At the end of the 1950s, with the discovery and use in medicine of antidepressants , there was a considerable advance in the treatment and understanding of depressible disorders. Not too long ago, around 1952, a French psychiatric hospital was one of the first to use medications to treat patients with mental disorders.
The term antidepressant came from the observation of improved mood in patients using some test medications for other health conditions, in the period shortly after World War II. Thereafter, depression, as well as hypertension and diabetes, became subject to drug treatment.
As discussed earlier in the article ” Are antidepressants only used to treat depression ?”, There are several options for antidepressant medications, which can be used for different types of illnesses, both psychiatric and non-psychiatric, but all of these substances with similar clinical responses. Here comes a question: how does the doctor choose the best antidepressant for each patient?
We will then list and discuss the main criteria used to choose the antidepressant individually:
The socioeconomic profile must always be taken into account. A patient who receives a minimum wage, for example, and has fixed monthly expenses for water, electricity, food, education and transportation may have a very (financial) difficulty in maintaining a treatment of 06 to 12 months (or more) with monthly cost above R $ 200.00 (there are monthly treatments that can cost more than R $ 1,000,000!).
- Side effects:
A patient who has difficulty sleeping can benefit from a medication that has drowsiness as the main side effect, and then it is recommended to take it at night, while a patient who experiences “lack of energy” during the day can take it, in the morning, an antidepressant that has an “energetic” effect, making you more willing to face day-to-day activities.
- Safety, comorbidities and “special” patient groups:
Patients who have a cardiac arrhythmia should avoid medications that may contribute to dysfunction of the electrical conduction of the heart, while patients with “problems” in the liver or kidney should avoid antidepressants that, to be eliminated from the body or to function properly, need these organs “Working” effectively. In addition, pregnant women and breastfeeding mothers should be aware of the possible risks to their children.
- Symptom groups:
A patient can present several types of symptoms in a single psychiatric disorder or, more than one patient, with different health conditions, can present the same group of symptoms (what we call syndromes). Thus, the same medication can be used to treat different diseases, but with the same set of symptoms. We can mention the main psychiatric syndromes: depressive, anxious, psychotic or obsessive.
- Greater Proven Effectiveness:
“Ah, that doctor only uses fluoxetine because he finds the best medication.” Some people think that the doctor uses “guessing” for the drug decision. However, evidence-based medicine is very important for creating a firmer basis for therapeutic choice. And, for that, several rigorous clinical studies involving tens to thousands of patients and multiple health and educational institutions are necessary to validate the specific use of each medication, including antidepressants.
- Patient tolerance:
“The effect of a medication varies from person to person!” Who never heard that? And it’s true. Some may experience a lot of heartburn, stomach pain, increased or decreased appetite, nausea or even diarrhea with the same medicine that a family member uses and does not show any unpleasant symptoms associated with it.
In this context, antidepressants that are associated with weight gain in a more significant way, would be difficult to tolerate for a patient who is already “struggling” to lose weight, so they should avoid them as the first therapeutic option.
- Family history:
When a family member (parents or sibling, especially) has a history of using some antidepressant with good response in the treatment, there is a greater probability that the patient will also benefit from the use of the same medication or another medication from the same “group”. The opposite is also true. If a family member has an important discomfort or an insufficient therapeutic response, that drug class will tend not to be prescribed.
- Dosage / Number of daily doses:
If you could choose between two medications that had the same result, with medication “A” needing to be taken four times a day while medication “B” could be used in a single daily dose, which one would you choose? I don’t think you need to answer, do you?
- Physician’s experience and intuition:
That’s what you read. With years of experience, seeing several and several cases of sick patients, with psychiatric and non-psychiatric syndromes, with the most diverse groups of symptoms and with different clinical and side effects, the doctor will perceive and / or intuit more clearly what the best group of medications for each patient “profile”.
With all the above criteria, the complexity of choosing an antidepressant is clear. Factors such as price, dosage, side effects, cardiovascular risks, age and patient tolerance should always be taken into account when making such a medical decision.
Thus, the search for a medical professional should always be instigated, aiming to minimize self-medication, the extension of the appropriate clinical diagnosis and its harmful consequences for the patient and, consequently, for his family.