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Active Ingredient: Amitriptyline

Endep is a tricyclic antidepressant from the group of non-selective inhibitors of the neuronal uptake of monoamines. It also has some analgesic (central genesis), H2-histamine-blocking and antiserotonin effect, helps eliminate bed-wetting and reduces appetite. It has a strong peripheral and central anticholinergic effect due to its high affinity for m-cholinergic receptors; strong sedative effect associated with affinity for H1-histamine receptors, and alpha-adreno-blocking action. It has the properties of an antiarrhythmic agent of the subgroup Ia, like quinidine in therapeutic doses it slows down ventricular conductivity (with an overdose it can cause severe intraventricular blockade).

Amitriptyline tablets, indications for use, side effects, reviews, analogues

Tricyclic antidepressant "Amitriptyline" is widely used by medical psychotherapists and psychiatrists to eliminate the symptoms of depression, insomnia, anxiety and fear.

The drug amitriptyline, in addition to antidepressant effects (unlike antidepressants SSRIs - Selective serotonin reuptake inhibitors) is a non-selective inhibitor of monoamine seizure (serotonin, dopamine, norepinephrine ...), and additionally has sedative, anti-anxiety and hypnotic effects.

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Thus, amitriptyline tablets will help you to relieve some depressive, neurotic symptoms, but it is unlikely that the disease itself, its source, will be cured.

To learn more, including about the analogues of this drug - read the article to the end.

Amitriptyline tablets - indications for use

Indications for use of Amitriptyline, in addition to depression, neurotic manifestations, fears and phobias, insomnia and anxiety, are such neurotic personality disorders as anorexia, bulimia, neurogenic pain, migraine and, even, enuresis in children.

Prescribe the drug and the dose can only your doctor. Do not experiment on your health, do not play a psychotherapist - consult a Skype expert.

Amitriptyline - side effects, contraindications and complications

Side effects of amitriptyline are broad and multivalued. This antidepressant drug has many contraindications and complications, especially when taking medication incorrectly and uncontrolled by the doctor.

Side effects when taking amitriptyline are more pronounced and more dangerous than other tricyclic antidepressants. Unlike selective antidepressants (SSRIs), this medicine is much worse tolerated by patients.

Main side effects and effects of amitriptyline:
dry mouth, blurred vision, constipation, including intestinal obstruction, difficulty urinating, hand tremor, drowsiness, lethargy, dizziness, apathy and passivity, weakness, lowering blood pressure, tachycardia, fainting, convulsions, decreased libido and potency, etc.

Complications of taking amitriptyline:
At high doses, there is a possibility of death. In highly depressed patients, amitriptyline can provoke suicidal thoughts, possibly with real behavior. Also, some neurotic disorders can develop: hypochondria, depersonalization, asthenia ...

Contraindications amitriptyline:
Amitriptyline should not be consumed while intoxicated, with ischemic heart disease, myocardial infarction, arrhythmia, atony of the bladder, intestinal obstruction, diseases of the prostate, thyroid gland, during pregnancy.

When taking this medication in any case, you can not drive a car and other mechanisms, as well as go to work, where you need attention and reaction.

Amitriptyline - reviews of patients and psychotherapists

Reviews of patients taking amitriptyline, suffering from depression and other psychological and emotional personality disorders are almost unambiguous - the drug helps relieve some of the symptoms, improve the general psycho-emotional state, but only while the patient drinks these pills. Since Amitriptyline does not cure the disease itself, therefore, with a decrease in doses or complete cancellation, which, by the way, cannot be done abruptly, the symptoms return.

Reviews of amitriptyline medical psychotherapists are ambiguous, but many of them prescribe this drug, especially in free clinics.

Non-medical psychotherapists, for the most part, have a negative attitude to the long-term use of this antidepressant. They suggest taking amitriptyline tablets in crisis situations, but in the future they prefer to treat the disease itself with various psychotherapeutic methods and techniques, without drugs.

Amitriptyline - analogues

The antidepressant, sedative, anti-anxiety and hypnotic medication Amitriptyline has analogues, as well as other drugs, which differ in price and quality, as well as the power of therapeutic effects and side effects.

The main drug analogues of amitroptilin are trimipramine, imipramine, clomipramine, desipramine, fluoroacyzine, northliptilin, protlitilin ... (all of them should be taken only as prescribed by a doctor).

