Treatment-Resistant Depression chungchang hi han sawi ila!

Thla tam tak chhung, kum tam tak chhung pawhin lungngaihna i tuar tawh mai thei. Doctor i hmu tawh a, hun bituk chhung chu damdawi pakhat ni lovin pahnih i ei tawh a, mahse i lungngaihna, engmah ngaihven lohna emaw, chu lungngaihna tuar theih loh chu a reh lo tak zet a ni. Tichuan "Treatment-Resistant Depression" (TRD) an tih chu i nei mai thei. Chu hming i hriat chuan hlau suh, "enkawl theih a ni lo" tihna a ni lo. Mahse, i tana enkawl dan tur dik tak zawn nan hun rei tak a la ngai thei. Hemi chungchang hi vawiin hian chipchiar tak leh awlsam takin sawi ila.

He treatment-resistant depression an tih hi eng nge ni?

A awlsam zawngin sawi ila, ‘treatment-resistant depression’ hi Major Depressive Disorder (MDD) subset a ni. Depression i neih a, first-line antidepressant pahnih tal i ei laiin, a dose tur leh hun bituk chhung (kar 6 atanga kar 8 tal) i ei laiin hmuhchhuah a ni a, mahse i symptoms chu a tha tawk lo.

Doctor-te chuan `SSRI` (Selective Serotonin Reuptake Inhibitors) emaw `SNRI` (Serotonin and Norepinephrine Reuptake Inhibitors) group a\angin damdawi an pe hmasa \hin. Hei hi a chhan chu, antidepressant dang nena khaikhin chuan, hengte hian side effect an nei tlem zawk a, a side effect pawh a na lo hle. A châng chuan, a hmaa antidepressant ei \hinte pawhin a hnuah `TRD` an nei thei a ni. A hming pawh nise, hei pawh hi enkawlna a awm a, mahse i tana tha tur zawn nan hun engemaw chen a la ngai thei.

Hetiang dinhmun hi engtiang chiahin nge a awm?

Major depressive disorder (MDD) vei nia hriat zinga 30% velin TRD an vei tih i hria em? MDD hi khawvela rilru lam hriselna lama harsatna awm tam ber zinga mi a ni. Mi 5% leh 17% inkar chu an dam chhungin engtik lai pawhin a nghawng thin. Chuvangin, nangmah chauh i ni lo tih hre reng ang che.

Hei hi eng symptoms nge ni?

`TRD` vei te hian `MDD` vei te nen hian symptom inang an nei ve tho. Chu chu, lungngaihna awm reng, lungngaihna, mut harsatna (mut loh tak tak, emaw, mut theih loh emaw), leh ei duhna inthlak danglamna (ei leh ei duh loh emaw, ei tam lutuk emaw) ang chi thilte a ni.

Mahse, heng thilte hi `TRD` vei zingah hian a tam zawk :

• Symptoms a na zual zel.
• Depression hian rei tak a daih a.
• ``Anhedonia'' tia koh dinhmun. I hla duh ber i ngaithla emaw, i ṭhian i biak emaw laiin, rilru natna i nei lo tih han ngaihtuah teh.
• Mihring dam chhunga lungngaihna (depressive episode) tawn tam.
• Lungkham lutuk neih .
• Mahni intihhlum tumnaTin, chutiang tur chuan beih theihna chance tam zawk a awm bawk.

Pawimawh: Nangmah emaw, i hriat miin emaw mahni nunna lak tumna i neih chuan Suicide and Crisis Lifeline 988 ah call la, nitin darkar 24 chhungin mi tu emaw tanpui turin a awm reng a ni. Doctor emaw mental health counselor emaw pawh a rang thei ang bera i hmu thei bawk.

Engvangin nge hetiang hi a lo awm? A chhan engte nge ni?

Dik tak chuan mi thenkhat lungngaihna hian damdawi ei a chhan loh chhan hi zirchiangtute hian an la hre chiang lo. Depression thlentu pakhat chauh a awm loh ang bawkin, thil tam tak, genetic influence leh thluaka chemical inthlak danglamna te hian he natna hi a thlen a ni.

