Amitriptyline instructions for use
Injection. Coated tablets.
1 tablet contains
Active ingredient: amitriptyline hydrochloride 10, 25 or 50 mg.
Excipients: core - lactose monohydrate, gelatin, colloidal silicon dioxide, calcium stearate, corn starch, talc. Shell - macrogol, dimethicone SE-2, Sepifilm 3048 Yellow (microcrystalline cellulose, hypromellozapolioksil 40 stearate, titanium dioxide, quinoline yellow).
Amitriptyline solution for i / m administration
In 1 ml of solution contains:
Active ingredient: amitriptyline hydrochloride 10 mg.
Excipients: glucose, benzethonium chloride, sodium chloride, water for injection.
Tablets: pack contains 10, 20, 50 or 100 pieces.
Solution: in packing - 5 or 10 ampoules on 2 ml.
Amitriptyline is a tricyclic antidepressant. It is an anti-depressant, has a small analgesic, anti-serotonin effect, reduces appetite and helps eliminate urinary incontinence. It has a potent central and peripheral anticholinergic effect (due to its affinity for m-cholinergic receptors), alpha-adreno-blocking action and sedation due to its affinity for H1-histamine receptors.
It has antiarrhythmic properties, is a drug of class IA, capable of slowing down ventricular conductivity (like quinidine) in therapeutic doses. When overdose can cause severe intraventricular blockade.
The antidepressant effect is associated with a mechanism for increasing the concentration of serotonin and (or) norepinephrine in the central nervous system and reducing their reuptake. The accumulation of these neurotransmitters results from the inhibition of their reuptake by membranes of presynaptic neurons. Long-term use of the drug helps to reduce the functional activity of serotonin and beta-adrenergic receptors of the brain, normalizes serotonergic and adrenergic transmission, restoring the balance of these systems, which was disturbed by depressive states. With depression, the drug helps to reduce anxiety and agitation.
The mechanism of the anti-ulcer action of amitriptyline is determined by the ability of the drug to have m-anticholinergic and sedative effects.
Elimination of nocturnal urinary incontinence is provided by anticholinergic activity, which increases the ability of the bladder to stretch, as well as beta-adrenergic stimulation and increased activity of alpha-adrenergic agonists, leading to an increase in sphincter tone and serotonin uptake by a central blockade.
The central analgesic effect of the drug may be due to changes in the central nervous system concentrations of monoamines (especially serotonin), as well as the effect on opioid endogenous systems.
In bulimia nervosa, the mechanism of action is unclear; it has some similarities with the effect of the drug in depression. There is a high efficacy of Amitriptyline in the treatment of bulimia, which occurs in combination with depression or without it. Moreover, the reduction of bulimia can occur even without easing the depression itself.
The antidepressant effect of Amitriptyline develops within 2-3 weeks of its regular use.
The drug has a high absorption. The bioavailability of amitriptyline is 30-60%, and nortriptyline (its active metabolite) is 46-70%. The maximum concentration in the blood is observed 2-7 hours after taking the drug inside.
The volume of distribution is 5-10 l / kg. Effective therapeutic concentrations in the blood are: for nortriptilin 50-150 ng / ml, for amitriptyline - 50-250 ng / ml. The maximum concentration (Cmax) in the blood plasma is 0.04-0.16 μg / ml. Active substances (including nortriptyline) are able to pass through histohematogenous barriers (blood-brain barrier and placental barrier inclusive), can penetrate into breast milk during the lactation period. Communication with plasma proteins is 96%.
Amitriptyline with the participation of CYP2D6 and CYP2C19 isoenzymes is metabolized in the liver tissues with the formation of active and inactive metabolites. Among the active ones are nortriptyline and 10-hydroxy-amitriptyline. The half-life of active substances from blood plasma is: for amitriptyline 10-26 hours, for nortriptyline - 18-44 hours. The drug is excreted mainly in the form of metabolites by the kidneys (80%) and partially with bile.