The best and realistically valid analogue of antidepressants in general and amitriptyline in particular (to get rid of not only the symptoms, but also from the original source of the disease) is non-medical psychotherapy without drugs.

About treating depression and trusting psychiatry

- Periodically in the media, data on the high prevalence of mental illness among the population is voiced. Is every tenth Russian mentally ill?

- It depends on who is considered mentally ill. Compare, for example, paranoid schizophrenia, the most severe mental disorder in this group and so-called. "schizoid personality type". To begin with, the disorders of the schizophrenic spectrum occupy a certain range. At the beginning of this range - the shizotymic temperament - is when a person is a bit withdrawn, introverted, prefers to be in his inner world more than in the world of communication with other people. Further, as schizoid traits increase, schizoid accentuation takes place, that is, this is already a trait of a person’s character - but that’s all. Next in terms of severity is schizoid psychopathy, that is, a schizoid warehouse of personality. In these people, due to the relatively high proportion of schizoid traits, so-called decompensation of the condition, usually in response to external stimuli. Decompensation occur with severe mental disorders, primarily of a depressive nature. More pronounced pathology is already cases of schizoaffective psychosis, when schizophrenic and affective disorders are combined (mood disorders - depression, mania), followed by cases of recurrent schizophrenia, followed by cases of fur-like schizophrenia, and at the top - paranoid schizophrenia. This is when a person falls ill - say, in adolescence (at 13-17 years old): he appears to have hallucinations, delusions, inappropriate behavior. In this form, the disease quickly leads to a defect, an increase in negative personality changes, and disability. Naturally, if adequate treatment measures are not taken.

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So, it is believed that throughout the world, at different times and in different cultures, the prevalence of this form of schizophrenia in all populations is about the same - 1% of the population. Historical example: Hitler destroyed all his mentally ill in Germany. 10 years have passed, and in this country the number of patients with paranoid schizophrenia has again reached the same proportion - 1%.

The definition of the border between a healthy and sick person largely depends on the psychiatric school, the diagnostic approaches adopted by the traditions.

If they are guided by the "expanded" concept of schizophrenia, which is accepted in our country, the diagnosis of schizophrenia will be made somewhat more often. If it is a tough concept and narrowed diagnostic criteria that are accepted in the United States, then only patients with paranoid form will be considered patients with schizophrenia. In the West, the application of these stringent criteria for disease derives from the concept of rehabilitation, because The diagnosis of schizophrenia involves obtaining certain social benefits: disability, free treatment, subsidies, benefits.

Relatively benign conditions that may, in principle, relate to schizophrenia, in the United States are denoted by other diagnoses - "schizotypal disorder," "borderline personality disorder," "bipolar affective disorder," etc. American scientists contributed to the spread of their classification of mental illness around the world (in the context of globalization) to the detriment of the development of more advanced clinical and psychopathological approaches. In this regard, many countries, including Germany and France, which in due time created their excellent psychiatric schools, now live according to the American classification, or according to the international one (the so-called ICD-10, that is, the International Classification of Diseases 10 revisions ), which is very close to American. According to these approaches, as long as a person is more or less adapted in social and labor terms, no peculiarities of his style of behavior, character, oddities and quirks allow us to consider him sick. He just has such a character.

- What is "decompensation"?

- Usually the term "decompensation" is used to characterize personality disorders (psychopathy) - this is a sharp increase in painful personality traits with the simultaneous appearance of other symptoms, most often, depressive. It is decompensation that often leads a person to a psychiatrist. Decompensation can (and should) be treated: drugs, psychotherapy, as well as spiritual means available to the Church. And when the patient copes with it, he can quite continue the socially useful life.

- Did I understand correctly that the schizoid personality type is not a disease, but if aggravated, it can reach the extent of the disease? And are other personality types also capable of some development ending in illness?

- Yes, the logic is the same here. Consider, for example, an example of psychasthenic. This is a modest, shy, vulnerable person, whose second signal system is more developed than the first, he is painfully experiencing the events, he is characterized by anxiety, anxiety over the slightest occasion. He, like every other type of personality, has certain "pain points". For psychasthenia, such a point is increased responsibility. For example, such a person is appointed head of the department, 25 people are subordinated to him - for him this is a terrible thing, a severe stressful problem. At the same time, he needs to speak in public, and a person has an innate social phobia. And if in the first days he feels euphoric because he received a promotion, then when a burden of responsibility accumulates (and he is a man and so hyper-responsible), any complicated matter begins to over-disturb him, makes him anxious. He cannot entrust anyone to anyone, because, because of his anxiety, he has to check everything personally - even if he entrusts some part of the work to his subordinates, he will then recheck her to do it anyway, since it is easier for him to do everything himself than to force someone do something. As a result, anxiety increases, depression appears, insomnia, obsessive thoughts - i.e. "decompensation", which may result in hospitalization in a psychiatric hospital.

