Coping With Fatigue Caused by an Antidepressant

Side effects from antidepressants are hard to avoid. Fatigue is one of them. This mostly is true of tricyclic antidepressants like Elavil (amitriptyline) and Tofranil (imipramine), which doctors don’t often prescribe any more.

But even the newer classes of antidepressants—including selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine)—can lay you low.

Given that depression itself can make you feel exhausted, it can be frustrating to find that the medication you’re taking to treat it isn’t helping with your fatigue. If you’re dealing with this particular problem, here are some ways you may be able to get the benefits of your medication without constantly feeling like you need a nap.

Why Antidepressants Cause Fatigue

Certain antidepressants work by acting on brain chemicals called neurotransmitters—in particular norepinephrine and serotonin—causing them to linger in the spaces between nerve cells where they carry out their job of regulating mood.

At the same time, though, these medications affect other neurotransmitters, including histamine and acetylcholine, sometimes leading to unpleasant side effects such as dry mouth, blurry vision, weight gain, and sedation. It’s this last side effect that may be responsible for the fatigue you experience when you take an antidepressant.

What to Avoid

If you’re truly fighting to keep your eyes open, there are some important things to avoid doing. Do not get behind the wheel of your car. Let someone else do the driving, call a car service or cab, or use public transportation until you’ve found a workaround for your fatigue.

Steer clear of alcohol and any medications that also tend to be sedating. The combo of either with your antidepressant could make your fatigue worse.

Strategies to Reduce Tiredness

You may be tempted to give in to exhaustion and set up camp on your couch, but there are other things you can do if your antidepressant is wiping you out. Here are some possibilities.

Nap

Make time to nap during the day. This doesn’t mean you have to climb under the covers and snooze the afternoon away. According to the National Sleep Foundation, just 20 minutes of sleep is enough to leave most people feeling refreshed and energized. In fact, more shut-eye than that can make you even groggier.

Work Out

Get some exercise. It sounds counterintuitive—how could moving possibly be helpful when the last thing you feel like doing is moving? A 2008 study at the University of Georgia found that regular low-intensity exercise could reduce fatigue by as much as 65%, for example.

This was especially true of people in the study who did low-intensity exercise as opposed to moderate-intensity activity. That means that a leisurely walk could do more to perk you up than, say, a challenging stint on an exercise bike.

Take Medications at Night

Pop your pill at bedtime. Unless there’s some reason your doctor would prefer you down your depression medication in the morning or during the day, taking it at night may help you fall asleep more easily so you get the rest you need to feel more alert during waking hours.  

Give It Time

Wait it out. For most people, the side effects of antidepressants wear off as their bodies become adjusted to the medication.

When to See Your Doctor

If after several weeks you’re still feeling zonked, you and your doctor may need to go back to the drawing board and try a different drug or supplement your medication with a second drug that’s stimulating, such as Provigil (modafinil).

Should I Take My Antidepressant at Night or in the Morning?

When It’s Better to Take In the Morning

Antidepressants are sometimes best when taken in the morning due to their potential side effects. Here are a few to consider.

Insomnia

Some selective serotonin reuptake inhibitors (SSRIs), the class of antidepressants most often used, can disrupt sleep for some people and would be best taken in the morning.

For example, the manufacturer of Prozac (fluoxetine) recommends it be taken in the morning because it can make some people feel more energized, especially at the beginning of treatment.

However, when Prozac is given in combination with Zyprexa (olanzapine)—a combination called Symbyax—as a therapy for treatment-resistant depression, it can cause sleepiness, so then it’s recommended to be taken in the evening.

Paxil (paroxetine) is generally taken in the morning in order to prevent sleeplessness at night. However, it may be given at bedtime if it is found to cause drowsiness in the person taking it. Wellbutrin (bupropion) is another antidepressant that is recommended to be taken in the morning in order to prevent insomnia at night. 

Urinary Problems

When prescribed in children or adolescents, Zoloft can cause frequent urination as well as urinary incontinence. In this case, taking the pill in the morning can prevent any nighttime bedwetting.

Sexual Issues

If you experience sexual side effects (such as low libido, erectile dysfunction, or inability to ejaculate) from your antidepressant, the timing of when you take your antidepressant can make a difference.

Research indicates that it may be helpful to consider the time of day when you’re most likely to engage in sexual activity and plan to take your antidepressant shortly thereafter.

When It’s Better to Take At Night

Some side effects are better tolerated if an antidepressant is taken closer to bedtime. These are a few of the effects that fall into this category.

Drowsiness

Unlike some SSRIs, certain other antidepressants tend to make you feel drowsy, so they’re better tolerated if you take them at bedtime.  Among these medications are Luvox (fluvoxamine), Remeron (mirtazapine), and the tricyclic antidepressants, including:

• Elavil (amitriptyline)
• Norpramin (desipramine)
• Tofranil (imipramine)
• Pamelor (nortriptyline)

Nausea

Some classes of antidepressants (mostly SSRIs) can trigger nausea as well as vomiting, diarrhea, and loss of appetite. While this often resolves itself as your body adjusts to the medication, sticking to a nighttime medication schedule can also help by hopefully allowing you to sleep through any digestive woes.

Other Optimal Medication Strategies

In addition to discussing with your doctor the time of day that is best to take your antidepressant, it’s critical to remember that there are other strategies that affect how well your medication will work, including:

Have Patience

Antidepressants take time to work; potentially anywhere from six to 12 weeks for the full effect, although many people notice improvement within a week or two. When you start your antidepressant, keep in close contact with your doctor and stay positive. You can find a way to treat your condition, but it may take a little bit of trial and error.

Stay Consistent

Take your antidepressant as directed at the same time every day and do not stop it without first talking to your doctor.

Talk to Your Doctor

If your antidepressant is causing side effects, remember that many, if not all of them, will go away with time. If the side effects are intolerable, get in touch with your doctor right away. Finding relief may be as simple as changing the dose, switching to a different antidepressant, or adding a second medication to ease the side effect.

A Word From Verywell

Taking an antidepressant needs to be part of a well-thought-out plan with your doctor to maximize its benefits and minimize any potential side effects. Don’t make any changes to your treatment plan without consulting with your doctor first.

The recommendations noted above are general and may or may not be applicable to your own unique situation. Your doctor will be able to provide you with specific recommendations about whether your antidepressant should be taken at a particular time of day for the best results for you.

How to Know Which Antidepressant Is Best for You

The quest to find the right antidepressant medication can feel very “hit or miss.” While it might seem a bit random how doctors choose which antidepressant to prescribe for you, there really is some logic to it.

In fact, there are even flow charts, called algorithms, which outline a logical progression that doctors might follow in determining what the best antidepressant is for you. These algorithms are based on the current knowledge in the medical field about which type of antidepressant works best for which patient.

Still, there is no telling what you may or may not respond to. In fact, many people don’t respond to their first antidepressant, or they experience undesirable side effects, so they have to try a second, third, or fourth option before finding what works best for them. 

Up to 80% of people do eventually respond to depression treatment, so there is every reason to have hope that you will land on the right one for you.

Factors to Consider

There many factors that are considered when a physician chooses an antidepressant for you—beyond the type of depression you are living with.

Your Symptoms

Some antidepressants can do double duty. For instance, if you have been losing weight because you’re not eating, your doctor might decide to put you on an antidepressant that is known to cause weight gain. If you’re having trouble sleeping, your doctor might choose one that you can take before bed that makes you sleepy.

Other examples of antidepressants that may have double-duty functions include:

• Smoking cessation: Wellbutrin (bupropion) is actually the same drug as the popular stop-smoking medication sold under the brand name Zyban. For a smoker, Wellbutrin may be the logical choice for lifting depression and aiding in smoking cessation.
• Neuropathy: Both tricyclic antidepressants and the serotonin-norepinephrine reuptake inhibitors (SNRIs) Cymbalta (duloxetine) and Effexor (venlafaxine) have been found to be helpful. 
• Bedwetting: Though tricyclic antidepressants tend to be used less often than some of the newer formulations, for those who are struggling with bedwetting, Tofranil (imipramine) may help with both problems.
• Learning disabilities: It’s thought that some antidepressants may have a secondary benefit of helping with some learning disabilities. If this is you, talk to your physician about whether or not one of these medications may work for you.

Potential Side Effects

If you’ve been on an antidepressant before, your doctor will want to know what side effects were particularly bothersome for you. If you are on a medication that has side effects you find intolerable, you’re less likely to stay on it, so choosing one that gives you the least side effects is the goal.  This can take some trial and error.

Other Medications You’re Taking

Some medications, including antibiotics and steroids, can interact with antidepressants, so your doctor needs to know what other medication (including over-the-counter, prescription, vitamins, and supplements) you’re taking to make the best decision.

Other Health Conditions You Have

Again, some antidepressants can do double duty with both physical and mental illnesses. So, for example, if you have attention-deficit/hyperactivity disorder (ADHD) and depression, taking a medication like Wellbutrin (bupropion) can help both. On the physical side, if you have fibromyalgia or chronic pain, your doctor might prescribe Cymbalta (duloxetine) because it can help with both pain and depression. 

When prescribing an antidepressant, the first goal should be treating depression.

Sometimes this may mean choosing an antidepressant that is more likely to cause weight gain even in someone who is overweight or choosing an antidepressant that doesn’t treat another condition the person has, even if that option appears to be available.

