Why it is dangerous to take antidepressants without a prescription

What is depression

If you are feeling sad or depressed, it doesn't have to be depression. Depression is a severe emotional disorder that occurs primarily due to internal causes rather than external factors.

This serious diagnosis is based on the following criteria:

deterioration in mood;
decrease in pleasure from those activities that you previously liked;
increased fatigue (fatigue rolls over after a short walk or doing simple things).

Moreover, all these symptoms should be observed most of the day and last at least two weeks. They will not disappear if some joyful event suddenly happened, for example, a person was promoted in position or he was presented with a long-desired thing.

There should be several additional signs from the listed ones:

inability to focus on the work being done;
self-doubt;
the feeling that the person himself is to blame for his illness;
a person ceases to see a "gap" in the future;
difficulty falling asleep, insomnia, heavy awakening;
loss of appetite;
desire to harm your body.

Only a doctor - a psychotherapist or psychiatrist - can evaluate these symptoms and make a diagnosis. There are three reasons for this.

First, there are various disorders that are very similar to depression, but they are not. These are, for example, bipolar disorder, schizophrenia, dementia. They are treated, respectively, in a different way.

Secondly, sometimes depression is caused by diseases of the internal organs, such as the heart or the endocrine system. In this case, the brain will receive less oxygen, and it will have to "turn off" or weaken not the most important functions. In particular, the mood. This depression is called somatogenic, and it will not go away until the underlying disease is treated.

Finally, there are atypical forms of depression. They are manifested by other symptoms, such as increased appetite, severe drowsiness. This requires a special approach to treatment.

How antidepressants work

Special chemicals called neurotransmitters are responsible for emotions in our body. It:

norepinephrine - a hormone, the release of which forms a feeling of anxiety, it is also responsible for wakefulness and adaptation in the outside world;
serotonin is a hormone that forms a feeling of happiness or pleasure, and also controls anxiety, aggressiveness, falling asleep, and sexual behavior;
dopamine - a hormone that causes a feeling of intense joy in response to reward or encouragement;
oxytocin - a hormone that creates feelings of trust, calmness, reduces anxiety and fears;
melatonin - a hormone that regulates the human circadian rhythm;
gamma-aminobutyric acid - a neurotransmitter with a sedative effect;
prolactin - a hormone that is responsible for the production of breast milk and the ability to have an orgasm in men and women;
other neurotransmitters.

Many of them are hormones and affect not only mood, but also the functioning of the whole organism: the functioning of the gonads, changes in blood pressure, activation or slowing down of the heart. Others, such as gamma-aminobutyric acid and phenylethylamine, are non-hormonal in nature and only govern emotions.

Most drugs that belong to the antidepressant group of the Federal Clinical Guidelines for the Diagnosis and Treatment of Recurrent Depressive Disorders work only with the first three listed molecules: norepinephrine, serotonin, and dopamine. Medicines work where the processes of two nerve cells meet (this is called a nerve synapse). One process secretes a neurotransmitter, which enters the space between the cells and there acts on the process of another nerve cell.

The processes of nerve cells interact with various substances. But in one unit of time, either those mediators that cause a feeling of joy or those that lead to a depressed mood can work. Two cannot turn on at once.

Antidepressants generally take one of three main pathways to have their effect:

They block the enzyme monoamine oxidase (MAO). Federal clinical guidelines for the diagnosis and treatment of recurrent depressive disorders that destroy neurotransmitters. As a result, serotonin, norepinephrine and dopamine act on neurons for a longer time than they did before. Drugs that act on MAO can inhibit it irreversibly or reversibly.
Do not allow neurons that have already secreted norepinephrine, dopamine, or serotonin to take these molecules back (drugs are called inhibitors, or reuptake blockers). As a result, nerve cells that need to receive neurotransmitters interact with these hormones of joy and pleasure longer. Then, if you maintain a constant concentration of the antidepressant in the body (that is, take it as prescribed by the doctor), the neurons will not have time to return to the previous state. The person will cease to experience such a depressed mood as before.
Increase the release of either norepinephrine and serotonin, or only serotonin from the desired neurons. As a result, more happiness hormones are supplied to the neurons, and the state of depression recedes.

A separate group of antidepressants is formed by drugs that act on neurons that produce melatonin, the sleep hormone. A decrease in its production causes seasonal depression. In addition to increasing the production of the hormone melatonin, they increase the release of dopamine and norepinephrine, block one of the types of receptors that perceive serotonin. More hormones of pleasure and happiness, and there is no room in the brain for depression-causing molecules.