And what happens to hysterics? His painful point is pride. A hysteric with all the fibers of his soul demonstrates himself as he wants to appear to people. He is a demonstrative person. If suddenly a situation arises, when they begin to mock at him, they say: "Uh, you show everyone that you are a pheasant of different colors, but in reality you cannot imagine anything of yourself" (or something like that), this person receives a blow to pride. Severe decompensation occurs, and immediately. But with hysterics, all actions are very bright - hand wringing, crying, hysteria begins. Now, of course, the ladies do not faint, it happens very rarely, now nausea, weakness, staggering, shallow depression occur more often.

Such patients are often prone to demonstrative suicide attempts, made to show how hard it is for them. After all, a suicidal attempt is always a cry for help, it is a signal: "Help, I feel bad!". A patient with a hysterical temperament will do it "hysterically": necessarily in front of many people, or, for example, in conditions where after a suicide they find him very quickly, before the onset of death. He may even climb into the loop - but exactly 5 seconds before people enter the room. But if they do not enter, then he, alas, will remain in this loop. Or scratch the skin of his forearms, or swallow pills, if possible some safe, and say that he swallowed a package of potent drugs. This is the so-called. hysterical suicide, or, as they say, "blackmail".

- Does psychiatry have an understanding of the spiritual causes of certain symptoms? For example, the Church considers the cause of anger pride, self-conceit. Or do psychiatrists only see symptoms of anger in manifestation of anger - and regard a person as a psychopath or schizophrenic?

- Of course, the psychiatrist will regard the frequent manifestations of anger as symptoms of the disease: either simply personality disorders, or schizophrenia, or affective pathology. If you meet an Orthodox psychiatrist, then I think he will penetrate into this situation and will try to distinguish between a truly spiritual and mental illness. But it is very difficult.

- Is the statistics known: what proportion of people who have attempted suicide is mentally ill?

- The points of view are polar here: someone believes that the absolute majority of those who commit suicide is in a painful state. Others believe that most suicidal attempts are made by healthy people. In principle, if you look into it, in most cases, those who have committed suicide can detect depression or decompensation. Suppose there was a depression in a hysterical person — they hit their vanity and a man fell into an agitated state, he had stress, his blood pressure increased, he suffers, is torn, and cuts himself. This is called parasuicide - a person has no intention to finally end his life, but there is a desire to attract attention to himself.

- How would a psychiatrist qualify such a state: people come to our site who give the impression of calm and cold-blooded people who are not at all excited. They say they have firmly decided to commit suicide, they absolutely do not want to live, they are not interested in anything.

- There is a so-called existential depression, when a person disappears - like all of a sudden, the reason for life. The dynamics here are different. Sometimes (especially often in adolescence) a person begins to read a lot of books, and books of a certain (metaphysical) direction, to search for the meaning of life, to get involved in existential theories. At a certain stage of such a drunken reading, he is so imbued with this metaphysical ideology that he really eludes the meaning of life. If he doesn’t come on time, say, to faith or not to see a doctor, then the case may go to suicide.

In suicidologists developed a typology of suicidal attempts. One of these types - the so-called. "negative balance". A suicide of the "negative balance" type occurs when a person in a relatively calm state weighs the pros and cons and comes to the conclusion that there are more minuses of continuing being, and then he makes a suicide attempt. If a person is in a state of depression, lying, not eating, not sleeping, losing weight, not working - everyone understands that he is sick, that he needs urgent help. And the other, with a "negative balance," continues to go to work, it even looks cheerful and no one thinks about what is going on in his soul. He performs all his duties. And all of a sudden, completely unexpectedly, she attempts a suicide. These suicides are the most dangerous, because no one is waiting for them, and they are carefully planned by man.

- Do you know any risk groups in terms of depression, for example, children from single-parent families?