Your Family History

Especially for parents or siblings, how a medication worked for them is a good indicator of how it might work, or not, for you.

Whether You’re Pregnant or Breastfeeding

Since antidepressants can have an effect on the baby, your doctor will want to steer clear of antidepressants that have been shown to be harmful. You and your doctor will have to figure out the best plan to manage your depression while you are pregnant or thinking of becoming pregnant or breastfeeding.

Health Insurance and Cost

Some newer antidepressants don’t have a generic form available yet and maybe costly, which may influence your doctor’s choice.

On and Off-Label Uses

It’s also important to make a distinction between on-label and off-label uses of medications. On-label use means that the medication has received FDA-approval for that indication. 

Off-label use does not mean that a medication is not useful, but rather that it does not yet have FDA-approval for that indication. It’s also important for people to know that some physicians are more willing than others to consider prescribing off-label medications.

The best thing you can do is to work together with your doctor as a team to find the right antidepressant. Nobody knows your body better than you do or understands your preferences as well as you.

Barriers to Finding the Right Treatment

Side effects, as mentioned above, can present major barriers to finding the right medication for you. This is the point when the physician and the patient must work together to find a solution that the patient can live with.

Depression Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor’s appointment.

Options might include the following:

• Accepting the side effect as a trade-off for depression relief
• Augmenting with other medications (using more than one medication together to control depression and/or relieve side effects)
• Trying a new medication

Your doctor should always try to find the drug that gives the best depression relief with the fewest side effects for you—but keep in mind that, unfortunately, no drug is going to be perfect. There are two side effects that people seem to find the most troubling: sexual dysfunction and weight gain.

Sexual Side Effects

One of the classic symptoms of depression is a loss of sex drive. Rather ironically, many of the medications used to treat depression can also potentially cause sexual side effects.

If these problems affect you and you cannot tolerate them, Serzone (nefazodone), Trintellix (vortioxetine), Wellbutrin (bupropion), and Remeron (mirtazapine) are medications that have fewer sexual side effects. Of course, these medications may have other side effects.

Weight Gain

Weight gain on antidepressants is another commonly complained about side-effect. In this department, Paxil (paroxetine) and Remeron (mirtazapine) are two of the worst offenders. Effexor (venlafaxine), Wellbutrin (bupropion), and Prozac (fluoxetine) are antidepressants that are not as likely to cause weight gain, and many people even lose a few pounds.

But again, everyone is different. Some people gain weight on medications unlikely to cause weight gain and lose weight on those that often cause weight gain.

Side Effects Aren’t Always Bad

Believe it or not, side effects are not necessarily a bad thing. A drug like Prozac that suppresses appetite may not be desirable for someone who has an eating disorder or is too thin but may be helpful for someone who has diabetes or is overweight.

Along those same lines, a drug that increases appetite, such as Paxil (paroxetine) or Remeron (mirtazapine), could benefit someone who is underweight while potentially causing issues for someone who is overweight. The same applies to antidepressants that are stimulating and those that are sedating.

An antidepressant that tends to be stimulating such as Wellbutrin (bupropion) may be helpful for someone with a vegetative depression or someone who seems to have no energy—but could be the wrong choice for someone living with an anxiety disorder in addition to depression.

By the same token, a sedating antidepressant such as mirtazapine could work well for someone who is anxious but might be the wrong choice for someone who is already feeling a total lack of energy with their depression. Again, it is important to remember that every person is different.

A Word From Verywell

Finding the best antidepressant for you may take some trial and error. When you start a new medication, monitor your symptoms for a couple of weeks and report back to your prescribing physician. Be prepared to have an open and honest conversation about your experience—what’s working for you and what’s not. Together, you can determine the right treatment plan for you.

Impact of escitalopram on nocturnal sleep, day-time sleepiness and performance compared to amitriptyline: a randomized, double-blind, placebo-controlled study in healthy male subjects

Introduction:

Antidepressant drugs vary in their effects on sleep, day-time sedation and performance. Up to now, no data are available for either escitalopram (ESCIT) or amitriptyline (AMI), measuring these by an objective test, such as the MULTIPLE SLEEP LATENCY TEST (MSLT).

Subjects and methods:

We therefore investigated the impact of a single evening dose of 10 mg ESCIT on polysomnographically recorded nocturnal sleep, day-time sleepiness and performance in comparison to 75 mg AMI and placebo (PLAC) in healthy male subjects.

Results:

Both antidepressants significantly suppressed REM sleep (p<0.001). Although polysomnographically measured sleep continuity was impaired after ESCIT (p=0.006), subjective estimates of sleep parameters did not differ. Periodic limb movements (PLMS) were increased after AMI (p<0.001) but not after ESCIT. Processing speed and performance were enhanced after ESCIT compared with AMI (p=0.011), but not with PLAC. Next-day alertness was significantly impaired by AMI (p=0.012), but not by ESCIT. Mean day-time sleep onset latencies increased significantly after evening ESCIT (p<0.001). In contrast, AMI led to a pronounced increase of day-time sleepiness (p=0.007).

Discussion:

This study demonstrates that single evening doses of either AMI or ESCIT exhibit different effects on next-day vigilance and alertness in terms of a slightly stimulating effect of ESCIT and a significant reduction after AMI.

Antidepressants and Sleepiness

Written by Steve Zorn, MD, Board Certified Sleep Physician and Medical Director of Iowa Sleep

The use of agents to treat disease and relieve pain have been suggested to date back at least to 5,000 BC with the Sumerians use of opium. Like other
medications, antidepressants are very useful. They are used to treat a myriad of health problems such as depression, anxiety, and nerve pain. Despite
their useful aspects, no medication is perfect.

Antidepressants can make you sleepy or they can produce insomnia. It is often a matter of your neurological wiring. Individuals on the same dose of
the same medication can have completely opposite effects. One person may become sleepy. One may report having insomnia. A third may not have the
sleepiness or the insomnia!

Here is a list of common antidepressants that have a risk of increased sleepiness compared to a placebo. It should be noted that this list does not
mean that an individual taking the drug will have increased sleepiness, it is just that there is an increased risk. This information came from
the work of Dr. Alberti from the Journal of Clinical Psychopharmacology.

• Agomelatine
• Fluoxetine
• Sertraline
• Escitalopram
• Venlafaxine
• Parozetine
• Desvenlafaxine
• Duloxetine
• Citalopram
• Fluvoxamine
• Mirtazapine
• Amitriptyline

In our clinic, patients who report daytime sleepiness and are on a morning dose of antidepressants are often switched to an evening dosing schedule
as a trial. This switch in the dosing does not interfere with the depression treatment and it helps to rule out another cause of excessive sleepiness.
These trials usually last 5 days and then are re-evaluated to see if the sleepiness has changed. PLEASE NOTE: ANY CHANGING IN DOSING OF MEDICATIONS SHOULD BE DONE WITH APPROVAL OF YOUR HEALTHCARE PRACTIIONER!

If you have questions, we encourage you to reach out to a doctor at Iowa Sleep by sending us a question.
We can help you identify the reasons you may not be sleeping well and get you on the path to sleeping better each night to wake you ready to take
on another day. You can also call (800) 226-6084 to schedule an consult with one of our board certified sleep physicians.

7 Lexapro Side Effects You Should Have On Your Radar

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Actress Amanda Seyfried admitted not long ago on a podcast that she’s been taking the antidepressant Lexapro for “years and years and years. ” She even continued taking the drug while pregnant with her first child.

Must be pretty harmless, right? For the most part, that assumption would be correct—however, there are some notable side effects associated with the drug.

For some people, those effects are worse than others: “Like all medications, Lexapro does have a long list of side effects,” says Susan Anderson, M.D., a psychiatrist with NorthShore University HealthSystem. “I’ve had patients say they don’t even want to look at the long list [of potential side effects] because they feel they have everything described,” she says.

Still, that’s no reason not to take it: One study in 2014 noted that about 60 percent of patients say they had at least one side effect when taking an antidepressant. The good news? The research also pointed out that Lexapro (the generic name is escitalopram) was among the most tolerable SSRIs.

Whether you’re starting treatment or have been taking the medication for a while, talk to your physician about potential side effects and what you should do if you notice them. “Also ask: ‘what should I do if I have questions after I leave the visit?’” she advises.

These are the side effects of Lexapro you should be on the lookout for:

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1

​Your libido may tank

SSRIs in general have the potential to cause sexual side effects, like taking longer to reach orgasm and decreased desire, explains Anderson. “What a combo, right! They can happen at any time in treatment—even weeks or months after starting,” she says.

That said, Anderson also adds that depression itself can decrease sexual functioning, too, so it’s important to know what’s normal for you. The best option is to talk to your doctor about what you can do if you notice your sex life has tanked.

2

Your stomach may be wonky

At first, you may notice that your bathroom habits are a bit…different. Anderson talks to her patients about GI side effects that may feel like a mild “stomach flu” with nausea and diarrhea. “It’s usually really mild and lasts a week or less,” she says. To soothe your stomach, take Lexapro with food. If your stomach issues just won’t quit, you know the drill: talk to your doc.

3

You may have insomnia

Suddenly find yourself up ’til 3 a.m. cruising Facebook? As the Mayo Clinic points out, trouble sleeping is one of the more common side effects of Lexapro as your body learns to adjust to the medication. Happily, it’s only short-term, they note.

