Ka twogere ku kiwuubaalo ekiziyiza obujjanjabi!

Oyinza okuba nga omaze emyezi, wadde emyaka mingi ng’olina ekiwuubaalo. Olabye omusawo n’omira eddagala si limu wabula bbiri okumala ekiseera ekiragiddwa, naye ennaku yo, obutafaayo ku kintu kyonna, oba ennaku eyo etagumiikiriza tekendedde n’akatono. Olwo oyinza okuba n'ekyo ekiyitibwa "Treatment-Resistant Depression" (TRD). Totya ng'owulira erinnya eryo, tekitegeeza nti "teriyinza kujjanjabwa." Kyokka kiyinza okukutwalira akaseera okusobola okufuna obujjanjabi obutuufu. Kino ka twogere mu bujjuvu era mu ngeri ennyangu ennyo leero.

Kino kye bayita ekiwuubaalo ekiziyiza obujjanjabi kye ki?

Mu ngeri ennyangu, ‘okwennyamira okuziyiza obujjanjabi’ kitundu kitono eky’obulwadde bw’okwennyamira okw’amaanyi (MDD). Kizuulibwa ng’olina ekiwuubaalo era ng’omira waakiri eddagala eriweweeza ku kweraliikirira erya layini esooka bbiri, ku ddoozi eragiddwa n’ekiseera ekiragiddwa (waakiri wiiki 6 ku 8) , naye obubonero bwo tebutereera mu ngeri ematiza.

Abasawo batera okusooka okuwandiika eddagala okuva mu kibinja kya `SSRI` (Selective Serotonin Reuptake Inhibitors) oba `SNRI` (Serotonin and Norepinephrine Reuptake Inhibitors). Kino kiri bwe kityo kubanga bw’ogeraageranya n’eddagala eddala eriweweeza ku kweraliikirira, lino lirina ebizibu ebitono, era ebizibu ebivaamu si bya maanyi nnyo. Oluusi, n’abantu abaali baddamu obulungi eddagala eriweweeza ku kweraliikirira basobola okufuna `TRD` oluvannyuma. Wadde erinnya lino liriwo, waliwo obujjanjabi ku kino nakyo, naye kiyinza okukutwalira ekiseera okuzuula ekikusaanira.

Embeera eno ya bulijjo etya?

Obadde okimanyi nti abantu nga 30% abazuuliddwa n’obulwadde bw’okwennyamira (MDD) ne babujjanjabwa nabo balina TRD? MDD y’emu ku mbeera z’obulamu bw’obwongo ezisinga okutawaanya abantu mu nsi yonna. Bukwata abantu wakati wa 5% ne 17% mu kiseera ekimu mu bulamu bwabwe. N’olwekyo, jjukira nti toli wekka.

Bubonero ki obulaga kino?

Abantu abalina `TRD` balina obubonero bwe bumu n'abo abalina `MDD`. Kwe kugamba, ebintu ng’ennaku buli kiseera, ennaku, obuzibu mu tulo (oba obutafuna tulo n’akatono, oba obutasobola kwebaka), n’enkyukakyuka mu njagala y’okulya (oba obutawulira nga oyagala kulya, oba okulya ekisusse).

Wabula ebintu bino bisinga kubeera mu bantu abalina `TRD`:

• Obubonero okweyongera okubeera obw’amaanyi.
• Okwennyamira kuwangaala.
• Embeera eyitibwa ``Anhedonia.'' Kitegeeza nti tokyasobola kufuna ssanyu lyonna okuva mu bintu ebyali bikuleetera essanyu oba essanyu. Kuba akafaananyi ng’owuliriza oluyimba lw’oyagala ennyo oba ng’oyogera ne mukwano gwo, naye nga towulira nneewulira yonna.
• Okweyongera kw‟emirundi gy‟okufuna ebiseera by‟okwennyamira mu bulamu bw‟omuntu.
• Okubeera n'okweraliikirira okuyitiridde .
• Ekirowoozo ky’okwettaEra emikisa mingi egy'okugezaako ku lw'ekyo.

