Why do I get random bad depression

Depressive disorders: Often associated with pain

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Depressive illnesses not only affect mood and drive. Up to 80 percent of those affected also suffer from physical symptoms - mainly pain, mostly in the musculoskeletal system, and headaches. Often times, physical symptoms complicate the diagnosis. But even when the mental illness is recognized and treated with antidepressants, it is often the physical symptoms that stand in the way of disease remission, explained Prof. Gerd Laux (Gabersee / Wasserburg) in Munich.
Available antidepressants are often not sufficiently effective
The rate of remission in patients who responded to antidepressant pain management is twice as high in studies as in patients whose physical symptoms are unresponsive to treatment. Residual symptoms are strong predictors of an early relapse of the depressive illness.
The tried and tested antidepressants, such as tricyclics and MAO inhibitors, have a non-specific and non-selective effect on the neurotransmitter metabolism in the CNS, which is why they provoke significant undesirable side effects. The selective serotonin reuptake inhibitors (SSRI) induce significantly fewer side effects, but their therapeutic effect is often insufficient and hardly affects the pain. However, tricyclics appear to be more analgesic than SSRIs.
The antidepressant effect of the SSRI only sets in fully after several weeks to two months, and only a few patients achieve a complete remission on the medication.
The neurotransmitters serotonin and norepinephrine play a key role in the pathogenesis of depressive disorders. Both messenger substances also play a dominant role in the transmission and processing of physical pain in the CNS. Its main place of action is the limbic system as an essential switching point for the perception of physical pain. This fact also explains the range of mental and physical symptoms that many depressed patients display. Only when a balance is struck between serotonergic and noradrenergic reuptake inhibition can both psychological and physical symptoms be eliminated. The selective serotonin-norepinephrine reuptake inhibitor (SSNRI) duloxetine, which is to be launched on the market at the beginning of 2005, has such a balancing effect profile.
The recommended standard dose of 60 mg duloxetine per day should show sufficient clinical effect in the majority of patients. Studies have found a high rate of remission under the substance, Laux reported. The effect already sets in after a week, and the side effect profile is very favorable because there is no relevant affinity to other than the serotonin and noradrenaline receptors. The dual mode of action of duloxetine not only achieves a high rate of complete remissions and thus significantly reduces the risk of relapse, it also eliminates or at least minimizes physical symptoms associated with depression.
Duloxetine will also be the first drug for stress urinary incontinence. Continence is also controlled by serotonergic and noradrenergic receptors. The impulses emanating from the midbrain and the cerebral cortex reach motor neurons via the sacral medulla and then the pudendal nerve, which increases the tone of the internal bladder sphincter.
Detrusor contraction is inhibited
By inhibiting the reuptake of serotonin and noradrenaline from the synaptic cleft, duloxetine increases the activity of the pudendal nerve. The rhabdosphincter contracts, the detrusor contraction is inhibited, and the bladder capacity increases. The preparation will have to be taken in a daily dose of 80 mg. Even in this higher dosage, it is well tolerated and should come on the market before the antidepressant. Siegfried Hoc

Press workshop "The other side of depression - physical complaints, especially pain - the dual mode of action of duloxetine (SSNRI)" by Boehringer Ingelheim and Lilly Germany in Munich
Depressive disorders: Often associated with pain

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