Psychiatry is often “mystified”, as a result of which the treatment of mental illness seems to most to be something extremely extraordinary, unknown and complex. And very often this is exactly what happens: the process of treating psychiatric patients really does cause a lot of problems and difficulties.
A psychiatrist is the same doctor as a therapist, cardiologist, ENT specialist, etc.
Society has developed a very specific attitude towards psychiatry, and it is unfounded and even absurd. Treatment by a psychiatrist, unfortunately, is condemned by people, considered shameful and often hidden from family and friends.
It is important to understand that mental health therapy is a routine treatment for an unusual illness. Nowadays, there are not so many differences between the principles of treatment in psychiatry and, say, therapy (although some “unusual” procedures are still used).
A person should not be more afraid of a visit to a psychiatrist than a visit to a therapist, cardiologist or ENT specialist. This, in many ways, is the key to the mental health of the population. Let's look at what a consultation with a psychiatrist can be like using the example of obsessive-compulsive neurosis, the treatment of which is very important due to its wide distribution.
What is obsessional neurosis, and does it need to be treated?
The main goal of treatment is to maximize the patient’s quality of life. If a disease interferes with life, then it definitely needs to be treated. Does obsessional neurosis interfere with normal life? To understand this, you need to find out what is commonly understood by this term.
Obsession is the appearance in a person of thoughts or actions that are perceived by him as something alien. A person cannot get rid of them: obsessions force him to perform certain actions, thereby becoming the cause of debilitating mental discomfort.
Manifestations of obsessional neurosis
The most common manifestation of obsessional neurosis is fear, which is very difficult and sometimes almost impossible to overcome. Phobias make social contacts, work and all other aspects of life very difficult.
Another version of neurosis is, in fact, obsessive thoughts that a person cannot “drive” out of his head. These thoughts interfere with learning, concentration and greatly tire the patient. An important criterion: a person with obsessional neurosis never realizes his thoughts. The last type is compulsive. It manifests itself through obsessive movements and excessive ritualism.
Examples of obsessional neurosis
It is very easy to explain the essence of this phenomenon with examples. Let's say you believe that you shouldn't look in the mirror before leaving the house. However, if you accidentally look in the mirror, you will still leave the house without giving it much importance.
Or, for example, a black cat on the road will not force you to reschedule your business: you may be a little worried, but you will soon forget about it. A person with compulsive obsessions, looking in the mirror, will bolt the door and stay at home all day, and, having met a black cat, go to the pharmacy for sedatives.
As you can see, obsessional neurosis makes the patient’s life very difficult. This means that we can say confidently and definitely: this disease definitely needs treatment, and the treatment must be professional and complete.
PROZAC (capsules)
of a drug that would not have a fatal effect on someone.
However, I will tell you about my real experience. Nowadays it is fashionable to criticize Western medicines, saying that they are expensive and of little use. There is aspirin, actually... Personally, in some simple cases, I also don’t try to buy imported medicines if there is a simple brilliant green to treat a scratch. Well, that's not the point. But in the case of serious illnesses, and depression is a real disease, whoever knows will confirm (not to be confused with sadness at the window) and I will still prefer Prozac than the domestic drug. Why? There was an opportunity to compare the effect of our fluoxetine in blue capsules (I don’t remember the brand), Lannacher and Prozac. It seems like it's all the same thing. But still no.
I give the lowest rating to our dear one in blue design. I would say that apart from some unpleasant somatic sensations, I didn’t feel anything from using these pills.
I give the rating ""helps, but from the third pack"" to the Lannacher company. Well... it's still better than nothing.
Compared to the samples presented above, Prozac is far ahead in terms of speed and quality of action. Anxiety, melancholy, tension and other troubles associated with depression go away in less than a week of taking 1 capsule per day (in my case). The drug is very “mild”, there were no “quick” side effects that can occur immediately when taking antidepressants. Reduces appetite. In general, as they say in Odessa, Prozac and fluoxetine for 30 rubles. two big differences.
I can’t say that my experience is universal, but the difference is learned by comparison. Therefore, if you have a choice, try not to save money and choose the branded drug. If you don’t see the difference, you can always buy a cheaper analogue. But the experience will still be useful.
however, despite this review or other positive ones, the dose must be determined by a specialist. Moreover, profile. All psychotropic drugs can have strong side effects, and these can vary from person to person to the same medication. From euphoria to suicide. Therefore, please do not get treatment on the Internet - go to a doctor. But if you have to choose which company to buy the medicine from, then it’s probably worth taking a closer look at someone else’s experience. Good health to everyone.
PS. For those who consider fluoxetines a panacea for excess weight. Fluoxetine reduces appetite. However, caution should be taken by those who suffer from edematous syndrome and are generally prone to edema, have hormonal problems, etc. The situation can worsen significantly due to disruption of the production of antidiuretic hormone - the hormone that controls the removal of fluid from the body (a rare and REMOTE side effect) . Weight gain due to this is real. Moreover, at first it’s invisible, but big. Therefore, if there is a tendency to edema, then you need to keep this in mind.
Treatment of obsessional neurosis
We found out what this disorder is and what its danger is. Let's return to the main question: how to treat obsessive-compulsive disorder? There are several options here. It is best to combine them if possible, because this is how you can achieve the best result.
