¿Debería cambiar de antidepresivos?

Cuándo considerar cambiar de antidepresivos

For people living with mental illness, antidepresivos can be an invaluable lifeline. However, it can be a case of trial and error to find the right type.

"There is a large body of evidence for the efficacy of antidepressant medication in those who experience 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," she adds. "The initial selection of an antidepressant is usually based on anticipated side effects, safety and tolerability for individual patients, patient preference, prior experience of antidepresivo medication and cost."

As is the case with many medications, however, people can respond differently to antidepresivos. Las personas pueden encontrar un tipo de medicamento más efectivo que otro, por lo que puede ser necesario cambiar de medicación con el tiempo hasta encontrar la opción adecuada.

"There can be various reasons for a doctor to consider switching to a different antidepresivo," dice Bijlani. "Una razón podría ser si no hay respuesta, o no hay una respuesta o mejora suficiente con la primera después de cuatro a seis semanas de uso, incluso después de haber aumentado la dosis al nivel máximo recomendado para ese medicamento."

According to a revisión de 2015, una de cada tres personas estará libre de síntomas después de tomar un antidepresivo. Por lo tanto, algunas personas pueden necesitar varios ensayos con antidepresivos antes de lograr una "remisión efectiva de los síntomas", explica Bijlani.

Efectos secundarios de los antidepresivos

People may also want to change antidepressants because of persistent side effects. Although they can be unpleasant, the initial side effects of antidepressants often subside after a few weeks. The common side effects of SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-noradrenaline reuptake inhibitors) include feeling agitated or more ansioso, feeling sick, indigestión, digestive problems, loss of apetito, insomnio y dolores de cabeza.

Side effects of tricyclic antidepressants (TCAs) include dry mouth, slight blurring of vision, constipation, problems passing urine, drowsiness, mareos, palpitaciones or a fast heartbeat (tachycardia).

After a few weeks, the side effects should ease as the body adjusts to the medicamento. Sin embargo, algunos efectos secundarios pueden persistir, y cambiar de medicación puede ayudar.

"Todos los medicamentos tienen el potencial de causar efectos no deseados, además de los efectos beneficiosos por los cuales el medicamento fue recetado en primer lugar. Los efectos secundarios pueden variar de una persona a otra y un medicamento que es muy bien tolerado y beneficioso para una persona puede ser completamente inadecuado para otra, explica Bijlani.

"Some patients may experience a slight increase in agitation or ansiedad as their body adjusts to some of the effects of the medication. If any of these symptoms become more intense within seven to 10 days of starting treatment, then the individual should seek guidance from the doctor who prescribed the medication."

In rare cases, some patients may experience pensamientos suicidas while taking antidepressant medication. "They should be advised to seek immediate and urgent medical help," says Bijlani.

"There are many different classes of antidepresivos available and if one particular drug doesn't seem effective or leads to unpleasant side effects, your doctor is likely to be able to suggest alternatives that could be better tolerated and efficacious for your symptoms."

Por qué cambiar de antidepresivos es un proceso cuidadoso

It's crucial not to stop taking your medication without speaking to your doctor first. When switching medications, the process needs to be gradual and any increases in dosages should be slow. Stopping your current medication too quickly can lead to síntomas de abstinencia or can cause symptoms of depresión o ansiedad to return.

También es importante que su médico lo supervise en busca de efectos secundarios mientras cambia de medicación, así como de interacciones adversas entre diferentes medicamentos. "Cambiar de antidepresivos a veces puede provocar síntomas de abstinencia, especialmente si el cambio se realiza demasiado rápido", dice Bijlani.

"Although antidepressants are not considered to be addictive, suddenly discontinuing or reducing the dose by too much can lead to uncomfortable and sometimes very unpleasant discontinuation symptoms which include gripe-like symptoms, insomnio, irritability, llantos spells and agitation. Patients can also occasionally experience movement disorders and problems with memory and concentration."

A veces, si se toman dos antidepresivos al mismo tiempo como parte del proceso de cambio, las personas pueden experimentar problemas como presión arterial baja y somnolencia.

Síndrome serotoninérgico

Some people may experience a rare condition called serotonin syndrome. This occurs when too much serotonina - a neurotransmitter that plays an important role in the functioning of nerve and brain cells and mood regulation - builds up in the body.

"Mild symptoms of serotonin syndrome include insomnio, ansiedad, náuseas, diarrea, and increased heart rate," says Bijlani. "Patients can go on to develop moderate and severe symptoms such as agitation, temblor, flushing, low-grade fiebre and eventual confusion, higher fever, respiratory failure, and even death."

Para reducir el riesgo de síndrome de serotonina, es necesario realizar una transición cruzada en algunas combinaciones de antidepresivos. Esto implica reducir gradualmente la dosis del primer antidepresivo al mismo tiempo que se aumenta lentamente la dosis de otro. Para otros, puede ser seguro dejar un antidepresivo y comenzar el otro al día siguiente.

To avoid problems, switching antidepresivos should always be done under the supervision of your doctor, who can advise on doses and keep track of any side effects or problems.