Today, depression affects not only adults, but also children and adolescents. This disease and methods of dealing with it are the subject of many studies by specialists and a huge number of articles and books. Translated from “scientific” into ordinary language, depression is a loss of strength and desire to live. Symptoms of this disease are apathy and constantly bad mood, anxiety and fatigue, lethargy and gloom.
Modern pharmacology offers the latest generation of antidepressants to combat this disease. How many generations of timoleptics (also called anti-depression drugs) exist today, what do they have in common and how do they differ from each other, what is the mechanism of their action? These and other questions will be considered in the article presented to your attention.
What are antidepressants?
These are medicines that can help relieve symptoms and even prevent depression. The main mechanism of their action is aimed at adjusting the biochemical activity of the human brain. Nerve cells, its components, constantly interact with each other through special substances - neurotransmitters. According to one theory, depressive disorders occur when, for various reasons, the level of a mediator or biogenic amine: dopamine, norepinephrine, or serotonin is significantly reduced in the brain. The antidepressants of the last generation, like all previous ones, have a regulatory and corrective effect on the biochemical processes of the brain by changing the concentration of a particular biogenic amine.
What are they needed for?
In addition to the fact that modern antidepressants help to cope with the symptoms of depression, quite often they are used to get rid of such problems:
- various pains of unknown origin;
- impaired appetite or sleep;
- fatigue or loss of strength;
- nervousness or feelings of constant tension;
- bouts of nervousness or anxiety;
- trouble concentrating or remembering.
Generations of Antidepressants
Before considering how many generations of anti-depression drugs have been created to date, we need to remember that antidepressants were discovered only in the middle of the 20th century. To date, depending on the time of invention and the start of use in clinical practice, as well as on the action of antidepressants, it is customary to distinguish four generations of these drugs.
First generation drugs
The first generation, discovered in the 50s of the last century, is represented by tricyclic timoleptics of cyclic action (TCA). These include the following medicines: Amitriptyline (the first antidepressant available) and its derivatives, as well as the preparations Nefazodon, Anafranil and Melipramin. These compounds block the reuptake of norepinephrine, thereby increasing its concentration. However, TCAs blocked not only norepinephrine (norepinephrine), but also all other neurotransmitters that fell in their path, which led to a large number of unpleasant side effects, especially such as a sharp increase in blood pressure and an increase in heart rate. The drugs of this group are quite toxic, and the likelihood of an overdose when using them is very high, which is why they are used so little in the treatment of depressive disorders today.
In addition, the first generation includes the drugs that are no longer used today that contain irreversible monoamine oxidase inhibitors (MAOs) - Iproniazide, Tranylcypromine, Isocarboxazide. Their action is based on the suppression of the activity of the nerve endings of brain neurons, resulting in an increase in the concentration of serotonin and norepinephrine.
Second generation drugs
The second generation, unlike the first, has a more selective, but also weaker effect on the neurotransmitters and the neurons themselves. It includes tetracyclic irreversible (MAO-B) and reversible (MAO-A) monoamine reuptake inhibitors represented by drugs such as Lerivon, Lyudiomil, Pyrazidol, and several others. Due to the fact that when they were taken, there were many rather serious side effects, as well as due to interaction with different drugs and unpredictability of exposure, drugs of this group are used extremely rarely. In pharmacies, it is quite difficult to find antidepressants from the group of monoamine reuptake inhibitors. But in some cases, they are found under other brand names. So, experts say that the drug Lyudiomil is the same Maprotilin tablets, the price, the manufacturer and the country are just different.
Third generation
Modern researchers have found that about 30 mediators participate in the work of the brain and nervous system, but only three of them are “involved” in depression: serotonin, dopamine and norepinephrine (norepinephrine). The third generation includes selective serotonin reuptake inhibitors (SSRIs) represented by the most commonly used modern antidepressants, such as Zoloft, Citalopram, Prozac, Cipralex, Paroxetine, Plizil and many others. These drugs do not block all mediators, but only one - serotonin. They are inferior in strength to the first-generation drugs, but they have much less side effects than any other predecessors. All SSRI drugs are very effective and should be tolerated by patients in approximately the same way. However, each of us has its own individual characteristics, and it is because of them that the number and strength of the manifestation of side effects will be different in each case. Doctors say that the most common unpleasant consequences of taking third-generation drugs are insomnia, dizziness, nausea, and anxiety.
