Como trocar antidepressivos com segurança

Several years ago, I was prescribed the antidepressivo citalopram for transtorno de ansiedade generalizada. As I expected, the first few weeks were rough - I felt enjoado e confuso, and I had constant dores de cabeça. Eu pensei que os efeitos colaterais desapareceriam com o tempo, mas infelizmente não desapareceram. Meses depois, eu me sentia tão ansioso quanto antes e meu cérebro parecia estar cheio de algodão, tornando difícil focar em qualquer coisa.

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 fadiga 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 ansiedade 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 transtorno disorder," says Dra. Natasha Bijlani, a consultant psychiatrist at Priory Hospital Roehampton. "These drugs can have a valuable role to play in the management of moderate to severe ansiedade disorders, alongside psychological interventions such as terapia cognitivo-comportamental."

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

Como mudar antidepressivos com segurança

Switching antidepressivos 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 alergias 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 saúde mental issue to return.

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

Desmame cruzado

"Um método chamado 'cross-tapering' é geralmente aconselhável," diz Bijlani. "Isso ocorre quando a dose do medicamento que foi considerado ineficaz ou mal tolerado é reduzida lentamente, enquanto o novo medicamento é introduzido gradualmente. No caso de alguns medicamentos, o cross-tapering deve ser evitado devido ao risco de efeitos adversos graves com o uso combinado."

Troca direta

Depending on the type of medication you are taking, it may be possible to stop taking your current drug and start on a new antidepressivo 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.

Reduzir e trocar

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

Desmame, lavagem e troca

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

O período de eliminação pode durar alguns dias ou semanas, dependendo do medicamento que você estava tomando originalmente e de quanto tempo leva para sair completamente do seu sistema. Essa abordagem pode ajudar a prevenir a interação entre os dois medicamentos e pode ser recomendada se você estiver mudando de uma classe de antidepressivos para outra.

Como seu médico escolherá a estratégia certa

Quando se trata de mudar sua medicação, a abordagem que seu médico escolherá dependerá de vários fatores diferentes. Eles levarão em consideração a gravidade dos seus sintomas, pois pode não ser seguro para você parar de tomar antidepressivos por dias ou 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 em cruzamento with the SSRIs paroxetine and fluvoxamine.

Your doctor will check guidance such as do Instituto Nacional para Excelência em Saúde e Cuidados (NICE) to confirm which strategy to take.

Por que trocar antidepressivos é um processo 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 depressão e ansiedade.

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 síndrome in the body, which can cause a range of symptoms from agitation and confusion to pressão alta e convulsões.

"A troca de antidepressivos deve ser feita apenas por indivíduos seguindo orientação médica", diz Bijlani, "As pessoas devem ter revisões regulares, bem como a oportunidade de se comunicar com seu médico sobre quaisquer problemas que possam estar enfrentando durante o processo."