4

​Your mouth may be dry

Among the potential side effects, dry mouth isn’t that big of a deal. But feeling like you ate a bunch of sand can really be a drag. Nearly 10 percent of patients who taking Lexapro for major depressive disorder experience dry mouth, the FDA reports. The likelihood of this (and other side effects) rises as you increase the dose. Mouthwashes with xylitol may moisten things up, the Mayo Clinic advises.

5

You may gain weight

Weight gain is frequently talked about as a side effect of many antidepressants. However, you may notice the opposite at first. “Many SSRI’s, including Lexapro, can cause a temporary decrease in appetite that lasts only for a short time,” says Anderson.

Because weight fluctuations are a possibility, this is the time to take stock of your eating and exercise habits. “If you notice an increase in weight, address it early,” she advises. One thing you don’t want to do is stop taking the medication all together without doctor supervision because of unwanted weight gain.

6

​You may feel dizzy and drowsy

The last thing you want is for a medication to put you in a weird head space. But Lexapro can cause dizziness or drowsiness. The US National Library of Medicine (NLM) recommends that you don’t drive until you know how you feel on the medication.

This side effect is most likely to hit during your first few weeks of taking the med. Taking a nap and finding time for physical activity can help you shake off the sleepy feeling, the Mayo Clinic advises.

7

Your behavior may change…for the worse

You went on this medication for relief from depression or anxiety—but the strange truth is that sometimes, it can make these things worse. The NLM notes some serious side effects are possible, like thoughts of hurting yourself or unusual behavior, anxiety, or seeing or hearing things that aren’t there. Any of these warrant a call to your doctor.

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Your 10 Biggest Antidepressant Problems, Solved

1.

‘Ugh. Suddenly my head hurts.’

During the first few days on your new prescription, you might find that you have a headache. All antidepressants have the potential to give you a headache for a few days, says psychiatrist Boadie Dunlop, MD, associate professor of psychiatry and behavioral sciences and director of the mood and anxiety disorders program at the Emory University School of Medicine in Atlanta.

RELATED: 6 Things I Didn’t Know About Depression Until It Happened to Me

He suggests taking Tylenol (acetaminophen) to help, adding that this symptom usually gets better within the first week or two.

2. ‘My stomach is upset, and I have diarrhea.’

People taking SSRI antidepressants (selective serotonin reuptake inhibitors) might find that they have nausea, diarrhea, or constipation. You can manage nausea by taking the medications with food, Dr. Dunlop says.

Make sure you’re eating enough fiber and drinking enough fluids; you also might consider taking an over-the-counter medication for constipation or diarrhea. Like headaches, these symptoms typically go away early in your treatment.

3. ‘I have the shakes.’

A small number of people find that their medication causes shakiness or tremors. “These can persist and can prevent people from continuing with their medication,” Dunlop says. If you develop this symptom, contact your doctor to discuss changing your dose, or the drug itself.

4. ‘I’m still sad.’

Of all antidepressant problems, this may be the thorniest to untangle. If you’re continuing to experience depression symptoms despite taking an antidepressant, there are a number of possible explanations to consider:

• You got the wrong diagnosis. “When someone has depression that doesn’t respond to treatment, the first thing you do is step back and make sure you have the right diagnosis,” Dr. Combs says. Your psychiatrist might want to do more tests to make sure some important clues weren’t missed the first time around.

• Your medication hasn’t kicked in yet. Sometimes it takes time for antidepressants to become effective. Check with your doctor to find out whether you need to wait a bit longer.

• You’re drinking alcohol or using drugs. These substances can interfere with your depression treatment, so you’ll need to quit if you want complete success.

• You’re not in therapy. It would be nice if medication could solve all depression problems, but you might also need to talk with a therapist to help you figure out how to cope with issues in your life that are causing you to feel sad or anxious.

• You’re taking the wrong medication. You might find relief by switching antidepressants or adding another medication, such as a thyroid drug or lithium. Talk about this with your doctor.

• You need to try something new. Ask your doctor whether you might benefit from other approaches — even unconventional ones. For example, dance movement therapy has been shown to help manage depression, according to research published in Frontiers in Psychology in 2015.

5. ‘I’m not sad, but I’m not happy either.’

Anywhere from 28 to 60 percent of people who take antidepressant medication experience emotional blunting — a feeling of being depleted of all emotions, including the good ones, according to research published in 2013 in the International Journal of Neuropsychopharmacology.

But you don’t have to lose your ability to feel joy just to get rid of the pain: Emotional blunting is best resolved by switching to a different class of antidepressants, adding a second medication, or talking with a therapist, Combs says.

6. ‘My antidepressant is making me fat.’

Some depression treatments, notably those that involve a combination of drugs, do put you at risk for weight gain, according to a review from 2015 in Expert Opinion on Drug Safety. Taking Lexapro (escitalopram) and Wellbutrin (bupropion) together, for instance, showed a greater likelihood of an increase in body mass index (BMI) than single-drug therapy, according to a study published in 2015 in Therapeutic Advances in Psychopharmacology.

RELATED: How Yoga Helps With Depression, Anxiety, and Addiction

If you have a history of being overweight, you’re more likely to gain while on an antidepressant — “so choose an antidepressant that is weight-neutral,” Combs advises. If that’s not an option, she emphasizes getting counseled in diet and exercise. An added bonus? The National Institute of Mental Health (NIMH) notes that exercise can be an important part of your treatment.

7. ‘Sex tonight? No way!’

Many people struggling with depression lose interest in sexual activity, but some antidepressants can also make it difficult to respond sexually. Doctors don’t always warn their patients about this effect, Combs says, and it can be very frustrating. Some people are willing to accept it as a temporary trade-off for successful depression treatment, but most people want solutions.

Consider switching antidepressants, trying a different dosing schedule, taking other medications to improve sexual response, or experimenting with new ways to increase arousal. Testosterone might be a solution for some people who have lost some interest in sex but need to stay on their antidepressant medication, according to research published in 2014 in The Journal of Sexual Medicine. 

8. ‘I’m up all night.’

Insomnia, sleeping too much, and other changes to your sleep cycle are all signs of depression, according to the NIMH. And when you can’t get a good night’s sleep, it can make it even harder to treat your depression effectively.

“Some antidepressants are identified as activating, and some are sedating,” Combs explains. Finding the right match for you is key. A sedating antidepressant, for instance, might be a good bet for someone who is having problems falling asleep. It’s also important to look at other lifestyle choices that might be affecting your sleep, like your environment, physical activity (or lack of it), caffeine consumption late in the day, napping during the day, and alcohol use.

9. ‘I want to stop taking my meds — but I’m afraid my depression will come back.

‘

Once you start feeling better, you’ll probably want to quit taking antidepressants — but, Dunlop says, you need to be stable on antidepressants for at least six months first, to reduce the risk of experiencing another bout of depression in the future.

Although antidepressants are only temporary for most people, you should never stop taking them (or any prescription medication) without the guidance of a doctor. Usually the best approach is to reduce the dosage very gradually — stopping “cold turkey” could result in unwanted side effects, Dunlop adds.

10. ‘I want to die.’

With depression, there’s always a risk of suicidal thoughts, but these can also be a side effect of antidepressants, though a rare one. A Finnish study published in 2014 in Human Psychopharmacology found that the risk for suicide is not significantly increased by the use of antidepressants, although other factors of depression, such as insomnia, do contribute to suicide risk.

Regardless of what might be prompting suicidal thoughts, call your doctor immediately if you start to experience worsening depression symptoms, including suicidal thoughts or thoughts of harming yourself or others, Dunlop advises.

If you’re running into a problem with your antidepressants, there’s likely a solution — so don’t ignore it. Get to the bottom of it.

Lexapro Tablet / Tablet in Russian – Item

LEXAPRO VS ZOLOFT – DIFFERENCE AND COMPARISON – HEALTH

Health 2021

When it comes to prescription antidepressants, patients often try different medications before choosing the one that works best for them. Lexapro and Zoloft are antidepressants RI, about

Content:

When it comes to prescription antidepressants, patients often try different medications before choosing the one that works best for them. Lexapro and Zoloft are prescription SSRI antidepressants for the treatment of depression and anxiety.

They work by restoring the balance of neurotransmitters such as serotonin. The difference is that Zoloft can treat several additional symptoms, but Lexapro has a faster release time. Lexapro and Zoloft also have different side effects.

