor agitation, reduced ability to concentrate, disorientation, confusion, dysarthria, hyperreflexia, muscle stiffness, choreoathetosis, epileptic syndrome.

On the part of the cardiovascular system: decrease in blood pressure, tachycardia, arrhythmia, impaired intracardiac conduction, ECG changes (especially QRS) that are characteristic of intoxication with tricyclic antidepressants, shock, heart failure; in very rare cases, cardiac arrest.

Other: respiratory depression, dyspnea, cyanosis, vomiting, hyperthermia, mydriasis, increased sweating, oliguria or anuria.

Symptoms develop 4 hours after an overdose, reach a maximum after 24 hours and last 4-6 days. If overdose is suspected, especially in children, the patient should be hospitalized.

Treatment: by oral administration: gastric lavage, activated charcoal intake; symptomatic and supportive therapy; with severe anticholinergic effects (lowering blood pressure, arrhythmias, coma, myoclonic epileptic seizures) - administration of cholinesterase inhibitors (the use of physostigmine is not recommended due to the increased risk of seizures); maintaining blood pressure and water-electrolyte balance. The monitoring of CVS functions (including ECG) for 5 days (relapse may occur after 48 hours and later), anticonvulsant therapy, artificial lung ventilation (ALV), and other resuscitation measures are shown. Hemodialysis and forced diuresis are ineffective.

Drug interaction

With the combined use of ethanol and drugs that inhibit the central nervous system (including other antidepressants, barbiturates, benzadiazepines and general anesthetics), a significant increase in the inhibitory effect on the central nervous system, respiratory depression and hypotensive effect is possible. Increases sensitivity to ethanol-containing beverages.

Increases the anticholinergic effect of drugs with anticholinergic activity (for example, phenothiazine derivatives, anti-Parkinsonian drugs, amantadine, atropine, biperiden, antihistamine drugs), which increases the risk of side effects (from the central nervous system, vision, bowel and bladder). When combined with anticholinergics, phenothiazine derivatives and benzodiazepines, mutual enhancement of the sedative and central anticholinergic effects and an increased risk of epileptic seizures (lowering the seizure threshold); phenothiazine derivatives, in addition, may increase the risk of neuroleptic malignant syndrome.

When used together with anticonvulsant drugs, it is possible to increase the inhibitory effect on the central nervous system, lowering the threshold for seizure activity (when used in high doses) and decrease the effectiveness of the latter.

When combined with antihistamine drugs, clonidine - increased inhibitory effects on the central nervous system; with atropine - increases the risk of paralytic intestinal obstruction; with drugs that cause extrapyramidal reactions, an increase in the severity and frequency of extrapyramidal effects.

With the simultaneous use of amitriptyline and indirect anticoagulants (coumarin or indadione derivatives), the anticoagulant activity of the latter can be increased. Amitriptyline can strengthen the depression caused by glucocorticosteroids (GKS). Drugs for the treatment of thyrotoxicosis increase the risk of agranulocytosis. Reduces the effectiveness of phenytoin and alpha-blockers.

Inhibitors of microsomal oxidation (cimetidine) lengthen T1 / 2, increase the risk of developing toxic effects of amitriptyline (a dose reduction of 20-30% may be required), inducers of microsomal liver enzymes (barbiturates, carbamazepine, phenytoin, nicotine and oral contraceptives) decrease plasma concentration. reduce the effectiveness of amitriptyline.

Combined use with disulfiram and other acetaldehyde hydrogenase inhibitors provokes delirium.

Fluoxetine and fluvoxamine increase plasma concentration of amitriptyline (it may be necessary to reduce the dose of amitriptyline by 50%).

Estrogen-containing oral contraceptive drugs and estrogens may increase the bioavailability of amitriptyline.

With the simultaneous use of amitriptilin with clonidine, guanethidine, betanidin, reserpine and methyldopa - reducing the hypotensive effect of the latter; with cocaine - the risk of heart arrhythmias.

Antiarrhythmic drugs (such as quinidine) increase the risk of developing rhythm disturbances (possibly slowing down the metabolism of amitriptyline).