Amitriptyline, indications for use
Amitriptyline is indicated for depressions, especially those associated with anxiety, agitation, and sleep disorders. The drug is allowed to use for the treatment of children.
Types of depression amenable to treatment with Amitriptyline: endogenous, reactive, neurotic, drug, involutional, and also resulting from organic brain damage.
The drug in the complex therapy is prescribed for:
- various mixed emotional disorders;
- alcohol withdrawal;
- psychosis in schizophrenia;
- behavior disorders (attention and activity);
- childhood nocturnal enuresis (with the exception of bladder hypotension);
- bulimia nervosa;
- migraines (for prophylactic purposes);
- post-traumatic neuropathy;
- postherpetic neuralgia;
- gastric ulcer and duodenal ulcer.
The drug effectively relieves pain in rheumatic and oncological diseases, atypical pain in the face, migraines, etc.
- hypersensitivity to the drug;
- acute alcohol intoxication;
- myocardial infarction (in the acute and subacute period);
- lactation period;
- angle-closure glaucoma;
- severe violations of intraventricular conduction and AV (AV block II of Art., Blockade of the bundle of the bundle of His);
- acute intoxication with drugs - hypnotics, analgesic or psychoactive;
- children's age up to 6 years.
Amitriptyline is contraindicated for 2 weeks before the start of treatment with MAO inhibitors and simultaneous use with them.
The drug contains milk sugar (lactose monohydrate), because its reception is not recommended for patients with hereditary intolerance to galactose, with glucose-galactose malabsorption and lactase deficiency.
Caution must be exercised in the treatment of patients suffering from diseases:
- bronchial asthma;
- schizophrenia (there is a risk of activation of psychosis);
- bipolar disorder;
- oppression of bone marrow hematopoiesis;
- angina pectoris;
- chronic heart failure;
- heart block;
- arterial hypertension;
- myocardial infarction;
- intraocular hypertension;
- a decrease in the motor function of the gastrointestinal tract (paralytic intestinal obstruction is possible);
- liver failure;
- renal failure;
- prostatic hyperplasia;
- hypotension of the bladder;
- urinary retention.
Caution must also be exercised in the treatment of older people and during pregnancy, especially in the 1st trimester.
Dosage and administration
Adults: the drug is prescribed 2-3 times a day inside after or during meals. The initial dose is 50-75 mg, which is then gradually increased until the antidepressant effect is obtained.
In most cases, the optimal therapeutic dose is 150-200 mg, most of which is taken overnight.
In severe depressive states, the dose may increase to 300 mg. The dosage is gradually reduced in 2-4 weeks after obtaining a persistent anti-depressive effect. The duration of therapy is at least 3 months. In the course of treatment, the patient is monitored, if his condition does not improve 3-4 weeks after the start of administration, then further therapy with Amitriptyline is not advisable.
In case of lung disorders and for the treatment of elderly patients, the drug is prescribed in a dosage of 25 to 100 g - taken once a day at night, or divided into several parts and taken during the day.
For children aged 6-10 years, the dose in the treatment of nocturnal enuresis ranges from 10 to 20 mg per night. The dosage for adolescents aged 11–16 years is from 25 to 50 mg per day. When treating children, it is necessary to ensure that no more than 2.5 mg per 1 kg of weight of the child falls.
For chronic neurogenic pain and migraine, the daily dose of the drug is 100 mg.
In severe depressions at the beginning of treatment, the drug may be administered as an injection - intramuscular or intravenous, up to 4 times per day in a dose of 10 to 30 ml. The dosage also increases gradually, up to a maximum daily dose of 150 mg. After 1-2 weeks, go to the pill.
The drug in the form of a solution can be used to treat the elderly and children over 12 years old, but they are assigned lower initial doses and increase them more slowly.
