I have been suffering from depression for 3 months. The doctor rationed me to take Prozac, but my condition has been repeated and I haven't recovered yet. Is there any good way?

The severity and symptoms of depression are different, and the commonly used treatments are:

(1) drug therapy: different drugs should be selected according to different symptoms.

1. Patients with anxiety and agitation should use amitriptyline, daily dose 150 ~ 300 mg, divided into 2 ~ 3 times;

2. Mipamine should be used in patients with depression who are slow and disobedient, and the dose is the same as amitriptyline;

3. Doxepin is used for depression patients with anxiety and obvious sleep disorder, and the dose is the same as amitriptyline;

4. Clomipramine is used for depressive patients with obsessive-compulsive disorder and panic disorder. The dose is 100 ~ 200mg per day, and it is taken 2 ~ 3 times.

5. Trim Impramine is used for patients with depression accompanied by anxiety and numerous complaints, with the same dose as amitriptyline;

6. Maprotiline is used in elderly patients with depression accompanied by anxiety and sleep disorder, and the dose is the same as amitriptyline;

7. Patients with depression accompanied by retardation and withdrawal symptoms use paroxetine at a dose of 20 ~ 60mg； every morning;

8. The elderly patients with depression accompanied by compulsion and fear were treated with fluoxetine at a dose of 20 ~ 60mg； every morning;

9. For patients with endogenous or drug-induced depression, monoamine oxidase inhibitors can be selected, with a dose of 50 ~ 100 mg per day, taken twice or three times;

10, for patients with depression accompanied by hallucinations, delusions and other symptoms of schizophrenia, antipsychotics, such as sulpiride or perphenazine, should be used in combination, and the general dose is moderate;

1 1. Depressive patients with obvious retardation and withdrawal symptoms can choose central nervous system stimulants, such as ritalin and pimoline;

12. Patients with refractory depression can be treated with soothing agents;

13, menopausal depression patients can be combined with hormone therapy.

(2) electroconvulsive therapy: For depressed patients with stiff limbs and strong suicidal words and deeds, electroconvulsive therapy can receive immediate results. In addition, it is also an effective treatment for patients with refractory depression.

(3) Sleep deprivation therapy: mainly used for endogenous depression and refractory depression. The method is to keep the patient awake on the day of treatment (take a lunch break for 30 ~ 60 minutes when necessary) and stay up all night; Stay awake during the day and don't take a lunch break before going to bed at night. As a treatment, it is treated twice a week, with 8 ~ 10 as a course of treatment. This treatment is forbidden for the elderly and patients with serious physical diseases.

With the increase in the number of patients with depression and the rapid development of psychopharmacology, more and more new varieties of antidepressants are being developed. Clinical commonly used antidepressants are divided into the following three categories.

(1) Tricyclic antidepressants: At present, the commonly used antidepressants mainly include imipramine, amitriptyline, doxepin, clomipramine and norimipramine. Its pharmacological action is related to blocking the reuptake of norepinephrine and serotonin in the brain, which can inhibit the reuptake of norepinephrine and serotonin by the presynaptic membrane of nerve endings, thus increasing the transmitter concentration in the receptor site and playing an antidepressant role.

(2) Bicyclic and tetracyclic antidepressants: Maprotiline, as the representative, has similar pharmacological effects to tricyclic antidepressants.

(3) Monoamine oxidase inhibitors: reversible and irreversible, with moclobemide as the representative of reversibility and phenelzine as the representative of irreversibility. Because of their high toxicity, these drugs are rarely used now. Its pharmacological function is to inhibit monoamine oxidase, reduce the degradation of norepinephrine, 5- hydroxytryptamine and dopamine, increase the content of catecholamine in the brain, and play an antidepressant role.

At present, some new antidepressants introduced clinically are mainly selective serotonin reuptake blockers, including fluoxetine, sertraline and paroxetine. Its pharmacological action is to selectively block the reuptake of 5- hydroxytryptamine by presynaptic membrane of nerve endings, thus increasing the level of 5- hydroxytryptamine in synaptic cleft and exerting its strong antidepressant effect. It is precisely because of the high selectivity, relatively few side effects and high compliance of patients with this drug that it is a new drug with broad development prospects.