Comparison Table

Lexapro vs Zoloft Comparison Table

	Lexapro	Zoloft
	Current Rating 3.08/5 (502 ratings)	current rating 3.12 / 5 (935 ratings)
Common name	Escitalopram	Sertraline
Use	Antidepressant, SSRI. Treats depression and anxiety.	SSRIs; Treats depression, obsessive-compulsive disorder, panic attacks, post-traumatic stress disorder, social anxiety disorder, premenstrual dysphoric disorder.
Do you need a prescription?	yes	yes
Prescription only	yes	yes
Forms	Tablet, liquid	Liquid tablets
Storage conditions	Room temperature without light and moisture. Do not flush or flush down the drain.	Room temperature without light and moisture. Do not flush or flush down the drain.
Cost	Approximately $ 83.83 per month (without insurance) or $ 30.31 (with insurance).	About $ 85 per month without insurance.
Directions for use	Take by mouth once a day, usually at the same time of the day.	Mix with four ounces of other liquid, measure with a pipette.Take orally once a day, usually at the same time of the day.
How it works	Rebalances neurotransmitters such as serotonin	Rebalances neurotransmitters such as serotonin
Time frame	One to two weeks before improvement begins. Four weeks before feeling complete improvement.	Without a significant period of time.
Administration	Oral	Oral
Mild side effects	Agitation, blurred vision, diarrhea, insomnia, drowsiness, dry mouth, fever, frequent urination, headache, indigestion, nausea, changes in appetite , sexual dysfunction and weight change.	Dizziness, drowsiness, diarrhea, dry mouth, increased sweating, insomnia, loss of appetite, nausea, upset stomach
Severe side effects	Often: confusion, difficulty concentrating, euphoria, suicidal thoughts, decreased sexuality attraction and ability. Rarely: aggressive behavior, high blood pressure, heart attack, blood clots, very rapid heartbeat, slow heartbeat, bleeding, kidney failure, seizures.	Often: suicidal thoughts, decreased sex drive, decreased sexual performance. Rarely: rapid heartbeat of the ventricles, slow heartbeat, hemorrhage, liver failure, acute kidney disease, euphoria.
Withdrawal symptoms	Confusion, headache, insomnia, nervousness, numbness, tingling.	Headache, mood swings, sleep changes, fatigue, short-term sensations such as electric shock.
Warnings	Medical history: mental disorder, attempted suicide, bleeding problems, liver disease, seizures, kidney disease, stomach bleeding, dehydration, low blood sodium; Avoid drinking alcohol, driving a vehicle, or operating equipment until you are confident to be vigilant.	Medical history: bleeding problems, liver disease, seizure disorders, thyroid disease; Avoid drinking alcohol; Avoid driving or operating machinery until you are confident of your vigilance.
FDA Approval	2002	1991
Expiry Date	3 Years	5 Years

Usage

Lexapro (collectively known as escitalopram), a selective serotonin reuptake inhibitor (SSRI), restores the balance of neurotransmitters such as serotonin. Doctors prescribe Lexapro to treat depression and anxiety. Lexapro should be prescribed and taken by mouth once a day, usually at the same time of the day.

Zoloft (generic name Sertraline) is also an SSRI that restores the balance of neurotransmitters (serotonin). Doctors prescribe Zoloft to treat depression, obsessive-compulsive disorder, panic attacks, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. Zoloft is also a prescription and is taken once daily after reconstitution, usually at the same time of day.

Dr. Pickett of Depression CAREPATH explains the use of SSRIs for depression:

Side Effects

Using Lexapro as well as Zoloft can cause several side effects.People using Lexapro may experience dizziness, drowsiness, constipation, dry mouth, increased sweating, insomnia, nausea, or tiredness. Pregnant women can take Lexapro, but there is a risk of birth defects. Some of the more serious side effects can include confusion, difficulty concentrating, euphoria, suicidal thoughts, decreased sex drive, and decreased sexual performance. Some side effects are rare, but still likely – these include violent behavior, high blood pressure, heart attack, blood clots, very fast heartbeats, slow heartbeats, bleeding, kidney failure, and seizures.

Zoloft users may experience dizziness, drowsiness, diarrhea, dry mouth, increased sweating, insomnia, loss of appetite, nausea, or upset stomach. As with Lexapro, pregnant women can use the drug, but there is a risk of birth defects. Common serious side effects include suicidal ideation, decreased sex drive, and decreased sexual performance. Rare side effects include increased ventricular heart rate, slow heartbeats, bleeding, liver failure, acute kidney disease, and euphoria.

Conclusion

Doctors recommend that patients stop taking Lexapro or Zoloft only under medical supervision. Patients who stop taking any of the drugs may experience withdrawal symptoms.

Lexapro withdrawal symptoms include confusion, headache, insomnia, nervousness, numbness, and tingling. Stopping the use of Zoloft may cause headaches, mood swings, sleep changes, fatigue, or a short-term sensation such as electric shock.

Warnings

Patients should disclose their entire medical history to their doctor before taking Lexapro or Zoloft. Consuming alcohol together with both drugs is not recommended. While using Lexapro or Zoloft, you should also avoid driving or operating machinery.

Any mental health disorder, attempted suicide, bleeding problems, liver disease, seizures, kidney disease, stomach bleeding, dehydration, and low blood sodium should be mentioned before deciding to use Lexapro.

Zoloft may not work if patients have bleeding problems, liver disease, seizure disorders, and thyroid problems.

Drug Interactions

Patients should be aware of drug interactions with both Lexapro and Zoloft. Neither work with MAO inhibitors such as isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, or tranylcypromine. The result can be fatal.

Both Lexapro and Zoloft increase the risk of bleeding when interacting with the following drugs: pimozide, antiplatelet drugs, NSAIDs, blood thinners, and aspirin. Increased drowsiness occurs when Lexapro or Zoloft interact with antihistamines, hypnotics or anxiety medications, muscle relaxants, or narcotic pain relievers.

Specific drug interactions can lead to serotonin syndrome. These drugs include dextromethorphan, lithium, St. John’s wort, sibutramine, tramadol, tryptophan, the SSRI antidepressants fluoxetine and paroxetine, and SSRI duloxetine and venlafaxine.People with serotonin syndrome experience several effects. Their mental state may change and they will experience agitation, delusions, or hallucinations. They may even go into a coma. Dizziness, hot flashes, hyperthermia and tachycardia are signs of autonomic instability. Neuromuscular effects include impaired motor coordination, rigidity, and tremors. People with serotonin syndrome can suffer from gastrointestinal conditions such as diarrhea, nausea, or vomiting. They may be prone to seizures.

Serotonin Syndrome is a side effect of mixing Lexapro or Zoloft with certain medications.

Storage and Shelf Life

Lexapro is the new of the two, which received FDA approval in 2002. Zoloft received FDA approval in 1991. Both should be kept at room temperature, free from light and moisture. When stored this way, Lexapro has a shelf life of three years and Zoloft five years. No medicine should be rinsed off or flushed down the drain.

90,000 Lexapro vs Zoloft: Differences, Similarities and What’s Best for You – Drug Vs.Friend

Drug Vs. Friend

Drug Review and Main Differences | Treatment conditions | Efficiency | Insurance coverage and cost comparison | Side Effects | Drug Interactions | Warnings | Frequently Asked Questions

Lexapro (escitalopram) and Zoloft (sertraline) are SSRIs (selective serotonin reuptake inhibitors) indicated for the treatment of depression and other psychological conditions. SSRIs work by increasing serotonin levels in the brain, which can help relieve symptoms.Both prescription drugs are approved by the Food and Drug Administration (FDA). Other SSRIs include Prozac (Fluoxetine), Celexa (Citalopram), and Paxil (Paroxetine). While Lexapro and Zoloft are similar, they have noticeable differences in readings as well as cost.

RELATED: About Lexapro | About Zoloft | About Prozac | About Celexa | About Paxil

What are the main differences between Lexapro and Zoloft?

Diseases treated by Lexapro and Zoloft

Lexapro is an SSRI indicated for the acute and supportive treatment of major depressive disorder (MDD) in adolescents 12-17 years old and adults, as well as for the acute treatment of generalized anxiety disorder (GAD) in adults.

Zoloft is an SSRI indicated for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder. (PMDD).

Are Lexapro or Zoloft more effective?

Lexapro has been shown in clinical trials to be significantly more effective than placebo in the treatment of major depressive disorder and generalized anxiety disorder.

Zoloft has been shown in clinical trials to be significantly more effective than placebo in the treatment of major depressive disorder, panic disorder, post-traumatic stress disorder, OCD, SBP, and PMDD.

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A 2014 study published in Clinical Psychopharmacology International suggested that Lexapro may be more effective and better tolerated than Zoloft or Paxil. Lexapro has different binding site interactions, which can lead to better performance and portability.However, another study found that Zoloft produced results that were at least as good or better than patients using Lexapro or Celexa in terms of adherence, drug costs, and medical costs.

However, the most effective drug should only be determined by your doctor based on your health condition (s), medical history, and other drugs you are taking.

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Lexapro vs Zoloft coverage and cost comparison

Lexapro is usually covered by both insurance and Medicare Part D, there will be a much lower co-pay for a generic, while for a brand the co-pay can be much higher or it may not be covered at all.Lexapro is available as 5, 10, or 20 mg tablets (branded or generic) and as a 5 mg / 5 ml oral solution (generic). Lexapro costs about $ 379 for 30 branded 10mg tablets; The co-pay for Medicare Part D generic drug (10 mg, 30 tablets) is usually between $ 0 and $ 30, and with a SingleCare card, you can expect to pay between $ 9 and $ 45 depending on your pharmacy.

Use a SingleCare prescription loyalty card

Zoloft is generally covered by both insurance and Medicare Part D, generics will have a much lower co-pay, whereas brands may have a much higher co-pay or no coverage at all.Zoloft is available in 25, 50, or 100 mg tablets (branded or generic) and as a liquid as a 20 mg / ml oral solution (generic). Zoloft costs about $ 365 for 30 branded 100mg tablets; The co-pay for Medicare Part D generic drug (100 mg, 30 tablets) is usually between $ 0 and $ 13, and with a SingleCare card, you can expect to pay between $ 9 and $ 31.