Use during pregnancy and lactation
Amitriptyline can be used for the treatment of pregnant women only if the expected benefit outweighs the potential risk. Approximately 7 weeks before childbirth, the drug should be gradually canceled to prevent the development of withdrawal syndrome in the newborn, which can manifest as dyspnea, drowsiness, increased nervous excitability, intestinal colic, tremor, spastic phenomena, lowering or increasing blood pressure.
The drug is able to penetrate into breast milk and cause drowsiness in children.
Because of the anticholinergic action of the drug, patients may experience: paresis, accommodation, increased intraocular pressure, blurred vision, dry mouth, constipation, urinary retention, intestinal obstruction and fever. All these phenomena after adaptation to the drug usually pass quickly. Sometimes a dose reduction is required.
There are side effects from various human organs and systems:
CNS: headache, ataxia, weakness, irritability, fatigue, dizziness, tinnitus, impaired concentration, drowsiness or insomnia, nightmares, confusion, hallucinations, dysarthria, motor agitation, paresthesia, tremor, peripheral neuropathy, disorientation, changes on the EEG. In rare cases - convulsions, anxiety, extrapyramidal disorders.
Cardiovascular system: tachycardia, arrhythmia, blood pressure lability, conduction disturbance, fainting, heart failure symptoms, on an ECG - an expansion of the QRS complex (due to a violation of intraventricular conduction).
Gastrointestinal tract: heartburn, anorexia, nausea, vomiting, darkening of the tongue, stomatitis, taste disorders, gastralgia, epigastric discomfort, increased activity of hepatic transaminases, diarrhea, rarely - cholestatic jaundice.
Endocrine system: changes in the secretion of ADH (antidiuretic hormone), an increase in the size of the glands on the chest (in women and men), galactorrhea, changes in libido, potency. Rarely - hyper- or hypoglycemia, swelling of the testicles, glycosuria, impaired glucose tolerance.
Allergic reactions: angioedema, skin rash, urticaria, pruritus, photosensitization.
Others: eosinophilia, thrombocytopenia, agranulocytosis, leukopenia, purpura, various blood changes, swollen lymph nodes, sweating, pollakiuria, hair loss, with prolonged use - an increase in body weight.
With abrupt discontinuation of the drug (especially if high doses were taken during treatment), withdrawal syndrome sometimes develops, which may be accompanied by headaches, nausea, vomiting, diarrhea, increased irritability, irritability and sleep disturbances with unusual bright dreams.
Before starting treatment with Amitriptilinov, it is necessary to establish monitoring of the condition of patients with labile or low blood pressure. During the period of treatment, control of peripheral blood is necessary, because in some cases there is a risk of agranulocytosis. With prolonged therapy, liver and cardiovascular function should be monitored.
Amitriptyline with alcohol is incompatible, therefore during treatment it is necessary to exclude the use of alcoholic beverages.
When taking MO inhibitors, Amitriptyline is prescribed no earlier than 2 weeks after their cancellation.
Doses of more than 150 mg per day reduce the threshold of seizure activity, which should be considered when treating patients prone to epileptic seizures and suffering from a predisposition to convulsive syndromes with brain damage, during the period of withdrawal of benzodiazepines and other drugs with anticonvulsant properties, etc.
Since there is a risk of suicidal action in severe depressions, at the beginning of treatment, amitriptyline can be combined with neuroleptics or drugs of the benzodiazepine group. Patients in severe depressive conditions require constant medical supervision in order to detect suicidal tendencies early.
In patients with cyclic affective disorders, during therapy during the depressive phase, various manic and hypomania states can develop (in such cases, the dose is reduced or the drug is completely canceled and the antipsychotic drug is prescribed). After the prevention of these conditions, treatment with low doses of Amitriptyline can be resumed when indicated.
Caution must also be taken when treating patients:
- receiving thyroid hormones and patients with thyrotoxicosis (due to the risk of cardiotoxic effects);
- in combination with electroconvulsive therapy (careful medical supervision is necessary);
- predisposed to the development of drug psychosis;
- with chronic constipation (risk of paralytic intestinal obstruction);
- using contact lenses (due to a decrease in tear fluid, corneal epithelium may be damaged).
