Experience in the use of tricyclic ...

Experience of using tricyclic antidepressants and MAO inhibitors showed that in some cases (30%), they proved to be ineffective or to give expression to the side effects holinoliticheskogo properties, thus exacerbating the disease state patients. This, of course, requires broadening the arsenal of antidepressants and justified search optimally effective for individual indications timoanaleptikov. Therefore, starting with the 60-ies the attention of psychiatrists increasingly began to attract the newly synthesized compounds in the literature called the new "atypical" antidepressants, known as antidepressants II generation. They differed from previous chemical structure (mostly they were bi-and tetracyclic compounds) and mechanisms of action - not affected by the reuptake of monoamines. Comparison of results of treatment of endogenous depressions with different nosological diagnosis revealed a somewhat higher efficacy of tricyclic ("typical"), antidepressants, compared with "atypical" with clinically more severe depressive states. Therapeutic effect as "atypical" antidepressants was greatest at relatively shallow depressions - neurosis, adynamic (asthenic), senestoipohondricheskoy, psychopathic, and to a lesser extent by the classical endogenous depressive syndromes. This trend is confirmed by data on more effective "atypical" antidepressants, compared with "typical" for a relatively mild depression (in 73.5% patients vs. 39.0%), whereas in the treatment of heavy (detailed) of depression New antidepressants significantly inferior to a "typical (respectively 47.9 and 80.0% of patients therapeutically effective) (see Table 1.). It was also found that "atypical" antidepressants differ significantly and the spectrum of antidepressant action, in which the actual timoanaleptichesky component manifested to a lesser extent than stimulating (activating) and sedative (anxiolytic). Therefore, these drugs can not be uniquely attributed to any drugs, stimulants or drugs for sedation. The simultaneous combination of all three components of the impact on major depressive symptoms gave grounds for some authors speak of a "bipolar", or "balanced" action of some of them, which determined the preferred range for the treatment of depressive syndromes "atypical" antidepressants and caused particular method of their appointment - three times a day, including an evening reception. Therapeutic improvement of the manifestations of depression in the treatment of "atypical" antidepressants found much faster, on average 3-4 days for drugs, whereas when using large tricyclic antidepressants, distinct signs of improvement recorded in most cases by 6-7 day therapy. Despite the relatively high frequency of cholinolytic side effects (at an average of 21.2 and 16.2% of patients, respectively), the most severe of these (muscle weakness, dizziness, drowsiness, decreased blood pressure, urinary retention, acute confusion) is more often accompanied by therapy typical antidepressants.