Tiyeni tikambirane za Matenda a Kukhumudwa Osachiritsika ndi Chithandizo!

Mwina mwakhala mukuvutika ndi kuvutika maganizo kwa miyezi ingapo, ngakhale zaka zambiri. Mwaonana ndi dokotala ndipo mwamwa mankhwala osati amodzi koma awiri kwa nthawi yoikidwiratu, koma chisoni chanu, kusowa chidwi ndi chilichonse, kapena chisoni chosapiririkacho sichinathe konse. Ndiye mwina muli ndi chomwe chimatchedwa "Chisoni Chosachiritsika ndi Chithandizo" (TRD). Musachite mantha mukamva dzina limenelo, sizitanthauza kuti "sichingathe kuchiritsidwa." Komabe, zingatenge nthawi kuti mupeze chithandizo choyenera kwa inu. Tiyeni tikambirane izi mwatsatanetsatane komanso mosavuta lero.

Kodi vuto lotchedwa kuvutika maganizo losalandira chithandizo ndi chiyani?

Mwachidule, 'kuvutika maganizo kosachiritsika ndi mankhwala' ndi gawo la Matenda Ovutika Maganizo Oopsa (MDD). Amapezeka ngati muli ndi kuvutika maganizo ndipo mukumwa mankhwala ochepetsa nkhawa awiri oyamba, pa mlingo woyenera komanso kwa nthawi yoyenera (osachepera masabata 6 mpaka 8) , koma zizindikiro zanu sizikuchepa mokwanira.

Madokotala nthawi zambiri amayamba akupereka mankhwala ochokera ku gulu la `SSRI` (Selective Serotonin Reuptake Inhibitors) kapena `SNRI` (Serotonin ndi Norepinephrine Reuptake Inhibitors). Izi zili choncho chifukwa, poyerekeza ndi mankhwala ena oletsa kuvutika maganizo, awa ali ndi zotsatirapo zochepa, ndipo zotsatirapo zake sizowopsa kwambiri. Nthawi zina, ngakhale anthu omwe kale adayankha bwino mankhwala oletsa kuvutika maganizo amatha kukhala ndi `TRD` pambuyo pake. Ngakhale dzina lake lili lotani, palinso mankhwala ena ochizira izi, koma zingatenge nthawi kuti mupeze yoyenera kwa inu.

Kodi vutoli ndi lofala bwanji?

Kodi mukudziwa kuti pafupifupi 30% ya anthu omwe adapezeka ndi matenda aakulu a maganizo (MDD) ndipo adachiritsidwa nawonso ali ndi matenda a TRD? MDD ndi imodzi mwa matenda ofala kwambiri padziko lonse lapansi. Imakhudza anthu pakati pa 5% ndi 17% nthawi ina m'miyoyo yawo. Chifukwa chake, kumbukirani kuti simuli nokha.

Kodi zizindikiro za izi ndi ziti?

Anthu omwe ali ndi `TRD` ali ndi zizindikiro zomwezo monga omwe ali ndi `MDD`. Izi zikutanthauza zinthu monga chisoni chosalekeza, kukhumudwa, matenda ogona (mwina osagona konse, kapena osagona), komanso kusintha kwa chilakolako (mwina osafuna kudya, kapena kudya mopitirira muyeso).

Komabe, zinthu izi ndizofala kwambiri pakati pa anthu omwe ali ndi `TRD`:

• Zizindikiro zikukulirakulira.
• Kuvutika maganizo kumatenga nthawi yaitali.
• Matenda otchedwa "Anhedonia." Zimatanthauza kuti simukuthanso kupeza chisangalalo chilichonse kuchokera ku zinthu zomwe zinkakubweretserani chisangalalo kapena chisangalalo. Tangoganizirani, mukumvetsera nyimbo yomwe mumakonda kapena mukulankhula ndi mnzanu, koma simukumva chilichonse.
• Kuwonjezeka kwa nthawi zomwe munthu amakumana ndi mavuto a maganizo pa moyo wake wonse.
• Kukhala ndi nkhawa kwambiri.
• Lingaliro lofuna kudziphaNdipo mwayi wochuluka woyesera.