Before performing local or general anesthesia, it is necessary to inform the surgeon about taking the drug. With long-term intake of Amitriptyline, the incidence of dental caries may increase, the need for riboflavin may increase.
When taking the drug may reduce the speed of psychomotor reactions and concentration, because for the period of treatment it is recommended to abandon the driving of vehicles and other activities that pose a potential danger.
When treating children, extreme caution is necessary - overdose is deadly for them.
The combination of Amitriptyline with drugs that depress the central nervous system (antidepressants, barbiturates, benzadiazepines, general anesthetics, etc.) can lead to increased inhibitory effects on the central nervous system, difficulty breathing and hypotensive effect.
Amitriptyline increases the anticholinergic effect of drugs with anticholinergic activity (atropine, biperiden, phenothiazine derivatives, antihistamine drugs, antiparkinsonian drugs, amantadine, etc.), which leads to an increased risk of side effects (from the eyes, the central nervous system, bladder and intestines). At the same time taking Amitriptyline with phenothiazine derivatives, holinoblockers and benzodiazepines, the central holinoblocking and sedative effects are mutually reinforced, and the risk of developing epileptic seizures increases (due to a decrease in the seizure threshold). In addition, the combination with phenothiazine derivatives leads to an increased likelihood of the development of an antipsychotic malignant syndrome.
The joint use of Amitriptyline and anticonvulsant drugs leads to increased inhibition of the central nervous system and lower the threshold of seizure activity, which decreases the effectiveness of the latter.
It is also possible the manifestation of various effects when used together:
- with clonidine and antihistamine drugs - enhanced inhibitory effect on the central nervous system;
- with extrapyramidal drug reactions — an increase in the frequency and severity of extrapyramidal effects;
- with atropine - increased risk of paralytic intestinal obstruction
- with indirect coagulants (derivatives of indadione and coumarin) - increasing their anticoagulant activity;
- with glucocorticosteroids (GCS) - increased depression;
- with drugs intended for the treatment of thyrotoxicosis, an increase in the risk of agranulocytosis;
- with inhibitors of microsomal oxidation (cimetidine and others) - T1 / 2 lengthening, increasing the risk of developing various toxic effects of Amitriptyline;
- with phenytoin and alpha-blockers - their effectiveness decreases;
- with inducers of microsomal liver enzymes (phenytoin, nicotine, barbiturates, carbamazepine, and oral contraceptives) plasma Amitriptyline concentration decreases, its effectiveness decreases;
- with disulfiram and other acetaldehyde hydrogenase inhibitors — delirium is provoked;
- with fluoxetine and fluvoxaminov - increase in plasma concentration of amitriptyline;
- with betanidin, reserpine, clonidine, methyldopa and guanethidine - leads to a decrease in the hypotensive effect of these drugs;
- with cocaine - there is a risk of heart arrhythmias;
- with antiarrhythmic drugs (for example, quinidine) - the risk of developing heart disorders increases (Amitriptyline metabolism may slow down);
- with Pimozide and Probukol - possibly increased cardiac arrhythmias, ECG manifests itself in prolongation of the Q-T interval;
- with epinephrine, isoprenaline, norepinephrine, ephedrine and phenylephrine - their effect on the cardiovascular system increases, the risk of developing tachycardia, heart rhythm disturbances, and severe arterial hypertension increases;
- with alpha-adrenomimetics intended for intranasal administration or for use in ophthalmology - enhancing the vasoconstrictor action of the latter;
- with thyroid hormones - a mutual enhancement of the therapeutic effect is observed, at the same time the toxic effect also increases;
- with MAO inhibitors - may be accompanied by an increase in the frequency of periods of hyperpyrexia, severe seizures, hypertensive crises, and patient death.
In case of overdose, a number of symptoms are observed: fever, drowsiness, disorientation, dilated pupils, confusion, shortness of breath, muscle rigidity, supor, dysarthria, agitation, hallucinations, seizures, coma, vomiting, heart failure, arrhythmia, respiratory depression, arterial hypotension .
