Loaʻa iā ʻoe kekahi kaumaha koʻikoʻi, a i ʻole e like me kā mākou e kapa nei ma ke ʻano lapaʻau, ʻo Major Depressive Disorder (MDD)? ʻOiai ma hope o ka hoʻohana ʻana i hoʻokahi a ʻelua paha lāʻau lapaʻau i kuhikuhi ʻia e ke kauka, ʻaʻole ʻoe e ʻike i kekahi hoʻomaikaʻi a loli paha? "He aha kaʻu e hana ai i kēia manawa?" Ke noʻonoʻo nei paha ʻoe me ka huhū nui. He mea maʻamau loa ka manaʻo mehameha a me ke kōkua ʻole i ka manawa e like me kēia. Akā, mai makaʻu. ʻAʻole ʻoe hoʻokahi. I ka holomua ʻana o ka ʻepekema, kū mai nā manaʻolana hou. I kēia lā, ke kamaʻilio nei mākou e pili ana i ia manaʻolana hou.
ʻO ka mea mua, e hoʻomanaʻo iki mākou iā ʻoe e pili ana i nā antidepressants maʻamau i kuhikuhi ʻia.
Inā ua hoʻomaka ʻoe i ka mālama ʻana no ke kaumaha, ua kuhikuhi mua paha kāu kauka iā ʻoe i kahi ʻano lāʻau i kapa ʻia he 'antidepressant kuʻuna.' Aia kekahi mau ʻano nui o kēia. Hana kēia mau lāʻau lapaʻau ma ke kaulike ʻana i ka hana o nā ʻelele kemika i loko o ka lolo, i kapa ʻia he neurotransmitters , e hoʻopilikia ana i ko mākou ʻano a me nā manaʻo. ʻO kēia mau mea ʻo serotonin , norepinephrine , a me dopamine .
Akā, aia kekahi mau pilikia me kēia mau lāʻau lapaʻau. ʻO kekahi, he manawa pōkole ko lākou e hoʻomaka ai e hana. Pono ʻoe e kali ma kahi o ʻehā a ʻewalu pule e ʻike i nā hopena. ʻO kekahi, ʻaʻole like ka hana o kēia mau lāʻau lapaʻau no nā kānaka a pau. Hōʻike nā haʻawina ʻaʻole i loaʻa i ʻelua o kēlā me kēia ʻekolu poʻe e hoʻohana ana iā lākou kahi ho'ōla piha .
I mea e maʻalahi ai iā ʻoe ke hoʻomaopopo, e nānā kākou i kekahi o nā lāʻau lapaʻau i hoʻohana pinepine ʻia ma kahi papa e like me kēia.
| Papa Lāʻau Lapaʻau | Nā Laʻana Maʻamau |
|---|---|
| Nā SSRI (Nā mea pale i ka hoʻihoʻi hou ʻana o ka serotonin koho) | ʻO Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline |
| Nā SNRI (Serotonin-Norepinephrine Reuptake Inhibitors) | ʻO Duloxetine, Venlafaxine |
| Nā lāʻau hoʻohaʻahaʻa kaumaha ʻano ʻole | ʻO Bupropion, Mirtazapine, Trazodone |
Inā ua hoʻāʻo ʻoe i hoʻokahi a ʻoi aku paha o kēia mau lāʻau lapaʻau a ʻaʻole naʻe ʻoe e ʻoluʻolu, mai hopohopo. ʻAʻole ia kou hewa. ʻO nā manawa e like me kēia e noʻonoʻo ai nā kauka e pili ana i nā lāʻau lapaʻau hou a ʻoi aku ka holomua.
No laila he aha kēia mau lāʻau lapaʻau NMDA hou?
I ka ʻōlelo maʻalahi, he ʻano ʻokoʻa loa kēia o ka mālama ʻana i ke kaumaha. ʻAʻole e like me nā lāʻau lapaʻau ma mua, kuhikuhi kēia lāʻau i nā mea loaʻa i loko o ka lolo i kapa ʻia ʻo N-methyl-D-aspartate (NMDA) .
E noʻonoʻo e like me kēia. I loko o ke kanaka me ke kaumaha nui, hiki i kekahi mau ʻāpana koʻikoʻi o ka lolo ke emi iki ka hana, me he mea lā e 'hiamoe' ana (ʻaʻole hana nui). ʻO ka hana a nā lāʻau lapaʻau NMDA, ʻo ia ke kāohi i ka hana o kekahi neurotransmitter ikaika ʻē aʻe i kapa ʻia ʻo glutamate , a hoʻoikaika i ka pilina ma waena o kēlā mau pūnaewele lolo 'hiamoe' (neurons). ʻO ia hoʻi, hoʻolalelale koke lākou i ka hoʻololi ʻana o nā leka ma waena o nā pūnaewele lolo.
Manaʻo nā loea ʻo kēia ala koke ʻana o nā pilina ma waena o nā hunaola lolo ke kumu o ka emi wikiwiki ʻana o nā hōʻailona o ke kaumaha.
ʻO ka pōmaikaʻi nui o kēia, ʻo ia ka wikiwiki. ʻOiai hiki i nā lāʻau lapaʻau maʻamau ke hala i nā pule e hana ai, hiki i kekahi mau lāʻau lapaʻau NMDA ke hoʻomaka e hāʻawi i ka hōʻoluʻolu nui a me kahi hoʻololi i ka mea maʻi i loko o nā hola .
