Lɛ wi tɔk bɔt Tritmɛnt-Resistant Depression!

Sɔntɛm yu dɔn de sɔfa wit pwɛl hat fɔ sɔm mɔnt, ivin fɔ lɔng lɔng tɛm. Yu dɔn go to dɔktɔ ɛn nɔ tek wan bɔt tu mɛrɛsin fɔ di tɛm we dɛn dɔn tɛl yu fɔ du, bɔt yu sɔri-at, nɔ intres pan ɛnitin, ɔ da sɔri-at we yu nɔ go ebul fɔ bia nɔ dɔn stɔp atɔl. Dɔn yu kin gɛt wae dɛn kɔl "Treatment-Resistant Depression" (TRD). Nɔ ala we yu yɛri da nem de, i nɔ min se "dɛn nɔ go ebul fɔ trit am." Bɔt, i kin tek sɔm tɛm fɔ fɛn di rayt tritmɛnt fɔ yu. Lɛ wi tɔk bɔt dis ditayli ɛn rili simpul wan tide.

Wetin na dis kayn pwɛl hat sik wae dɛn kin kɔl tritmɛnt-resistant depression?

Fɔ tɔk am simpul wan, ‘diprɛshɔn we nɔ de tek tritmɛnt’ na sɔm pat pan di sik we dɛn kɔl Major Depression Disorder (MDD). Dɛn kin no am wae yu gɛt pwɛl hat ɛn yu de tek at le tu fɔs layn antidipreshan, di doz wae dɛn kin gi yu ɛn fɔ di tɛm wae dɛn kin gi yu (at le 6 to 8 wiks) , bɔt yu sik nɔr kin bɛtɛ fayn fayn wan.

Dɔktɔ dɛn kin fɔs gi mɛrɛsin frɔm di `SSRI` (Selective Serotonin Reuptake Inhibitors) ɔ `SNRI` (Serotonin ɛn Norepinephrine Reuptake Inhibitors) grup. Dis na bikɔs, we yu kɔmpia dɛn wit ɔda mɛrɛsin dɛn we de mek pɔsin fil bad, dɛn tin ya nɔ kin gɛt bɔku sayd ɛfɛkt, ɛn di sayd ɛfɛkt nɔ kin rili bad. Sɔmtɛm, ivin pipul dɛm wae bin dɔn ansa fayn fayn wan to antidipreshan kin gɛt `TRD` leta. Pan ɔl di nem, tritmɛnt dɛn de fɔ dis bak, bɔt i kin tek sɔm tɛm fɔ fɛn di rayt wan fɔ yu.

Aw dis sik kin kɔmɔn?

Yu no se lɛk 30% pan di pipul dɛm wae dɛn dɔn no se gɛt mɛjɔr pwɛl hat sik (MDD) ɛn wae dɛn trit fɔ am gɛt TRD bak? MDD na wan pan di kɔmɔn mɛntɛl hεlth kכndyushכn dεm na di wכl. I kin afɛkt bitwin 5% ɛn 17% pan pipul dɛm sɔm tɛm na dɛn layf. So, mɛmba se nɔto yu wangren de.

Wetin na di sayn dɛm fɔ dis?

Pipul wae gɛt `TRD` gɛt di sem sayn dɛm lɛk di wan dɛm wae gɛt `MDD`. Dat min se, tin dɛm lɛk fɔ fil bad ɔltɛm, fɔ fil bad, fɔ nɔr de slip fayn (we yu nɔr de slip atɔl, ɔr yu nɔr ebul fɔ slip), ɛn chenj wae yu want fɔ it (we yu nɔr fil lɛk fɔ it, ɔr it pasmak).

Bɔt dɛn tin ya kin apin mɔ pan pipul dɛn we gɛt `TRD`:

• Di sayn dɛm wae de kam tranga pasmak.
• Pwɛl hat kin te fɔ lɔng tɛm.
• Wan kɔndishɔn we dɛn kɔl ``Anhedonia.'' I min se yu nɔr ebul fɔ gɛt ɛni gladi at igen frɔm tin dɛm wae bin de briŋ yu gladi ɔr gladi at. Imajin, yu de lisin to yu fav siŋ ɔ yu de tɔk to yu padi, bɔt yu nɔ de fil ɛni filin.
• Bɔrku bɔrku wae pɔrsin kin gɛt pwɛl hat sik wae pɔrsin de liv in layf.
• Fɔ gɛt wɔri pasmak .
• Di aidia fɔ kil yusɛfƐn mɔ chans fɔ tray fɔ am.