The group of antidepressants also includes preparations based on St. John's wort extract. They are able to suppress the reuptake of all three neurotransmitters: dopamine, serotonin, and norepinephrine. Antidepressants also include drugs based on methionine, an amino acid that takes part in the synthesis of adrenaline.

Antidepressant myths and exposures

Oftentimes, people are afraid to take antidepressants because of the far-fetched side effects. Let's analyze popular misconceptions.

Antidepressants do not help solve problems, they only make them forget about them

The drugs do not affect memory. In addition, when a person is depressed, they have a distorted perception of their problems and little energy to solve them. Prescribing antidepressants can often help you better deal with current tasks by conserving the mental energy that a person needs.

Antidepressants Can Gain Weight

Some drugs can actually promote weight gain, but there are also drugs that can help you lose weight by reducing your appetite. These are fluoxetine, sertraline, escitalopram.

If a person is concerned about a problem with weight, the doctor prescribing antidepressants should be told about it.

The drugs will have to be used for life

On average, antidepressants are taken for 6-9 months, sometimes longer. During this time, the symptoms of depression disappear. However, in more than 20% of the Federal Clinical Guidelines for the Diagnosis and Treatment of Recurrent Depressive Disorders in Patients, the signs of depression reappear over time.

Antidepressants affect potency

This is not true. Some drugs affect your sex life. But they only reduce libido, without affecting potency or the ability to get an orgasm. In some cases (for example, if the person was very sexually active before the depression), it can even improve the sexual relationship.

How antidepressants can actually harm

According to the order of the Order of the Ministry of Health of the Russian Federation of July 11, 2017 No. 403n "On approval of the rules for the dispensing of drugs for medical use, including immunobiological drugs, by pharmaceutical organizations, individual entrepreneurs licensed to pharmaceutical activities" of the Ministry of Health of the Russian Federation No. 403n "On approval of the rules for dispensing drugs”, all antidepressants are dispensed by prescription. Many still find ways to buy such drugs without a doctor's prescription, not considering that these are far from harmless drugs. They interfere with the natural balance of neurotransmitters, most of which, as we said, are hormones, that is, substances that work not only with the brain, but also with various internal organs.

The main side effects of antidepressants are:

Effects on the cardiovascular system. This is an increase in heart rate, a decrease in blood pressure with a sudden rise from bed, fainting, shortness of breath.
Changes in the work of the endocrine system. Some antidepressants can cause an increase, less often a decrease in blood sugar levels. There may also be milk secretion from the mammary glands in non-lactating women.
Deterioration of the digestive system. Certain antidepressants can cause nausea, vomiting, poor appetite, abdominal pain, taste disturbances, and darkening of the tongue.
Disruption of the nervous system: insomnia or drowsiness, dizziness, tremors (tremors).
Other side effects: an increase in the size of the breasts (in men and women), hair loss, swollen lymph nodes, weight gain (body weight increases if the drug is taken for more than a year), hemorrhages in the skin or mucous membranes.

Taking medications for depression should be clearly justified also because these medications are “fine-tuned”. They are difficult to combine with other medications, and they should not be taken with alcohol at all (and the course of treatment lasts at least 6 months). Moreover, antidepressants "do not allow" the use of certain foods.

For example, when taking monoamine oxidase inhibitors, you should not eat food that contains the amino acids tyramine or tyrosine. These are cheeses, smoked meats, dairy products, meat broths, legumes, beets and sauerkraut, sausages and wieners, liver of animals or birds. If a person taking pyrazidol, moclobemide, or other MAO inhibitors consumes such foods, they may develop tyramine syndrome. This is a sharp increase in blood pressure along with a severe headache, and sometimes other symptoms:

severe redness of the head and face;
intense pain in the heart;
violation of the heart rhythm;
photophobia;
dizziness;
convulsions.

If you take an MAO inhibitor and a drug that blocks the reuptake of one or more neurotransmitters, severe adverse reactions also develop:

temperature increase;
nausea or vomiting;
dizziness;
convulsions, up to causing respiratory arrest.

What to do if you notice signs of depression

Depression is something that causes severe emotional and physical suffering, reduces the quality of a person's life and can lead to disability, since a person no longer finds the moral strength to work and even take care of himself. If this is a disease, and not a temporary deterioration in mood, then a little later, suicidal thoughts may appear. Depression needs to be treated.

Therapy should be prescribed by a specialist - psychiatrist or psychotherapist. The doctor does not necessarily start treatment with the prescription of antidepressants. In mild to moderate cases, especially in children and adolescents, psychotherapy, taking magnesium supplements, and increasing physical activity may be quite enough.

Self-medication is definitely not worth it. You will not be able to objectively assess which drugs are right for you and increase the risk of side effects.