Studies have shown that taking medicine is not the only way to fight depression. According to USA-Today, about 500,000 children and teenagers in the United States take antidepressants. There are also data showing that the proportion of children suffering from depression is much higher than before. Relatively speaking, the current drugs have less side effects and are considered safer for children. Although many young people have made remarkable progress after taking these antidepressants, doctors have not prescribed them. This problem has attracted the attention of some parents and doctors. These concerns have an indisputable basis: the US Food and Drug Administration has not approved any drugs for children. This shows that the Committee has not realized that these antidepressants are safe and effective for children. Parents and teachers are also thinking about whether drugs are the only weapon to fight depression. What should families and schools do? American society should further reflect on the social reasons behind this phenomenon.

depress

Depression is a kind of mental illness with abnormal mental state as its main clinical manifestation, and its prevalence rate is still 3-5%. This kind of cheek is more frequent or aggravated in spring and autumn, and it tends to recur, similar to the familiar sadness, but more lasting. The patient was depressed and worried all day, sighing. Serious people are depressed, pessimistic and desperate, and feel that "life is like a year" and "life is worse than death". The more they blame themselves, the more negative thoughts they have, and the better world turns gray in their eyes.

Many people dare not admit that they are suffering from depression together, for fear of being mistaken for "mental illness", and try their best to deny and cover up their illness, which will only delay the treatment opportunity and turn depression into a chronic and refractory disease.

People with depression don't go to see a psychiatrist because of depression. They often go to the internal medicine or neurology department of a general hospital to treat a series of physical symptoms related to depression, such as headache, dizziness, fatigue and memory loss, which leads to some patients being misdiagnosed as neurosis, menopausal syndrome, migraine, insomnia, or being diagnosed as yin deficiency and blood deficiency in traditional Chinese medicine.

A simple way to identify typical depression, that is, a person's depression lasts for more than two weeks, accompanied by any of the following nine symptoms:

1. Lose interest or pleasure, and feel that nothing can cheer them up.

2. Loss of energy or continuous fatigue, difficulty in recovering physical strength, and bed fatigue.

3. Decreased activity or slow action, and I just want to spend most of the day in bed.

4. Excessive remorse or guilt, blaming yourself for some small mistakes in the past.

5. Lenovo is difficult or unable to concentrate, feeling that the brain is stagnant.

6. Repeated suicidal thoughts or behaviors.

7. Insomnia or early awakening, with prominent depression in the morning.

8. Lose weight or appetite, or even refuse to eat.

9. Sexual desire declines, or even does not exist.

The common types of depression are as follows:

1. Endogenous depression.

2. Psychological depression.

3. Secondary depression.

Treatment:

In addition to the common principle of using antidepressants, the treatment methods of the above different types of depression also have their own emphasis. The treatment of endogenous depression mainly depends on drugs, and electroconvulsive therapy can be used if necessary; To treat the symptoms of psychological depression and depressive neurosis, we should give priority to psychotherapy, encourage patients to talk about their inner depression with goodwill and sympathy, and give guidance and help so that patients can enjoy the environment and get social support; The treatment of secondary depression tries to eliminate the pathogenic factors and try to treat the body and disease; Hormone therapy can be used for menopausal depression patients with endocrine dysfunction.

Why can selective deprivation of rapid eye movement sleep treat depression?

The treatment of depression by selectively depriving REM sleep was initiated by vogel (1968) and other researchers in the late 1960s. The reason why they thought of using this treatment method was inspired by the following three aspects:

(1) The effective methods to treat depression are electric shock and antidepressants. Both electroshock and antidepressants can significantly inhibit REM sleep. Therefore, rem sleep deprivation may have the effect of treating depression.

(2) People who take reserpine sometimes suffer from drug-induced depression, and reserpine can increase REM sleep. This is strong evidence.

(3) In animal experiments, rem sleep deprivation can often enhance behaviors related to instinct, increase the activity of experimental animals, and increase appetite and sexual desire. The clinical manifestations of depression are decreased activity, decreased appetite and sexual desire. Therefore, it is considered that rem sleep deprivation may have therapeutic effect on behavior.

Practice has proved that selective deprivation of rapid eye movement sleep can alleviate depressive episodes. However, this treatment method needs examination equipment and personnel in the sleep laboratory, which is quite troublesome, and because its curative effect is not better than taking antidepressants, it has no clinical promotion value.