In case of overdose, you should stop taking the drug and wash the stomach. The treatment uses: symptomatic therapy, fluid infusion, maintenance of water and electrolyte balance and blood pressure. Relapse can occur after 48 hours and later, because within 5 days it is necessary to monitor the patient's cardiovascular activity. In case of poisoning with Amitriptyline, forced diuresis and hemodialysis are ineffective.
Indications for use
F32 Depressive episode, F33 Recurrent depressive disorder, F60.3 Emotionally unstable personality disorder, F20 Schizophrenia, F29 Inorganic psychosis, unspecified, F10.3 Withdrawal symptoms, F91.9 Disorder of unspecified, F90.0 Disruption of activity and attention, F98.0 Enuresis inorganic nature, F50.2 Bulimia nervosa, R51 Headache, R52.1 Permanent non-compensable pain, R52.2 Other constant pain, G43.9 Migraine, unspecified, G53.0 Neuralgia after shingles (B02.2 +), T14.4 Trauma to a nerve (nerves) of an unspecified body region, G63.2 Dia Concrete polyneuropathy (E10-E14 + with a common fourth .4 sign), K25 Gastric ulcer, K26 Duodenal ulcer, G62.9 Unspecified polyneuropathy, M79.0 Rheumatism, unspecified, R52.9 Unspecified pain, M79.2 Neuralgia and unspecified neuritis, F41 .2 Mixed anxiety and depressive disorder, F92.0 Depressive behavior disorder
The drug is stored at a temperature of 15 to 25 ° C, in a dry place, protected from light and inaccessible to children.
What is depression and why does it occur more often?
This disease hits the news pages almost daily. Juliet Jovit asks questions about what causes depression, who is prone to it and how best to cope with it.
What is depression?
People suffering from depression do not necessarily go everywhere with stretched faces, or cry at the first opportunity. On the US mental health website, MentalHealth.gov, this disease is defined as "loss of interest in important aspects of life." Symptoms include an excess or lack of food and sleep; distance from people and ordinary activities; lack of energy; feeling of no meaning, numbness; unusually strong inconsistency and forgetfulness; feeling like you are on the verge of, angry, upset, worried, or scared; thoughts of hurting yourself or others.
An intuitive description is cited by the British Mind Foundation: "It starts like a sadness, then I feel that I am disconnecting and less and less cope with reality. In the end, I feel numbness and emptiness. "
Depression is often mixed with other health problems: for example, long-term illness, irritability, obsessive-compulsive disorder, or schizophrenia.
The term "dysthymia" is used to describe long-term and less severe depression - it usually lasts for two years or more.
I don't know why I'm so sad.
To me this is a burden; I hear you too.
But where I caught the sadness, found Il got.
What makes up what will give birth to her, - I would like to know!
- says Antonio in the play "The Merchant of Venice". However, he was not the only character of Shakespeare who was experiencing depression: if Hamlet or Macbeth went to a modern doctor, they would have been prescribed antidepressants. And also Faust, Madame Bovary and Raskolnikov. Dante begins the Divine Comedy like this:
Earth life having come to half,
I found myself in a gloomy forest
Having lost the right path in the darkness of the valley.
And he really groped for something like that.
Clinical depression is not a 21st century problem. It is as old as humanity. New became only its scale. But in this sense it is hard to say whether more people are really depressed today than in the past, or simply they talk about it more.
How many people suffer from depression?
Clinical depression has developed to the scale of the epidemic in recent decades, and has evolved from a rarely mentioned scourge from the outskirts of society into a phenomenon that rarely leaves the news. It has spread to schools and commercial companies, in refugee camps and cities, on farms and in the suburbs.
It is estimated that 300 million people are suffering from depression at any given time — about 4% of the global population. This follows from the 2015 World Health Organization report. Women are more prone to depression than men.