Chofunika: Ngati inu kapena munthu amene mumamudziwa akuganiza zodzipha, chonde imbani Suicide and Crisis Lifeline pa 988. Winawake alipo maola 24 patsiku kuti akuthandizeni. Muthanso kuonana ndi dokotala kapena mlangizi wa zaumoyo wamaganizo mwamsanga.

N’chifukwa chiyani izi zikuchitika? Kodi zifukwa zake ndi ziti?

Ndipotu, ofufuza sakudziwabe chifukwa chake vuto la kuvutika maganizo la anthu ena silingayankhe mankhwala. Monga momwe palibe chifukwa chimodzi chokha choyambitsa kuvutika maganizo, zinthu zambiri, kuphatikizapo majini ndi kusintha kwa mankhwala muubongo, zimayambitsa vutoli.

Koma, akuganiza kuti, kupsinjika maganizo kosatha kungayambitse vuto lalikulu pa izi. Mukudziwa bwanji? Tili ndi dongosolo lofunika kwambiri m'thupi lathu lotchedwa `Hypothalamic-Pituitary-Adrenal (HPA) axis. Izi ndi zomwe zimatithandiza kuzolowera kupsinjika maganizo. Chifukwa chake, kupsinjika maganizo kosalekeza kungasinthe momwe `HPA` iyi imagwirira ntchito. Izi zikachitika, kupsinjika maganizo kumakhala koopsa kwambiri komanso kovuta kuchiza.

Ndani amene ali pachiwopsezo chachikulu?

Kafukufuku wasonyeza kuti, poyerekeza ndi anthu omwe ali ndi MDD omwe amayankha mankhwala, anthu omwe ali ndi TRD ali ndi mwayi waukulu wokhala ndi matenda awa:

• Matenda a autoimmune (ndiko kuti, matenda omwe chitetezo cha mthupi chimadziukira chokha).
• Matenda a chithokomiro.
• Matenda a mtima.
• Matenda a mitsempha ya m'mitsempha (ndiko kuti, matenda omwe amapezeka m'mitsempha yomwe imapereka magazi ku ubongo).

Izi sizikutanthauza kuti aliyense amene ali ndi matenda amenewa adzakhala ndi matenda a TRD, koma izi zitha kukhala zinthu zomwe zingawabweretsere mavuto.

Kodi madokotala amazindikira bwanji izi?

Kuzindikira kwa `TRD` sikudziwika bwino. Komabe, madokotala ambiri amazindikira vutoli ngati simunawone kusintha kulikonse mu zizindikiro zanu za kuvutika maganizo mutamwa mankhwala osachepera awiri mwa omwe mukugwiritsa ntchito panopa. Madokotala nthawi zambiri amaona zotsatirazi ngati mankhwala oyamba a kuvutika maganizo:

• `SSRIs`
• `SNRIs`
• Bupropion
• Mirtazapine

Kawirikawiri, muyenera kugwiritsa ntchito mankhwala kwa milungu isanu ndi umodzi kapena isanu ndi itatu kuti muwone ngati akugwira ntchito kapena ayi.

Ngati mukumwa mankhwala awiri koma simukumva bwino, dokotala wanu angakutumizireni kwa dokotala wa matenda amisala . Kumeneko, adzakudziwitsani mbiri yonse ya thanzi lanu lachipatala komanso la maganizo. Izi zingaphatikizepo:

• Mankhwala onse omwe mukumwa panopa (omwe dokotala wanu wakupatsani, omwe mumagwiritsa ntchito pa mankhwala, mankhwala azitsamba, ngakhale mankhwala osokoneza bongo)Funsani izi. Chifukwa mankhwala ena amatha kusokoneza mphamvu ya mankhwala ochepetsa nkhawa kapena kupangitsa kuti kuvutika maganizo kukhale koipa kwambiri.
• Adzakambirana ngati mukumwa mankhwala ochepetsa nkhawa ndi mankhwala ena moyenera komanso monga momwe mwalangizidwira .
• Adzafufuza ngati mwalandira chithandizo cha psychotherapy kapena cha kulankhula komanso ngati chakuthandizani ndi kuvutika maganizo kwanu.
• Matenda ena akuthupi, monga matenda a chithokomiro ndi ululu wosatha, angayambitse kapena kukulitsa kuvutika maganizo, choncho amafufuzidwa.
• Amafufuza mavuto monga kugwiritsa ntchito mankhwala osokoneza bongo .
• Ganizirani ngati zizindikiro zanu zitha kupezeka kuti muli ndi vuto lina la matenda amisala (monga bipolar disorder kapena personality disorder) .

Pambuyo pokambirana zonsezi ndikuchita mayeso ofunikira, dokotala wanu adzadziwa ngati muli ndi `TRD` kapena ayi. Kenako, adzakuthandizani kupeza njira yabwino kwambiri yothandizira.

Ndiye kodi mankhwala ake ndi otani?

Pali njira zingapo zowongolera `TRD`. Zingatenge nthawi kuti mupeze zotsatira zomwe mukufuna, koma musataye mtima.

Choyamba, dokotala wanu wa matenda amisala angayesere zinthu izi:

• Perekani mankhwala oletsa kuvutika maganizo omwe mukutenga nthawi yochulukirapo kuti mugwire ntchito.
• Wonjezerani mlingo wa mankhwala oyamba oletsa kuvutika maganizo omwe mukumwa panopa.
• Onjezani mankhwala oletsa kuvutika maganizo ochokera ku gulu lina. Kenako mukumwa mankhwala awiri nthawi imodzi.
• Dzilimbikitseni kuti mukakumane ndi katswiri wa zamaganizo ndikupeza chithandizo chamankhwala . Zingatenge nthawi kuti mupeze katswiri wa zamaganizo yemwe "amakuthandizani." Komanso, pali mitundu yosiyanasiyana ya chithandizo chamankhwala.

Kodi mumatani pambuyo pake ngati mankhwala wamba sakugwira ntchito?

Ngati njira zoyambira izi sizikugwira ntchito, dokotala wanu wa matenda amisala nthawi zambiri amalangiza mtundu wina wa mankhwala, kuphatikiza mankhwala, kapena njira ina yochiritsira.

Pakadali pano, bungwe la US Food and Drug Administration (FDA) lavomereza mankhwala asanu a TRD:

• Aripiprazole (Abilify®) ndi Brexpiprazole (Rexulti®): Awa ndi mankhwala a m'badwo wachitatu oletsa matenda amisala. Angathe kuchepetsa zizindikiro za kuvutika maganizo pokhudza kuchuluka kwa serotonin ndi norepinephrine muubongo wanu.
• Quetiapine (Seroquel®) ndi Olanzapine (Zyprexa®): Awa ndi mankhwala oletsa matenda amisala a m'badwo wachiwiri. Quetiapine imavomerezedwa ngati mankhwala othandizira a TRD okhala ndi mankhwala oletsa kuvutika maganizo. Olanzapine imavomerezedwa ikaperekedwa pamodzi ndi Fluoxetine (Prozac®). Amathandiza kuchepetsa zizindikiro za kuvutika maganizo pokhudza kuchuluka kwa dopamine muubongo. Mankhwalawa angayambitsenso kugona tulo.
• Esketamine pamphuno spray (Spravato®): Ichi chimapangidwa kuchokera ku chinthu chotchedwa ketamine. FDA idachivomereza mu 2019 ngati chithandizo chowonjezera kwa akuluakulu omwe ali ndi TRD, pamodzi ndi mankhwala oletsa kupsinjika maganizo pakamwa. Esketamine ikhoza kuyamba kuchepetsa zizindikiro za kuvutika maganizo mkati mwa maola awiri mutamwa. Komabe, chifukwa ingayambitse kugona kwambiri (kugona movutikira), kusokonezeka (kutayika kwa chidziwitso cha komwe muli kapena zomwe zikuchitika), komanso chifukwa ingagwiritsidwe ntchito molakwika, mankhwalawa amaperekedwa pokhapokha ngati dokotala akukuyang'anirani kuchipatala. Madokotala adzakuyang'anirani kwa maola awiri mutamwa mankhwalawo.

