9 best antidepressants

We have already presented readers a rating of sedatives, including both prescription and non-prescription drugs. But when it comes to the best antidepressants, we have to warn: all these prescription drugs. Some of them require not just a sheet of paper stamped and signed by a doctor, but must be discharged on a special form, and after the purchase, the prescription remains at the pharmacy, where it is stored for three months. Therefore, it is not possible to prescribe an antidepressant only on the basis of an article from the Internet (and they should notice, fortunately). To do this, you will have to visit a doctor - a neurologist or a psychiatrist, who will write out a prescription, based on your own ideas about which tool is most suitable for a particular patient. Therefore, our ranking of the best antidepressants is for informational purposes only and should not in any way be a guide to self-treatment.

What are antidepressants and when they are prescribed

The work of our brain, including the general background of mood and emotions, depends on the content of special substances in it - neurotransmitters. One of these substances - serotonin, called the hormone of joy. He maintains a good mood and creates a feeling of happiness. In people with depression, serotonin levels are reduced.

These are purely biochemical processes, and offering a person suffering from depression against a background of low serotonin levels “just to pull yourself together and start moving” is about as productive as offering a diabetic patient to maintain the desired level of sugar by willpower.

Antidepressants increase the amount of serotonin in the body, restoring the "normal" state of a person.

By the way, they are appointed not only to raise the mood. Another common area of ​​use for antidepressants is chronic pain (backache, headaches, fibromyalgia, pains in irritable bowel syndrome, etc.). Against the background of constant pain, the synthesis of the body’s own painkillers is disrupted; Doctors call this dysfunction of the antinociceptive system. Antidepressants restore the natural mechanisms of pain suppression. Moreover, if their main action, mood improvement, takes 2–3 weeks, then the analgesic effect appears literally from 1–2 pills.

Antidepressants are also recommended for anxiety disorders, premenstrual and menopausal syndromes, urinary and fecal incontinence, and other pathologies.

Antidepressant Treatment Precautions

Modern drugs do not cause addiction, but in order for the body to adapt to biochemical changes, both to start taking them and to finish them gradually. Usually, doctors recommend that in the first two days take a quarter from the normal dosage, then use a half tablet for a few days, and only then a full dose. You need to complete the course in the reverse order.

When starting the use of drugs, one should keep in mind that the desired effect does not occur earlier than two weeks, and the minimum WHO recommended course duration is six months (except for situations when the drug is not prescribed to treat depression).You can not take breaks, so you need to plan visits to the doctor in advance to update the prescription.

Since serotonin receptors are not only in the brain (and most of them, oddly at first glance, in the intestine), the side effects of most antidepressants are quite similar:

1. pain and discomfort in the abdomen,
2. violation of the chair,
3. dry mouth
4. taste disorders
5. hand shake
6. pupil dilation
7. increase in heart rate and blood pressure.

Other adverse events are possible. Therefore, taking medication, you need to monitor your condition and consult a doctor if you suspect any problems. Just in case, we recall: the long list of possible side effects does not mean at all that they will all appear when taking the medicine.

Antidepressants cannot be combined with melatonin (sold over-the-counter and is very popular as an effective and safe, non-addictive sleeping pill); hunter and drugs based on it; sibutramine-based slimming products based on 5-NTR (serotonin precursor). This can provoke an excessive increase in the level of serotonin in the body, the so-called serotonin crisis, which is extremely unpleasant in its manifestations and potentially life-threatening. You can not combine them with a group of drugs called monoamine oxidase inhibitors, but since these drugs are also prescription, doctors usually take into account possible drug interactions.

It is often said that antidepressants can trigger suicide attempts. Indeed, the recommendations for specialists expressly prohibit the appointment of these tools to people who have expressed thoughts about suicide. But it also happens that soon after the start of the use of antidepressants, suicide attempts are made by people who have not previously demonstrated such intentions. The fact is that during severe depression a person usually has no strength for anything — and a conscious attempt at suicide also requires strength. After the start of taking the medication, but before the necessary therapeutic effect appears (we remind you that usually takes 2-4 weeks to do this), strength and determination are added - but, alas, sometimes these forces and determination take irreversible actions. Simply put, before the use of antidepressants, a person simply did not have the strength to get out of bed and go out of the window, and after the start of their use, they were found. Not every patient with suicidal intent is voiced by their family or doctor.