- Of course, such risk groups exist. I think that children from dysfunctional families are certainly more prone to mood disorders, depression, the situation itself will push them to this. People with post-traumatic stress disorder (PTSD) are those who have been in "hot spots" who participated in hostilities (they could be called "scorched by war") - they also belong, of course, to the "risk group".

PTSD is a diagnosis that is difficult to accurately establish and treat, because patients, often without receiving qualified help, are engaged in self-treatment. "Treated", mainly alcohol, sometimes drugs. After the Great Patriotic War, this disorder was a mass phenomenon, and, of course, many were "drunk up" and died. Now a significant part of these patients has switched to drugs or entered into various destructive sects.

Few people help these people; they usually go to a psychiatrist with two diagnoses: post-traumatic stress disorder and / or alcoholism. In general, this is an extremely difficult problem, not only psychiatric, but also social ("Chechen," "Afghan" syndromes — its other designations).

- Also, probably, at risk are people from families in which there are already mental diseases?

- Heredity is burdened by those with a relative who was sick with depression or some kind of mental disorder. It is transmitted, however, the predisposition of the nervous system to respond to the disease, and not the disease itself. Suppose if one parent is sick with schizophrenia, then the probability that the child will inherit the disease is approximately 10%, if two parents are sick, then already 50%. At the same time, in the families of patients with schizophrenia, the "deck", if I may say so, is generally shuffled very bizarrely: one of the descendants, for example, may suffer from paranoid schizophrenia, two - manic-depressive psychosis, one - oligophrenia, one - will be talented or even brilliant, and the other is more or less normal, and man 2 also suffers from alcoholism.

- Alcoholics, drinking people are at risk? Young people, for example, who often drink beer, almost every day?

- Beer alcoholism is the same alcoholism as vodka. Perennial consumption of beer in large quantities leads to obesity, severe liver damage, severe depression. And these depressions, of course, are fraught with suicidal attempts.

- Are participants in groups of emo, ready to belong to risk groups?

- As a matter of fact, all these youth marginal groups actively attract our patients. Punks had a pessimistic slogan: "All shit, there is no future!" (sorry for the expression), and the Goths to a greater extent, emo to a lesser extent, develop this idea further. I am ready to practice a kind of death cult, corresponding to music, I would call it destructive. A person who is quite a lot (or long) listening to this music will inevitably fall into depression. Those who are drawn to communicate with such children - as a rule, are already in some kind of chronic subdepression that they themselves may not yet be aware of, nevertheless, the careful doctor will detect it with careful examination.

As for emo, this is such a kind of game for older students, for whom skin cuts, in fact, only complement the image, they have no death cult as such, they talk more about it than they do in practice. Emo, basically, do not get to the clinic, with the exception of some particularly zealous representatives.

- As you know, the concept of "critics" plays an important role in the diagnosis of mental illness. What it is?

- Criticism is the awareness by the patient of their illness, the feeling of certain deviations from the norm, the feeling that you are not all right. Criticism can be formal when a person says: "Yes, I am sick," but when the doctor begins to find out what he is sick with, the young man cannot clearly articulate. That is, he, in principle, agrees that the disease exists, because 10 people have already told him that he is sick. The patient agrees to be left behind: "Yes, I am sick," but he does not think so. This is called formal criticism.

But this is also a criticism. He even agrees with the existence of the disease. Because when a person has no criticism at all, he actively disagrees, he says: "You are all sick, and I am healthier than you and know better than anyone what to do."

Partial criticism is when the patient is critically critical of some phenomena, and absolutely uncritical of others. Suppose he says: "Yes, I have headaches. I want to get rid of it." Or: "I have a social phobia - I want to be treated for it." People often come to the doctor and say: "I have a social phobia." You start to examine the patient, and it turns out that a social phobia is only the "tip of the iceberg", and besides the phobia, he has a lot of other disorders that are not recognized by him at all.

- Is it possible to somehow stimulate criticism? Is the man himself capable of doing this?

- There is no definite answer. This concept is quite subtle. To some extent, self-education can help here: having read something on this topic, a person sees that someone else had the same thing, specialists treated him (with medication or psychotherapy), and everything returned to normal. And then he suddenly realizes - this is effective when it comes to depression. With psychosis, reading special literature, stimulating criticism is useless, because even after reading the special texts many times, the patient will say: "I am not the same, I have something else, I do not care about other crazy people." In psychoses, the absence of criticism is a rather complex disorder caused by mental illness as such and rather difficult to correct.