Impɔtant: If yu ɔ pɔsin we yu sabi de tink fɔ tek in yon layf, duya kɔl di Suicide and Crisis Lifeline na 988. Sɔmbɔdi de 24 awa ɛvride fɔ ɛp yu. Yu kin go bak to dɔktɔ ɔ mental wɛlbɔdi advaysa kwik kwik wan.

Wetin mek dis de apin? Wetin na di rizin dɛn?

Infakt, pipul dɛm wae de stɔdi bɔt dis stil nɔr no bɛtɛ bɛtɛ wan wetin mek sɔm pipul dɛm wae gɛt pwɛl hat sik nɔr de tek mɛrɛsin. Jɔs lɛk aw no wan tin nɔ de we kin mek pɔsin gɛt pwɛl at, bɔku tin dɛn lɛk di tin dɛn we kin apin to pɔsin in jɛnɛtiks ɛn di chenj dɛn we kin apin na di bren we kin mek i gɛt dis sik.

Bɔt, dɛn tink se, strɛs we nɔ de dɔn kin gɛt big impak pan dis. Aw yu no? wi gεt wan imכtant sistεm na wi bכdi we dεn kכl di `Hypothalamic-Pituitary-Adrenal (HPA) axis. Dis na wetin de ɛp wi fɔ ajɔst to strɛs. So, strεs we de go bifo kin chenj di fכnshכn fכ dis `HPA` aks. We dat kin apin, pwɛl hat kin tranga ɛn i nɔ kin izi fɔ trit am.

Udat dɛn de pan denja pas ɔlman?

Risach dɔn sho se, we yu kɔmpia pipul dɛm wae gɛt MDD wae de ansa to mɛrɛsin, pipul dɛm wae gɛt TRD kin gɛt dɛn kayn bɔdi prɔblɛm ya:

• כtoimyun sik dεm (dat na sik dεm we di bכdi in imyun sistεm de atak insεf).
• Tayrɔyd sik.
• At sik.
• Sεribrovaskul sik (dat na sik dεm we de apin na di vessel dεm we de gi bכdi to di bren).

Dis nɔ min se ɔlman we gɛt dɛn sik ya go gɛt TRD, bɔt dɛn tin ya kin bi tin dɛn we kin mek i gɛt dis sik.

Aw dɔktɔ dɛn kin no dis kɔrɛkt wan?

Di diagnosis fɔ `TRD` nɔr rili klia. Bɔt bɔrku dɔktɔ dɛn kin no dis sik wae yu nɔr si ɛni impɔtant tin pan yu pwɛl hat sik afta yu dɔn tek at le tu pan de mɛrɛsin wae yu de yuse naw. Bɔku tɛm, dɔktɔ dɛn kin tek dɛn tin ya as fɔs layn antidipreshɔn:

• `SSRI ​​dɛn`
• `SNRI dɛn`
• Bupropion we dɛn kɔl Bupropion
• Mirtazapin we dɛn kɔl mirtazapin

Jɛnɛral wan, yu nid fɔ yuz wan mɛrɛsin fɔ at le siks to et wiks fɔ si if i wok.

If yu de tek tu mɛrɛsin ɛn stil nɔ de fil se yu dɔn bɛtɛ, yu dɔktɔ kin sɛn yu to dɔktɔ we de mɛn yu maynd . Na de, i go tek wan gud gud mɛdikal ɛn mental wɛlbɔdi istri. Dis kin inklud:

• Ɔl di mɛrɛsin dɛn we yu de tek naw (dɔktɔ we de gi yu, we yu nɔ de bay, mɛrɛsin we dɛn kin yuz fɔ mɛn yu bɔdi, ivin nakotiks) .Aks bɔt dis. Bikɔs sɔm mɛrɛsin dɛn kin ambɔg di we aw di mɛrɛsin dɛn we de mek pɔsin fil bad nɔ wok ɔ ivin mek di pwɛl hat sik wɔs.
• Dɛn go tɔk bɔt if yu de tek mɛrɛsin fɔ mek yu nɔ fil bad ɛn ɔda mɛrɛsin dɛn kɔrɛkt wan ɛn lɛk aw dɛn tɛl yu fɔ tek .
• Dɛn go chɛk if yu dɔn gɛt saykotɛrapi ɔr tɔk tritmɛnt ɛn if i dɔn ɛp yu fɔ gɛt pwɛl hat sik.
• Sɔm tin dɛn we kin apin to pɔsin in bɔdi, lɛk tayroyd sik ɛn pen we nɔ de dɔn, kin mek pɔsin gɛt pwɛl hat ɔ mek i wɔs, so dɛn kin chɛk fɔ si if i gɛt.
• Dɛn kin chɛk fɔ prɔblɛm dɛn lɛk fɔ yuz drɔgs .
• Tink bɔt if yu kin gɛt ɔda sik wae de kam pan pɔrsin in maynd (e.g., bipolar disorder ɔr pɔrsin in pasɔnaliti disɔda) .

Afta yu dɔn tɔk bɔt ɔl dis ɛn du di tɛst dɛn we yu nid, yu dɔktɔ go no if yu gɛt `TRD` ɔ yu nɔ gɛt am. Dɔn, i go ɛp yu fɔ fɛn di bɛst tritmɛnt fɔ yu.

So wetin na di tritmɛnt fɔ dis?

Bɔku we dɛn de fɔ kɔntrol `TRD`. I kin tek sɔm tɛm fɔ mek yu gɛt di tin dɛn we yu want, bɔt nɔ giv ɔp di op.

Fɔs, yu saykayatrist kin tray dɛn tin ya:

• Gi di antidipreshan wae yu de tek naw smɔl mɔr tɛm fɔ woke.
• Inkrisayz di doz fɔ wan fɔs layn antidipreshan we yu de tek naw.
• Ad wan antidipreshan frɔm ɔda klas. Dɔn yu de tek tu mɛrɛsin wan tɛm.
• Ɛnkɔrej yusɛf fɔ mit wit pɔsin we de stɔdi bɔt pɔsin in maynd ɛn gɛt saykotɛrapi . E kin tek sɔm tɛm fɔ fɛn tritmɛnt wae "gɛt yu." Dɔn bak, difrɛn kayn saykotɛrapi de.

Wetin yu kin du nɛks wae nɔrmal tritmɛnt nɔr kin woke?

If dɛn besik we ya nɔr woke, bɔrku tɛm yu saykayatrist go tɛl yu fɔ tek difrɛn kayn mɛrɛsin, fɔ yu fɔ tek ɔda mɛrɛsin, ɔr fɔ gɛt difrɛn tritmɛnt.

Naw, di US Food and Drug Administration (FDA) dɔn gri fɔ fayv mɛrɛsin fɔ TRD:

• Aripiprazole (Abilify®) ɛn Brexpiprazole (Rexulti®): Dɛn wan ya na tɔd jɛnɛreshɔn antisaykotik mɛrɛsin. Dɛn kin ridyus di sayn dɛm fɔ pwɛl hat bay wae dɛn kin afɛkt di lɛvɛl dɛm fɔ sɛrotonin ɛn norepinephrine na yu bren.
• Kwɛtiapin (Seroquel®) ɛn Olanzapine (Zyprexa®): Dɛn tin ya na sɛkɔn jɛnɛreshɔn antisaykotik. Dɛn dɔn gri fɔ kwɛtiapin as adjɔnt tritmɛnt fɔ TRD wit antidipreshan. Dɛn kin gri fɔ gi ɔlanzapin we dɛn gi am togɛda wit Fluoxetine (Prozac®). Dɛn kin ɛp fɔ ridyus di sayn dɛm fɔ pwɛl hat bay wae dɛn kin afɛkt di dopamin lɛvɛl na di bren. Dɛn mɛrɛsin ya kin mek pɔsin slip bak.
• Esketamine nasal spray (Spravato®): Dɛn kin mek dis wit wan tin we dɛn kɔl ketamine. Di FDA bin gri fɔ am insay 2019 as ad-ɔn tritmɛnt fɔ big pipul dɛn we gɛt TRD, wit wan ɔral antidipreshan. Esketamine kin bigin fɔ ridyus di sayn dɛm fɔ pwɛl hat insay lɛk tu awa afta yu tek am. Bɔt bikɔs i kin mek yu slip pasmak (sedation), dissociation (nɔ kin no usay yu de ɔ wetin de apin), ɛn bikɔs dɛn kin yuz am bad bad wan, dɛn kin jɔs gi dis mɛrɛsin ɔnda di sɔpɔtishɔn fɔ dɔktɔ na klinik. Dɔktɔ dɛn go de wach yu fɔ tu awa afta dɛn dɔn tek di mɛrɛsin.

