Treatment of VSD with antidepressants: features of the use of drugs
Vegeto-vascular dystonia (neurocirculatory dystonia, VSD or NDC) is a symptom-complex that includes various manifestations of vegetative disorders. Symptoms include fainting, cardiovascular problems, and a breathing disorder. The pathological condition is often associated with diseases such as Parkinson's disease and diabetes mellitus.
Vegeto-vascular dystonia occurs in various forms, but all of them are associated with disorders of the autonomic nervous system (VNS ).
VNS is responsible for maintaining a constant internal temperature in the body, regulating breathing, monitoring blood pressure and heart rate. She also participates in the dilatation of the pupil, sexual arousal and excretion.
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Description of the IRR
Symptoms of vegetative-vascular dystonia are usually associated with problems of internal organs that were affected during the development of dystonia.
VSD is defined by approximately 70 million people around the world.
Facts about vegetative-vascular dystonia:
- There are about 15 types of IRR
- Primary VSD is usually inherited or occurs against a background of degenerative disease, while secondary VSDs are the result of another disease or trauma.
- The most common type of VSD is neurocardiogenic syncope, which leads to loss of consciousness. Pathology affects millions of people around the world.
- There is no single treatment of VSD, which would take into account all the nuances of the course of the disease.
Vegeto-vascular dystonia is a pathological process that affects the functioning of the neural network, which controls all automatic (unconditioned) processes in the body, such as breathing, pupil dilating, palpitation, etc.
There are many different types of VSD, and the symptoms in each case will be different. Most often, clinical signs are visually invisible and touch, mainly, internal organs.
The nature of the manifested symptoms is often difficult to predict. They can arise and disappear, and often change depending on the seriousness of the clinical picture. Sometimes physical activity can cause a deterioration in the patient's well-being. This can lead to the fact that people with VSD avoid excessive overstrain.
There are the following common features that can arise in people with VSD.
- The inability to stay upright for a long time.
- Dizziness, weakness and fainting.
- Fast, slow or irregular heartbeat.
- Pain behind the sternum.
- Low blood pressure.
- Problems with the gastrointestinal system.
- Infringements of fields of vision.
- Difficulty breathing.
- Mood swings.
- Fatigue and intolerance.
- Disturbance of the structure of sleep.
- Frequent urination.
- Problems with temperature control.
- Attention concentration and memory disorder.
- Poor appetite.
- Supersensitivity, especially when exposed to noise and light.
Symptoms with VSD can occur in various combinations, which makes the diagnosis of the disease difficult.
Types of IRR
There are at least 15 different types of vegetative-vascular dystonia. The most common are neurocardiogenic syncope and postural orthostatic tachycardia syndrome (SPOT).
For today, studies are still going on that will help to find out how quickly a person can recover from the VSD. In addition, there is evidence that the prognostic conclusion depends entirely on the type of dystonia. This pathology covers a wide range of factors of influence, which differ in severity.
Vegeto-vascular dystonia occurs for a number of reasons, which in turn are often associated with other pathological conditions.
Primary VSD is inherited or arises from a degenerative disease. Secondary dysfunction occurs as a result of an injury or other condition.
General conditions that may lead to a secondary IRR include:
- Multiple sclerosis.
- Rheumatoid arthritis.
- Parkinson's disease.
- Celiac disease.
Vegeto-vascular dystonia is difficult to diagnose, therefore, in clinical practice, an incorrect definition of the condition is quite common. Symptoms can be mistaken for the manifestation of those diseases that were previously present.
The success of the diagnosis often depends on the close cooperation of several narrowly specialized specialists.
Currently, there are no medications for primary vegetative-vascular dystonia. Nevertheless, the symptoms of secondary PCI are often improved in the treatment of the disease in the initial stage of development.
Treatment is aimed at reducing the severity of symptoms, which allows the patient to begin a therapy program for the purpose of physical recovery and strengthening of the body. This can help balance the work of the autonomic nervous system, especially when it does not work properly.
The treatment plan will depend on the type and specific combinations of symptoms. As a rule, medical care is provided on an individual basis, but often includes exercise therapy, physical therapy and psychological counseling. Such measures allow a person with the VSD to cope with a lifestyle change, which is often recommended for severe dystonia.
Doctors of various specializations can take part in the treatment of patients at VSD. Most often, a cardiologist, or specialist in cardiovascular diseases, and a neurologist, or a specialist in pathological conditions of the nervous system, is involved in the management of such patients.
Medications are mainly used to reduce distressing symptoms. The prescribed course of therapy may change over time to adapt the patient to any physical changes that he often has to experience. Also, drugs can not act immediately, so to feel the effect of their effect takes quite a long time.
The main recommendations for patients with VSD:
- You need to drink from 2 to 4 liters of water a day.
- It should be increased daily intake of salt to 4-5 grams (provided that there are no serious heart and kidney diseases).
