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When and why pills for depression make sense

Many consider depression to be a temporary phase that no one needs pills for. Those affected suffer greatly, and antidepressants can often help.

Tablets are part of everyday life. Unpack the blister with the contraceptive pill in the café or ask your colleague for an aspirin if you have a headache? Absolutely normal. It’s also totally okay to cancel an appointment because of abdominal pain or migraines. But what happens when you say: “Don’t count on me. I am in a depressive episode and take antidepressants ”? Often there are only long faces and silence.

Depression is a common disease. The confirmed that during their lifetime one in four women are affected by the disease. Together with the male comrades in suffering, there are 5.3 million people suffering from depression . The majority can be treated by the family doctor, who, according to statistics, prescribes medication more often than psychotherapy.

But it is not only the disease that is often tabooed, but also drugs. Why are antidepressants such a taboo subject? It seems that the prevailing opinion is that depression is just a phase. A sad state of mind that you can get out of with a little chocolate or a vacation. Depression is a disease that severely restricts those affected.

What are antidepressants?

Antidepressants are drugs that can lighten the negative mood and reduce listlessness in depression. They can also have a positive effect on side effects such as sleep disorders. However, their active ingredients are not harmless and can certainly cause side effects. Not least because of this, antidepressants require a prescription.

How do antidepressants work?

Ultimately, they control physical processes through chemical substances. The active ingredients contained in it influence messenger substances in the brain that are responsible for the transmission of nerve impulses, especially the neurotransmitters norepinephrine and serotonin, which are responsible for mood and our drive.

There are these antidepressants:

  • Selective serotonin reuptake inhibitors
    Known as: fluoxetine, paroxetine, citalopram, sertraline Effect: Inhibit the reuptake of serotonin from the synaptic gap back into the nerve cell, the serotonin concentration in the synaptic gap increases.
    Side effects: Rather rare. Sexual dysfunction, gastrointestinal complaints
  • Selective serotonin norepinephrine reuptake inhibitors
    Known under: Venlafaxine, Duloxetine, Milnacipran Effect: Inhibits serotonin and also the reuptake of norepinephrine. Improve the mood & have a stimulating effect.
    Side effects: Rather rare. Loss of appetite, nausea, trouble sleeping, restlessness, dry mouth
  • Benzodiazepines
    Known under: Diazepam, Lorazepam, Temazepam Effect: Rapidly relieves anxiety and promotes sleep. Often used to bridge the gap until the actual antidepressant works.
    Side effects: addiction (already possible after 4 weeks!), Tiredness, dizziness, drowsiness.

fizkes / Shutterstock.com

How effective are antidepressants?

The mode of action of antidepressants is controversial. Studies comparing the effect of antidepressants with placebos show that the so-called effect size is statistically only 0.2. However, this ineffectiveness only applies if the drug is used against mild and moderate depression.

The success rate of the tablets increases with the severity of the mental illness. But ultimately the placebo effect is also an effect. “A large part of the positive effect of the drugs comes from the fact that patients know they are getting something that can help them,” says Prof. Dr. Tom Bschor, specialist in psychiatry and psychotherapy.

What side effects can antidepressants have?

In addition to classic ineffectiveness, there can be other problems: Side effects such as nausea, digestive problems, dry mouth or sexual dysfunction can occur.

When stopping it is important: from a chemical point of view, most antidepressants actually have no potential for dependence – with the exception of the benzodiazepines, which contain sleeping pills. Nevertheless, withdrawal symptoms can occur, which is why medical supervision is so important.

fizkes / Shutterstock.com
Listlessness is one of the symptoms of depression that antidepressants can help relieve.

What is the difference between depression and upset?

Prof. Ulrich Hegerl, Chairman of the German Depression Aid Foundation and retired specialist in psychiatry, neurology and psychotherapy, confirms that depression is all too often confused with a stress-related upset: “Everyone knows this: experiences of loss, excessive demands or partnership problems affect the mood But depression is different and feels different too. “

Important to know: Depression can occur without the occurrence of major stress factors. “The decisive factor is the disposition. If you have this, there is no need for an external stress factor.”

In his book “Antidepressants – how to use them correctly and who shouldn’t take them” (Südwest, 20 euros), Prof. Bschor explains that although depression is not a hereditary disease , this susceptibility or predisposition, known as vulnerability, is is inherited. Negative childhood experiences can make them worse. Under these conditions, acute negative living conditions can easily trigger the disease or make it worse.

But none of these are the real causes of depression. “However, even those affected are often convinced that a current problem in their living environment is to blame,” says Hegerl, “Then it doesn’t make sense why one should take antidepressants. You don’t understand that it’s a disease that needs to be treated. “

Why do many hide the fact that they are taking antidepressants?

People with depression are often labeled as weak or inefficient in their environment because of precisely this ignorance. And that is probably the reason for the stigmatization. “In a performance society you have to be successful and show results. It doesn’t fit to be productive and have enough drive with just the crutch of drugs,” Bschor said.

Perhaps this explains why 8 times as many daily doses of antidepressants are prescribed today as in 1990, but hardly anyone is talking about this amount of 1.4 billion tablets. Of course, all of this does not mean that reaching for the tablet always has to be the right way.

What are the alternatives to antidepressants?

There are many other measures that can be tried. Therapy is obvious, but places are scarce, at least with health insurance therapists. The current figures from the Federal Chamber of Psychotherapists show: You wait almost 20 weeks to get your first appointment. Mind you: only for visiting a consultation hour in which a need for therapy is only then determined.

Finally, it can be said: If antidepressants help, don’t be afraid to speak openly about them. Specialist Bschor is of the same opinion: “After all, there are no substances that change personality. They merely restore the body to its ‘normal state’.”

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