Pimozide and probucol can enhance cardiac arrhythmias, which is manifested in the prolongation of the Q-T interval on the ECG.

It enhances the effect on the CVS of epinephrine, norepinephrine, isoprenaline, ephedrine and phenylephrine (including when these medicines are part of local anesthetics) and increases the risk of developing heart rhythm disorders, tachycardia, and severe arterial hypertension.

When used jointly with alpha-adrenomimetics for intranasal administration or for use in ophthalmology (with significant systemic absorption), the vasoconstrictor effect of the latter can be enhanced.

When taken together with thyroid hormones, mutual enhancement of the therapeutic effect and toxic action (including cardiac arrhythmias and a stimulating effect on the central nervous system).

M-holinoblokatory and antipsychotic drugs (neuroleptics) increase the risk of hyperpyrexia (especially in hot weather).

If coadministered with other hematotoxic drugs, hematotoxicity may be enhanced.

Incompatible with MAO inhibitors (possible increase in the frequency of periods of hyperpyrexia, severe seizures, hypertensive crises and death of the patient).

Special instructions

Before treatment, control of blood pressure is necessary (in patients with low or labile blood pressure, it may decrease even more); during treatment - control of peripheral blood (in some cases, agranulocytosis may develop, and therefore it is recommended to monitor the blood picture, especially when the body temperature rises, the development of flu-like symptoms and angina), with long-term therapy - monitoring the functions of the cardiovascular system and the liver. In the elderly and patients with cardiovascular disease, control of heart rate, blood pressure, ECG is shown. On the ECG, the appearance of clinically insignificant changes is possible (smoothing of the T wave, depression of the ST segment, expansion of the QRS complex).

Care must be taken when abruptly moving to a vertical position from a "lying" or "sitting" position.

During the period of treatment should be excluded the use of ethanol.

Assign no earlier than 14 days after discontinuation of MAO inhibitors, starting with small doses.

With a sudden cessation of treatment after prolonged treatment may develop a syndrome of "cancellation."

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Amitriptyline in doses above 150 mg / day. reduces the seizure threshold (the risk of epileptic seizures in susceptible patients should be considered, as well as in the presence of other factors predisposing to the onset of convulsive syndrome, such as brain damage of any etiology, simultaneous use of antipsychotic drugs (neuroleptics), in the period of ethanol failure or cancellation of drugs with anticonvulsant properties, such as benzodiazepines). Severe depression is characterized by the risk of suicidal acts, which may persist until a significant remission is achieved. In this regard, at the beginning of treatment, a combination with drugs from the group of benzodiazepines or antipsychotic drugs and constant medical supervision (to delegate storage and distribution of drugs) can be shown. In children, adolescents and young people (under 24 years) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing amitriptyline or any other antidepressants in this category of patients, the risk of suicide should be correlated with the benefits of their use. In short-term studies, the risk of suicide was not increased in people over 24 years of age, while in people over 65 years of age it was somewhat reduced. During antidepressant treatment, all patients should be monitored for the purpose of early detection of suicidal tendencies.

In patients with cyclic affective disorders during the depressive phase during therapy, manic or hypomania states may develop (a dose reduction or withdrawal of the drug and the prescription of an antipsychotic drug are necessary). After stopping these conditions, if there are indications, treatment in low doses can be resumed.

Due to possible cardiotoxic effects, care must be taken when treating patients with thyrotoxicosis or patients receiving thyroid hormone preparations.

In combination with electroconvulsive therapy is prescribed only under the condition of careful medical supervision.

In predisposed patients and elderly patients, it can provoke the development of medicinal psychoses, mainly at night (after discontinuation of the drug, they disappear within a few days).

It can cause paralytic intestinal obstruction, mainly in patients with chronic constipation, the elderly or in patients forced to adhere to bed rest.

Prior to general or local anesthesia, the anesthetist should be warned that the patient is taking amitriptyline.

Due to the anticholinergic action, there can be a decrease in tearing and a relative increase in the amount of mucus in the composition of the tear fluid, which can lead to damage to the corneal epithelium in patients who use contact lenses.

