Reka tuvuge ku ndwara yo kwiheba idakira imiti!

Ushobora kuba umaze amezi menshi, ndetse n'imyaka urwaye indwara yo kwiheba. Wagiye kwa muganga ukafata imiti imwe cyangwa ibiri mu gihe runaka, ariko agahinda kawe, kutagira icyo ushishikajwe nacyo, cyangwa agahinda katakwihanganirwa ntikarashira na gato. Hanyuma ushobora kuba ufite icyo bita "Ihungabana ridashobora kuvurwa" (TRD). Ntugatinye iyo wumvise iryo zina, ntabwo bivuze ko "ridashobora kuvurwa." Ariko, bishobora gufata igihe kugira ngo ubone umuti ukubereye. Reka tubiganireho birambuye kandi byoroshye uyu munsi.

Iyi ndwara yitwa ihungabana ridakira kuvurwa ni iki?

Mu magambo make, 'ihungabana ridashobora kuvurwa' ni itsinda ry'indwara ikomeye yo kwiheba (MDD). Irasuzumwa iyo ufite ihungabana kandi ufata nibura imiti ibiri ya mbere yo kwiheba, ku gipimo cyagenwe kandi mu gihe cyagenwe (nibura ibyumweru 6 kugeza kuri 8) , ariko ibimenyetso byawe ntibigenda neza.

Ubusanzwe abaganga babanza gutanga imiti ikomoka mu itsinda rya `SSRI` (Selective Serotonin Reuptake Inhibitors) cyangwa `SNRI` (Serotonin na Norepinephrine Reuptake Inhibitors). Ibi biterwa nuko, ugereranije n'indi miti igabanya ubukana, iyi miti igira ingaruka nke, kandi ingaruka zayo ntiziba zikomeye cyane. Hari igihe n'abantu bakiraga neza imiti igabanya ubukana bashobora kurwara `TRD` nyuma. Nubwo izina ryayo rivugwa, hari n'uburyo bwo kuyivura, ariko bishobora gufata igihe kugira ngo ubone iyikubereye.

Iyi ndwara ikunze kugaragara gute?

Ese wari uzi ko abantu bagera kuri 30% barwaye indwara ikomeye yo kwiheba (MDD) bakayivurwa nabo bafite indwara ya TRD? MDD ni imwe mu ndwara zo mu mutwe zikunze kugaragara ku isi. Ifata abantu bari hagati ya 5% na 17% mu gihe runaka mu buzima bwabo. Rero, ibuka ko utari wenyine.

Ni ibihe bimenyetso by'ibi?

Abantu barwaye `TRD` bafite ibimenyetso bimwe n'iby'abafite `MDD`. Ni ukuvuga ibintu nk'agahinda gahoraho, kwiheba, ibibazo byo gusinzira (kuba batasinziriye na gato, cyangwa kudashobora gusinzira), hamwe n'impinduka mu kurya (kuba batashaka kurya, cyangwa kurya cyane).

Ariko, ibi bintu bikunze kugaragara cyane mu bantu bafite `TRD`:

• Ibimenyetso bigenda birushaho gukomera.
• Ihungabana rimara igihe kirekire.
• Indwara yitwa "Anhedonia." Bisobanura ko utagishobora kuryoherwa n'ibintu byakuzaniraga ibyishimo cyangwa ibyishimo. Tekereza, uri kumva indirimbo ukunda cyangwa uganira n'inshuti, ariko nta marangamutima wumva.
• Kwiyongera k'ibihe byo kwiheba mu buzima bw'umuntu.
• Kugira imihangayiko ikabije.
• Igitekerezo cyo kwiyahuraKandi amahirwe menshi yo kubigerageza.

Icy'ingenzi: Niba wowe cyangwa umuntu uzi afite igitekerezo cyo kwiyahura, nyamuneka hamagara umurongo w'ubuzima bwo kwiyahura n'ibibazo kuri 988. Hari umuntu uhari amasaha 24 ku munsi kugira ngo agufashe. Ushobora kandi kubonana na muganga cyangwa umujyanama mu by'ubuzima bwo mu mutwe vuba bishoboka.

Kuki ibi bibaho? Impamvu ni izihe?

Mu by’ukuri, abashakashatsi ntibaramenya neza impamvu indwara yo kwiheba ya bamwe mu bantu idakira imiti. Nk’uko nta mpamvu imwe itera kwiheba, hari ibintu byinshi, harimo ingaruka za genetiki n’impinduka mu mikorere y’ubwonko, bigira uruhare muri iyi ndwara.

