The use of antidepressants in neurological practice

Abstract

Antidepressants are widely used in neurological practice, and their use in stroke, Alzheimer's disease, depression with cognitive impairment, Parkinson's disease, multiple sclerosis, chronic back pain and chronic migraine is discussed. Antidepressants are used in the presence of severe depressive symptoms, which are observed in 20–30% of neurological patients. The effect of antidepressants is higher in case of combination with recurrent depression. Presence of episodes of depression before the development of a neurological disease, history of effectiveness of antidepressants, hereditary burden of affective disorders, characteristic daily dynamics of symptoms with typical impaired sleep architecture indicate the likelihood of a combined affective disorder. Final establishment of a psychiatric diagnosis is possible with a consultation of a neurological patient by a psychiatrist, but in clinical practice this is realistic only in a small number of patients. The most commonly used antidepressants are selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants in low or medium doses, the duration of their administration is usually at least 3-6 months. In neurological diseases, the effectiveness of only some drugs has been noted, many antidepressants have not been studied in neurological diseases, but this does not exclude their effectiveness. When prescribing antidepressants, it is necessary to take into account possible drug interactions and avoid those combinations that may cause adverse reactions. It is advisable to use antidepressants in complex therapy in combination with an educational program, cognitive behavioral therapy and kinesiotherapy. Many questions regarding the efficacy and safety of treatment, the choice of the optimal antidepressant, its dosage and duration of use require further study.