With prolonged use, an increase in the incidence of dental caries is observed. The need for riboflavin may be increased.

The study of reproduction in animals revealed an adverse effect on the fetus, and adequate and strictly controlled studies in pregnant women have not been carried out. In pregnant women, the drug should be used only if the intended benefit to the mother outweighs the potential risk to the fetus.

Penetrates into breast milk and may cause drowsiness in infants. In order to avoid the development of the "cancellation" syndrome in newborns (manifested by shortness of breath, drowsiness, intestinal colic, increased nervous irritability, increased or decreased blood pressure, tremor or spastic phenomena), amitriptyline is gradually canceled at least 7 weeks before the expected birth.

Children are more sensitive to acute overdose, which should be considered dangerous and potentially fatal to them.

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and psychomotor speed.

Pregnancy and lactation

In pregnant women, the drug should be used only if the intended benefit to the mother outweighs the potential risk to the fetus.

Penetrates into breast milk and may cause drowsiness in infants. In order to avoid the development of the "cancellation" syndrome in newborns (manifested by shortness of breath, drowsiness, intestinal colic, increased nervous irritability, increased or decreased blood pressure, tremor or spastic phenomena), amitriptyline is gradually canceled at least 7 weeks before the expected birth.

Contraindicated in children under 6 years.

In children, adolescents and young people (under 24 years) with depression and other mental disorders, antidepressants, compared with placebo, increase the risk of suicidal thoughts and suicidal behavior. Therefore, when prescribing amitriptyline or any other antidepressants in this category of patients, the risk of suicide should be correlated with the benefits of their use.

In case of impaired renal function

Use with caution in renal failure.

With abnormal liver function

Use with caution in liver failure.

Use in old age

Use with caution in the elderly.

In elderly patients, the drug may provoke the development of drug psychosis, mostly at night (after drug withdrawal, they disappear within a few days).

Pharmacy sales terms

The drug is available on prescription.

Terms and conditions of storage

Store the preparation in a dry, dark place at a temperature not exceeding 25 ° C. Keep out of the reach of children.

Shelf life - 3 years. Do not use after expiration date.

How I overcame depression and fell in love with myself: the story of Natalia Patrakova

This text needs to be read by everyone - depression can happen to everyone. And here it is important to help - either to yourself or to a close person. How to do it right - says Natalia Patrakova, who has gone through all the stages of depression and has found harmony with herself.

- I think it’s necessary to speak openly about depression. This text was copied several times, corrected, and, in general, I spent several months in my drafts. As you might guess, he is very personal. I am no longer afraid to publish it - I recently began to openly talk about it with friends, and everyone, without exception, although not fully understanding, empathized with me. Why do I consider it necessary to talk about it? Firstly, it was often difficult for my loved ones to deal with me, and they could not do anything about it. Secondly (and this is the main thing), with myself it was often difficult, and I also could not do anything. I have always blamed my character, with whom I have lived and lived all my life, but I can’t cope with it. But everything turned out to be easier.

Have you ever thought about someone that he or she is "crazy", "crazy", "all in pens"? What is your attitude to such people? Will you initiate a gentle conversation with a friend who suddenly became aggressive or, conversely, sluggish? Or would you prefer not to mess up and withdraw? In our still conservative society, unfortunately, it is customary to condemn and label, and with the phrase "mental disorders", white soft walls, straitjackets and fetters on hands are the first to appear. Meanwhile, anxiety disorders, neurasthenia, apathy live in us for years and are not perceived separately from our personality. And if we had learned that many of the problems that are considered to be part of a bad nature are in fact a feature of physiology or a failure in the exchange of neurotransmitters, and this can be easily corrected by pills and psychotherapy?

Many are surprised at my openness. And I, in turn, wondering why at dinner in the company one can easily declare lactose intolerance, diabetes, flu or a broken finger, but one cannot speak of mental health. A couple of facts for those who like statistics: depression is a real scourge of modern times.

- According to various estimates, from 20 to 40% of people in the world are in the stage of depression that requires medical assistance. This means that you know such people. Perhaps you are among these people. Think about it: 15% of patients with depression commit suicide. This is a really deadly disease.