Ndi mankhwala ena ati omwe FDA yavomereza?

FDA yavomerezanso mankhwala awa a TRD:

• Chithandizo cha Electroconvulsive (ECT): Ichi ndi njira yachipatala. Pachifukwa ichi, mphamvu zamagetsi zochepa zimatumizidwa kudzera mu ubongo wanu, zomwe zimayambitsa khunyu kakang'ono. Izi zimalimbitsa maselo amitsempha ndipo zingayambitse kusintha kwa ubongo komwe kumawongolera malingaliro anu.
• Kubwerezabwereza kwa maginito a transcranial magnetic stimulation (rTMS): Iyi ndi njira yosalowerera. Mu njira imeneyi, coil ya maginito imagwiritsidwa ntchito kusintha mphamvu yamagetsi ya ubongo wanu. Izi zingayambitse kusintha m'malo enaake a ubongo zomwe zimakhudza momwe mukumvera.

Kodi pali njira zina zochiritsira?

Pali njira zina zingapo zochiritsira TRD, koma izi sizingapezeke kwambiri kapena zitha kukhalabe mu gawo lofufuza:

• Kulimbikitsa ubongo mozama (DBS): Iyi ndi njira yachipatala. Apa, magetsi ofatsa amaperekedwa ku gawo linalake la ubongo wanu. Magetsi awa amalimbitsa maselo a ubongo m'derali, zomwe zingapereke mpumulo ku matenda osiyanasiyana, kuphatikizapo TRD.
• Lithium (Eskalith®): Kafukufuku wasonyeza kuti kumwa lithiamu ndi mankhwala oletsa kuvutika maganizo (monga citalopram) kungathandize TRD.
• `MAOI` (zoletsa za Monoamine oxidase): Izi zinali mankhwala oyamba oletsa kuvutika maganizo kupezeka. Komabe, chifukwa cha zoletsa zambiri pa kudya, zotsatirapo zake, komanso nkhawa zokhudzana ndi chitetezo, madokotala amalemba mankhwalawa pokhapokha ngati mankhwala ena onse oletsa kuvutika maganizo alephera.
• Pramipexole (Mirapex®): Iyi ndi mankhwala ovomerezeka ndi FDA a matenda a Parkinson. Kafukufuku wasonyeza kuti imatha kuchepetsa zizindikiro za kukhumudwa mu matenda a Parkinson. Ingathandizenso anthu omwe ali ndi TRD.
• Kulimbikitsa mitsempha ya vagus (VNS):Apa, chipangizo chimayikidwa chomwe chimatumiza ma pulse amagetsi okhazikika komanso ofewa ku ubongo wanu kudzera mu mitsempha ya vagus yomwe ili pakhosi panu. Izi zitha kusintha kuchuluka kwa 'ma neurotransmitters' ena mu ubongo wanu omwe amalamulira momwe mukumvera.

Ofufuza akufufuzanso za psilocybin, mankhwala opangidwa kuchokera ku bowa wochititsa mantha, ngati mankhwala a TRD.

Kodi pali zotsatirapo zilizonse pa mankhwala awa?

Kawirikawiri, mankhwala ndi mankhwala a `TRD` amatha kukhala ndi zotsatirapo zoyipa zambiri kuposa mankhwala oyamba oletsa kuvutika maganizo. Komanso, zotsatirapo zake zimatha kusiyana kwambiri. Dokotala wanu adzakuwuzani za zotsatirapo zoyipa kapena zovuta za njira iliyonse yothandizira. Musazengereze kufunsa mafunso.