- Caffeine and drinks with a high sugar content should be avoided, especially for young patients.
If necessary, you can also talk with your doctor about which treatment is best for you.
If vegetative-vascular dystonia occurs in severe form, that is, fainting often occurs, the patient is deeply concerned about depression, then serious medications such as antidepressants can be used. They are taken only according to the doctor's prescription, because with serious misuse, serious side effects may occur.
Features of antidepressants
Antidepressants are effective for the treatment of moderate and severe depression associated with various psychomotor and physiological changes:
- Loss of appetite.
- Sleep disturbance.
Poor sleep with frequent insomnia and disturbing thoughts are usually the most important indications for prescribing antidepressant therapy. Ideally, patients with moderate and severe depression should be treated with psychological therapy combined with medication.
Antidepressants are also effective in dysthymia (chronic depression of low severity, which usually lasts at least 2 years).
Antidepressants should not be used regularly for mild depression. In such cases, first psychological therapy should be conducted; However, the use of antidepressants may be considered in cases that are not amenable to psychological influence or in the presence of psychosocial or medical indications.
Sometimes drug therapy for depression is seen as an adjunct in patients with a moderate or severe clinic that has emerged against the background of the VSD.
Choice of antidepressants
The main classes of drugs include:
- Tricyclic antidepressants.
- Related antidepressants.
- Selective inhibitors of serotonin reuptake (SIPPs).
- Inhibitors of monoamine oxidase (iMAO).
Some antidepressants can not be included in such a classification.
There is little difference between the classes of antidepressants presented in terms of effectiveness. Often the choice of the drug is based on the individual needs of the patient, including the presence of concomitant disease, existing therapy, the risk of suicide and the previous response to the effects of antidepressants. Between courses of taking antidepressants, you may need an interval of 2 weeks. This can lead to electroconvulsive treatment, especially in severe depression, when the delay in anti-anxiety therapy is dangerous or unbearable.
During the first few weeks of treatment with antidepressants, there is an increased risk of agitation, anxiety and suicidal ideation.
SIPPs are better tolerated and more safe in overdose than other drugs from other classes of antidepressants. Funds from this class are mainly considered as primary for the treatment of depression in VSD. In patients with unstable angina or with recent myocardial infarction, it is considered that sertraline is safe.
Tricyclic antidepressants have similar efficacy with SIPPs, but their use is stopped most quickly due to the development of side effects; toxicity in overdose and other health problems. SIPPs are less calming and have less antimuscarinic and cardiotoxic effects than tricyclic antidepressants.
MAO inhibitors are noted in hazardous interactions with certain products and medicines. They must also be pre-ordered by a doctor who will conduct the appropriate appointment to the patient.
Although anxiety is often present in a depressive illness (and may be one of the symptoms of an AVR), the use of an antipsychotic or anxiolytic agent may mask a true diagnosis. Therefore, anxiolytics or antipsychotics should be used with caution in case of depression. Moreover, they are useful auxiliary substances in the treatment of excited patients.
The combination of antidepressants with antipsychotics under the supervision of specialists may also be required for patients with depression and psychotic symptoms.
Hypericum (Hypericum perforatum) is a popular drug widely used to treat various diseases, including mild depression. It is not prescribed by prescription and is not specifically recommended for depression, since St. John's wort can induce enzymes that metabolize narcotic substances. Several important interactions have also been identified between St. John's wort and conventional medicines, including conventional antidepressants. In addition, the amount of active ingredient varies between different preparations of St. John's Wort and a transition from one to the other, which can change the degree of induction of the enzyme. If the patient ceases to take St. John's wort, the concentration of interacting drugs may increase, leading to toxicity. Therefore, drugs from St. John's wort for the treatment of depression with VSD should be taken strictly according to the doctor's prescription.
Use of antidepressants
Patients taking antidepressants should undergo a medical examination every 1-2 weeks, especially at the beginning of antidepressant treatment. The drug exposure continues for at least 4 weeks (6 weeks in old age). Further consideration is given to whether antidepressants should be abandoned because of lack of efficacy. In case of partial response, therapy continues for 2-4 weeks (older patients may need more time to respond).
Most antidepressants can not be combined with alcoholic beverages.
After remission, antidepressant medication should be continued at the same dose for at least 6 months (about 12 months in the elderly) or for at least 12 months in patients receiving generalized anxiety disorder (because the likelihood of recurrence is very high). Patients with a history of recurrent depression should undergo maintenance treatment for at least 2 years.
In severe vascular dystonia, antidepressants may be required. Bethol and pyrazidol proved to be quite effective. Bethol is prescribed for 100-300 mg per day, with the dose being divided 2-3 times. Pyrazidol is given 100 mg every 8-12 hours.
It is important to remind once again that only the attending physician (neurologist or therapist) can prescribe antidepressants, since self-medication with these drugs is unacceptable.
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