Hur man byter antidepressiva säkert

Several years ago, I was prescribed the antidepressiva citalopram for generaliserat ångestsyndrom. As I expected, the first few weeks were rough - I felt illamående och dimmig, and I had constant huvudvärk. Jag trodde att biverkningarna skulle avta med tiden, men tyvärr gjorde de inte det. Månader senare kände jag mig lika orolig som tidigare och min hjärna kändes som om den var fylld med bomull, vilket gjorde det svårt att fokusera på något.

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 trötthet 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 ångest 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 depressiv disorder," says Dr 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 ångest disorders, alongside psychological interventions such as kognitiv beteendeterapi."

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

Hur man byter antidepressiva säkert

Switching antidepressiva 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 allergier 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 mentala hälsa issue to return.

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

Kors-titrering

"En metod som kallas 'cross-tapering' är generellt sett att rekommendera," säger Bijlani. "Detta är när dosen av läkemedlet som har bedömts som ineffektivt eller dåligt tolererat långsamt minskas, medan det nya läkemedlet gradvis introduceras. I vissa fall måste cross-tapering undvikas på grund av risken för allvarliga biverkningar vid kombinationsanvändning."

Direkt byte

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

Minska och byt

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

Avsmalning, utsköljning och byte

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

Utsättningsperioden kan vara några dagar eller veckor, beroende på vilken medicin du ursprungligen tog och hur lång tid det tar för den att helt lämna ditt system. Denna metod kan hjälpa till att förhindra att de två läkemedlen interagerar och kan rekommenderas om du byter från en klass av antidepressiva till en annan.

Hur din läkare kommer att välja rätt strategi

När det gäller att ändra din medicinering kommer den metod som din läkare väljer att bero på olika faktorer. De kommer att ta hänsyn till hur allvarliga dina symtom är, eftersom det kanske inte är säkert för dig att sluta med antidepressiva medel under dagar eller veckor.

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 kors-titreras with the SSRIs paroxetine and fluvoxamine.

Your doctor will check guidance such as från det Nationella institutet för hälsa och vård (NICE) to confirm which strategy to take.

Varför byte av antidepressiva är en känslig process

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 depression och ångest.

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 serotonin in the body, which can cause a range of symptoms from agitation and confusion to högt blodtryck och anfall.

"Att byta antidepressiva läkemedel bör endast göras av individer som följer medicinsk vägledning," säger Bijlani, "Människor bör ha regelbundna uppföljningar samt möjlighet att kommunicera med sin läkare om eventuella problem de kan uppleva under processen."