In depressions, it seems to me, it is possible to stimulate the level of criticism in just this way - in a cognitive (that is, educational) way.

- What are the treatment guidelines for depression?

- First, we need to determine whether we are dealing with endogenous, i.e. associated with internal genetic hereditary factors, depression, or with some other - not endogenous. Depression can be reactive (as a result of exposure to a strong psycho-traumatic factor), it can be organic (with damage to internal organs, brain injuries), it can be caused by drug or alcohol abuse, severe toxic goiter. The treatment approach is completely different.

If, for example, depression is reactive, then, first of all, it should be treated with psychotherapeutic agents. Reactive depression is a reaction to some traumatic event. Here, for example, the girl had to have a wedding in a month. And her fiance calls her and says: "You and I are not getting married. Mom said that it’s too early for me to marry." The girl will fall into a sharp reactive depression, and literally in a few hours after the message she makes a suicide attempt - she swallows psychotropic pills in large quantities. They bring this girl to the doctor, she is in acute hysterics. Naturally, this urgency must be removed with medicines, because it is impossible to help here by talking alone. Small doses of some sedatives are used, but not tranquilizers. Because under the influence of tranquilizers, a person seems to "get drunk", if we speak in simple language, and can make repeated suicide attempts, his "hands are untied". Such an acute condition can be removed with drugs for several days. But then you already need to connect psychotherapy. In the same case, if the depression drags on, say, for half a year, it will, of course, be about taking more effective drugs - because, perhaps, the depression is already developing from reactive to endogenous (i.e. due to internal causes, it ceases to be a reaction on the event).

Drug treatment depends on the severity of depression. If the depression is not deep, then it is possible to get by with minimal doses of fairly safe drugs, even in the form of monotherapy: prescribe one drug, possibly an antidepressant. If the depression is deeper, or it is long-term, then here, of course, one cannot do without taking more effective drugs.

Purely endogenous depression arises in a person for no reason, suddenly, "like snow on his head" and develops according to his own laws. It is based on a violation of the brain's biochemistry (lack of serotonin, norepinephrine, dopamine), therefore, it can only be treated with medication, replenishing the amount of these substances in the brain with the help of drugs (such as vitamin deficiency vitamin deficiency treatment).

Neurological, mild depressions require, mainly, psychotherapy (here the cognitive-behavioral is the most affective), and as the severity of the disease increases, the treatment regimen changes: light antidepressants are added to psychotherapy. In severe depression, a combination of antidepressant drugs with neuroleptics is required, which is already associated with a deeper lesion: here, dopamine CNS pathways may already be affected. And the most severe depressions, as they say, with urgent indications - that is, life-threatening - require the use of electroconvulsive therapy. This is one of the methods of not only treating, but also saving such patients. EST is now performed under general anesthesia and using muscle relaxants. Now, if one famous Russian writer had once been treated by this method, he would have had two or three sessions to get out of the state in which he died.

- What is the idea of ​​cognitive-behavioral psychotherapy?

- The idea is that a person, as a rule, is dominated by erroneous ideas about himself. He misinterprets the reaction of others to himself, falling into a state of helplessness because of this. This is called cognitive distortion. Consequently, in this state all the information that it receives, communicating with society, is negative. This negative consistently deepens the depression.

The creator of the cognitive theory of depression - Aaron Beck. For several psychotherapeutic sessions, he tried to correct these incorrect, distorted thoughts of the patient, which led to an earlier recovery.

- There is a purely domestic notion of antidepressants, that this is some kind of vodka analogue: he drank it - then it will become easier, and then it will be even worse. And how really? Can you explain what antidepressants are, is there really nothing harmful about them?

- What, in principle, happens with depression? For various reasons, the number of circulating norepinephrine or serotonin decreases in the brain, as a result of which transmission of nerve impulses is difficult, and, accordingly, a person's energy level decreases, his mood drops, anxiety and some other disorders develop. Due to the deficiency of one or another mediator (a substance transmitting nerve impulses in the brain), there are more noradrenalin or more serotonin depressions. Depending on what kind of depression psychiatrists deal with, appropriate drugs are also chosen to correct the disorders.