Common side effects Lexapro and Zoloft

Both drugs have a long list of serious warnings that are included in the warnings section below. In addition, you may encounter other, more common side effects from Lexapro or Zoloft.

The most common Lexapro adverse reactions are headache, indigestion / nausea, sexual dysfunction / delayed ejaculation, insomnia, fatigue and drowsiness.

The most common adverse reactions of Zoloft are nausea, diarrhea, sexual dysfunction / delayed ejaculation, dry mouth, insomnia and drowsiness.

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Side effects vary; this is an incomplete list. You will be given a medication guide with a new prescription or prescription for Lexapro or Zoloft refill with information on side effects and other warnings.Check with your healthcare professional for a complete list of side effects.

Source: DailyMed ( Lexapro), DailyMed (Zoloft)

Drug interaction Lexapro versus Zoloft

Since both Reparata belong to the same category, they have similar drug interactions.

MAO inhibitors such as selegiline should not be used within 14 days of taking Lexapro or Zoloft; the combination may increase the risk of serotonin syndrome, a life-threatening medical emergency due to accumulation of serotonin.

Triptans used to treat migraines such as Imitrex (sumatriptan), as well as other antidepressants such as Elavil or Tsimbalta, should not be used in combination with Lexapro or Zoloft due to the risk of serotonin syndrome.

Other drugs that can interact with Lexapro or Zoloft include macrolide antibiotics such as Zithromax, NSAIDs (non-steroidal anti-inflammatory drugs) such as Mobic, or pain relievers such as Ultram.

Alcohol cannot be used with Lexapro or Zoloft.

(tramadol)

This is not a complete list of drug interactions.Consult your healthcare professional for medical advice.

Lexapro and Zoloft Warnings

Both Lexapro and Zoloft come with an FDA black box warning for antidepressants and suicidality. Children, adolescents, and young adults (under 24) who are taking antidepressants are at increased risk of suicidal ideation and behavior. All patients taking antidepressants should be closely monitored.

Other warnings associated with both drugs include:

Can claritin and allegra be taken at the same time?

• Serotonin Syndrome Risk: A life-threatening medical emergency caused by an accumulation of too much serotonin.Patients should be closely monitored for symptoms, including hallucinations, seizures, and agitation.
• Discontinuation: When you stop taking one of these drugs, you may experience symptoms such as agitation; Patients should gradually reduce the dose of the drug.
• Seizures: Lexapro or Zoloft should be used with caution in patients with seizures.
• Hyponatremia (low sodium) due to inappropriate antidiuretic hormone (SIADH) secretion syndrome: Patients may experience headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness that can lead to a fall.More serious cases are possible. When symptoms appear, patients should seek emergency care and stop taking SSRIs.
• Angle-closure glaucoma: SSRIs should be avoided in patients with untreated anatomically narrow angles.
• Bleeding: SSRIs may increase the risk of bleeding; the risk increases with the concomitant use of aspirin, NSAIDs, or warfarin.
• Activation of mania or hypomania: In patients with bipolar disorder, antidepressants can cause a mixed / manic episode.

Lexapro or Zoloft should be used during pregnancy only if the benefit to the mother outweighs the risk to the baby. Stopping the medication can cause a relapse of depression or anxiety. Therefore, patients should be assessed on a case-by-case basis.

If you are already taking Lexapro or Zoloft and find that you are pregnant, contact your doctor immediately. Lexapro or Zoloft should be used with caution by nursing mothers, and the child should be examined for any adverse reactions.

Zoloft Oral Solution contains 12% alcohol and should not be used during pregnancy or breastfeeding due to its alcohol content.

Frequently Asked Questions about Lexapro vs. Zoloft

What is Lexapro?

Lexapro (escitalopram) is an SSRI indicated for the acute and supportive treatment of major depressive disorder (MDD) in adolescents 12-17 years old and adults, and for the acute treatment of generalized anxiety disorder (GAD) in adults.

What is Zoloft?

Zoloft (sertraline) – Selective serotonin reuptake inhibitor indicated for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), social anxiety disorder (SAD) … and premenstrual dysphoric disorder (PMDD).

Are Lexapro and Zoloft the same thing?

Lexapro and Zoloft are SSRI drugs, but their indications differ (see.Above). Since they belong to the same category, they have many of the same drug interactions and side effects.

Lexapro or Zoloft is better?

Differently. Each medicine has a different indication; one may be more appropriate for your condition (s). Check with your doctor to determine which medication is best for you.

Can I use Lexapro vs. Zoloft during pregnancy?

Differently. Check with your healthcare professional.Your doctor will weigh the benefits of taking antidepressants against the risks to your child. Some doctors prescribe a low dose of antidepressant medication during pregnancy. If you are already taking Lexapro or Zoloft and find out that you are pregnant, contact your obstetrician-gynecologist immediately for advice. If you are breastfeeding, also consult your obstetrician / gynecologist.

Can I use Lexapro vs. Zoloft with alcohol?

No. Combining antidepressants with alcohol can worsen symptoms of depression or anxiety, impair your thinking and alertness, and increase sedation and sleepiness.

What’s the best SSRI for anxiety?

SSRIs can be very helpful in treating anxiety, but it is best to consult with your doctor about which one is best for you, taking into account your medical history, medical condition and other medications you are taking.

Are Lexapro or Zoloft Causing More Weight Gain?

Everyone has different experiences; some people have not changed their weight, and some may gain or lose weight while taking these medications.

90,000 DIFFERENCE BETWEEN XANAX AND LEXAPRO | COMPARE THE DIFFERENCE BETWEEN SIMILAR TERMS – LIFE

Xanax vs. Lexapro | Alprazolam vs. Escitolopam | Mechanism of action, pharmacological effects, use, pharmacokinetics and side effects Names of drugs, Xanax and Lexapro, although s

Xanax vs. Lexapro | Alprazolam vs. Escitolopam | Mechanism of Action, Pharmacological Effects, Uses, Pharmacokinetics and Side Effects

The names of the drugs, Xanax and Lexapro, may sound like they belong to the same category, but they are not.Xanax is the brand name for alprazolam, which is a short-acting banzodiazepine, and lexapro is the brand name for escitolopam, which is a selective serotonin reuptake inhibitor (SSRI). Both of these categories have differences in mechanism of action, pharmacological effects, use, pharmacokinetics, and side effects. Because they are widely used in clinical practice, this article will point out these differences to help differentiate between the two drugs.

Xanax

Xanax belongs to the group of benzodiazepines. It selectively acts on GABA receptors and enhances the GABA response, which is an inhibitory neurotransmitter in the central nervous system, facilitating the opening of chloride channels.

Has a calming effect, reduces anxiety and aggression; Therefore, it is widely used as an anxiolytic drug. Other effects include sedation and sleep stimulation, decreased muscle tone and coordination, anticonvulsant effects, and anterograde amnesia.In modern surgical practice, it is used for small procedures such as endoscopy.

The drug is well absorbed by oral administration, but intravenous and intramuscular forms are also available. It binds tightly to plasma proteins, and their lipid solubility causes them to gradually accumulate in adipose tissue. It is metabolized and ultimately excreted in the urine.

Acute overdose of the drug can cause prolonged sleep without serious respiratory or cardiovascular depression, but in the presence of other central nervous system depressants such as alcohol, it can cause severe respiratory depression.Side effects in the therapeutic range include drowsiness, confusion, amnesia, impaired coordination that affects manual skills such as driving skills, and increased depressive effects of other antidepressants. Alprazplam short-acting may cause more drastic withdrawal effects.

Lexapro

It is a selective serotonin reuptake inhibitor (SSRI). As the name suggests, it acts selectively on serotonin receptors.According to the monoamine hypothesis, deficiencies in the neurotransmitters norepinephrine and serotonin in the brain lead to depression. Therefore, the drug is widely used as an antidepressant.

The drug is available in tablet form. It is metabolized and ultimately excreted in the urine. Side effects of the drug include nausea, vomiting, diarrhea, constipation, increased or decreased appetite, nervousness, urinary retention, insomnia, heart palpitations, bradycardia and sexual dysfunction, but less anticholinergic effects and less dangerous in overdose compared with other anticholinergic drugs.depressive drugs.

It is not prescribed in conjunction with MAOIs because a dangerous serotonin reaction can occur, which includes hyperthermia, muscle stiffness and cardiovascular collapse.

FDA approved first generic Lexapro

FDA approved the first generic drug Lexapro

22.03.2012

American
Food Sanitary Inspectorate and
drug approved the first generic
Lexapro (escitalopram) for the treatment of depression and anxiety in adults.

Depression
characterized by symptoms that reduce the ability to work properly, sleep, study
and enjoy life.

Signs of depression: low mood, loss
interest in ordinary activities,
significant change in weight or appetite, insomnia or excessive sleepiness,
psychomotor agitation, fatigue, feelings of guilt or worthlessness, delayed
thinking and inability to concentrate,
attempted suicide or thoughts of suicide.

Patients
with general anxiety syndrome arrive in a state of anxiety and tension,
even in the absence of grounds for such conditions. They are overly concerned
health problems, money, family problems or difficulties at work. Diagnosis
placed if the condition lasts more than six months.

