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¿Por qué los antidepresivos pueden mejorar los síntomas del colon irritable? Uno de los síntomas del colon irritable es la diarrea.
El Síndrome de Intestino Irritable (SII ) al que lo habitual es referirse como “colon irritable” es una enfermedad crónica del tubo digestivo . A pesar de su condición de patología benigna algunos de sus síntomas como la diarrea pueden ser incómodos para llevar un ritmo de vida normal. Además, si el paciente sufre episodios de ansiedad o se debe enfrentar a eventos estresantes la situación empeora. En Uppers hemos consultado sus causas, cuáles son todos sus síntomas, qué tratamiento se recomienda y por qué los antidepresivos pueden mejorar el colon irritable .
El SII se produce en el colon, que concretamente es el intestino grueso y la parte final del sistema digestivo. Se trata de un tubo largo y hueco donde el organismo produce y almacena las heces. La enfermedad es un trastorno del funcionamiento del tubo digestivo, tal como se ha dicho, crónico y benigno. La Fundación Española del Aparato Digestivo (FEAD) destaca que es el trastorno gastrointestinal más frecuente y, después del resfriado común, la segunda causa de absentismo laboral debido a sus síntomas .
Los síntomas del colon irritable Estos síntomas se manifiestan con la alteración del hábito intestinal , ya que se produce diarrea o estreñimiento e incluso ambas alternativamente, al igual que cambios en la frecuencia de las deposiciones o en su consistencia. Otras consecuencias son hinchazón o dolores abdominales , que pueden ser difusos o localizados y de moderada intensidad y que suelen desaparecer tras la defecación. Sin embargo, esos dolores respetan el sueño. Muchas veces, los pacientes lo relacionan con alimentos que han comido y les han sentado mal , por ello, tal como subraya la Fundación, sólo un 15% de los afectados acude a consulta por este motivo.
Junto a los dolores abdominales , los afectados notan distensión abdominal y tenesmo rectal (que es la sensación de no quedarse satisfecho tras la defecación), además de dolor anal o torácico, ardor (pirosis), saciedad precoz al comer, náuseas, vómitos o flatulencias , entre otros. En ocasiones se produce incontinencia fecal o las heces presentan moco . Además, es frecuente que estos síntomas empeoren ante ciertas alteraciones psicológicas como la ansiedad, la depresión, la angustia o eventos estresantes.
Los profesionales aconsejan acudir al médico cuando una persona se encuentra en estas circunstancias, sobre todo si tiene más de 50 años. Por otra parte, el estadio puede empeorar con la presencia de síntomas nocturnos, diarrea continua o liquida, la presencia de sangre en las heces, la pérdida de peso no intencionada, dolor abdominal muy intenso o existen antecedentes familiares de cáncer de colon o enfermedad inflamatoria intestinal.
El reto del control de los síntomas del colon irritable Desde la Fundación Española del Aparato Digestivo aseguran que “la naturaleza crónica del SII y el reto que supone controlar sus síntomas puede ser frustrante tanto para los pacientes como para los médicos”. No obstante, existen tratamientos y terapias que consiguen ayudar a mejorar bastante la calidad de vida, más aún cuando se trata de una afección benigna. El hecho de que “no predispone a otras enfermedades ni a cáncer ayuda a los pacientes a afrontar su patología y tratamiento con mayor serenidad”, apuntan desde la organización.
Estos tratamientos para el colon irritable se centran en aliviar los síntomas que se vayan presentando. Cuando son leves el control del estrés ayuda bastante porque se pueden mantener a raya. De la misma manera es importante revisar las costumbres y los hábitos si fuera necesario. Casi todo se relaciona con llevar una vida saludable donde la alimentación, el ejercicio y el sueño son los pilares básicos .
En la Fundación constatan que el tratamiento consiste en combinar un estilo de vida saludable, una dieta adecuada y farmacología . Una vida ordenada y equilibrada; hacer ejercicio cada día acomodado a la persona; ser regular a la hora de defecar diariamente; no fumar ni consumir alcohol; realizar entre cuatro y cinco comidas diarias; masticar bien y tomarse tiempo para comer; e identificar aquellos alimentos que no sientan bien para reducir o eliminar su consumo.
Generalmente suelen ser las especias, la cafeína, los picantes, las grasas y los alimentos que provocan gases o están muy condimentados . Igualmente se recomienda que sea un experto en nutrición quien ayude a elaborar una dieta individualizada o a enumerar esas comidas que se tienen que evitar según los síntomas. Es habitual que se aconseje moderar el consumo de fibra insoluble y potenciar el consumo de fibra soluble como el dulce de membrillo o la manzana.
Los antidepresivos contra el colon irritable Con todo ello, de entre la farmacología que se receta, tal como describe la Fundación, en ocasiones se prescriben antidepresivos. El objetivo “no es regular el estado de ánimo ”, destaca la Fundación. Lo que se aplica en estos casos es “su mecanismo de acción a nivel intestinal”. Puede utilizarse el grupo de antidepresivos tricíclicos o el grupo de los ISRS (inhibidores selectivos de la recaptación de serotonina). Regulan la sensibilidad visceral y favorecen la motilidad (la capacidad para que el intestino se mueva de forma espontánea). La entidad también subraya que se debe tener en cuenta que los estudios disponibles que han analizado la eficacia de los antidepresivos para mejorar los síntomas de los pacientes con SII “son muy heterogéneos”.
Por una parte, los antidepresivos tricíclicos en principio son eficaces para aliviar el dolor abdominal por sus efectos anticolinérgicos ya que inhiben la actividad de las neuronas que controlan los intestinos . Se prescriben en dosis bajas si el paciente no padece depresión y suelen ser más eficaces en aquellas personas que el SII se manifiesta con diarreas . Los antidepresivos se deben tomar antes de acostarse debido a sus efectos secundarios: somnolencia, visión borrosa, mareos o sequedad en la boca. Por otra parte, los antidepresivos ISRS se emplean cuando el colon irritable cursa con estreñimiento y dolor.
Desde otros ámbitos especializados pautan, además de antidepresivos o los medicamentos que correspondan, la participación de psicólogos especializados. Señalan que “el mecanismo fisiopatológico esencial en esta enfermedad es la hipersensibilidad visceral por lo que el tratamiento debe estar dirigido a modelos terapéuticos que tengan acción sobre ésta”. Así, es básica la individualización de la selección terapéutica en función de los síntomas predominantes .
Los pacientes muy angustiados por ellos pueden asistir a terapia cognitivo conductual. También nombran la hipnoterapia, donde el especialista conduce al paciente a una relajación progresiva para crear imágenes relacionadas con el control de los síntomas y la normalización de la función intestinal, aunque en este caso hay dudas sobre la metodología. Por supuesto, los expertos ponen de manifiesto que en muchas ocasiones se combinan todas las opciones con resultados positivos, incluyendo los antidepresivos en dosis bajas. Siempre será el profesional médico quien paute lo más oportuno en cada caso.
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