SSRIs are quite expensive. So, for the fairly well-known and widely used drug “Citalopram”, the price in pharmacies, depending on the brand under which it is issued, can vary from 870 to 2000 rubles.
Fourth Generation Antidepressants
They include drugs of the SSRIsiN group (selective serotonin and norepinephrine reuptake inhibitors). These are the latest generation of antidepressants, such as the medicines "Simbalta", "Milnacipran", "Remeron", "Effexor", which block the capture of norepinephrine and serotonin. The preparations Zyban and Velbutrin do not interact with serotonin, but retain dopamine and norepinephrine. The development of medicines belonging to this group began only in the mid-90s of the last century, and every year more and more new medicines appear.
Doctors cannot unequivocally say that it is in this group that the best antidepressant is available, this is in principle impossible, since drugs are selected individually for the treatment of various types of depressive disorders, taking into account the health characteristics of each patient.
Popular modern timoleptics
Knowing the serious effects of the drugs of this group on the nervous system, it must be remembered that all possible consequences, both positive and negative, can be predicted and mitigated only by a qualified specialist - a doctor. Given all the individual characteristics and making a diagnosis, it is the doctor who will be able to prescribe exactly those antidepressants that are best able to help in your particular case, with minimal side effects. In the event that there are any problems when taking the prescribed medication, it is the attending physician who will be able to adjust or change the treatment regimen. Today, most practitioners recommend patients with depressive disorders drugs from the group of selective serotonin and norepinephrine reuptake inhibitors, the effective effects of which have been tested in practice. Medicines such as Milnacipran, Fluxen (Fluoxetine), Duloxetine, Velaxin (Venlafaxine) are the most typical and widely used antidepressants of the latest generation. Consider the most popular timoleptics in the treatment of depressive disorders.
The medicine "Flucosetin"
This drug is one of the first representatives of the SSRIs group, it combines both antidepressant and stimulating effects. The medicine “Fluxen”, also known as the antidepressant “Fluoxetine”, helps to reduce anxiety and tension, eliminates the feeling of fear and improves mood. Its use is most effective, according to practicing psychotherapists, in cases of asthenic depressive disorders with apathy, as well as in depression of varying severity and obsessive states. This drug is also used in the treatment of bulimia. The antidepressant "Fluoxetine" was first registered in 1974 in the United States, and in the last decade it came out on top in sales in the UK, only under a different trade name - the drug "Prozac". In Russia, this medicine is widely used, and many medical practitioners confirm that it is he or his generics who are prescribed to patients for various depressive conditions.
The drug "Paroxetine"
This is the most powerful representative of the group of selective inhibitors of selective absorption of serotonin, widely used in the treatment of anxiety and depression. Today, there are a lot of drugs whose active ingredient is paroxetine. This is the Russian drug Adepress from Veropharm, the medicine Plizil from the Croatian company Pliva, the Hungarian Rexetin tablets from Gedeon Richter and many others. Regardless of the name of the drug "Paroxetine", reviews about it both in patients and doctors are mostly positive.
The drug "Velbutrin"
More commonly known as Zyban or NouSmok. The active substance of all three drugs is bupropion hydrochloride, which contributes to an increase in the amount of dopamine and norepinephrine in the brain. Medications with this active ingredient not only relieve symptoms of depression, but also help overcome the emotional effects of quitting nicotine. This medication improves mood and increases performance. Reviews of those who got rid of nicotine addiction with the help of such drugs as Velbutrin, NouSmok, and Zyban speak of the high effectiveness of these drugs during smoking cessation.
