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La lucha incierta para dejar los antidepresivos


Raquel Segovia

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Los síntomas que se presentan pueden ser complejos de tratar

Victoria Toline de Tacoma, Washington, dijo que le llevó 9 meses dejar atrás un antidepresivo. Dice que recién ahora siente que puede intentar "reingresar a la sociedad "Ruth Fremson/The New York Times).

Por Benedict Carey y Robert Gebeloff

Victoria Toline se encorvaba sobre la mesa de la cocina, ponía firmes las manos y extraía una gota de un frasquito con un gotero. Era una operación delicada que se había vuelto una rutina diaria: extraer dosis cada vez más pequeñas del antidepresivo que había tomado durante tres años, de manera intermitente, y que desesperadamente intentaba dejar.

Aconsejada por su ginecólogo, Robin Hempel empezó a tomar antidepresivos debido a un cuadro premestrual severo (Cheryl Senter para The New York Times)

Aconsejada por su ginecólogo, Robin Hempel empezó a tomar antidepresivos debido a un cuadro premestrual severo (Cheryl Senter para The New York Times)

“Básicamente eso es todo lo que he estado haciendo —lidiar con los mareos, la confusión, la fatiga, todos los síntomas de la abstinencia”, dijo Toline, de 27 años. Le tomó nueve meses desacostumbrarse al fármaco, Zoloft (sertralina), al tomar dosis cada vez más pequeñas.

“No pude terminar mis estudios universitarios”, dijo. “Apenas ahora me siento lo suficientemente bien para intentar reingresar a la sociedad y volver a trabajar”.

El uso prolongado de antidepresivos está en alza en Estados Unidos, de acuerdo con un nuevo análisis de datos federales realizado por The New York Times. Alrededor de 15,5 millones de estadounidenses llevan por lo menos 5 años tomando estos medicamentos. La tasa casi se ha duplicado desde 2010 y aumentó a más del triple desde 2000.

Las prescripciones a largo plazo de antidepresivos están en aumento en gran parte del mundo desarrollado. La Organización para la Cooperación y el Desarrollo Económicos, que cuenta con 35 miembros, reportó en 2017 que el consumo de medicamentos antidepresivos se duplicó en los países miembros entre 2000 y 2015.

En Gran Bretaña, las tasas de prescripciones se han duplicado en la última década, y las autoridades de salud comenzaron en enero una revisión nacional de la dependencia y abstinencia de los medicamentos de prescripción médica.

Y en EE.UU., casi 25 millones de adultos han estado tomando antidepresivos durante al menos dos años, un incremento del 60 por ciento desde 2010.

Estos fármacos han ayudado a millones de personas a aliviar la depresión y la ansiedad, y son ampliamente considerados como un antes y una después en el tratamiento psiquiátrico. Muchas personas, quizá la mayoría, deja de tomar los medicamentos sin problemas significativos. Pero el aumento en el empleo a largo plazo también es resultado de un problema creciente e imprevisto: muchos que intentan dejar el medicamento dicen no poder hacerlo debido a los síntomas de abstinencia de los cuales nunca les advirtieron.

Algunos científicos previeron hace mucho tiempo que unos cuantos pacientes podrían experimentar síntomas de abstinencia si intentaban dejar los antidepresivos —lo llamaron “síndrome de discontinuación”.

Los fármacos fueron aprobados en un principio para el uso a corto plazo, tras estudios que duraban unos dos meses. Incluso hoy, hay pocos datos sobre el uso a largo plazo.

Con financiamiento del gobierno, Anthony Kendrick, profesor en la Universidad de Southampton en Gran Bretaña, está desarrollando apoyo telefónico y online para ayudar a médicos y pacientes. “¿Realmente debemos recetar antidepresivos a largo plazo a tanta gente cuando no sabemos si es bueno para ellos, o si podrán dejarlos?”, cuestionó.

Los antidepresivos fueron originalmente prescritos para problemas episódicos del ánimo, para ser tomados durante seis a nueve meses, lo suficiente para superar una crisis.

Estudios posteriores sugirieron que el uso a mayor plazo podría evitar que la depresión regresara en algunos, pero esas pruebas en raras ocasiones duraron más de dos años.

Los antidepresivos por lo regular causan anestesia emocional, problemas sexuales como falta de deseo o disfunción eréctil y aumento de peso. Algunos usuarios a largo plazo reportan una creciente inquietud por el uso diario de los fármacos.

