The choice of drugs for the treatment of depression ...

The choice of drugs for the treatment of depressive disorders is carried out must take into account the side effects ie . preference should be given drugs with a weakly orthostatic effects (doxepin, nortriptyline), minimal anticholinergic activity (desipramine, trazodone, MAOIs), with less pronounced sedative properties (nomifenzin). Tricyclic antidepressants (TAD) is still quite often used to treat mild and moderate depression. Although that was not detected excellence in clinical effectiveness of second-generation antidepressants compared with TAD, and the absence of much less severity of side effects makes them an advantage in the appointment of treatment of the elderly and the elderly. In somatized depression effectively use nomifenzina. In addition, the drug is particularly preferred for outpatient gerontopsihiatricheskoy practice due to the fact that, compared with TAD is faster and causes fewer side effects. Among the other antidepressants netritsiklicheskih proven clinical efficacy and safety of Mianserin and doxepin. The newly discussed the possibility of using MAO inhibitors ( selective) for the treatment of depressive patients with middle and old age. Especially effective is their application in atypical depression with the properties of reactive lability. Among antidepressants, appointed by the elderly and the elderly, justified the use of drugs with selective focus action, such as fluoxetine, which has selectively blocks the action of the reverse seizure of serotonin. antidepressants in this group (fluoxetine, paroxetine, fluvoxamine, etc.) are inferior to the efficiency of TAD, but there are faster and have fewer anticholinergic effects, although they can increase anxiety and induce sleep. The best is a one-time during the day the medication. In the treatment of moderately expressed, and severe depression is highly mirtazapine group of HACC (noradrenergic and specific serotonergic antidepressant). Due to its specific binding to receptors in virtually no anticholinergic mirtazapine, antiadrenergicheskie and serotonergic (typical of serotonin reuptake inhibitors) side effects, which is especially true for geriatric depression contingent patients. The benefits of this drug are determined by speed of onset antiadrenergicheskogo effect from the second week of treatment, protivotrevozhnymi properties, ability to achieve better sleep without the use of tranquilizers night. In comparison with the TAD and serotonin reuptake inhibitors mirtazapine is much better tolerated in the elderly (not increase blood pressure and does not cause arrhythmia), but contra is the presence of glaucoma and benign prostatic hyperplasia. In a series of modern antidepressants, whose purpose is justified in patients with middle and old age is paroxetine.