The general scheme of dosing usually ...

The general scheme of dosing usually determines the half-life of the drug (the time during which the organism is derived from half the dose of the drug). However, individual differences make major amendments to the scheme of therapy, so the order for drugs may vary in different patients and change during treatment of the same patient. Selection of an adequate dose timoanaleptikov remains one of the most difficult questions in the treatment of depression. The recommendations contained in this respect the instructions for use of any funds, provide only general information about the "therapeutic window" based on the averaged data obtained in clinical trials. It does not take into account any individual sensitivity, nor the possibility of comorbid pathology of internal organs, which determines the somatic condition of the patient. In common practice, especially when combined affective and somatic pathology, daily doses of antidepressants (even first-line drugs) should be lower than used in psychiatry (Table 2). If necessary, increase the daily dose of the increase (titration) is carried out gradually with careful monitoring of changes in psychic and somatic in the area. Neurochemical mechanisms that are affected by antidepressants, have inertia, in connection with this timoanaleptichesky effect in some cases develops gradually. This fact should be borne in mind and not to interrupt therapy, if its result is not found in the first few days. However, with no effect over 1 to 2 weeks inevitably raises the question of modification of treatment. Upon reaching the desired effect daily dose reduced gradually: a rapid dose reduction or withdrawal of the drug can cause withdrawal symptoms, the deterioration of both mental and physical condition. In some cases, even with complete reduction of affective disorders is necessary to continue treatment. Treatment of depression consists of three phases: the cropped, supportive and preventive. Cropped therapy is conducted in several stages according to the algorithm shown in the diagram (Fig. 1). Fig. 1. Algorithm for treatment of depression (scheme) In the general medical practices are feasible therapeutic effects related to phase 1 - 3B. Thus it is desirable to determine the need for psychiatric consultation, especially with somatic diseases. Intensive methods (stages 3B - 4), providing intravenous drip of psychotropic drugs, and even more so - electroconvulsive therapy (ECT) - the competence of psychiatric services. Moreover, such effects are shown with heavy, psychotic levels of depression or chronic, resistant to treatment conditions. In identifying such trends physician working in the establishment of general medicine, must submit a patient to a psychiatrist. Cropped treatment effects can achieve a reduction of depressive symptoms up to complete the reverse of depression and remission (intermission).