Ekikulu: Bw’oba ​​ggwe oba omuntu gw’omanyi alina ebirowoozo by’okwetta, nsaba kuba ku ssimu ya Suicide and Crisis Lifeline ku 988. Waliwo omuntu aliwo essaawa 24 buli lunaku okukuyamba. Osobola n’okulaba omusawo oba omubuulirizi ku by’obwongo amangu ddala nga bwe kisoboka.

Lwaki kino kigenda mu maaso? Ensonga ze ziruwa?

Mu butuufu, abanoonyereza n’okutuusa kati tebamanyi bulungi lwaki ekiwuubaalo ky’abantu abamu tekiddamu kunywa ddagala. Nga bwe watali kintu kimu ekivaako okwennyamira, ebintu bingi, omuli obuzaale n’enkyukakyuka mu ddagala ly’obwongo, bivaako embeera eno.

Naye, balowooza nti, situleesi etawona esobola okukosa kinene ku kino. Omanyi otya? Tulina enkola enkulu mu mibiri gyaffe eyitibwa `Hypothalamic-Pituitary-Adrenal (HPA) axis. Kino kye kituyamba okumanyiira situleesi. Kale, situleesi egenda mu maaso esobola okukyusa enkola y’ekisiki kino ekya `HPA`. Ekyo bwe kibaawo, okwennyamira kweyongera okukaluba okujjanjaba.

Ani asinga okubeera mu bulabe?

Okunoonyereza kulaga nti, bw’ogeraageranya n’abantu abalina MDD abaddamu eddagala, abantu abalina TRD batera okuba n’embeera z’omubiri zino wammanga:

• Endwadde z’abaserikale b’omubiri (kwe kugamba, endwadde abaserikale b’omubiri mwe beelumba).
• Obulwadde bwa thyroid.
• Obulwadde bw’omutima.
• Obulwadde bw’emisuwa gy’obwongo (kwe kugamba, endwadde ezibeera mu misuwa egigasa omusaayi mu bwongo).

Si buli muntu alina endwadde zino nti ajja kufuna TRD, naye bino biyinza okuba eby’obulabe.

Abasawo kino bakizuula batya ddala?

Okuzuula `TRD` tekunnyonnyoddwa bulungi nnyo. Wabula abasawo abasinga bazuula embeera eno ng’obadde tolaba kulongooka kwonna mu bubonero bwo obw’okwennyamira oluvannyuma lw’okumira waakiri eddagala eriweweeza ku kweraliikirira eritakka wansi wa bibiri ly’okozesa mu kiseera kino. Abasawo batera okutwala bino wammanga ng’eddagala erisooka eriweweeza ku kweraliikirira:

• `Eddagala lya SSRI`
• `SNRIs`
• Ekirungo kya Bupropion
• Eddagala lya Mirtazapine

Okutwalira awamu, olina okukozesa eddagala okumala waakiri wiiki mukaaga ku munaana okulaba oba likola oba nedda.

Bw’oba ​​omira eddagala bbiri ate ng’okyawulira ng’oteredde, omusawo ayinza okukusindika ew’omusawo w’eby’omutwe . Eyo, ajja kutwala ebyafaayo ebijjuvu eby’obujjanjabi n’obulamu bw’obwongo. Kino kiyinza okuli:

• Eddagala lyonna ly’omira mu kiseera kino (erikulagiddwa omusawo, eritali ku ddagala, eddagala ly’ebimera, wadde ebiragalalagala)Buuza ku nsonga eno. Kubanga eddagala erimu liyinza okutaataaganya obulungi bw’eddagala eriweweeza ku kweraliikirira oba n’okwongera okwennyamira.
• Bajja kuteesa oba omira eddagala eriweweeza ku kweraliikirira n'eddagala eddala mu butuufu era nga bwe likulagidde .
• Bajja kukebera oba ofunye obujjanjabi bw’eby’omwoyo oba obw’okwogera era oba buyambye ku kweraliikirira kwo.
• Embeera ezimu ez’omubiri, gamba ng’obulwadde bwa thyroid n’obulumi obutawona, zisobola okuleeta oba okwongera okwennyamira, n’olwekyo zikeberebwa.
• Bakebera oba waliwo ebizibu ng'okukozesa ebiragalalagala .
• Lowooza oba obubonero bwo butera okuzuulibwa n‟embeera endala ey‟obulamu bw‟omutwe (e.g., obuzibu bw‟okuwuguka oba obuzibu bw‟obuntu) .

Oluvannyuma lw'okukubaganya ebirowoozo ku bino byonna n'okukola ebigezo ebyetaagisa, omusawo wo ajja kuzuula oba olina `TRD` oba nedda. Olwo, ajja kukuyamba okufuna obujjanjabi obusinga obulungi gy’oli.

Kale bujjanjabi ki obukolebwa ku kino?

Waliwo engeri eziwerako ez'okufuga `TRD`. Kiyinza okutwala ekiseera okufuna ebivaamu by’oyagala, naye toggwaamu ssuubi.

Okusooka, omusawo wo ow’eby’omutwe ayinza okugezaako ebintu bino:

• Eddagala eriweweeza ku kweraliikirira ly’okozesa mu kiseera kino liwe akaseera katono okukola.
• Yongera ku ddoozi y’eddagala eriweweeza ku kweraliikirira erya layini esooka ly’omira mu kiseera kino.
• Okwongerako eddagala eriweweeza ku kweraliikirira okuva mu kiraasi endala. Olwo oba omira eddagala bbiri omulundi gumu.
• Weekubirize okusisinkana omukugu mu by'empisa ofune obujjanjabi bw'eby'omwoyo . Kiyinza okutwala ekiseera okuzuula omusawo omujjanjabi "akufuna." Ate era, waliwo ebika by’obujjanjabi obw’eby’omwoyo obw’enjawulo.

Kiki ky’oddako ng’obujjanjabi obwa bulijjo tebukola?

Singa enkola zino enkulu tezikola, omusawo wo ow’eby’omutwe atera okukuwa amagezi ku kika ky’eddagala eky’enjawulo, eddagala erigatta oba enkola ey’enjawulo ey’obujjanjabi.

Mu kiseera kino, ekitongole kya Amerika ekivunaanyizibwa ku by’emmere n’eddagala ekya FDA kikkirizza eddagala ttaano eriweebwa TRD:

• Aripiprazole (Abilify®) ne Brexpiprazole (Rexulti®): Lino ddagala lya mulembe gwa kusatu eriweweeza ku bulwadde bw’omutima. Ziyinza okukendeeza ku bubonero bw’okwennyamira nga zikosa emiwendo gya serotonin ne norepinephrine mu bwongo bwo.
• Quetiapine (Seroquel®) ne Olanzapine (Zyprexa®): Zino ddagala lya mulembe gwa kubiri eriweweeza ku bulwadde bw’omutima. Quetiapine akkiriziddwa ng’obujjanjabi obw’okugatta ku TRD n’eddagala eriweweeza ku kweraliikirira. Olanzapine akkirizibwa nga aweereddwa wamu ne Fluoxetine (Prozac®). Ziyamba okukendeeza ku bubonero bw’okwennyamira nga zikosa emiwendo gya dopamine mu bwongo. Eddagala lino era liyinza okuleeta otulo.
• Esketamine nasal spray (Spravato®): Kino kikolebwa mu kintu ekiyitibwa ketamine. Ekitongole kya FDA kyakikkiriza mu 2019 ng’eddagala ery’okwongerako eri abantu abakulu abalina TRD, wamu n’eddagala eriweweeza ku kweraliikirira ery’omu kamwa. Esketamine esobola okutandika okukendeeza ku bubonero bw’okwennyamira mu ssaawa nga bbiri ng’agimira. Wabula olw’okuba kiyinza okuvaako otulo otuyitiridde (okukkakkanya), okwekutula (okubulwa okumanya w’oli oba ekigenda mu maaso), era olw’okuba kiyinza okukozesebwa obubi, eddagala lino liweebwa wansi w’obulabirizi bw’omusawo mu ddwaaliro lyokka. Abasawo bajja kukulondoola okumala essaawa bbiri ng’omaze okumira eddagala.