Kodi vutoli lingalepheretsedwe kuchitika?

Popeza asayansi sadziwa bwino chomwe chimayambitsa TRD, nthawi zambiri zimakhala zovuta kupewa. Komabe, popeza kupsinjika maganizo kosatha kungayambitse vutoli, mutha kuchita izi kuti muchepetse kupsinjika kwanu:

• Kuchita masewera olimbitsa thupi nthawi zonse. Ngakhale kuyenda pang'ono kungakuthandizeni kukhala ndi maganizo abwino.
• Gonani bwino. Izi ndizofunikira kwambiri pa thanzi lanu lonse.
• Yesani zinthu monga kusinkhasinkha, yoga, masewera olimbitsa thupi opumira, ndi masewera olimbitsa thupi opumula minofu .
• Ikani zolinga zanu za tsiku, sabata, ndi mwezi. Mukayang'ana kwambiri zinthu zazing'ono, mudzamva ngati muli ndi mphamvu pa nthawiyo komanso nthawi yayitali.
• Yesetsani kukhala osamala komanso oyamikira . Ganizirani zabwino zomwe mumachita tsiku lililonse kapena pa moyo wanu.
• Khalani ndi chizolowezi chokana maudindo ena owonjezera mukakhala otanganidwa kapena opsinjika maganizo.
• Sungani ubale ndi anthu omwe amakusungani bata, kukuthandizani m'maganizo, komanso kukuthandizani ndi zinthu zothandiza.
• Ganizirani kulankhula ndi katswiri wa zamaganizo kapena dokotala wanu za nkhawa.

Ngati muli ndi vuto la kuvutika maganizo lomwe silingathe kulandira chithandizo, kodi mungachite chiyani kunyumba?

Kuwonjezera pa kufunafuna thandizo la akatswiri komanso lachipatala la TRD, pali zinthu zingapo zomwe mungachite kunyumba zomwe zingathandize kuchepetsa zizindikiro zanu:

• Kuchita masewera olimbitsa thupi nthawi zonse.
• Kugona bwino (osati kugona mopitirira muyeso kapena kugona mokwanira).
• Kudya zakudya zabwino.
• Pewani mowa ndi mankhwala enaake omwe si achipatala. Mowa umathetsa nkhawa.
• Kucheza ndi anthu omwe mumawakonda komanso kuwakonda.

Kodi muyenera kupita kwa dokotala liti?

Mpaka mutapeza njira yothandiza yothandizira TRD yomwe ikukuthandizani, onani momwe imagwirira ntchito.Muyenera kuonana ndi dokotala wanu nthawi zonse.

Kuonjezera apo, funsani dokotala wanu pazochitika izi:

• Ngati mukukumana ndi zotsatirapo zoyipa.
• Ngati zizindikiro zanu sizikusintha, kapena ngati zikuipiraipira.
• Ngati mukuganiza zosiya kumwa mankhwala anu (musasiye kumwa mankhwala popanda upangiri wa dokotala).

Chinthu chofunika kwambiri chomwe muyenera kunena

Ngati muli ndi `TRD`, choyamba kumbukirani kuti simuli nokha . Pafupifupi 30% ya anthu omwe ali ndi vuto lalikulu la kuvutika maganizo ali ndi vutoli. Pali njira zingapo zochiritsira `TRD`, koma zingatenge nthawi kuti mupeze lomwe likukuyenderani bwino. Dokotala wanu ndi/kapena dokotala wa matenda amisala adzakuthandizani paulendo wanu. Musataye mtima. Ndi chithandizo choyenera komanso chithandizo, mutha kuthana ndi vutoli ndikukhala ndi moyo wabwino.

Kuvutika maganizo kosachiritsika, kuvutika maganizo, thanzi la maganizo, TRD, MDD, chithandizo cha kuvutika maganizo, matenda amisala