Mahse, an ngaihdan chuan, chronic stress hian hei hi nghawng lian tak a nei thei a ni. Engtin nge i hriat? Kan taksaah hian system pawimawh tak `Hypothalamic-Pituitary-Adrenal (HPA) axis kan nei a. Hei hian stress kan insiamrem theih nan min pui thin. Chuvangin, ongoing stress hian he `HPA` axis hnathawh dan hi a thlak danglam thei a ni. Chutiang a nih chuan depression chu a na zual a, enkawl a harsa zual bawk.

Tu nge hlauhawm ber?

Research atanga a lan dan chuan, MDD vei, damdawi ei thinte nena khaikhin chuan, TRD vei te hian a hnuaia taksa dinhmun te hi an nei tam zawk a ni:

• Autoimmune diseases (chu chu taksa immune system in a beih nana natna a ni).
• Thyroid natna a ni.
• Lung natna.
• Cerebrovascular disease (chu chu thluaka thisen petu vessel-a natna lo awm tihna a ni).

Heng natna vei zawng zawng hian TRD an nei vek dawn tihna a ni lo va, mahse hengte hi risk factor a ni thei.

Engtin nge doctor-te hian hei hi an hriat chian tak?

`TRD` diagnosis hi a chiang vak lo. Mahse, doctor tam zawk chuan he natna hi tuna i hman mek antidepressant pahnih tal i ei hnua i lungngaihna lanchhuahnaah hmasawnna i hmuh loh hunah an hmuchhuak thin. Doctor-te chuan a hnuaia mite hi first-line antidepressant angin an ngai fo thin:

• `SSRIs` tih te hi a ni
• `SNRIs` tih te hi a ni
• Bupropion a ni
• Mirtazapine a ni

A tlangpuiin damdawi pakhat chu a thawk tha em tih hriat nan kar ruk atanga kar riat tal i hman a ngai a ni.

Damdawi pahnih i ei a, hmasawnna i la nei lo a nih chuan i doctor chuan rilru lam doctor hnenah a refer thei che a ni . Chutah chuan medical leh mental health history kimchang tak a la ang. Hei hian a huam thei ang:

• Tuna i damdawi ei zawng zawng (doctor-in a pek, over-the-counter, herbal remedies, narcotics thlengin) .Hemi chungchang hi zawt rawh. A chhan chu damdawi thenkhat hian antidepressant hman tangkai dan a tibuai thei a, depression pawh a tizual thei bawk.
• Antidepressant leh damdawi dang i ei dik leh tih loh chu an sawiho ang .
• Psychotherapy emaw talk therapy emaw i dawng tawh em tih leh i depression-ah a pui em tih an enfiah ang.
• Taksa lam dinhmun thenkhat, thyroid natna leh natna rei tak te hian lungngaihna a thlen thei emaw, a tizual thei emaw a, chuvangin an enfiah thin.
• Ruihhlo hman ang chi harsatna an awm leh awm loh an enfiah thin .
• I natna lan chhuah dan chu rilru lam hriselna lama harsatna dang (e.g., bipolar disorder emaw personality disorder) neia hriat a nih a rinawm zawk em tih ngaihtuah rawh .

Heng zawng zawng hi sawiho a, test tulte i tih zawh hnuah i doctor chuan `TRD` i neih leh neih loh a rel ang. Tichuan, i tâna enkawlna ṭha ber zawng tûrin a ṭanpui ang che.

Chuti a nih chuan hei hi eng enkawlna nge ni?

`TRD` control dan kawng hrang hrang a awm. Duhthusam result hmuh theih nan hun engemaw chen a la ngai mai thei, mahse beiseina bansan suh.

Pakhatnaah chuan i rilru lam doctor chuan heng thilte hi a lo enchhin thei ang:

• Tuna i hman mek antidepressant hi hnathawh nan hun tlem tal pe rawh.
• Tuna i ei mek first-line antidepressant hi tipung rawh.
• Class dang atanga antidepressant pakhat dah tel bawk ang che. Tichuan vawi khatah damdawi pahnih i ei ta a.
• Psychologist hmu turin infuih la , psychotherapy la rawh . "Get you" therapist zawn nan hun engemaw chen a ngai thei. Tin, psychotherapy chi hrang hrang a awm bawk.

Enkawlna pangngaiin a hlawhtlin loh chuan eng nge i tih leh ang?

