Cómo cambiar de antidepresivos de manera segura

Several years ago, I was prescribed the antidepresivo citalopram for trastorno de ansiedad generalizada. As I expected, the first few weeks were rough - I felt mareado y confuso, and I had constant dolores de cabeza. Pensé que los efectos secundarios desaparecerían con el tiempo, pero desafortunadamente no lo hicieron. Meses después, me sentía tan ansioso como antes y mi cerebro parecía estar lleno de algodón, lo que hacía difícil concentrarme en cualquier cosa.

I spoke to my doctor, who suggested switching to another type of SSRI (selective serotonin reuptake inhibitor) called sertraline. We worked out a plan to taper off the old medication gradually and introduce the new one, to avoid me feeling worse in the interim. However, I still experienced a plethora of miserable symptoms, from nausea and fatiga to 'brain zaps' - mini electric shock-like sensations in the brain.

After some time, though, my body began to adjust to the new drugs and I began to feel better. The side effects wore off and my ansiedad began to feel more manageable. Had I switched medications more suddenly, my unpleasant symptoms may have been much worse.

"There is a large body of evidence for the effectiveness of antidepressant medication in people with moderate to severe la Dra. Natasha Bijlani disorder," says la Dra. Natasha Bijlani, a consultant psychiatrist at Hospital Priory Roehampton. "These drugs can have a valuable role to play in the management of moderate to severe ansiedad disorders, alongside psychological interventions such as terapia cognitivo-conductual."

However, not everyone finds the right antidepresivo for them on the first attempt. For me, it took changing medications to finally get my anxiety under control - a gradual but worthwhile process.

Cómo cambiar antidepresivos de manera segura

Switching antidepresivos should only be carried out under the advice and guidance of an experienced doctor who is aware of your history and any co-existing medical problems. It's also important for your doctor to know about any alimentarias or other medications you are taking, to avoid interactions.

It's essential to keep taking your medication unless your doctor says otherwise - and to follow their plan for switching drugs. Stopping your current medication too quickly can lead to withdrawal symptoms, or can cause the symptoms of your salud mental issue to return.

"If a patient needs to change from one antidepressant to another, abrupt la retirada should usually be avoided," says Bijlani.

Reducción cruzada

"Un método denominado 'reducción cruzada' es generalmente recomendable," dice Bijlani. "Esto es cuando la dosis del medicamento que se ha considerado ineficaz o mal tolerado se reduce lentamente, mientras que el nuevo medicamento se introduce gradualmente. En el caso de algunos medicamentos, se debe evitar la reducción cruzada debido al riesgo de efectos adversos graves con el uso combinado."

Cambio directo

Depending on the type of medication you are taking, it may be possible to stop taking your current drug and start on a new antidepresivo the next day. However, this can depend on whether you are going from an SSRI or SNRI (serotonin-norepinephrine reuptake inhibitor) to another drug in the same class.

Reducir y cambiar

"With some drugs, one could gradually reduce the dose of the first antidepressant and then start the second antidepresivo immediately after discontinuation of the first," says Bijlani.

Reducción, lavado y cambio

"Sometimes tapering the first drug until it is stopped, then switching to the second antidepresivo after waiting for a few days, is recommended. The interval between use of one antidepressant and another is termed the 'washout' period," adds Bijlani.

El período de eliminación puede durar unos días o semanas, dependiendo del medicamento que estabas tomando originalmente y cuánto tiempo tarda en salir completamente de tu sistema. Este enfoque puede ayudar a prevenir que los dos medicamentos interactúen y puede ser recomendado si estás cambiando de una clase de antidepresivos a otra.

Cómo su médico elegirá la estrategia adecuada

Cuando se trata de cambiar tu medicación, el enfoque que elija tu médico dependerá de varios factores diferentes. Tendrán en cuenta la gravedad de tus síntomas, ya que puede no ser seguro que dejes de tomar antidepresivos durante días o semanas.

It can also depend on your current medication and which drugs you are switching between. Certain antidepressants can interact with each other in dangerous ways. For example, it is inadvisable for clomipramine - a type of tricyclic antidepressant - to be titulada cruzadamente with the SSRIs paroxetine and fluvoxamine.

Your doctor will check guidance such as del Instituto Nacional para la Excelencia en Salud y Atención (NICE) to confirm which strategy to take.

Por qué cambiar de antidepresivos es un proceso delicado

Crucially, the process of changing antidepressants should be done with care, under the supervision of your doctor. This will help to avoid side effects and the worsening of the symptoms of depresión y ansiedad.

Another risk of switching antidepressants is serotonin syndrome, a potentially serious condition that can occur if you start taking a new medication before the old one is out of your system. It is an excess of serotonina in the body, which can cause a range of symptoms from agitation and confusion to presión arterial alta y convulsiones.

"El cambio de antidepresivos solo debe realizarse bajo la guía médica," dice Bijlani, "Las personas deben tener revisiones regulares, así como la oportunidad de comunicarse con su médico sobre cualquier problema que puedan estar experimentando durante el proceso."