Depression, by the way, happens also at animals. And now the good news: this disease is treatable, and quickly and efficiently. Why do we not talk about it and suffer for years? There is no excuse for keeping silent about this topic. It is for the sake of awareness, for the sake of potential dialogues, I share my experience, especially negative.

I was diagnosed in early January. In order to understand my problem, accept it and treat it, I faced a host of everyday problems, as well as a deep misunderstanding on the part of people. No one really knows what it is and what to do about it. Consider how depressed the word is depressed and how often it is used with or without it. The first reaction to the phrase about depression is the question: "Why? What happened? "We think that this is some kind of temporary decline in mood caused by objective reasons, some negative experience. Or even worse - just a weakness of character. And I want to say that this is an incorrect interpretation of the term.

My story has evolved according to the classic scenario. All positive feelings began to be blunted, travel did not cling, gatherings with friends did not bring joy, work did not give pleasure. Self-digging worked for me at full capacity, I constantly analyzed what did not suit me. One by one, I tried to solve obvious problems. Build relationships, fill free time with new hobbies, generate ideas. It seemed that we would solve this issue with a guy - and everything will be fine. I will talk to the boss and everything will be fine. Spend a little at home, and then tired of traveling - and everything will be fine. Tired of sitting at home, now I will go somewhere - and everything will be fine. It turns out to analyze in this case in a medical sense is harmful.

- When we try to rationalize negative emotions and do not find explanations for them, we experience guilt, lack of understanding, as a result we unconsciously forbid ourselves to feel. And man is a wonderfully balanced nature. If he cannot experience "bad" emotions, he will no longer have "good" ones.

Everyone is used to thinking about exogenous depression, which is caused by some external factors. Stress at work, illness, problems in personal life - traditionally these very reasons come to mind. But in reality, for the first time in many years, there was nothing bad in my life. Yes, there were some moments that did not suit me, but in general I seemed to have stepped onto a white line. Looking back at last spring, I remember a feeling of elation and even, perhaps, happiness.

Nevertheless, by the autumn everything suddenly began to lose its meaning, and discontent, disappointment, and a feeling of heavy ordinariness imperceptibly and slyly leaked into life. Now the brightest emotions were negative. Anger, irritation, longing, anxiety. If you are predisposed to changes in mood, you can take it for a very long time for your bad temper. I thought that I always need adrenaline to something was wrong - only then I live fully, so here I am a difficult person. In fact, depression depends on many factors: no less on biochemical and genetic than on lifestyle and traumatic events. The danger of this condition is that it affects the entire body and changes the behavior of a person, his thoughts, feelings. The exchange of serotonin is disturbed, endorphin receptors are degraded, and the joys are simply nowhere to take.

By November, it took me 3-4 hours to at least start planning a working day (by December these numbers had grown). This time was spent on mental urges to rise from bed and breakfast. There was no incentive to work, but I considered this problem unserious until I realized: all the same symptoms had long since flowed into other areas of life. I bore meetings with friends or even canceled them altogether. In conversations I could not concentrate on what they say to me. It was difficult to make sentences, more often I brushed off monosyllabic phrases. I pretended more and more that I was listening and I understood what the conversation was about, what I find interesting, funny. It seemed to me that people should understand that my eyes are completely empty. I was annoyed by the closest people, sometimes with difficulty tolerated touch, could begin to make trouble from scratch, quarrel, break and cry for hours.

If this is an endogenous depression, it is impossible to determine exactly what exactly triggered its beginning. This is like a chicken and egg problem: either a chemical failure in the exchange of serotonin first occurred, which contributed to the emergence of a stressful state, or, conversely, some kind of daily stress led to a failure. And then destructive thoughts do their work, closing the circle of depression. My irritation - a frequent symptom - led to conflicts, after which I felt guilty, then I spent hours mentally condemning my own behavior. From what the mood, of course, spoiled even more. I went around my pens - and the longer, the more it seemed to me that I made all the possible wrong choices. I spent years on the wrong career path, killed my spiritual strength on unnecessary people in my personal life, did not learn anything, I’m not smart enough, not strong enough, not talented enough; no wonder no one truly loves me and stuff like that. Periodically, I began to dwell on some mistakes of the past, I could spend days mentally thinking about a situation that had long been unimportant.