Heng hmanraw bulpui te hian hna a thawk lo a nih chuan i rilru lam doctor chuan damdawi chi dang, damdawi inkawp, emaw, enkawl dan dang emaw a rawt fo ang.

Tunah hian US Food and Drug Administration (FDA) chuan TRD atan damdawi panga a pawm tawh a, chungte chu:

• Aripiprazole (Abilify®) leh Brexpiprazole (Rexulti®): Hengte hi thlah thumna antipsychotic damdawi an ni. I thluaka serotonin leh norepinephrine level a nghawng avangin depression symptoms a tihziaawm thei a ni.
• Quetiapine (Seroquel®) leh Olanzapine (Zyprexa®): Hengte hi antipsychotics thlah hnihna an ni. Quetiapine hi TRD enkawlna atana adjunctive treatment atan antidepressant hmanga pawm a ni. Olanzapine hi Fluoxetine (Prozac®) nena pek dun a nih chuan pawm a ni. Thluaka dopamine level a nghawng avangin depression symptoms tihziaawmna atan an pui thin. Heng damdawi te hian mutthilhna a thlen thei bawk.
• Esketamine nasal spray (Spravato®): Hei hi ketamine tih hming pu thil atanga siam a ni. FDA chuan kum 2019 khan TRD vei puitling tan add-on treatment atan a pawm a, oral antidepressant pawh a pawm bawk. Esketamine hian a ei atanga darkar hnih vel chhungin depression symptoms a tihziaawm tan thei a ni. Mahse, mutthilh lutuk (sedation), dissociation (i awmna leh thil thleng hriat lohna) a thlen theih avangin leh hmansual theih a nih avangin he damdawi hi clinic-a doctor enkawlna hnuaiah chauh pek a ni. Damdawi ei hnu darkar hnih chhung chu Doctor ten an vil reng ang che.

Eng enkawlna dang nge FDA-in a pawmpui?

FDA pawhin TRD enkawlna atana heng enkawlnate hi a pawm tawh bawk:

• Electroconvulsive therapy (ECT): Hei hi damdawi lam thil a ni. Hei hian i thluak kaltlangin electrical impulse na lo tak tak a thawn a, chu chuan seizure tenau a thlen thin. Hei hian nerve cells a tichak a, thluaka inthlak danglamna a thlen thei a, chu chuan i mood a ti tha thei a ni.
• Repetitive transcranial magnetic stimulation (rTMS): Hei hi noninvasive hmanga enkawlna a ni. He enkawlnaah hian magnetic coil hmangin i thluak natural electrical activity a nghawng a ni. Hei hian thluak hmun bik hrang hrangah inthlak danglamna a thlen thei a, chu chuan i mood a tichhe thei a ni.

Enkawlna dang a awm em?

TRD enkawlna dang engemaw zat a awm a, mahse hengte hi a la awm lo emaw, zirchianna stage-ah a la awm emaw pawh a ni thei:

• Deep brain stimulation (DBS): Hei hi damdawi lam thil a ni bawk. Hetah hian i thluak hmun bik pakhatah electrical current nem tak a thleng a. He electric hian chu lai hmuna thluak cell te chu a tichak a, chu chuan TRD telin thil engemaw zat atanga chhanchhuahna a pe thei a ni.
• Lithium (Eskalith®): Research atanga a lan dan chuan lithium hi antidepressant (e.g., citalopram) nena ei hian TRD a ti tha thei a ni.
• `MAOI` (Monoamine oxidase inhibitors): Hengte hi antidepressant hmuhchhuah hmasak ber an ni. Mahse, ei leh in lama khapna tam tak a awm avangin, a side effects, leh himna chungchangah doctor-te chuan antidepressant dang zawng zawng a hlawhchham hunah chauh an pe thin.
• Pramipexole (Mirapex®): Hei hi Parkinson natna damdawi FDA-in a pawmpui a ni. Zirna hrang hrangah chuan Parkinson natnaah hian lungngaihna lanchhuahna a tihziaawm thei tih hmuhchhuah a ni. TRD vei te pawh a pui thei bawk.
• Vagus nerve tihchakna (VNS): 1.1.Hetah hian device pakhat dah a ni a, chu chuan i kawr chhunga vagus nerve kaltlangin i thluak bul ah electrical pulse mumal leh nem tak a thawn thin. Hei hian i thluaka i mood control tu ‘neurotransmitters’ thenkhat level a tidanglam thei a ni.