Bujjanjabi ki obulala obukkirizibwa FDA?

Ekitongole kya FDA era kikkirizza obujjanjabi buno ku TRD:

• Electroconvulsive therapy (ECT): Eno nkola ya bujjanjabi. Mu kino, amasannyalaze amatono ennyo gasindikibwa mu bwongo bwo, ekivaako okukonziba okutono. Kino kisitula obutoffaali bw’obusimu era kiyinza okuleeta enkyukakyuka mu bwongo ezitereeza embeera yo.
• Repetitive transcranial magnetic stimulation (rTMS): Buno bujjanjabi obutayingirira. Mu bujjanjabi buno, magineeti ekozesebwa okufuga enkola y’amasannyalaze ag’obutonde ag’obwongo bwo. Kino kiyinza okuleeta enkyukakyuka mu bitundu by’obwongo ebimu ebikosa embeera yo.

Waliwo engeri endala ez’obujjanjabi?

Waliwo obujjanjabi obulala obuwerako ku TRD, naye buno buyinza obutabaawo nnyo oba buyinza okuba nga bukyali mu mutendera gw’okunoonyereza:

• Okusitula obwongo mu buziba (DBS): Eno nayo nkola ya bujjanjabi. Wano, amasannyalaze amagonvu gatuusibwa mu kitundu ekimu eky’obwongo bwo. Amasannyalaze gano gasitula obutoffaali bw’obwongo mu kitundu ekyo, obuyinza okuwa obuweerero okuva mu mbeera eziwerako omuli ne TRD.
• Lithium (Eskalith®): Okunoonyereza kulaga nti okumira lithium n’eddagala eriweweeza ku kweraliikirira (e.g., citalopram) kiyinza okulongoosa TRD.
• `MAOI` (Monoamine oxidase inhibitors): Zino ze ddagala eriweweeza ku kweraliikirira eryasooka okuzuulibwa. Kyokka, olw’obukwakkulizo bungi obuliwo ku mmere, ebizibu ebivaamu, n’okweraliikirira obukuumi, abasawo baziwandiika ng’eddagala eddala lyonna eriziyiza okwennyamira liremye.
• Pramipexole (Mirapex®): Lino ddagala erikkirizibwa ekitongole kya FDA erijjanjaba obulwadde bwa Parkinson. Okunoonyereza kulaga nti asobola okukendeeza ku bubonero bw’okwennyamira mu bulwadde bwa Parkinson. Era kiyinza okuyamba abantu abalina TRD.
• Okusikirizibwa kw’obusimu obuyitibwa Vagus nerve stimulation (VNS): .Wano, ekyuma kiteekebwamu ekiweereza amasannyalaze aga bulijjo era agagonvu ku kikolo ky’obwongo bwo nga kiyita mu busimu obuyitibwa vagus nerve mu bulago bwo. Kino kiyinza okukyusa emiwendo gya ‘neurotransmitters’ ezimu mu bwongo bwo ezifuga embeera yo.

Abanoonyereza era banoonyereza ku psilocybin, ekirungo ekyawulwa mu ffene akola ebirooto, ng’eddagala eriweweeza ku TRD.

Waliwo ebizibu byonna ebiva mu bujjanjabi buno?

Okutwaliza awamu, eddagala n'obujjanjabi bwa `TRD` bisobola okuba n'ebizibu bingi okusinga eddagala erisooka eriweweeza ku kweraliikirira. Ate era, ebizibu ebyo biyinza okwawukana nnyo. Omusawo wo ajja kwogera naawe ku buzibu oba ebizibu ebiyinza okuva mu buli bujjanjabi. Tolwawo kubuuza bibuuzo.