Ariko, batekereza ko stress idakira ishobora kugira ingaruka zikomeye kuri ibi. Ubizi ute? Dufite sisitemu y'ingenzi mu mibiri yacu yitwa `Hypothalamic-Pituitary-Adrenal (HPA). Ibi nibyo bidufasha kumenyera stress. Rero, stress ihoraho ishobora guhindura imikorere y'iyi `HPA`. Iyo bibaye, ihungabana rirushaho gukomera kandi rigakomera kuvura.

Ni nde uri mu kaga gakomeye kurusha abandi?

Ubushakashatsi bwagaragaje ko, ugereranyije n'abantu barwaye MDD basubiza imiti, abantu barwaye TRD bafite amahirwe menshi yo kugira indwara zikurikira:

• Indwara ziterwa n'ubwiyongere bw'umubiri (ni ukuvuga indwara aho ubudahangarwa bw'umubiri bwibasira).
• Indwara ya tiroyide.
• Indwara z'umutima.
• Indwara z'imitsi yo mu bwonko (ni ukuvuga indwara zibaho mu miyoboro itanga amaraso mu bwonko).

Si abantu bose bafite izi ndwara bazarwara indwara ya TRD, ariko izi zishobora kuba impamvu z’ibyago.

Ni gute abaganga basuzuma ibi neza?

Uburyo indwara ya `TRD` ipimwa ntabwo isobanutse neza. Ariko, abaganga benshi bapima iyi ndwara iyo utabonye impinduka mu bimenyetso byawe byo kwiheba nyuma yo gufata nibura imiti ibiri yo kwiheba ukoresha ubu. Abaganga bakunze gufata ibi bikurikira nk'imiti yo kwiheba ya mbere:

• `SSRIs`
• `SNRIs`
• Bupropiyoni
• Mirtazapine

Muri rusange, ugomba gukoresha umuti nibura ibyumweru bitandatu kugeza ku munani kugira ngo urebe niba ukora cyangwa utarakora.

Niba ufata imiti ibiri ariko ntugire icyo ugeraho, muganga wawe ashobora kukwohereza kwa muganga w’indwara zo mu mutwe . Aho ngaho, azagusuzuma neza amateka y’ubuzima bwawe n’ubuzima bwo mu mutwe. Ibi bishobora kuba birimo:

• Imiti yose urimo gufata ubu (wandikiwe na muganga, uyihabwa ku giciro cya muganga, imiti y'ibimera, ndetse n'imiti igabanya ubukana)Ibaze ibi. Kubera ko imiti imwe n'imwe ishobora kubangamira imikorere y'imiti igabanya ubukana bw'indwara zo kwiheba cyangwa ikongera kwiheba.
• Bazaganira niba ufata imiti igabanya ubukana bw'indwara zo kwiheba n'indi miti neza kandi nkuko byategetswe .
• Bazasuzuma niba warahawe ubuvuzi bwo mu mutwe cyangwa uburyo bwo kuvugana n'abantu , kandi niba byaragufashije mu gihe cyo kwiheba.
• Indwara zimwe na zimwe zo mu mubiri, nk'indwara ya tiroyide n'ububabare budakira, zishobora gutera cyangwa zigatuma umuntu arushaho kwiheba, bityo zigasuzumwa.
• Basuzuma ibibazo nko gukoresha ibiyobyabwenge .
• Tekereza niba ibimenyetso byawe bishobora gusanganwa n'indi ndwara yo mu mutwe (urugero: indwara ya bipolar cyangwa indwara y'imico) .

Nyuma yo kuganira kuri ibi byose no gukora ibizamini bikenewe, muganga wawe azasuzuma niba ufite `TRD` cyangwa udafite. Hanyuma, azagufasha kubona uburyo bwiza bwo kuvura.

None se ni ubuhe buryo bwo kuvura ibi?

Hari uburyo bwinshi bwo kugenzura `TRD`. Bishobora gufata igihe kugira ngo ubone umusaruro wifuza, ariko ntugacike intege.

Ubwa mbere, umurwayi wawe w’indwara zo mu mutwe ashobora kugerageza ibi bintu:

• Ha umuti ugabanya ubukana bw'indwara zo kwiheba urimo gufata umwanya munini wo gukora.
• Ongera igipimo cy'umuti wo ku rwego rwa mbere uvura indwara zo mu mutwe uri gufata ubu.
• Ongeraho umuti wo kurwanya indwara uturutse mu kindi cyiciro. Hanyuma urimo gufata imiti ibiri icyarimwe.
• Ihutire guhura n'umuganga w'imitekerereze y'abantu (psychologist) maze uhabwe ubuvuzi bwo mu mutwe (psychotherapy) . Bishobora gufata igihe kugira ngo ubone umuganga w'imitekerereze "ugufasha." Nanone, hari ubwoko butandukanye bw'ubuvuzi bwo mu mutwe.

