15 percent of all Germans suffer from depression that requires treatment at least once in their life. Antidepressants can – in addition to psychotherapy – help to find more joy in life again. But which ones are really suitable? Warentest found that out.
Persistent sadness, inner emptiness and lack of strength are just a few of the distressing symptoms that can occur with depression. Mental illness should by no means be underestimated, because if it is not treated in time, there is a risk of further psychological complications and, in the worst case, even suicide. In the case of moderate and severe depression, treatment with antidepressants can be an option in addition to psychotherapy.
But do the remedies really help against the stressful symptoms? What is the risk-benefit ratio for the individual preparations that are currently available? The testers from Stiftung Warentest took a closer look at six over-the-counter and 25 prescription-only remedies for mental illness.
Those who are only affected by a mild depressive episode should avoid taking prescription medication. The reason for this is that studies have shown that these antidepressants work no better than a placebo. If you still want to take something, St. John’s wort is an option. It is also available over the counter in drugstores and pharmacies. Here, Stiftung Warentest recommends Laif 900 Balance (0.68 euros per daily ration) and Neuroplant Aktiv (0.62 euros per daily ration), as these products not only work, but are also inexpensive. John’s wort is generally well tolerated. However, there are also disadvantages. Anyone who takes medication or the pill may have to reckon with interactions. For example, the preparations can ensure that thyroid patients suddenly need a higher dose of L-thyroxine. Furthermore, contraceptive safety can be impaired when taking the pill.
If you have moderate depression, you don’t necessarily have to take prescription medication. Of course that is an option. However, it can be worthwhile to first contact a psychotherapist. The professional treatment offered there is often sufficient to get the symptoms under control. If the depression is already more advanced, it should be treated with medication and psychotherapy. The earlier you get help, the better. Diagnostic questionnaires can be used to determine how severe the depression is in an individual case. It should also be noted that psychologists and psychotherapists cannot prescribe antidepressants if they do not have medical residency training. It is therefore often necessary in such cases to also consult a psychiatrist.
There are different types of antidepressants. These include, for example, the serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors (SNRI), tetracyclic antidepressants, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). According to the product test, all of the SSRI drugs are suitable. They work not only against the depressive mood, but also against fears. In addition, they do not make you tired. The testers only see problems with fluoxetine because the drug is still effective a few days after ingestion and interactions with other drugs are common. According to Warentest, SNRIs are more likely to have side effects (nausea, restlessness, sleep disorders, etc.), but the drugs do their job and work reliably against depression and anxiety. The testers only recommend the active ingredient Milancipran to a limited extent, since further studies on the effectiveness and safety of this drug are still required.
Of the tetracyclic antidepressants, the testers only consider mirtazapine to be suitable. It has a calming and anxiolytic effect. Mianserin sometimes even threatens serious bleeding disorders. According to Warentest, all of the TZA are suitable. However, they tend to make you tired and often have side effects such as weight gain or dizziness. Here – as with all antidepressants – a doctor’s consultation is necessary as to whether the drugs are suitable. With the MAO inhibitors, restrictions in nutrition are often necessary, especially with the active ingredient tranylcypromine, which is why Stiftung Warentest only recommends it to a limited extent. The testers consider other agents such as agomelatine or tianepin to be only recommended to a limited extent. The reason for this is that further studies are required here that can prove the therapeutic effectiveness. However, they can be used if all other antidepressants have so far had little effect and/or are not tolerated.
It is important to have patience. Antidepressants often take weeks to take effect. However, if the desired effect does not appear for a long time, it may be worth switching to another drug in consultation with the doctor treating you.