The medicine "Simbalta"
The drug is the fourth generation of antidepressants, which is an inhibitor of the reuptake of norepinephrine and serotonin, along with a slight uptake of dopamine. This drug, the active substance of which is duloxetine, is characterized by a rather high speed of action in comparison with other antidepressants. According to reviews of both doctors and patients, a clear antidepressant effect is manifested by the end of the first - the beginning of the second week of admission. In addition, this drug is characterized by uniformity of action and throughout the entire time of its use. However, there is a group of patients whose reviews indicate that the effect of this medicine, if it occurs, is very weak. As already mentioned, the individual characteristics of the course of biochemical reactions quite often lead to the fact that a particular medication prescribed by a doctor may not have the expected result.
How much is?
Today, it’s quite difficult to talk about drug prices. This is due to the fact that the foreign exchange market is extremely unstable, and new antidepressants for the most part come to us from foreign manufacturers, whose prices are presented in euros. That is why the table below presents the minimum and maximum prices in rubles, since it is simply impossible to average them. Some of the drugs received earlier are sold at old prices, and new arrivals are much more expensive.
Group | Active substance | Tradename | Price range in rubles Min max |
Tricyclic antidepressants | amitriptyline | "Elavel" | 58 | 62 |
imipramine | Imizin | 300 | 350 |
clomipramine | Anafranil | 280 | 295 |
maprotiline | "Lyudiomil" | 305 | 374 |
Selective Serotonin Reuptake Inhibitors (SSRIs) | sertraline | Zoloft | 460 | 1280 |
paroxetine | Paxil | 218 | 2180 |
fluvoxamine | Fevarin | 750 | 942 |
fluoxetine | Prozac | 460 | 534 |
citalopram | Tsipramil | 870 | 2000 |
escitalopram | Lenuxin | 605 | 680 |
Serotonin and Norepinephrine Reuptake Inhibitors (SSRIs) | bupropion | Velbutrin | 6500 | 6940 |
venlafaxine | Velaxin | 620 | 1607 |
duloxetine | Simbalta | 890 | 2100 |
If you carefully look at the table, you can see that there are no second-generation drugs, namely IMAO (monoamine reuptake inhibitors). It's not a mistake. The thing is that these antidepressants, which have a large number of unpleasant side effects and are incompatible with many drugs, are practically not used in European countries. In the United States, Isocarboxazide, Ugenelzine, and Tranylcypromine are rarely used, and in our country, Nialamide. All of the above medicines are available only under the supervision of psychiatrists.
This table shows well that the price for “classic” tricyclic antidepressants is much lower than for newer drugs from the SSRIs and SSRIs groups. Thus, it is not necessary to talk about the high availability of effective antidepressant drugs for the majority of the population. However, a doctor can help you choose a less expensive drug with similar properties, the so-called generic.
Interaction with other drugs
Antidepressants can interact with other drugs, even those that seem completely safe and familiar to us. The most active in this regard are tricyclic thymoanaleptics and monoamine oxidase inhibitors, but preparations of the SSRI and SSRI groups practically do not interact with other medicines. In any case, if the doctor prescribes any drugs for depression, be sure to find out if you can combine their intake with the use of other drugs, dietary supplements, and even teas and decoctions on herbs.
Alcohol and antidepressants
Oddly enough this sounds, but many people who need taking timoleptics for various reasons, ask how often it is possible to combine the intake of "strong" drinks and tablets for depression. The answer to this question is quite simple: if you want to risk your mental and physical health, and maybe life, try it! The fact is that both alcohol and antidepressants have a serious effect on the central nervous system and the brain, and such double pressure can adversely affect both the "flight control center" itself, that is, the brain, and the organs and systems subordinate to it. Whether or not to combine it is up to you and only you to decide.
Instead of a conclusion
Do not think and “puzzle” over which antidepressants are better and more effective. If you feel that every new day is getting harder to live than the previous one, you don’t have enough strength even for the simplest and most ordinary things, contact a specialist! The doctor will be able to diagnose your disease and prescribe the necessary treatment by choosing the most appropriate medication for you. It can be not only antidepressants. The arsenal of today's medicine is quite extensive: various types of psychotherapy, physical activity and acupuncture, breathing practices and physiotherapeutic procedures.