Embeera eno esobola okulemesebwa okubaawo?

Olw’okuba bannassaayansi tebamanyi bulungi kivaako TRD, ebiseera ebisinga kiba kizibu okugiziyiza. Kyokka olw’okuba situleesi etawona eyinza okugiviirako, osobola okukola ebintu bino okusobola okuddukanya situleesi yo:

• Dduyiro buli kiseera. Ne bw’otambulako akaseera katono kiyinza okulongoosa embeera yo.
• Funa otulo otulungi. Kino kyetaagisa nnyo eri obulamu okutwalira awamu.
• Gezaako ebintu ng’okufumiitiriza , yoga, dduyiro w’okussa, n’okukola dduyiro ow’okuwummuza ebinywa .
• Teekawo ebiruubirirwa by’olunaku lwo, wiiki yo, n’omwezi gwo. Bw’ossa essira ku bintu ebitonotono, ojja kuwulira ng’olina obuyinza ku kaseera ako n’ebbanga eddene.
• Weegezeemu okulowooza n'okwebaza . Lowooza ku birungi ebiri mu lunaku lwo oba mu bulamu bwo.
• Funa omuze gw'okugamba nti "nedda" ku buvunaanyizibwa obw'enjawulo ng'oli bbize oba nga oli ku situleesi.
• Kuuma enkolagana n’abantu abakukuuma ng’oli mukkakkamu, abakuwagira mu nneewulira, era abakuyamba mu bintu eby’omugaso.
• Lowooza ku ky’okwogera n’omusawo oba omusawo wo ku situleesi.

Bw’oba ​​olina ekiwuubaalo ekiziyiza obujjanjabi, kiki ky’oyinza okukola awaka?

Ng’oggyeeko okunoonya obuyambi obw’ekikugu, obw’abasawo ku TRD, waliwo ebintu ebiwerako by’osobola okukola awaka ebiyinza okuyamba okukendeeza ku bubonero bwo:

• Okukola dduyiro buli kiseera.
• Okufuna otulo otw’omutindo omulungi (obuteebaka nnyo wadde okwebaka obubi).
• Okulya emmere ennungi.
• Weewale omwenge n’ebiragalalagala ebitali bya bujjanjabi. Omwenge gukendeeza ku kiwuubaalo.
• Okumala ebiseera n’abo b’oyagala era b’ofaako.

Ddi lw’osaanidde okulaba omusawo?

Okutuusa lw’onoofuna enteekateeka ennungi ey’obujjanjabi bwa TRD ekukolera, laba engeri gy’ekola.Olina okulaba omusawo buli kiseera.

Ng’oggyeeko ekyo, yogerako n’omusawo wo mu mbeera zino:

• Singa ofuna ebizibu ebikutawaanya.
• Singa obubonero bwo tebutereera, oba bweyongera okusajjuka.
• Bw’oba ​​olowooza okukomya eddagala lyo (tolekera awo kumira ddagala nga tolina magezi ga musawo).

Ekisinga obukulu ky’olina okwogera

Bwoba olina `TRD`, sooka ojjukire nti toli wekka . Abantu nga 30% abalina ekiwuubaalo ekinene balina embeera eno. Waliwo obujjanjabi obuwerako obwa `TRD`, naye kiyinza okukutwalira ekiseera okuzuula ekisinga okukukolera. Omusawo wo ne/oba omusawo w’eby’omutwe ajja kukuwagira mu lugendo olwo. Toggwaamu ssuubi. Bw’ofuna obuwagizi n’obujjanjabi obutuufu, osobola okuddukanya embeera eno n’obeera n’obulamu obulungi.

` Okwennyamira okuziyiza obujjanjabi, okwennyamira, obulamu bw‟omutwe, TRD, MDD, obujjanjabi bw‟okwennyamira, obulwadde bw‟obwongo