Depression is the leading global problem, and unipolar depression (as opposed to bipolar) is the 10th on the list of leading causes of early death. The link between suicide, the second most common cause of death for young people aged 15-29, and depression is obvious, and around the world every two minutes two people complete their lives.
And although in the world the figures for depression and other common health problems vary widely, the United States is the "most depressed" country in the world, closely followed by Colombia, Ukraine, the Netherlands and France. At the other end of the scale are Japan, Nigeria and China.
Where does this scatter come from?
A striking contrast between countries has led to the appearance of a depression as a "first world problem" or a "luxury". The logic is this - if a gun is aimed at your head or you don’t know where you’ll get the money for the next meal, you don’t have time for such self-digging.
Recent studies point to a whole sea of causes, many of which overlap: in particular, less developed countries often lack the infrastructure to collect data on depression, and there it is less likely to recognize this condition as a disease. Also in these countries, society does not encourage people to talk about their feelings and their residents are less willing to turn to professionals for help.
Statistics are also not so simple to claim that the rich are depressed, and the poor are not.
One work in the journal Plos Medicine claims that, if we reject the extreme cases, in most countries the number of cases of depression is about the same. It is also argued that depression suffers most in Eastern Europe, North Africa and the Middle East; and most years of disability because of depression lost in Afghanistan, and least of all in Japan.
What causes depression?
Since then, when it was thought that the devil had infiltrated people with mental problems, and when such people were expelled from the community or hung up for witchcraft, the situation had greatly improved. But until now, the understanding of this disease remains extremely distorted, especially the idea that people suffering from depression simply need to "pull themselves together" or "leave the house more".
The psychiatrist Tim Kantofer is expressing a completely different opinion in his book Depressive Illness: The Curse of the Strong [Depressive Illness: The Curse of the Strong].
He argues that there is a site in the brain called the "limbic system" [in fact, it is a combination of several brain structures / approx. trans.], acting like a thermostat that controls various functions of the body — including mood — and restores balance after inherent descents and lifts. The limbic system is a circuit of nerves that transmit signals to each other through two chemicals, serotonin and norepinephrine, which are not enough for people with depression. According to this description, a depressive illness is basically physical, not psychological.
Kantofer says that under the influence of stress, weak or lazy people give up very quickly; strong people continue to go forward, doubling their efforts, struggle with any pressure that forces them to surrender, and bring the limbic system to the point of failure. However, there is no scientific evidence for this theory, since it is impossible to conduct experiments on the living brain.
It is also accepted that the disease is initiated by the resulting injuries or ill-treatment; genetic predisposition, which may or may not coincide with the history of diseases in the family; life stress, including financial problems or heavy losses; chronic pain or illness; drugs, including marijuana, ecstasy and heroin.
There is, although it is actively disputed, the view that extreme stress or certain diseases can cause an overly strong immune response that causes inflammation in the brain, which leads to depression.
WHO estimates that less than half of people suffering from depression are treated for it. Many receive inadequate assistance, often focused on medications, with a lack of speech therapy, which is considered a critical ally.
Among the pharmacological agents for depression, antidepressants of the group of selective serotonin reuptake inhibitors, which decrease serotonin absorption and increase its overall level, are most often prescribed. Another popular class of drugs is selective serotonin and norepinephrine reuptake inhibitors, which work simultaneously with serotonin and norepinephrine.
Among the methods of treatment, cognitive-behavioral psychotherapy is most often used, which smashes the person’s overwhelming problems into situations, thoughts, emotions, physical sensations and actions aimed at uncovering the vicious circle of negative thoughts.
Other types are interpersonal therapy, behavioral activation, psychodynamic psychotherapy and pair therapy. All types of speech therapy can be used alone, or in combination with medications.
In addition to the medical approach, doctors may prescribe physical activity or artistic therapy, while some patients choose alternative or supportive therapies, the most popular of which are Hypericum, meditation, and yoga.