How do antidepressants work? The drugs either increase the release into the synaptic cleft of the mediators - norepinephrine, serotonin, or they block the reuptake of serotonin. As a result, the amount of serotonin in the brain increases and, accordingly, the depression is gradually leveled. However, stopping depression with antidepressants is not easy. To do this, you need at least six months, after which the drugs are gradually canceled, and, as a rule, depression does not return.

Antidepressants do not act like drugs. How many would not have taken them, drug intoxication ("buzz" - colloquially) the patient does not occur. Dependence on antidepressants does not occur, because they do not act on any - neither the opiate nor the benzodiazepine - receptors.

But where does this domestic popular expression come from: "hooked on antidepressants"? It sounds almost like "hooked on the wheels." This is usually explained as follows: for example, with a well-chosen scheme, a person normally feels against the background of taking an antidepressant, but if the depression has not completely stopped, i.e. has a protracted nature, with the premature cancellation of antidepressants - it unfolds with a new force. It is precisely about these cases that they are completely unreasonably saying that the person is "addicted to antidepressants," he allegedly developed a "dependence on drugs."

A very negative role in creating myths about psychiatry is played by the views of the so-called. antipsychiatry. You know that there are numerous societies that have their own websites, actively promote the idea that psychiatry is either mockery of a person, or a social or political order, or the machinations of psychiatrists, and mental illness does not exist at all. As a result, antipsychiatrists distribute books, leaflets, make films, go to antipsychiatric meetings. All these activities are generously sponsored, especially by the West, from America, by various organizations such as Scientologists. The latter generously finance antipsychiatrists because they know that it is their contingent - those that are treated by psychiatrists. If we manage to fool the head of our patients, then we can lure them to ourselves - comprehend Dianetics.

- What is the basis of the opinion that approximately in half a year of treatment with antidepressants you can solve the problem? Due to the action of the antidepressants themselves or due to the fact that the root cause is due to some other factors, the effect on which the problem of depression can be solved?

- The root cause only happens in a reactive depression. Endogenous depression exists by its own laws, it develops exactly when the body's rather complex internal mechanisms trigger, and ends when it is supposed to end. Antidepressants also allow you to interrupt it much earlier.

It is statistically shown that depression usually lasts, say, one and a half years. I will express a somewhat seditious thought: if the patient is not treated, then in one and a half years he himself, most likely, will come out of depression. But a year and a half he will suffer. If he is treated, then with the help of antidepressants he will be able to get out of depression in 2-3 months and the rest of his life will live in a practically healthy state. And then the depression will end on its own. At this point, it is important to cancel antidepressants on time. If they are not canceled, they can provoke a transition (inversion) of depression into a manic state: excess energy will begin to manifest itself.

- What can you say about the criticism to your condition of patients with depression and mania?

- In general, if you compare the tactics of treatment of these two affective states - depression and mania - then it is much easier to treat patients with depression, because patients understand that they are sick. Patients with mania (these are also affective states, only with a different pole, when a person is full of energy, sleeps little, builds unreasonable searchlights, spends money without thought, feels overwhelmed by sexual energy, feels healthier than anyone else), They are either brought by relatives under the white hands, or they enter the hospital involuntarily - by ambulance, because they are already committing some kind of aggressive or illegal actions.

Patients with depression are characterized by the presence of criticism - they are ill, they are depressed, they have anxiety - usually they usually seek help. There are, of course, depressive-delusional states, when a person believes in his delusional ideas, but does not believe that he is sick. He has no criticism, and he does not consult a doctor. There are depressive-delusional states that are very dangerous, for example, Kotar's syndrome, when it seems to a person that he is to blame for everyone, that he allegedly committed some terrible atrocities and should be punished. Moreover, he must be executed, because because of him the world perishes. And here the patient sometimes commits an extended suicide - that is, he, from his point of view, does a good deed - eliminates the punishment of his children, his wife (kills them, then himself).

- By what symptoms can a person understand if he needs to go to a psychiatrist?

- If you appear: steadily low mood, depression, anxiety, disability, lethargy, the desire to lie in bed all the time, loss of appetite or sleep disturbance, it becomes clear that you need to contact a psychiatrist or psychotherapist.

It is important to note that there are not so many good (highly qualified) psychotherapists in our country, so his choice (as well as a psychologist) should be taken very seriously. If a patient comes to a psychotherapist who is only concerned with solving his financial or mental problems, he will not receive the desired help.