By mid-December, psychosomatics was already playing. At first the dream "broke". Without the help of melatonin, I could not fall asleep until seven in the morning and, at best, I slept for four hours. I was losing weight, although for the first time in my life I stopped denying myself sweets — I tried to cheer myself up with food. But by January, buckwheat and ice cream became about the same tasteless food for me. There was no appetite - I ate mostly just bread and drank sweet tea to think something. Pick up the phone calls has become a difficult task. I sat in a cafe for a long time over coffee, gathering my strength just to ask for a bill. A couple of times I managed to have fun in companies with the help of alcohol, but after that the feeling of emptiness intensified many times. Increasingly, when entering people, I caught myself thinking that it would be better to stay at home in bed. I literally lost money on the fact that I could not force myself to call and sort out this or that household situation. This immersion in cold death is perhaps the easiest to explain with the description of the Dementors from the Harry Potter saga. Remember how the heroes felt as if everything good disappeared from life, the life force quickly evaporated and only a feeling of hopelessness remained? Well-known fact: JK Rowling came up with Dementors when she suffered from severe depression.

The reaction of others was predictable. "Yes, you throw yourself away from idleness, go in for sports / learn Spanish / go to a dance / go on vacation / go relax in a bar." There were also claims like "you only think about yourself, you feel very sorry for yourself, look at my problems here, but I can cope with it, I would like to know how other things are." I did not want to explain that it was hard for me to even wash my face, not to do sports, so I closed in and avoided communication. It is believed that willpower is an obligatory attribute of a stable person, but this is not true. Will power directly depends on the state of the psyche at one time or another.

- The most useless thing that can be said to a depressed person is advise to pull himself together and do something. First, if he could, he would have done it already. Believe me: what you can say, he himself has repeated hundreds of times. Secondly, it only gets worse.

Thus, you devalue the problem by explaining the state of a person by his personal choice, although he did not do it. You are unlikely to tell a diabetic person "do not invent and eat sugar". Rather, you will advise him not to forget about regular injections. So far, due to the fact that we do not understand what depression is, suffering people are flooded with typical evil thoughts: I am sour, like a dirty rag in a sink, I am weak-willed, I am lazy, I am selfish.

My physical condition worsened, as indifference to my appearance intensified. I bite my nails, wore the same thing, did not wash. Washing the head seemed like a daunting task that requires several days of preparation. The brain was working worse: I read the workers' letters for ten minutes before sending them — I didn’t trust myself after several stupid mistakes. In a stupor, she hung in front of ATMs, remembering the pin-code of the card, and even in front of her own doorway, typing the code incorrectly. My birthdays and phone numbers flew out of my head; I came back home, leaving there without a phone and keys; constantly forgot to put food in the fridge for the night. Absent-mindedness, which always pursued me to one degree or another, reached a new level.

By a happy coincidence in the same period, as part of expanding my horizons, I leafed through a book about mental disorders and, having come to the chapter on depression, I was amazed to find all the symptoms. I still had no desire to communicate with people and generally get out of bed, but now I had a new voice in my head, which consciously noted everything that was happening to me. It's funny, but it was the scientific, as if third-party, interest in my condition that eventually made me take the next step - to sign up for a psychotherapist.

By the end of the first session, after answering some questions from the doctor, I was finally struck by the emotions. I realized: I have no way, I feel bad. The recognition of this was my first success. Depression is not about gloomy mood, sobbing and hysterics. This is about the loss of taste for life, about the feeling of falling into the swamp of the ordinary. When the disease is at such a stage, it is imperative that you tell your loved ones about what is happening to you, no matter how unbearable. You should not be alone with your powerlessness and bad thoughts. The presence of other people will help if they do not pull out of this pit, so at least temporarily solve some domestic problems. When I lay in my nursery for a week, my mother would put a tray with different foods near me so that I could eat something and stretch my back, which was terribly sick from being constantly in the fetal position. And the young man, sewing up with studies in distant America, found time to make tablets for me to the shareholders and write macros while I lay in prostration with my eyes closed to the sounds of the next season of the series.