“Such features
mental state interfere with the usual
activities ”,
He speaks
Janet Woodcock, Director of the Center for Assessment and
FDA research.“This therapy
widely used by patients who need to monitor the condition in
over time, so it is important to have possible treatment options. ”

Teva Pharmaceutical Industries / IVAX Pharmaceuticals received
FDA approval for the production of generic escitalopram in doses 5, 10 and 20
mg.

V
In clinical trials, Lexapro has caused the following adverse reactions:
insomnia, nausea, increased
sweating, tiredness, drowsiness, and decreased libido.

Eescitalopram
and all other antidepressant drugs have
warning of an increased risk of suicide and suicidal thoughts
in children, adolescents, and young adults aged 18 – 24 in the initial period
therapy.

Moreover
the risk is not increased in adults over 24 and in patients over 65,
taking antidepressants, the risk
suicide and suicidal thoughts are reduced.

_{Source : FDA NEWS RELEASE, 14.03.12}

_{Ref http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm296006.htm}

_{Prepared
Margarita Leonovich}

90,000% d1% 81% d0% be% d0% bd% d0% bb% d0% b8% d0% b2% d0% be% d1% 81% d1% 82% d1% 8c in English – Russian-English Dictionary

Song Pokemon Mezase PokeMon Master Aim To Be A PokeMon Master brought to you by Lyrics-Keeper. The Flash feature can be used as a karaoke for the song Mezase PokeMon Master Aim To Be A PokeMon Master, if you can download the backing track.

The Pokemon Mezase PokeMon Master Aim To Be A PokeMon Master lyrics are brought to you by Lyrics-Keeper.

Common crawl

The Working Party agreed that the text of draft article 92, as contained in document A / CN.9 / WG.III / WP. 81 is acceptable and will be supplemented with the necessary data.

The Working Group agreed that the text of draft article 92 as contained in A / CN.9 / WG.III / WP. 81 was acceptable and would be supplemented as needed.

UN-2

During the reporting period, a total of 41 training and operational activities were carried out (29 for the Army of the Republika Srpska and 12 for the Army of the Federation) and 81 events related to the transfer of forces (63 for the Army of the Republika Srpska and 18 for the Army Federation).

There were a total of 41 training and operation activities (29 Republika Srpska Army and 12 Federation Army) and 81 movements (63 Republika Srpska Army and 18 Federation Army) conducted during the reporting period.

UN-2

Assuming that such investors find FE holders willing to purchase their BE , then a significant BE to FE rate looms, which depends on the size of the transaction, the relative impatience of the BE holders and the expected duration of capital controls.

Assuming such depositors find FE holders willing to purchase their BE , a substantial BE- FE exchange rate emerges, varying with the size of the transaction, BE holders’ relative impatience, and the expected duration of capital controls.

ProjectSyndicate

Reaffirming the Declaration on the Right to Development adopted by the General Assembly in its resolution 41/128 of 4 December 1986, as well as the resolutions and decisions adopted by the United Nations on the problem of external debt of developing countries, in particular Commission resolution 2000/ 82 of 26 April 2000

Reaffirming the Declaration on the Right to Development, adopted by the General Assembly in its resolution 41/128 of 4 December 1986, and the resolutions and decisions adopted by the United Nations in connection with the problem of the foreign debt of the developing countries, particularly Commission resolution 2000/ 82 of 26 April 2000,

UN-2

The overview report on the financing of United Nations peacekeeping operations details the ongoing efforts of the Department of Field Support and the Conduct and Discipline Teams in the field to consolidate and strengthen the prevention of sexual exploitation and abuse, and to ensure proper compliance. and taking corrective measures (A / 67/723, paras. 82 90 005 -84).

The report on the overview of the financing of United Nations peacekeeping operations provides details concerning continued efforts to strengthen the capacity of the Department of Field Support and conduct and discipline teams in the field to consolidate and enhance the prevention of sexual exploitation and abuse and ensure proper enforcement and remedial action (A / 67/723, paras. 82 -84).

UN-2

The Li-Fi market is projected to grow at a CAGR of 82.% between 2013 and 2018 and will be over $ 6 billion per year by 2018.

The Li-Fi market was projected to have a compound annual growth rate of 82 % from 2013 to 2018 and to be worth over $ 6 billion per year by 2018 ..

WikiMatrix

81 ballots were cast, among which there were no invalid ballots; 81 bulletin was found valid; 81 90 005 participating States took part in the voting; the required two-thirds majority was 54 votes.

Eighty -one ballots were cast, of which none were invalid; 81 were valid; the number of States Parties voting was 81 ; and the required two-thirds majority was 54.

UN-2

Differing views were expressed regarding the content and wording of the recommendations 82 90 005 –88.

A number of different views were expressed with respect to the scope and drafting of recommendations (82) to (88).

UN-2

From 2002 to 2010, of the $ 56 billion in financial assistance provided to Afghanistan, 82 % was spent through non-state institutions.

From 2002 to 2010, 82 % of the $ 56 billion in aid delivered to Afghanistan was spent through non-state institutions.

ProjectSyndicate

Microcomponents (Sb, As, Ba, Be , Bi, Ca, F, Ga, Au, Mg, Pd, Ru, Sr, S, Y, Zr)

Microconstituents (Sb, As, Ba, Be , Bi, Ca, F, Ga, Au, Mg, Pd, Ru, Sr, S, Y, Zr)

UN-2

The President (spoke in French): I give the floor to the representative of the Dominican Republic to introduce draft resolution A / 65 / L. 82 .

The President (spoke in French): I now give the floor to the representative of the Dominican Republic to introduce draft resolution A / 65 / L. 82 .

UN-2

The actual number of outreach / information products for all elements of the public awareness campaign was: 14,000 brochures, 7,500 posters, 82 ,500 copies of the bimonthly magazine Focus Kosovo. ), 180,000 copies of the monthly newsletter “Dana I Sutra” (“Today and Tomorrow”), 489 broadcasts on radio, television and the Internet, 15 official announcements on radio, television and the Internet, 57 press briefings, 372 press releases. release, 356 morning news picks, 271 media analysts and 536 international news bulletins)

The actual outputs with respect to all elements of the public information campaign to: 14,000 brochures, 7,500 posters, 82,500 copies of the bimonthly magazine Focus Kosovo, 180,000 copies of the monthly newsletter Dana I Sutra (Today and Tomorrow), 489 radio, television and Web broadcasts, 15 radio, television and Web public service announcements, 57 press briefings, 372 press releases, 356 morning headlines, 271 media reports and 536 international media clippings)

UN-2

Report of the Secretary-General on products harmful to health and the environment (A / 59/ 81 -E / 2004/63)

Report of the Secretary-General on products harmful to health and the environment (A / 59/ 81 -E / 2004/63)

UN-2

In the period from June 1 to August 16, the Afghan police units for the fight against drugs carried out 597 operations, as a result of which 529 suspects were arrested, 16 clandestine laboratories for the manufacture of heroin were dismantled, 4460 kg of precursors, 13 295 kg of opium, 105 kg of poppy seeds were seized. 654 kg of heroin, 2642 kg of hashish, 2165 kg of amphetamine-type stimulants, 2 kg of morphine, 81 a vehicle and 66 weapons of various types.

Between 1 June and 16 August, the counter-narcotics police of Afghanistan conducted 597 operations, resulting in the arrest of 529 suspects, the dismantling of 16 illicit heroin laboratories and the seizure of 4,460 kg of precursor chemicals, 13,295 kg of opium, 105 kg of poppy seeds, 654 kg of heroin, 2,642 kg of hashish, 2,165 kg of amphetamines, 2 kg of morphine, 81 vehicles and 66 weapons of different types.

UN-2

Both Messier 81 and Messier 82 are easily visible with binoculars and small telescopes.

Messier 81 and Messier 82 can both be viewed easily using binoculars and small telescopes.

WikiMatrix

For the display of the navigation elements and parameters listed in Appendix 3 to IMO resolution MCS.232 ( 82 ), colors and symbols that are not specified in chapter 4.7 shall be used.

To present navigational elements and parameters as listed in the IMO Resolution MSC. 232 ( 82 ), Appendix 3, other colors and symbols than those mentioned in 4.7 (a) shall be used.

UN-2

During 2011, the construction was completed and a regime building for 180 places was completed for keeping women in custody in the Kiev pre-trial detention center, sectors of the maximum security level for 152 places were created in correctional colonies No. 82 and No. 97 in the Donetsk region, and also completed capital and current repairs of priority facilities of bodies and institutions of the State Penitentiary Service of Ukraine.

During 2011, construction was completed on a new block with 180 places for female detainees at the Kyiv remand center, maximum security sectors with 152 places were set up in No. 82 and No. 97 correctional colonies in Donetsk region, and extensive and running repairs were made to priority agencies and facilities of the State Prison Service.

UN-2

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Truck 81 , companies are still behind a train.

OpenSubtitles2018.v3

Contributions in kind from the United Kingdom amounted to US $ 225,806 and from the Netherlands US $ 81 093.

The contributions in kind from the United Kingdom totalled US $ 225,806 and from the Netherlands US $ 81,093.

UN-2

They operate in 17 regions of the country, as well as in 40 provinces, 38 cities and 82 municipalities.

These are present in the 17 regions of the country, and in 40 provinces, 38 cities, and 82 municipalities.