He aha nā lāʻau lapaʻau e pili ana i ka NMDA? Aia kekahi mau pilikia?
ʻO Ketamine kahi lāʻau lapaʻau koʻikoʻi i hoʻohana ʻia e mālama i ke kaumaha kūpaʻa-lāʻau lapaʻau ma o ka hoʻopaʻa ʻana i nā mea hoʻokipa NMDA.
Hāʻawi pinepine ʻia kēia i ka mea maʻi ma o kahi aʻa (intravenous a i ʻole IV) me ka saline . Akā aia kekahi mea āu e pono ai e hoʻomanaʻo ma aneʻi.
ʻAʻole kēia ʻo ka lāʻau lapaʻau mua a ke kauka e ʻōlelo ai no ke kaumaha.
Hoʻohana wale ʻia kēia mau mea no nā poʻe maʻi me ke kaumaha nui i hoʻāʻo i nā koho ʻē aʻe a ʻaʻole i loaʻa ka holomua. Eia kekahi, hana maoli ʻia kēia lāʻau lapaʻau ma kahi haukapila, ma lalo o ka nānā pono ʻana o nā kauka loea a me nā limahana i aʻo ʻia. ʻAʻole kēia he lāʻau lapaʻau e hiki ke kūʻai ʻia mai kahi hale kūʻai lāʻau a lawe ʻia i ka home.
No ke aha ʻoe e hana ai i kēlā? No ka mea, e like me nā lāʻau lapaʻau āpau, aia nā hopena ʻaoʻao. I ka wā o ka mālama ʻana, hiki iā ʻoe ke ʻike i nā loli i ke koko, ka poniuniu, ka luaʻi, a i kekahi manawa kahi hoʻokaʻawale iki mai ka ʻoiaʻiʻo. He mea nui ka nānā ʻana o ke kauka e hoʻokele i kēia mau mea āpau.
Pehea e ʻike ai au inā kūpono wau no kēia lāʻau lapaʻau?
ʻO kēia ka nīnau koʻikoʻi loa. Hiki ke hoʻoholo ʻia ka pane i kēia e kāu kauka lapaʻau wale nō. Inā he moho maikaʻi ʻoe no kahi lāʻau lapaʻau holomua e like me ka NMDA therapy e hilinaʻi ʻia i kekahi mau kumu:
- He aha nā ʻano antidepressants āu i hoʻohana ai ma mua?
- ʻEhia ka lōʻihi o ko lākou hoʻohana ʻia ʻana, a ma ke ʻano kūpono?
- Pehea i pane ai kou kino iā lākou?
- Ke koʻikoʻi o kou mau hōʻailona kaumaha i kēia manawa.
- Kou kūlana olakino holoʻokoʻa (nā maʻi ʻē aʻe, nā lāʻau lapaʻau ʻē aʻe āu e lawe nei, a pēlā aku).
No laila, ʻo ka mea maikaʻi loa hiki iā ʻoe ke hana, ʻo ia ke kamaʻilio ākea me kāu kauka e pili ana i nā mea āpau e noʻonoʻo nei ʻoe. Mai makaʻu e nīnau i nā nīnau e like me, "E ke kauka, ua lawe au i kēia lāʻau lapaʻau no nā mahina i kēia manawa, akā ʻaʻole naʻe au i ʻike i kekahi ʻokoʻa," a i ʻole "ʻAʻohe ala ʻē aʻe e hiki ai iaʻu ke lanakila ma luna o kēia?" ʻO ka nui o kāu kamaʻilio ʻana e pili ana i kou mau manaʻo a me kou mau ʻike, ʻo ka maʻalahi o ke koho ʻana o kāu kauka i ka lāʻau lapaʻau maikaʻi loa nāu.
Leka Lawe-Home
- He maʻi koʻikoʻi ka maʻi kaumaha nui (MDD) e pono ai ka mālama ʻana. ʻAʻole hana like nā antidepressants maʻamau (SSRIs, SNRIs) no nā kānaka a pau.
- No ka poʻe i pane ʻole i nā lāʻau lapaʻau maʻamau, aia nā lāʻau lapaʻau hou e like me Ketamine, kahi e kuhikuhi ana i nā mea loaʻa NMDA.
- Hiki i kēia mau mea ke hoʻopilikia i ka glutamate i loko o ka lolo, e hoʻoikaika koke ana i nā pilina ma waena o nā pūnaewele lolo, a me ka hāʻawi ʻana i ka ho'ōla wikiwiki.
- He mau lāʻau lapaʻau kūikawā kēia, a hāʻawi wale ʻia i nā poʻe maʻi i hāʻule i nā lāʻau lapaʻau ʻē aʻe, ma lalo o ka mākaʻikaʻi lapaʻau koʻikoʻi ma ka haukapila.
- Inā ʻaʻole ʻoe e loaʻa ka hōʻoluʻolu mai kāu mau lāʻau lapaʻau o kēia manawa, mai haʻalele i ka manaʻolana a kamaʻilio ākea me kāu kauka e pili ana i nā koho āpau.
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