A week before my 25th birthday, I was on antidepressants. Trips to the bars were over - alcohol is prohibited during their reception. The problem with pills is that you have some kind of anticipation that you are about to feel better, but they need 2-3 weeks to take action. At the same time, after a few days, despite the still negative attitude, a person has energy. On the fifth day of taking antidepressants, I woke up and finally wanted to eat. The mood was still bad, my tears flowed while the cocoa was heated in the microwave, but I had strength. All day I was rocked from irritation to almost a smile and back, my thoughts were noisy in my head and were mostly negative. There is a danger of the first weeks on antidepressants - the probability of suicide increases among depressed patients during this period.

My energy turned into anxiety, quick speech, violent gestures, I could not sit in one place and nervously circled around the apartment. World practice in such cases - to prescribe tranquilizers at the beginning of treatment with antidepressants. However, in Russia the majority of drugs of such an effect are equated to almost drugs. And permitted light tranquilizers may not work on patients in serious condition. They worked with me, and I began to fall asleep at a normal time. After a few more days, my appetite began to return.

By the fourth week of drug treatment, I noticed significant improvements. My first few hours in the mornings were still heavy, but then it became easier. Sometimes most of the day I felt downright good, felt joy and lightness, and all of a sudden there were sudden bouts of anxiety and despair in the evening. My mood swings were swinging up and down. I slowly began to sing along to the radio, there was an interest in reading, the working hours were rather calm. Then I felt ready to help myself get out of this state. The days in which I woke up with weight in my body and could not get out of bed for a long time gradually became less. The work ceased to be annoying, I again began to initiate various projects to improve the processes and assumed more responsibilities. I couldn’t even believe that quite recently all the numbers looked the same to me, and I made up proposals for working letters for half an hour.

Already recovering, I realized how long I lived with thoughts typical for depression: I occupy other people's places in all spheres of life until someone appears better, and then they will easily forget about me, and in general no one ever took me seriously. I was so afraid of being abandoned for the sake of something or someone else that unconsciously provoked conflicts and behaved defiantly so that the end of the relationship was not unexpected for me. And in the beginning of the end, I never doubted. My consciousness turned everything upside down, putting question marks to all manifestations of love and kindness towards me. I considered what was happening around me inside my paradigm, based on negative prerequisites - as if the presumption of guilt was applied to everything. The shocking discovery of such a deep degree of self-doubt was a very terrible vision.

I could not understand why, why this is happening to me, how and when it started. It seemed as though I had a gearbox, and more and more I could not switch from self-destruction mode. But that moment was enlightenment, I understood: this state has nothing to do with what I really am. As the curved nasal septum prevents breathing, and depression prevented my mind from working normally. Ahead were months of psychotherapy, topical books and constant work on oneself.

Now I am in the process of treatment and am learning to conduct the right internal dialogue with me. I already calmly communicate with people, it is easy for me to do business, to make plans. To some extent, I was lucky: many do not immediately find their psychotherapist, some try different antidepressants until they start to act. I got to the point from the first time in both cases. And how my life will develop further depends on me. I am no longer ashamed of my emotions, I am not trying to suppress them, because they are a part of me. Now I am learning to steer them, instead of them driving me. I do not gain weight from antidepressants (what the forums were frightening with), and the most striking effect of the treatment - my head stopped hurting. For many years I suffered from migraines, which sometimes knocked me out of the working mode for several days and from which painkillers did not always help, but it turned out that a significant part of these pains was simple psychosomatics. I could not even imagine how the quality of my life would change in the course of psychotherapy, and only a little regret that I did not dare to do this a few years earlier.