UN-2

Surplus organic fertilizer fee: BE NL

Charge on surplus manure: BE NL

UN-2

The level of opposition is especially high among women with secondary or higher education ( 81 percent).

Opposition is particularly high among women with secondary or higher education ( 81 per cent).

UN-2

An on-site follow-up audit conducted from 11 to 20 October 2010 determined that UNCDF had made “significant progress” in addressing deficiencies identified in an earlier audit in 2009, having completed 82 per cent of 24 recommendations by the due date.

An on-site follow-up audit conducted from 11 to 20 October 2010 found that UNCDF had made “significant progress” in addressing weaknesses identified in the earlier 2009 audit, having implemented 82 percent of the 24 recommendations due by that time.

UN-2

Law No. 82 , Law on People’s Courts, Gaseta Officeial No. 8;

Law No. 82 , Law on People’s Courts, Official Gazette No. eight;

UN-2

90,000 Choice of antidepressant by effectiveness and tolerability

Summary

A classification of the side effects of antidepressants is presented.Side effects can be toxic or neuronal. Neuronal side effects are categorized as “non-therapeutic” (persistent or reversible) and “paramedic”. Seven categories of tolerability of antidepressants have been identified. The lowest category VII included clomipramine, imipramine, maprotiline, agomelatine. Category VI includes amitriptyline, V – pipofezine, trazodone, mianserin and mirtazapine, IV – vortioxetine, III – venlafaxine and duloxetine, II – sertraline, paroxetine, citalopram, escitalopram, fluoxetine, fluvoxamine, I – milna and moclobemide.Of the most effective antidepressants (amitriptyline, imipramine, venlafaxine in high daily doses), venlafaxine was the best tolerated. This drug is the most effective and tolerated antidepressant. Other options for the practical use of classifications are discussed.

Summary

A classification of the side effects of antidepressants is presented. Side effects can be toxic or neuronal. Neuronal side effects are divided into “extratherapeutic” (persistent or reversible), as well as “paratherapeutic”.Seven antidepressant tolerability categories have been identified. The lowest VII category included clomipramine, imipramine, maprotiline, agomelatine. Amitriptyline belongs to the VI category, pipofezin, trazodone, mianserin and mirtazapine to the V category, vortioxetine belong to the IV category, venlafaxine and duloxetine to the III category, sertraline, paroxetine, citalopram, escitalopram, fluoxetine, fluranvoxamine and IIcipitalopram category, and pirlindole and moclobemide to the I category.Among the most effective antidepressants (amitriptyline, imipramine, venlafaxine in high daily doses), venlafaxine was in the best category of tolerability. This drug is the most effective and tolerable antidepressant. Other options for the practical use of classifications are discussed.

In the previous article, the characteristics of the mechanism of action of various antidepressants (tricyclic – TCA, sertonin-modulating – SMA, four-cyclic – HcA, reversible inhibitors of monoamine oxidase type “A” – OIMAO-A, selective serotonin reuptake inhibitors – SSRIs, selective serotonin reuptake inhibitors and – SNRIs, norepinephrine and selective serotonin – HACCA, melatoninergic – MeA, multimodal – MMA) (tab.one).

Table 1. Antidepressants known in Russia, their effect on neurons and the “formula” of the mechanism of action (1-4).

* – white color – the drug does not affect neurons, dark gray – a pronounced increase in activity, light gray – a moderate increase in activity, ** – in high doses, IOZ – neurotransmitter reuptake inhibitors, CBRR – drugs affecting regulatory receptors, OIMAO-A – reversible inhibitors of monoamine oxidase type “A”.

All these drugs, to varying degrees, promote the activation of serotonin (↑ C or ↑ s), norepinephrine (↑ N or ↑ n), dopamine (↑ D or ↑ e) or melatonin (↑ M or ↑ m) neurons, the “tone” of which decreases with depression. But the most pronounced effect on the vital activity of neurons is ↑ SND antidepressants: amitriptyline and imipramine (TCA), as well as venlafaxine (SNRI) in high daily doses. It is no coincidence that many experts consider them to be the most effective drugs for the treatment of depression (5).

Of course, the choice of any antidepressant should be associated not only with its medicinal properties (effectiveness), but also with side effects (tolerance). The overwhelming majority of authors agree that the tolerance is best for SSRIs and worse for TCA (6-9), and the rest of the drugs are located between them (1). This assessment of the tolerability of antidepressants is correct, but it is generalized. To clarify it, one should refer to the data on the mechanisms of the formation of side effects.

A smaller part of them is due to the toxic effect of antidepressants on the organs and tissues of patients. These “toxic” side effects are very dangerous (10). For example, while taking some TCAs (clomipramine, imipramine), as well as MeA (agomelaptin), drug hepatitis is observed, which leads to the death of patients (10, 11). Maprotiline also has serious toxic side effects, which causes agranulocytosis and leukopenia (12). Fortunately, toxic side effects are very rare and can be detected early in the tests.

For example, when agomelatine was found to cause severe and drug-induced hepatitis, detailed precautions were included in its label (11). They include a biochemical blood test, which is prescribed to all patients (without exception) before prescribing the drug, as well as while taking it. A similar analysis is required for patients receiving clomipramine and imipramine (13,14). However, when prescribing these antidepressants, biochemical analysis is required only for patients with pre-existing liver diseases.Finally, regular general blood tests aimed at detecting agranulocytosis and leukopenia are also necessary during treatment with maprotiline (12).

Obviously, the need for additional testing can significantly complicate the use of antidepressants. Fortunately, this is only required when using the listed drugs. When prescribing other antidepressants, you do not need to resort to additional examinations. However, their tolerance can be impaired due to the adverse effects of drugs on neurons.As a result, “neuronal” side effects are formed, which, however, do not directly threaten the life of patients and are easily diagnosed by their complaints.

Some of the neuronal side effects are due to the effect of an antidepressant on histamine and acetylcholine neurons, which do not decrease their activity in the formation of mental disorders that are indications for the prescription of antidepressants (2,15). Accordingly, such pharmacological properties can be designated as “non-therapeutic” (unnecessary, not related to the treatment process) side effects.They only increase the number of neuronal systems that are affected in the patient. More often than not, the “non-therapeutic” side effects are persistent. They can be observed throughout the course of treatment, in particular when the antidepressant blocks excitatory receptors on histamine and acetylcholine neurons (15).

This mechanism of action, which is more characteristic of antipsychotics than antidepressants, leads to a sharp drop in the activity (inhibition) of these nerve cells (↓ G and ↓ A) (1,2).Moreover, normal histamine and acetylcholine neurons cannot restore their functions, since there are no effective compensatory mechanisms for this. Accordingly, patients develop persistent mental and somatic symptoms that seriously complicate treatment (Table 2).

Table 2. The main “non-therapeutic” side effects of antidepressants associated with blockade of excitatory receptors on histamine and acetylcholine neurons (1,2)

Drowsiness, fatigue, impairment of memory and attention are characteristic.Complaints of dry mouth, disturbances in accommodation and urination, constipation, pain in the eyes due to an increase in intraocular pressure, disturbances in the heart rhythm, increased appetite and weight gain.

There is, however, an antidepressant for which the “non-therapeutic” side effects are not persistent. This drug is vortioxetine. It does not inhibit histamine and acetylcholine neurons (due to blockade of excitatory receptors), but increases their “tone” due to the effect on regulatory receptors (16).On the one hand, this provides vortioxetine with a unique nature of “non-therapeutic” side effects. In particular, when taking this antidepressant, excitement, anger, “unusual” dreams, and insomnia can be observed (Table 3).

Table 3. “Extra-therapeutic” side effects of vortioxetine (16,17).

Characterized by ketoacidosis, somatic complaints of dizziness, itching (including generalized), sweating, hot flashes, nausea, diarrhea, vomiting.On the other hand, these side effects are fundamentally reversible, since neurons have special mechanisms that are aimed at combating excessive activation. To do this, they can, for example, desensitize their regulatory receptors (a mechanism known as self-regulation). Therefore, the “non-therapeutic” side effects of vortioxetine are often reduced on their own in the first two weeks of treatment (16).

Turning now to the rest of the antidepressants, we point out that the overwhelming majority of them do not have “non-therapeutic” side effects at all, which increase the number of affected neuronal systems (2).Many drugs do not affect histamine and acetylcholine neurons. Moreover, they increase the activity of only those neurons (serotonin, norepinephrine and dopamine), whose “tone” decreases in mental disorders that are indications for the appointment of antidepressants. However, even this feature cannot rid antidepressants of the “neuronal” side effects. The latter will arise due to the fact that within any affected system of neurons the activity of only part of the nerve cells decreases, and the functions of the other part are not disturbed.Antidepressants both activate “affected” neurons and create therapeutic effects, and increase the “tone” of normally functioning nerve cells and cause side effects.

In this case, the tolerance of antidepressants, paradoxically, turns out to be a “hostage” of their therapeutic properties. The more effective the drug activates the affected neurons, the more it affects similar nerve cells that are still functioning at the proper level. Therefore, the considered side effects should be designated as “paramedic”.They are manifested by anxiety, restlessness, insomnia and anxiety (Table 4).

Table 4. Main “paratherapy” side effects of antidepressants (15)

Somatic complaints are represented by sexual dysfunction, disruption of the digestive system and heart rhythm, fluctuations in blood pressure. As a rule, “paratherapy” side effects are reversible. They may go away on their own in the second or third week of treatment (18).This is due to the already noted above ability of “normal” neurons to quickly adapt to excessive activation, reducing their sensitivity to neurotransmitters (2) ² .