- Rumors about the dangers of treatment in psychiatric hospitals are widespread in society. These are two kinds of dangers: the label is "psycho" (the patient’s fear that the "discrediting" diagnosis once made to him can be recognized by everyone, both in a close circle and in an educational institution, at work) and the second danger is that in a psychiatric hospital speaking, can "heal" - turn into a chronicle. What is the real situation and how great is the risk that the treatment will not help, and what, on the contrary, will the patient become worse?

- There is a mass of speculative publications in newspapers, and television stories on this topic. Show the lattice, dilapidated buildings, the suffering of the mentally ill, harassment of them. Basically, these are staged plots. In psychiatric hospitals, people with cameras are practically not allowed (for ethical reasons, in order to maintain the confidentiality of treatment). And the existence of such "terrible" conditions in modern hospitals has long been excluded. In some suburban boarding schools, the patients are really very difficult: these are boarding schools for psychochronicists. And there, these reporters looking for shocking shots find what they want — grates and old buildings. Naturally, when a person watches on TV, on the Internet, in newspapers with obvious yellowness, he will be afraid to go to a psychiatrist because he will "know" HOW they are being treated. In fact, in psychiatric hospitals very carefully approach the selection of a treatment regimen; if a patient does not tolerate a particular drug, they are promptly replaced. Doctors know well how to deal with neuroleptic complications and how to prevent them. Of course, among psychiatrists, as well as among doctors of other specialties, there are people with more or less experience and qualifications, but I am sure that no one will cause harm to the patient.

And now to the question of the "stamp of the psyche" or so-called. stigma. In 1993, our country adopted the "Law on Psychiatric Assistance and Guarantees for Citizens in its Provision." In this law, instead of the concept of "accounting" introduced the concept of "observation". Supervision in a clinic (PND) happens dynamic and advisory. Those who are sick with schizophrenia and epilepsy fall into the dynamic group. Those who are sick with depression, cyclothymia, neurosis, psychopathy - in the advisory. When consultative observation, no one bothers the patient, they do not call him to the dispensary, there is a map in the PND, but there are no restrictions on rights. Dynamic is a bit harder: a lot depends on the dispensary and the nature of the disease itself. With regard to employment, for patients under counseling supervision, there are no restrictions on the place of work. Under dynamic observation, there are such restrictions, but there are few of them (driving, serving in power structures, possession of weapons, working at heights and with dangerous materials).

- Not only in the modern "yellow" press, but in many books, aminazine is often mentioned, the use of which is presented almost as a punitive remedy: they stick it in to make the patient stupefied.

- Aminazin is used very widely. Invented it back in 1951 in the West. When it was opened, there was a revolution in psychiatry, because before that there had been no medicine at all for the treatment of mental illness. After it was invented, patients began to recover in the hundreds and were discharged from hospitals, where they spent many years. The hospitals are empty. And so it was for many years, until aminazin ceased to help just as effectively. Resistance developed to it, and many patients gradually returned to the walls of their hospitals. But, accordingly, other antipsychotic drugs were synthesized. Now there are a lot of antipsychotics - more than fifty. And why aminazin stayed? It is one of the most powerful, universal remedies that effectively help with psychosis. They can remove the excitement of an aggressive patient. If you appoint him competently, with skill, he brings a lot of benefits.

- Even in the books of Soviet dissidents, a drug was mentioned that caused physical pain.

- It is a sulfazine (sulfur suspension in peach oil). Now this technique is prohibited, and no one uses it. It was used to raise body temperature in order to overcome resistance to treatment. I had patients who found this sulfazin themselves and asked them to set a course, but we do not have the right to do so.

- And this is "healing", it is somehow associated with stupefaction. Could this effect be from conventional treatment?

- When acute psychosis is treated, naturally, large doses are prescribed, because if you do not withdraw psychomotor agitation and aggression, the patient is simply dangerous for himself and others. Naturally, this may be due to increased sleepiness, lethargy, weakness. This is probably called "healing", "stupefaction." If you correctly assign drugs, this relaxation (sedation) passes quickly enough. Now there are antipsychotics of the new generation. They quickly relieve excitement, aggression and at the same time give much less side effects. After the removal of acute arousal and agreement with the patient, we move to the appointment of modern antipsychotics, which do not lead to "stupefaction" do not interfere with work, study, do not affect personal and social life. Therefore, patients take them without coercion. (Igor Oleichik)