That is why many experts recommend combining antidepressants with psychotherapy or asking to make follow-up visits in order to be able to assess the patient's condition. We repeat once again: antidepressants are very serious drugs whose self-treatment is unacceptable.

Offering our readers the rating of the best antidepressants, we should note that the division further into “invigorating”, “soothing” and “neutral” is not an official classification, but an attempt to explain more or less clearly what to expect from one or another pill.

Top antidepressants rating

Nomination	a place	Name of product	price
The best "neutral" antidepressants	1	Sertraline	568 ₽
	2	Venlafaxine	348 ₽
	3	Escitalopram	507 ₽
	4	Duloxetine	641 ₽
The best anti-depressants with an invigorating effect.	1	Fluoxetine	51 ₽
	2	Paroxetine	322 ₽
Top Soothing Antidepressants	1	Fluvoxamine	758 ₽
	2	Trazodone	754 ₽
	3	Amitriptyline	59 ₽

The best "neutral" antidepressants

These funds do not have a pronounced sedative or active tonic effect. Such antidepressants are considered safer, since they do not change the gross "tuning" of the nervous system, regulating the overall emotional background.

Sertraline

Rating: 4.9

Trade names: Zoloft, Stipuloton, Serenata, Serlift, Center.

One of the safest antidepressants with a relatively fast (about a week) onset of action.Approved for use in children, during pregnancy - subject to the assessment of the ratio of the possible risk and benefit. Not recommended for lactating, as it passes into breast milk.

The instructions do not indicate incompatibility with alcohol, however, this does not mean that you need to eat vodka tablets.

Despite the available generics, the average cost of the drug is relatively high: from 800 rubles per month intake (as of early April 2019).

Venlafaxine

Rating: 4.8

Trade names: Velaksin, Velafaks, Venlaksor.

This antidepressant has been well known in the world for a long time, and patent protection has already been lifted for it, which has been in force for 20 years from the moment of molecule registration. But for our country, this drug is relatively new. It regulates not only the exchange of serotonin, but also norepinephrine and dopamine, which also affect the overall emotional status of the organism.

It becomes effective pretty soon: by the end of the first week, but on condition of a quick (5 days) increase in dosage from the minimum - 75 mg per day - to the maximum daily dose of 375 mg. It showed itself well in the treatment of resistant depressions (by the way - approximately in ⅓ of cases, the originally prescribed antidepressant is ineffective and the drug has to be changed). It improves attention, memory, normalizes sleep.

Side effects when taking venlafaxine are not uncommon: approximately 10% of all cases. On the other hand, they are safe for life: nausea, weight loss, unusual vivid dreams, sweating. May increase blood pressure. Adverse effects are dose-dependent: if you reduce the dosage of the agent, the severity of side effects decreases.

With the abrupt cancellation of the medication, extremely unpleasant paresthesias appear - a feeling that a discharge of current is passing along the nerves.

Not approved for use by pregnant women and children under 18 years.

Escitalopram

Rating: 4.7

Trade names: Tsipraleks, Selectra, Elycea, Lenuksin.

Slightly "softer" Zolofta, just as rarely causes undesirable effects. Effective with anxiety disorders, panic attacks.

Some patients complain that escitalopram increases cravings for sweets.

Not shown to children under 18 years old. In pregnancy, the instruction recommends assessing the risk-benefit ratio, but according to post-marketing research, newborns often required hospitalization and resuscitation measures due to respiratory disorders, vomiting, low pressure and other symptoms, possibly associated with a sharp cessation of the drug.

Does not enhance the effects of alcohol, however, to combine the use of an antidepressant with alcohol is not recommended.

Does not reduce the reaction rate, so you can take those who drive a car.

Duloxetine

Rating: 4.6

Trade names: Simbalta, Duloksta.

In terms of efficacy and safety, it is comparable with other antidepressants, but it has a pronounced central analgesic effect. Therefore, it is especially recommended for long-term pain syndromes of neurogenic origin.

The drug reduces the reaction rate, so it is not shown to drivers.

It is not recommended for pregnant women, lactating women and children under 18 due to the lack of safety data (it is obvious that no one would risk consciously experimenting with these categories of people).

The best anti-depressants with an invigorating effect.