Here is what a psychiatrist has in his “arsenal” for patients with obsessional neurosis:
- antidepressants of various types and generations; - means that normalize mood (normalizers); - psychotherapy.
Now let's look at each of these points in more detail.
Antidepressants
Antidepressants are a group of drugs that affect certain active substances in the brain. By changing the balance of these active substances, and acting differently on the same substance, antidepressants change the speed and orientation of many mental processes, mood and general condition.
In the treatment of obsessional neurosis, antidepressants occupy a central place, because only they can return a person to the possibility of normal communication and full socialization. Proper use of antidepressants guarantees long-term remission without relapse. Sometimes a course of treatment (combined, of course) is enough for a person to get rid of neurosis for life.
In recent years, there have been quite a lot of antidepressants: fundamentally new substances have been synthesized that have fewer side effects, are safer and more effective. Old drugs are gradually leaving the practice of psychiatrists (although they remain in the practice of doctors of other specialties). It is unlikely that a psychiatrist will prescribe you amitriptyline or a similar drug: much more effective substances are now available, the use of which gives lasting, good results without the risk of repeated exacerbations or unsuccessful treatment.
The most popular are antidepressants that affect serotonin receptors. These medications do not cause drug dependence and have relatively few contraindications. One significant disadvantage of this group of drugs: in the first week of treatment, almost all patients complain of severe, debilitating nausea.
Normotimics
Mood stabilizers are drugs used to correct mood: they ensure its stability, stability and constancy. Interestingly, there is not a single drug that belongs specifically to this group and was created only to normalize mood. All such drugs (even the ancient drug made from lithium salts) initially had a different purpose, and the normothimic effect is a kind of pleasant bonus.
If a person suffers from obsessive neurosis, his treatment will necessarily include drugs that normalize mood. Like antidepressants, mood stabilizers affect the main links in the pathogenesis of obsessional neurosis, and their combination is considered the most effective treatment method.
Carbamazepine and its derivatives are most often used. This drug is also used to treat epilepsy (and its various types), but in addition to the anticonvulsant effect, carbamazepine also has a pronounced normothimic effect. By the way, carbamazepine is a substance that was synthesized from a strong antidepressant. To some extent, this explains this effect and high effectiveness in the treatment of obsessive thoughts and, in particular, obsessive movements (compulsions).
Psychotherapy
One of the most important aspects of treating obsessions is psychotherapy. Perhaps you notice fear or obsessive thoughts, or maybe you observe obsessive movements in your child, contact a psychiatrist. In this situation, individual psychotherapy is indicated.
The most common direction is behavioral psychotherapy, based on neurolinguistic programming or “body” orientation. Indeed, in a sense, obsessions are behavioral disorders, so treatment should be aimed at it. Behavioral psychotherapy can be combined with suggestive psychotherapy (it is rarely used as a single treatment method).
Suggestion is what is called “suggestion.” This technique is carried out, as a rule, after preliminary preparation: the person is immersed in a state of medicated or natural sleep, hypnosis, etc. Sometimes suggestion is practiced with a awake person, who must, of course, be calm and relaxed. This state is most easily achieved with sedatives, although experienced psychotherapists can do without them.
Prozac
Prozac should not be co-administered with MAO inhibitors and for at least 14 days after stopping treatment with MAO inhibitors. After discontinuation of fluoxetine and initiation of treatment with MAO inhibitors, there should be an interval of at least 5 weeks. If long-term treatment with fluoxetine was carried out and/or the drug was used in high doses, then this interval should be increased. Among patients who had previously taken fluoxetine and started taking MAO inhibitors at a shorter interval, serious cases of serotonin syndrome (manifestations of which may be similar to NMS), including death, have been reported.
Fluoxetine has the ability to inhibit the CYP2D6 isoenzyme. Therefore, treatment with drugs that are metabolized by this system and that have a narrow therapeutic index should be started with the lowest doses if the patient is concurrently receiving fluoxetine or has taken it within the previous 5 weeks. If fluoxetine is included in the treatment regimen of a patient already taking a similar drug, a reduction in the dose of the first drug should be considered.
When used concomitantly with Prozac, changes in blood concentrations of phenytoin, carbamazepine, haloperidol, clozapine, diazepam, alprazolam, lithium, imipramine and desipramine are observed, and in some cases toxic effects were observed. When taking fluoxetine in combination with these drugs, conservative dosage selection should be provided and the patient's condition should be monitored.
Fluoxetine is tightly bound to plasma proteins. Therefore, when prescribing fluoxetine while using another drug that binds tightly to plasma proteins, changes in the plasma concentrations of both drugs are possible.
When fluoxetine was used concomitantly with warfarin, an increase in bleeding time was observed. Changes in anticoagulant action (laboratory values and/or clinical signs and symptoms) were inconsistent. As with warfarin in combination with many other drugs, close monitoring of blood clotting parameters should be performed when fluoxetine is initiated or discontinued during warfarin therapy.
If it is necessary to prescribe other drugs after discontinuation of Prozac, the long half-life of fluoxetine and its active metabolite norfluoxetine and, therefore, the possibility of drug interactions should be taken into account.
There have been rare cases of increased duration of seizures in patients taking fluoxetine during electroconvulsive therapy.