Researcher-te chuan TRD enkawlna atan hallucinogenic mushroom atanga compound lakchhuah psilocybin an zirchiang mek bawk.

Heng enkawlnate hian side effect a nei em?

A tlangpuiin `TRD` damdawi leh enkawlna hian first-line antidepressant aiin side effect a nei tam zawk thei. Tin, chutiang side effects te chu a danglam thei hle bawk. I doctor chuan enkawlna kawng hrang hranga side effect emaw, complication emaw awm thei te chu a sawipui ang che. Zawhna zawt hreh suh.

Hetiang dinhmun hi a lo thlen loh nan ven theih a ni em?

Scientist ten TRD thlentu dik tak an hriat loh avangin ven a harsa tlangpui. Mahse, chronic stress hian a thlen theih avangin, i stress control nan heng thilte hi i ti thei ang:

• Exercise neih fo thin ang che. Kea kal rei pawh hian i mood a ti tha thei hle.
• Mut tha rawh. Hei hi hriselna pum pui atan a pawimawh hle.
• Meditation, yoga, thawk chhuahna exercise, leh taksa ruh tih hahdamna exercise ang chi thilte chu ti ve rawh .
• I ni, kar, leh thla atân thiltum siam rawh. Thil tenawm tak takah i rilru i pek chuan, hun rei tak chhung leh hun rei tak chhunga thil thleng tur chu i thunun thei ang maiin i inhria ang.
• Ngaihtuahna leh lawmthu sawina practice rawh . I ni emaw, i nunah emaw thil tha awmte chu ngaihtuah rawh.
• I buai emaw, i stress emaw laiin mawhphurhna dang (extra responsibilities)-ah "ni lo" tih hi hmang thin ang che.
• I rilru ti hahdamtu, rilru lama ṭanpuitu che, leh thil ṭangkai taka ṭanpuitu che mite nêna inlaichînna vawng reng rawh.
• Therapist emaw, i doctor emaw nen stress chungchangah inbiakna neih tum ang che.

Treatment-resistant depression i neih chuan in lamah eng nge i tih theih ang?

TRD tana professional, medical tanpuina zawng bakah hian in lama i tih theih tur thil engemaw zat a awm a, chu chuan i natna lan chhuah dan a tihziaawm thei a ni:

• Exercise neih fo thin.
• Mut quality tha tak neih (mut tam lutuk emaw, mut tlem emaw pawh ni lo).
• Ei leh in hrisel ei.
• Zu leh damdawi lam ni lo damdawi hman loh tur. Zu hi depressant a ni.
• I hmangaih leh ngaihsakte nena hun hman.

Engtikah nge Doctor i hmuh ang?

TRD enkawlna tur ruahmanna \ha tak i hmuh hma loh chuan a hnathawh dan chu en rawh.Doctor i pan fo tur a ni.

Chumi piah lamah chuan heng thil thlengah hian i doctor nen inbia ang che:

• Side effects buaithlak tak tak i tawn chuan.
• I symptoms a lo tha lo a nih chuan, emaw, a na zual a nih chuan.
• I damdawi ei kha tihtawp i ngaihtuah a nih chuan (damdawi lam thurawn tel lovin damdawi ei kha bansan ngai suh).

I sawi tur pawimawh ber chu

`TRD` i neih chuan nangmah chauh i ni lo tih hre reng ang che . Major depression nei zinga 30% vel chuan he natna hi an nei a ni. `TRD` hi enkawlna kawng hrang hrang a awm a, mahse i tana tha ber tur zawn nan hun engemaw chen a la ngai thei. Chu zinkawngah chuan i doctor leh/ emaw psychiatrist chuan a pui ang che. Beiseina chu bansan ngai suh. Support leh enkawlna dik tak i neih chuan he natna hi i enkawl thei a, nun tha zawk i hmang thei bawk.

` Treatment-resistant depression, depression, rilru hriselna, TRD, MDD, depression enkawlna, rilru natna