The presented data on toxic and neuronal side effects can be used to classify antidepressants into seven tolerance categories, where the last, seventh, is the worst and the first is the best (Table 5).

Table 5. Categories of tolerance of antidepressants, taking into account toxic and neuronal side effects.

Thus, antidepressants from the lowest category VII (clomipramine, imipramine, maprotiline, agomelatine) have toxic side effects that directly threaten the lives of patients. Moreover, when prescribing them, additional examination of patients is required. Problems with the tolerance of other antidepressants are due to neuronal side effects. All of them are not fatal, and additional examination is usually not required to identify them.

Neuronal side effects are categorized as “non-therapeutic” and “para-therapeutic”. The first, as mentioned above, are associated with an “additional” dysfunction of histamine and acetylcholine neurons, which do not reduce their activity in mental disorders that are indications for the appointment of antidepressants. Accordingly, “non-therapeutic” side effects, expanding the range of affected neuronal systems, determine the drugs belonging to the lower tolerance categories (VI, V and IV).In particular, amitriptyline contributes to a persistent decrease in the activity of histamine and acetylcholine neurons and therefore is assigned to the VI category of tolerance. The “non-therapeutic” side effects of Category V antidepressants are more limited. After all, pipofezin, trazodone, mianserin and mirtazapine contribute to a persistent decrease in the activity of only histamine neurons. Vortioxetine is assigned to the next – higher IV category of tolerance. This antidepressant has the ability to increase the activity of histamine and acetylcholine neurons.However, the associated side effects are often reversible.

The highest tolerance categories I – III include antidepressants that affect only serotonin, norepinephrine and dopamine neurons, which are affected by mental disorders that are indications for prescribing drugs. These drugs are characterized by “paratherapeutic” side effects that do not increase the number of affected neuronal systems (Table 5). They arise due to the activation of a part of serotonin, norepinephrine and dopamine neurons, which still maintain a normal “tone” (2).At the same time, the severity of “paramedic” side effects depends, first of all, on the ability of the antidepressant to affect serotonin and norepinephrine nerve cells, since they all have little effect on dopamine (Table 1).

Accordingly, the III category of tolerance includes antidepressants, which simultaneously effectively activate serotonin and norepinephrine neurons. These drugs are venlafaxine and duloxetine (Tables 1 and 5). The first of these, depending on the dose, is a ↑ SN or ↑ SNd antidepressant.As for duloxetine, it has the properties of a ↑ CH-drug. Category II includes antidepressants that promote a pronounced activation of only serotonin or only norepinephrine neurons (Tables 1 and 5). These include all ↑ C-antidepressants (sertraline, paroxetine, citalopram, escitalopram, fluoxetine, fluvoxamine), as well as ↑ SND antidepressants – milnacipran. Finally, the highest category I of tolerance is possessed by drugs that are not capable of strong activation of serotonin, norepinephrine neurons (Table 1).1 and 5). These are two ↑ antidepressants, pirlindol and moclobemide.

In conclusion, it should be noted that the presented classification of antidepressants by tolerance does not claim to be comprehensive. However, it provides clear criteria for evaluating major side effects that allow comparisons between different drugs. This seems to be especially important in a situation where there are no clear recommendations on how to take side effects into account when prescribing antidepressants.For example, a generic formula is currently used in various publications and guidelines. The antidepressant is suggested to be used “only after a careful assessment of the ratio of the expected benefit to the possible risk in patients” (11). But the results of this “careful evaluation” tend to be in favor of the drug being prescribed.

In particular, it is written about agomelatine that if all the requirements of the instructions for prescribing an antidepressant are met, then the risk of developing drug-induced hepatitis becomes minimal (19).At the same time, the unique mechanism of action attributed to agomelatine allows us to state that the benefits of prescribing an antidepressant are much greater than certain inconveniences associated with its hepatotoxicity (19). Meanwhile, the whole uniqueness of the mechanism of action of agomelatine comes down to the possibility of influencing the neurons of the suprachiasmatic nucleus, the neurotransmitter of which is melatonin. And this effect is not at all required for the treatment of depression, since any antidepressant that activates serotonin and norepinephrine neurons can compensate for the deficiency of melatonin activity (20).

The “careful assessment” guidelines presented are by no means the only lightweight judgment about antidepressant tolerance. Some authors believe that side effects are weakly related to the mechanism of action of the drugs. It is argued that side effects are non-specific, probabilistic and therefore almost unpredictable (18). Other authors are at least looking for the reasons for the formation of side effects in order to take them into account when prescribing antidepressants.Unfortunately, they find these reasons not in the mechanisms of action of drugs, but in the peculiarities of depression, public opinion or the psychology of the patient.

Thus, it is reported that even with the use of any “most easily tolerated drugs in 80% of patients with mild to moderate depression” (21), there are heterogeneous adverse events. They most often occur in dysthymia, first depressive conditions, with anxiety and somatic symptoms (21, 22), in persons over 45 years old, with a high body weight deficit (22), and a history of negative placebo reactions (23).It is reported that poor tolerance to antidepressants is associated with high demands on the quality of life of patients (24), their anxiety about social maladjustment (25). The initially negative attitude towards psychiatry on the part of public opinion, low awareness of the patient about his own illness and the therapy recommended by the doctor, unsatisfactory experience of previous treatment, etc., also contributes to the problem. (22, 26).

The speculation of such constructions is obvious.To refute them, it suffices to say that the side effects of drugs, according to the WHO definition, are caused by their pharmacological properties (37). It is difficult to imagine that the inhibition of histamine and acetylcholine neurons occurred due to the patient’s high demands on the quality of life, excessive activation of serotonin, norepinephrine and dopamine neurons due to negative attitudes towards psychiatry from public opinion, and medicinal hepatitis due to social concerns. maladjustment.

Thus, the presented classification of antidepressants by tolerance categories allows the study of side effects to return to the mainstream of biological psychiatry. In addition, this classification is easy to use in practical medicine. In particular, the lower the tolerance category of an antidepressant, the greater the need for a special justification for its prescription (effectiveness, positive experience of treatment in the past, the patient’s desire, etc.). In turn, the appearance of such a detailed justification in the history of the disease will allow avoiding many problems (psychological, social and others) that arise in the process of treatment between a doctor and his patient.

With the help of the presented classification, it is easy to solve the question of choosing the most effective and tolerable antidepressant. To do this, it is only necessary to compare the tolerance categories for the most effective drugs: amitriptyline (TCA), imipramine (TCA), and venlafaxine (SNRI) (5). The first of them (amitriptyline) belongs to the VI category of tolerance (Table 5). The side effects of the second antidepressant (imipramine) are even worse. This drug belongs to the VII category of tolerance.As for venlafaxine, the side effects of this antidepressant are much weaker, and this drug belongs to the III category of tolerance. Thus, venlafaxine, when used in high doses, is the most effective and tolerated drug in the treatment of depression.

Venlafaxine is well known in our country under the trade name Velaksin (Egis). This drug has been studied by leading scientific organizations that carry out cutting-edge research in the field of psychiatry.Among them are the Federal State Budgetary Institutions “State Scientific Center for Social and Forensic Psychiatry named after V.P. Serbsky “and” Moscow Research Institute of Psychiatry “of the Ministry of Health of Russia, St. Petersburg Scientific Research Institute. V.M. Ankylosing spondylitis (28.29). Long-acting capsules (Velaksin retard) (30) are also well known, with the use of which there is a significant decrease in the frequency of such side effects of the drug as nausea (31). In addition, the study of Velaxin was successfully carried out not only in psychiatry, but also in neurology (32).

A video by M.Yu Drobizhev on the same topic can be viewed at the link: https://www.youtube.com/watch?v=SwtO_bC_838&t=11s

References

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M.Yu. Drobizhev , Doctor of Medical Sciences, Head of the Educational Department of the Training Center of the Association of Medical and Pharmaceutical Universities of Russia. Contact information – dmyu2001 @ mail.ru

E.Yu. Antokhin , Candidate of Medical Sciences, Associate Professor, Head of the Department of Clinical Psychology and Psychotherapy, Orenburg State Medical University, Ministry of Health of Russia.

R.I. Palaeva – Assistant of the Department of Clinical Psychology and Psychotherapy of the Federal State Budgetary Educational Institution of Higher Education “Orenburg State Medical University” of the Ministry of Health of Russia.

S. V. Kikta , candidate of medical sciences, head.Department of the Federal State Budgetary Institution “Polyclinic No. 3” of the Administrative Department of the President of the Russian Federation, Moscow

¹ There are probably side effects due to excessive activation of melatonin nerve cells. However, they are not yet described even in the instructions for agomelatine, a melatoninergic drug that has a direct effect on them (11).

² Theoretically, “paratherapy” side effects can be observed even against the background of “non-treatment”. After all, any antidepressants to varying degrees activate serotonin, norepinephrine or dopamine neurons.However, drugs are dominated by “non-therapeutic” side effects, if only because they are most often persistent. At the same time, “paratherapy” side effects are always reversible. In addition, not all antidepressants with “non-therapeutic” side effects are capable of serious activation of serotonin, norepinephrine and dopamine neurons.