It is important not to get bogged down in self-flagellation, but to increase your erudition. Last April, I ended up at TEDx at the University of Chicago. One of the speakers was a girl who suffered from depression. I remember when I also thought stereotypically, easily labeled and thought: yes, she looks confused, such people get depressed, and, thank God, I never understand what she is saying, I am cheerful. What irony. I reviewed her performance on YouTube and a huge number of others devoted to depression, and I saw how different, how beautiful, intelligent and successful people might suddenly fall off their feet under the weight of a failure in neurophysiology. I googled celebrities on depression and saw a lot of interviews of famous, rich and funny people who have been drinking small doses of SSRIs for many years (selective serotonin reuptake inhibitors; antidepressants. - Ed.).

I know very well how difficult it is to recognize in the heap of my thoughts those that unleash depression, being just shots in the air. Sometimes the simplest reaction of the psyche is just to go with the flow of obsessive ideas and as a result, of course, to go the wrong way. My first task was to learn not to ignore the question "so what?", The beacon of which has been lit up for the last six months as a reaction to all good situations. "So what, what a vacation? So what if breakfast is delicious? So what if I'm next to a loved one? "This question devalues ​​the good. Here you have to answer for yourself why "well and that", why it matters, why it’s cool. It is necessary to conduct a constant dialogue with an internal negative in order to prevent it from spreading. It is necessary to learn to stop and be aware that these thoughts under them have no basis. It was a hard change for me to begin to accept the unknown, and not to think everything over to a catastrophe - just to know the result. In reality, life does not give us any guarantees. Neither that she will be happy, nor that she will be long. Other people will never give us guarantees either. We need to realize this and learn to live with it.

- Antidepressants quickly help to rise from the bottom, but relapses of depression are almost inevitable, if you do not carry out psychological work. Disruptions in the exchange of serotonin in varying degrees, can happen at any time in any person. But the mood of the psyche - a powerful weapon that can both push into the abyss, and keep on the edge.

You need to constantly listen to yourself - this is really important. Celebrate moments that bring joy, even if it is just a small thing. Now I know what pit you can fall into if you don't do this. In modern society, which is aimed at a result, existential crises are not uncommon, because the word "must" almost replaced the notion of "like". Once it ceases to want, and with it, and finally ceases to be "necessary." As my psychotherapist told me, the result of life is always the same for everyone, only the process will get pleasure. Perhaps this will have to completely revise their goals and priorities. It was typical for me to delve into the past and talk endlessly about the future, in these arguments the reality is lost - what is happening now, in the present.

This is a hard job. I can list several cases where I took on too much of a fit of medical euphoria, and then began to sob right after waking up, without getting out of bed all day. Suddenly she fell into despair in the middle of a good day. At these moments, my psychotherapist urged me to slow down, not to give out promises right and left, but to enter social activity slowly. To learn not to waste all energy at once, but to distribute it moderately.

What have I learned? I bring order and introduce the routine - in the good sense of the word - into my daily life. I know how to tune up in the morning and how to get ready for bed in the evening, I don’t use any gadgets for food and so on. I refuse to race and goals that are not important to me personally, but simply accustomed to the so-called millenial. I try to more calmly treat minor problems at work.

- I no longer reproach myself for negative emotions. I have every right to feel anything, and these emotions are part of me. My relatives are talking about a breakthrough that I have made over the past six months. But even more important for me was the daily lightness I gained.

Of course, the path to fully accepting oneself as I am has not yet been covered. Rethinking values ​​in one day is obtained, most likely, only in films with beautiful indie music, and real people have to search for the right form of life for themselves for a long time. But laziness and powerlessness are not flaws, but bells calling for a halt and a break. We always overestimate our own role in the world, and it’s hard for us to believe that the planet will not collapse, our company will not go bankrupt, and our close ones will not cry if we take jobs, take a vacation and spend only a few days doing something I want to do.

Loving yourself is even harder than loving another person — we know ourselves too well. But it is love for oneself that can and should be unconditional. You can change your environment a thousand times in your life, but the only person who will always be there is you.

- First, you need to improve relations with yourself and stop constantly giving yourself assessments. In moments of misunderstanding, it is better to mentally embrace yourself, to praise and confess your love, even if in advance. Warm yourself up Common sense can only live in warmth - this is what I understand now.

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