The number of types of treatment for depression increases, but the problem is not solved, but grows. Between 2005 and 2015, the number of cases of depression increased by almost one fifth. The probability of getting this disease in people born after 1945 has increased tenfold. According to WHO, this reflects both the growth of the population and the proportional increase in the number of cases of depression among the most susceptible age groups.
However, globally, the number of suicides has decreased by about a quarter. In 1990, their number was 14.55 people per 100,000 people, in 2016 it was already 11.16 per 100,000.
The key reason for the growth of depression is that medications do not necessarily "cure" the patient, and there are often not enough other methods of treatment that can unfold the situation.
Other reasons for growth are an aging population (in the 60-74 age group, the likelihood of depression is higher than in others), and an increase in stress and isolation.
Over the past 25 years, not a single new antidepressant has been developed, forcing psychiatrists to seek help in other areas.
Were conducted positive experiments with ketamine and psilocybin, the active ingredient of the "magic mushrooms". Hopes for a new generation of treatment methods appeared after the discovery of 44 mutations that, according to scientists, increase the risk of depression. Another controversial area of research is the treatment of depressed immunity and the controversial link between depression and inflammatory processes.
Different countries increasingly understand the need to increase the number of psychologists as a replacement or supplement to drug treatment.
Perhaps the most important is a cultural shift that makes it easier for people to seek help and talk about their illness.
Among the celebrities at the head of this shift are the British princes William and Harry, who founded the charity foundation Heads Together, and spoke publicly about their problems. Also recently, the wrestler and actor Dwayne Johnson talked about his depression, and the singer Mariah Carey about bipolar disorder.
How to cope with depression? Useful tips on overcoming the "black band" in life
"I'm depressed" - we often hear these words. But most often people call depression ordinary bouts of blues and bad mood, which often go away on their own within a few days. Real depression is a disease that can poison life for many years and never goes away without treatment.
What is depression?
Depression is a serious illness that is characterized by clear symptoms that distinguish it from bad mood. The main signs of depression include:
- Joyless, depressed;
- Frequent and sudden mood swings;
- Anhedonia, loss of sensation of pleasure ("Nothing pleases and does not interest");
- Inability to concentrate, impaired memory;
- Inability to make a decision, constant return to the same questions;
- Fear, anxiety, panic attacks, attacks of aggression;
- Chronic feeling of tiredness, lethargy ("I wake up broken");
- Sleep disturbance, insomnia or, on the contrary, constant sleepiness;
- Loss of appetite, weight loss, digestive problems;
- Decreased libido;
- Feeling of pressure, heaviness in the abdomen and chest, shortness of breath;
- Various vegetative symptoms, such as excessive sweating, tremor, dry mouth and others.
If these symptoms appear simultaneously and persist for several weeks, then there is every reason to suspect depression.
We are used to thinking that depression is always the result of some sad events - the loss of loved ones, divorce, the loss of your favorite work. But it is not so. There are three main types of depression - reactive, somatic and endogenous. Reactive is really the result of dramatic changes in life or experienced injuries. Endogenous appears as if "out of the blue", for no apparent reason. In fact, there are reasons, they are just not so noticeable to others. Endogenous depression can be the result of a hormonal imbalance (post-natal depression is especially widely known), taking certain drugs, alcohol or drugs. Somatic depression is one of the manifestations of another disease, such as Alzheimer's disease, hypothyroidism, traumatic brain injury, or even ordinary flu.
In addition, residents of northern latitudes often experience seasonal depression associated with a lack of sunlight.
It is very dangerous to underestimate or poetize depression. In this state, there is nothing attractive or romantic, it destroys the life and personality of a person, affecting not only himself, but also his relatives. Tips to "stop whining" and "pull yourself together" are not only useless, but also very harmful - a person suffering from depression is unable to control this condition just as a patient with a broken leg cannot run a hundred meters. Reproaches of friends lead only to the fact that a person is even more convinced of his weakness and worthlessness and plunges even deeper into this state. The opinion that a disease is the result of the tendency to analyze too much and "wind yourself up" is not true either. Even small children who barely learned to speak can suffer from depression.