“Hemos llegado a un punto, al menos en Occidente, en que parece que la mitad de la gente está deprimida y toma medicamentos de prescripción”, dijo Edward Shorter, historiador de psiquiatría en la Universidad de Toronto.

Las compañías farmacéuticas no niegan que algunos pacientes sufren síntomas severos de abstinencia.

“La probabilidad de desarrollar síndrome de discontinuación varía según la persona, el tratamiento y la dosis prescrita”, dijo Thomas Biegi, vocero de Pfizer, fabricante de Zoloft y Effexor (venlafaxina).

La farmacéutica Eli Lilly, en referencia a dos medicamentos populares, señaló en un comunicado que la compañía “sigue comprometida con Prozac (fluoxetina) y Cymbalta (duloxetina) y la seguridad y los beneficios de éstas”.

Los pocos estudios que han sido publicados sugieren que es más difícil dejar algunos medicamentos que otros. Esto se debe a la vida media de los fármacos.

Las marcas con una vida media relativamente corta, como Effexor y Paxil (paroxetina), parecen causar más síntomas con más rapidez que las que permanecen en el organismo por más tiempo, como Prozac.

En un estudio, Eli Lilly hizo que personas que tomaban Zoloft, Paxil o Prozac las dejaran de manera abrupta, durante una semana. La mitad de las que tomaban Paxil tuvieron mareos serios; el 42 por ciento, confusión, y el 39 por ciento, insomnio.

Entre los pacientes que dejaron de tomar Zoloft, el 38 por ciento tuvo irritabilidad severa; el 29 por ciento experimentó mareos, y el 23 por ciento, fatiga. Los síntomas se solucionaron una vez que volvieron a tomar las pastillas.

Quienes tomaban Prozac no experimentaron un aumento inicial en los síntomas cuando lo dejaron, pero este resultado no fue ninguna sorpresa. El Prozac necesita varias semanas para ser desechado por completo del cuerpo, así que la interrupción de una semana no es una prueba de abstinencia.

En un estudio de Cymbalta, las personas en abstinencia experimentaron de dos a tres síntomas en promedio. Los más comunes eran mareos, náuseas, dolor de cabeza y parestesia —sensación de descargas eléctricas en el cerebro. La mayoría de estos síntomas duraron más de dos semanas.

“Me tomó un año dejarlo por completo —un año”, dijo Tom Stock­mann, psiquiatra de 34 años, de Londres, que experimentó confusión, vértigo y la sensación de descargas cerebrales cuando dejó de tomar Cymbalta luego de 18 meses. Comenzó a quitar unas cuantas bolitas de las cápsulas del medicamento cada día —la única salida, decidió. “Sabía que algunas personas experimentaban reacciones de abstinencia, pero no tenía idea de lo difícil que sería”, dijo Stockmann.

Robin Hempel, de 54 años, de New Hampshire, empezó a tomar el antidepresivo Paxil hace 21 años para el síndrome premenstrual severo por recomendación de su ginecólogo. “Me dijo: ‘esta pastillita te va a cambiar la vida’”, recordó. “Y vaya que lo hizo”.

El medicamento mitigó sus síntomas del SPM, dijo, pero también provocó que subiera casi 20 kilos en nueve meses.

Dejarlo fue casi imposible. Hempel lo logró, en 2015, al disminuir con el paso de los meses a 10 miligramos, luego a 5, de los 20 que tomaba y “finalmente hasta llegar a partículas de polvo”, después de lo cual estuvo postrada en cama tres semanas con mareos, náuseas y episodios de llanto.

“Si me hubieran dicho los riesgos de tratar de dejar este medicamento, nunca hubiera empezado a tomarlo”, dijo Hempel.

Por ahora, las personas que no han podido dejarlo siguiendo las recomendaciones del médico están recurriendo a la microdisminución gradual: hacer diminutas reducciones durante nueve meses, un año, dos años —lo que sea necesario.

“Se ha requerido muchísimo tiempo para que alguien ponga atención a esta problemática”, dijo Luke Montagu, fundador del Consejo para Psiquiatría Basada en Evidencia, con sede en Londres, que impulsó la revisión británica de la adicción y dependencia de los medicamentos de prescripción.

“Ha surgido una enorme comunidad paralela, principalmente online, en la que las personas se apoyan entre sí a superar la abstinencia y desarrollar mejores prácticas en gran medida sin la ayuda de doctores”, señaló.

“Un año y medio después de dejarlo, aún tengo problemas. No soy yo en este momento. No tengo creatividad, energía. Ella (Robin) se ha ido”.

© 2018 The New York Times

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