We have talked before about the confusion that exists between sadness and depression . Who has not been sad at some point? Who has not been helped to feel better when they were sad? Perhaps this is what has caused almost everyone to dare to “treat” or give advice on how to treat depression . And perhaps it is what has increased the fear or rejection of treatment with antidepressants due to the perception that it is easy to improve sadness without them. But depression is much more complex than the emotion of sadness.
Major depressive disorder
In major depressive disorder , or what we commonly refer to as depression, we see that not only is the mood affected (hypothymia), but also the ability to feel pleasure (hedonia), the ability to have motivation and persist in the act (apathyabulia), cognitive abilities (slowness, mental dullness), motor abilities (motor slowness and clumsiness), eating, sex and sleep. So, all vital areas of the individual are affected.
Not all neurotransmitters involved in depression perform the same functions. We observed that serotonin is more related to impulsivity, appetite, libido and aggression; and noradrenaline with attention, memory, energy and motivation. Both are related to anxiety, irritability, pain, cognitive function, mood and emotion.
Antidepressant drugs will try to regulate the functioning of serotonin, norepinephrine and, to a lesser extent, dopamine in order to try to reactivate the functions affected by depression.
When do antidepressants take effect?
The effect of antidepressants is not immediate . Many patients who come to therapy and begin treatment with antidepressants are unaware of the time it takes to start experiencing their results. This is why they may end up interrupting treatment, having only experienced its side effects.Once we begin psychopharmacological treatment with antidepressants, a synaptic increase occurs, that is, a readjustment of the receptors and neurotransmitters involved. To do this, information about the new situation must be passed to the cell nucleus, and the nucleus must order the balanced synthesis of the new receptors, enzymes and neurotransmitters involved.
This process takes two to four weeks . The patient will not experience any improvement in his or her symptoms during the first few days. They may even get worse, since the synaptic discharge will immediately produce an increase in the neurotransmitter and the appearance of some of its side effects, which may cause anxiety. Also, special care must be taken with alcohol consumption, since it increases its effects.
To assess whether an antidepressant is effective or not, you have to wait about four weeks. This is the time needed for the system to readjust and for the drug to start to take effect. The first few weeks are usually accompanied by side effects, with the feeling that perhaps the
When does treatment with antidepressants end?
Once the desired therapeutic effects and an improvement in mood are achieved, treatment is usually maintained at the minimum dose for at least two months. After this, a slow and progressive reduction of the dose begins until a total period of about 6 months is completed.
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