Depression can manifest itself in different ways. Maybe - anxiety, nervousness, obsessive thoughts about how "everything is bad." Then it is better to use "soothing" antidepressants. But depression often causes apathy: a condition in which to slip out of bed and walk to the kitchen at breakfast becomes a real feat. It is such patients, who literally have no strength for anything, and need "invigorating" antidepressants.

Fluoxetine

Rating: 4.5

Trade names: Prozac, Profluzak, Deprex.

One of the first non-addictive antidepressants. For several decades, active use has demonstrated both strengths and weaknesses. Causes a surge of activity, uplifting. But if the selected dosage is too high, heightened activity can turn into inadequately high spirits, psycho-emotional arousal, an excessive thirst for activity, up to a complete loss of connection with reality. Hypomania or mania, agitation - frequent side effects.

Another side effect is loss of appetite (anorexia). Because of this, fluoxetine has been and remains popular with visitors to “slimming” public tables and forums. As well as with a heightened mood, the line between the expected action and the side effect is rather thin here. It is because of these nuances that antidepressants (and not only fluoxetine) should be taken only under the supervision of a physician.

Since the drug has been known for a long time, it has a lot of generics (funds with other trade names but the same active ingredient). Therefore, there is always the opportunity to choose the drug within our means.

Fluoxetine is contraindicated in children under 18, pregnant and lactating.

Paroxetine

Rating: 4.4

Trade names: Paksil, Reksetin, Adepress, Plizil.

It has not only a stimulating effect, but also a pronounced anti-anxiety effect. Especially recommended for patients with compulsive obsessive disorders and panic attacks. It has a more selective action than fluoxetine, that is, there is less chance that the agent will cause side effects. On the other hand, and the stimulating effect of paroxetine is less pronounced.

Like many antidepressants, it enhances the toxic effect of alcohol, so alcohol cannot be consumed during therapy.

The instructions for the use of the drug stipulate that it does not affect the speed of decision making and intellectual functions, while manufacturers still recommend not to drive a car and not to work with mechanisms that require a quick reaction during therapy. It is difficult to say how this reservation is a manifestation of the usual caution for the manufacturer of drugs. It is best to discuss this with your doctor, who can assess the condition of a particular patient and has experience using the medication, and, therefore, some statistics.

Do not use pregnant, lactating, children (no safety studies).

Top Soothing Antidepressants

These are antidepressants with a pronounced sedative effect. They are well suited to people with anxiety disorders, obsessive thoughts, sleep disorders.

Fluvoxamine

Rating: 4.3

Trade name: Fevarin.

A modern drug, while not having generics. It perfectly restores sleep, which, however, can turn into problems with awakening and drowsiness during the day. Approved for use in children, but only for the treatment of obsessive-compulsive disorders (obsessive-compulsive disorder). And in principle, judging by the reviews of doctors, it is more effective for the treatment of obsessive-compulsive disorders than depression.Also well proven in the treatment of post-traumatic stress disorder.

Not recommended for pregnant and lactating.

You can drive a car not earlier than 2 weeks from the start of the drug intake - when the absence of side effects in the form of drowsiness will be obvious.

Due to the fact that there are no generics for this antidepressant, it is not cheap: about 1000 rubles for 15 tablets.

Trazodone

Rating: 4.2

Trade name: Trittiko.

Another relatively new antidepressant is not yet generic.

Well normalizes sleep, reduces anxiety. Unlike most antidepressants, it does not reduce sexual desire, but, on the contrary, strengthens it.

Not recommended for children, pregnant or nursing. May cause drowsiness, so it’s worth getting behind the wheel only after several weeks of administration, when there will be an obvious lack of side effects.

Amitriptyline

Rating: 4.1

At first glance, this medicine has absolutely nothing to do in the ranking of the best antidepressants. The drug of the first generation has many side effects, the lightest of which is constant drowsiness, is addictive. But this is the only antidepressant that is not only possible, but also necessary for people with suicidal tendencies. It is this state of “inflexibility” that almost everyone who has taken amitriptyline complains about and will save the patient from an irreparable step. Most often, the tool is recommended in combination with other antidepressants and smoothly cancel as the other drug begins to act effectively.

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Attention! This rating is subjective, is not advertising and does not serve as a guide to the purchase. Before buying, you should consult with a specialist.