Us ɔda tritmɛnt dɛn we FDA dɔn gri fɔ?

Di FDA dɔn gri bak fɔ dɛn tritmɛnt ya fɔ TRD:

• Ilɛktrokɔnvulsiv tɛrapi (ECT): Dis na mɛrɛsin we dɛn kin du. Insay dis, dɛn kin sɛn ilɛktrik impuls dɛn we rili smɔl pas yu bren, ɛn dis kin mek yu gɛt smɔl sik. Dis kin mek di nerve cells wok ɛn i kin mek chenj dɛn na di bren we kin mek yu fil fayn.
• Ripititiv transkranial magnεtik stimulashכn (rTMS): Dis na tritmεnt we nכ de invayv. Insay dis tritmɛnt, dɛn kin yuz magnɛtik kɔyl fɔ afɛkt di natura l ilɛktrik aktiviti na yu bren. Dis kin mek chenj na sɔm patikyula say dɛn na yu bren we kin afɛkt yu maynd.

Ɔda tritmɛnt dɛn de we yu kin du?

Bɔku ɔda tritmɛnt dɛn de fɔ TRD, bɔt dɛn wan ya nɔ kin de ɔlsay ɔ dɛn kin stil de na di risach stej:

• Dip bren stimulashɔn (DBS): Dis na mɛrɛsin bak we dɛn kin du fɔ mɛn pipul dɛn. Na ya, dɛn kin sɛn ilɛktrik kɔrɛnt we saful to wan patikyula pat na yu bren. dis ilɛktrik de mek di bren sɛl dɛn na da eria de wok, we kin mek pɔsin fil fri frɔm sɔm tin dɛn, lɛk TRD.
• Lithium (Eskalith®): Risach dɔn sho se if yu tek lithium wit antidipreshan (e.g., citalopram) i kin mek TRD bɛtɛ.
• `MAOI` (Monoamine oxidase inhibitors): Dɛn tin ya na bin di fɔs antidipreshan dɛm we dɛn bin fɛn. Bɔt bikɔs ɔf di bɔku tin dɛn we de stɔp pipul dɛn fɔ it, di bad tin dɛn we kin apin to pɔsin, ɛn di tin dɛn we kin mek i nɔ gɛt prɔblɛm, di dɔktɔ dɛn kin jɔs gi am we ɔl di ɔda mɛrɛsin dɛn we de mek pɔsin in at pwɛl nɔ wok.
• Pramipexole (Mirapex®): Dis na mɛrɛsin we FDA dɔn gri fɔ fɔ di sik we dɛn kɔl Parkinson. Stɔdi dɔn sho se e kin ridyus di pwɛl hat sik wae de kam pan pɔrsin wae gɛt dis sik. I kin ɛp pipul dɛm bak we gɛt TRD.
• Vagus nεv stimulashכn (VNS): .na ya, dεn put wan divays we de sεnd rεgulεr, jεntεl ilektrikal puls dεm to yu bren stεm tru di vagus nεv we de na yu nεk. dis kin chenj di lεvεl dεm fכ sכm ‘nyurotransmitta dεm’ na yu bren we de kכntro yu mכd.

Risach pipul dɛn de stɔdi bak se psilocybin, we na wan kɔmpawnd we dɛn pul frɔm hallucinogenic mushroom, as tritmɛnt fɔ TRD.

Ɛni bad tin de we dɛn tritmɛnt ya kin du?

In jɛnɛral, mɛrɛsin ɛn tritmɛnt fɔ `TRD` kin gɛt mɔ sayd ifɛkt pas fɔs-layn antidipreshan. Dɔn bak, dɛn bad bad tin dɛn de kin difrɛn bad bad wan. Yu dɔktɔ go tɔk to yu bɔt di sayd ɛfɛkt ɔ prɔblɛm dɛn we kin apin to ɛni tritmɛnt we yu kin gɛt. Nɔ shem fɔ aks kwɛstyɔn.

Yu tink se dɛn go ebul fɔ mek dis tin nɔ apin?