This disease is one of the most common mental disorders - more than 350 million people of all age groups suffer from it. Every year, about 150 million people in the world lose their ability to work because of depression. At the same time, women get sick twice as often as men - although doctors explain such statistics not by the "persistence" of the stronger sex, but only by the fact that men turn to experts less often and "are treated" mainly by alcohol or other similar means. There is another alarming fact - according to statistics, the risk of getting depression increases threefold, if someone in the family already suffers from this disease.
Treat, can not be postponed!
It is very difficult to quickly get rid of depression, but without the help of doctors and psychologists it is completely impossible. But the disease is successfully treated with the right approach. Comprehensive measures are usually assigned.
First, antidepressants are used to fight. A doctor should pick them up - as a rule, such pills cannot be bought without a prescription, and the uncontrolled use of this group of drugs can lead not to recovery, but to deterioration. Antidepressants relieve the main symptoms. As a rule, the stage of drug treatment lasts from several weeks to several months. As an adjunct to antidepressants, sedatives are often prescribed. In some cases, physiotherapy, light therapy, and acupuncture also give a good effect.
After the improvement of the condition, the period of fixing the results begins. This stage of treatment is no less important - depression is insidious and can return again in a few months or even years. In order not to leave the disease a single chance, a course of psychotherapy and individual work with a psychologist is necessary. To combat depression, there are many methods - cognitive psychotherapy, the purpose of which is to change a person’s perception of himself and the world around him; interpersonal psychotherapy to help settle conflicts with others; behavioral therapy designed to change behavior, leading to stress and depression; psychodynamic method that resolves internal conflicts of a person with himself and many others. The duration of this stage depends on the severity of the condition and on how ready the patient is to cooperate: it will take from several sessions to several months of work with a specialist.
Alternative opinion - The author of The Loss of Sadness: How Psychiatry Turned Normal Sorrow into Pathological Depression Jerome Wakefield argues that depression can trigger positive changes in life, allowing you to sort through your desires and learn from mistakes.
How to beat depression, or anti-depression tips
Overcome depression can only really want this. And if the fight against the disease is limited only to the formal taking of pills and visiting doctors, the result will not be achieved or the path to recovery will stretch for long months or even years. To get back in shape as soon as possible, you need to actively incorporate "anti-depressive measures" into everyday life. There are no trifles in treating depression. Of course, these tips will not help cure the disease without medication and psychotherapy, but can significantly speed up the process.
For depression, obsessive thoughts are typical, and it is very difficult to get rid of them. If you feel that you are already scrolling the same memories and questions in your head for the hundredth time, turn your attention to any subject. Lift a pebble from the ground, examine it, mark the color, texture, weight, roll in your hands, think what it looks like. Instead of a pebble, you can use any other object - a key, a leaf from a tree, everything that comes handy. It is important to concentrate on contemplation. In a few minutes, dark thoughts will recede.
Go in for sports
This is no longer psychology, but pure physiology - during exercise, whether we like them or not, the brain produces endorphins - hormones of happiness and joy, the deficiency of which provokes depressive states.
Art therapy is a whole section of psychotherapy. Creativity really helps to cope with depression. Any result of creative work enhances self-esteem, and the process itself is important. But the artistic value does not matter.
Do not keep emotions in yourself
The requirements "to take oneself in hands", "to take a punch" and "not to unstuck", as we have said, only drive a person into an even deeper depression. The restrained emotions are like a bomb that explodes inside. Even healthy people who keep everything in themselves pay for their apparent composure with neuroses and psychosomatic diseases. If you want to cry - weep, you want to scream - scream, you want to run amok - smash the sofa cushion.
Begin to keep a diary in which you will celebrate all the pleasant moments, even if they were quite fleeting and insignificant. Pay attention to what pleases you most often, and strive for it.