Fake medicine in hospitals

This is the 4641th article of Da Yi Xiao Hu

One day, a middle-aged lady came to the outpatient clinic. The patient was a follow-up patient. She came in with anger and said, "Doctor, your medicine is not effective at all. I feel nauseous and can't eat after taking it. Is your medicine "fake"? After listening to her, I quickly looked through her medical history and learned that the patient was diagnosed with "depressive episode" a week ago. It was the first time to take an antidepressant drug, the main mechanism of which is to inhibit the reuptake of serotonin (5-HT), that is, 5-HT reuptake inhibitors (SSRIs).

1. Is this drug a fake one?

The answer is yes - it is not a fake drug. The drug has passed clinical trials, has its own ID card (drug approval number issued by the National Drug Administration), and is a regular drug.

2. So why is there no effect after taking the medicine for a week?

That is because the pharmacological mechanism of the drug is to inhibit the reuptake of 5-HT by the 5-HT transporter to increase the concentration of 5-HT and further improve our mood. We hope to increase 5-HT on the target receptors and target pathways (axon terminals in the brain area) to produce therapeutic effects, such as improving depression and anxiety. However, in fact, during drug treatment, 5-HT on the cell body dendrites located in the raphe nucleus will increase first, and after a series of pharmacological effects, 5-HT on the axon terminals in the brain area will increase, which generally takes about two weeks.

3. Why are there adverse reactions?

That's because during drug treatment, 5-HT in all pathways and receptors may increase. Some effects are undesirable, which are adverse reactions, such as increased gastrointestinal motility, gastrointestinal cramping and diarrhea. Many of the adverse reactions of SSRIs occur during the acute phase of treatment, when treatment is first started, and are gradually tolerated as treatment continues. Fortunately, most of the adverse reactions of SSRIs are just annoying and not very dangerous. Generally, they can be gradually reduced with treatment. However, for some patients, these adverse reactions may be severe, causing patients to stop taking the drug because they cannot tolerate it or cannot completely relieve their depressive symptoms.

After listening to the doctor's explanation, the patient suddenly realized that the doctor had told me that this medicine takes a long time to work and may cause adverse gastrointestinal reactions. I'm sorry to have wasted your time, but your explanation has given me more confidence in the treatment. I'll go back and take it for a while and see.

Author: Shanghai Fengxian District Mental Health Center

Psychiatry Department Attending Physician Wang Chunlian

Wang Jinde Attending Physician