Bikɔs sayɛnsman dɛn nɔ no bɛtɛ bɛtɛ wan wetin kin mek pɔsin gɛt TRD, bɔku tɛm i nɔ kin izi fɔ mek dɛn nɔ gɛt am. Bɔt bikɔs strɛs we nɔ de dɔn kin mek yu gɛt am, yu kin du dɛn tin ya fɔ kɔntrol yu strɛs:

• Ɛksesaiz ɔltɛm. Ivin if yu waka fɔ shɔt tɛm, dat kin mek yu fil fayn.
• Gɛt gud slip. Dis impɔtant fɔ mek ɔlman gɛt wɛlbɔdi.
• Tray fɔ du tin dɛn lɛk fɔ tink gud wan, yoga, ɛksesaiz fɔ blo, ɛn fɔ rilaks mɔsul dɛn .
• Sɛt gol dɛn fɔ yu de, wik, ɛn mɔnt. We yu pe atɛnshɔn pan di smɔl smɔl tin dɛn, yu go fil lɛk se yu gɛt kɔntrol pan di tɛm ɛn di lɔng tɛm.
• Praktis fɔ tink gud wan ɛn fɔ tɛl tɛnki . Tink bɔt di gud tin dɛn we de apin na yu de ɔ na yu layf.
• Gɛt di abit fɔ se "nɔ" to ɛkstra rispɔnsibiliti we yu bizi ɔ strɛs.
• Mek yu gɛt padi biznɛs wit pipul dɛn we de mek yu nɔ gɛt wanwɔd, we de sɔpɔt yu pan yu maynd, ɛn we de ɛp yu fɔ du tin dɛn we yu go ebul fɔ du.
• Tink bɔt fɔ tɔk to dɔktɔ ɔ yu dɔktɔ bɔt strɛs.

If yu gɛt pwɛl hat sik wae nɔr kin gɛt tritmɛnt, wetin yu kin du na os?

Apat frɔm we yu de luk fɔ pɔrsin, mɛrɛsin ɛp fɔ TRD, sɔm tin dɛn de we yu kin du na os we kin ɛp fɔ ridyus yu sik dɛn:

• Fɔ du ɛksasaiz ɔltɛm.
• Fɔ gɛt gud kwaliti slip (nɔ fɔ slip pasmak ɔ fɔ slip bɛtɛ).
• Fɔ it tin dɛn we gɛt wɛlbɔdi.
• Nɔ drink rɔm ɛn tek drɔgs we nɔto mɛrɛsin. Rɔk na tin we de mek pɔsin in at pwɛl.
• Fɔ spɛn tɛm wit di wan dɛn we yu lɛk ɛn bisin bɔt.

Ustɛm yu fɔ go to dɔktɔ?

Te yu fɛn wan fayn tritmɛnt plan fɔ TRD we go wok fɔ yu, si aw i de wok.Yu fɔ go to yu dɔktɔ ɔltɛm.

Apat frɔm dat, tɔk to yu dɔktɔ pan dɛn kayn tin ya:

• If yu gɛt sayd ɛfɛkt dɛn we de mɔna yu.
• If yu sik nɔr de bɛtɛ, ɔr if dɛn de wɔs.
• If yu de tink fɔ stɔp yu mɛrɛsin. (Nɔ ɛva stɔp fɔ tek mɛrɛsin if yu nɔ gɛt dɔktɔ advays).

Di tin we impɔtant pas ɔl we yu gɛt fɔ tɔk

If yu gɛt `TRD`, fɔs mɛmba se nɔto yu wan de . Na lɛk 30% pan di pipul dɛm wae gɛt dis sik kin gɛt dis sik. Bɔku tritmɛnt opshɔn dɛn de fɔ `TRD`, bɔt i kin tek sɔm tɛm fɔ fɛn di wan we go woke fayn fɔ yu. Yu dɔktɔ ɛn/ɔ saykayatrist go sɔpɔt yu pan da joyn de. Nɔ ɛva giv ɔp op. If yu gɛt di rayt sɔpɔt ɛn tritmɛnt, yu kin ebul fɔ kɔntrol dis sik ɛn liv bɛtɛ layf.

` Diprɛshɔn wae nɔr de tek tritmɛnt, pwɛl hat, maynd wɛl bɔdi, TRD, MDD, pwɛl hat tritmɛnt, maynd sik