Ukora iki nyuma yaho iyo ubuvuzi busanzwe budakora?

Iyo ubu buryo bw'ibanze budakora, umuganga wawe w'indwara z'imitsi akunze kukugira inama yo gukoresha ubundi bwoko bw'imiti, imiti ivanze, cyangwa ubundi buryo bwo kuvura.

Kugeza ubu, Ikigo gishinzwe ibiribwa n'imiti muri Amerika (FDA) cyemeje imiti itanu ya TRD:

• Aripiprazole (Abilify®) na Brexpiprazole (Rexulti®): Iyi ni imiti igabanya ubukana bw'indwara zo mu mutwe yo mu gisekuru cya gatatu. Ishobora kugabanya ibimenyetso by'ihungabana ikagira ingaruka ku rugero rwa serotonin na norepinephrine mu bwonko bwawe.
• Quetiapine (Seroquel®) na Olanzapine (Zyprexa®): Iyi ni imiti igabanya ubukana bw'indwara zo mu mutwe yo mu gisekuru cya kabiri. Quetiapine yemejwe nk'umuti w'inyongera kuri TRD hamwe n'imiti igabanya ubukana bw'indwara zo mu mutwe. Olanzapine yemejwe iyo itanzwe hamwe na Fluoxetine (Prozac®). Ifasha kugabanya ibimenyetso by'ihungabana bigira ingaruka ku rugero rwa dopamine mu bwonko. Iyi miti ishobora no gutera gusinzira.
• Spray yo mu mazuru ya Esketamine (Spravato®): Iyi ikorwa mu kintu cyitwa ketamine. FDA yemeje mu 2019 nk'umuti wongera ku bantu bakuru barwaye TRD, hamwe n'umuti wo mu kanwa ugabanya ubukana bw'indwara. Esketamine ishobora gutangira kugabanya ibimenyetso by'ihungabana mu masaha abiri uyifashe. Ariko, kubera ko ishobora gutera gusinzira cyane (gusinzira), gutandukana (kutamenya aho uri cyangwa ibiri kuba), kandi kubera ko ishobora gukoreshwa nabi, uyu muti utangwa gusa munsi y'ubugenzuzi bwa muganga mu ivuriro. Abaganga bazagukurikirana amasaha abiri nyuma yo gufata umuti.

Ni ubuhe bundi buryo bwo kuvura bwemewe na FDA?

FDA yemeje kandi ubu buryo bwo kuvura TRD:

• Ubuvuzi bwa Electroconvulsive (ECT): Ubu ni uburyo bw'ubuvuzi. Muri ubu buryo, amashanyarazi yoroshye cyane yoherezwa mu bwonko bwawe, bigatera isereri nto. Ibi bikangura uturemangingo tw'imitsi kandi bishobora guteza impinduka mu bwonko zituma wumva umerewe neza.
• Gukangura amashanyarazi mu bwonko (rTMS) bisubiramo: Ubu ni uburyo bwo kuvura budakoresha amashanyarazi menshi. Muri ubu buryo bwo kuvura, icyuma gikoresha amashanyarazi gikoreshwa mu kugira ingaruka ku mikorere y’ubwonko bwawe. Ibi bishobora guteza impinduka mu bice bimwe na bimwe by’ubwonko bigira ingaruka ku byiyumvo byawe.

Ese hari ubundi buryo bwo kuvura?

Hari ubundi buryo bwinshi bwo kuvura TRD, ariko ubu buryo bushobora kuba budakunze kuboneka cyangwa bushobora kuba bukiri mu cyiciro cy’ubushakashatsi:

• Gukangura ubwonko mu buryo bwimbitse (DBS): Ubu buryo kandi ni ubuvuzi. Aha, amashanyarazi yoroshye agezwa mu gice runaka cy'ubwonko bwawe. Aya mashanyarazi akangura uturemangingo tw'ubwonko muri ako gace, dushobora gutanga ubutabazi ku ndwara zitandukanye, harimo na TRD.
• Lithium (Eskalith®): Ubushakashatsi bwagaragaje ko gufata lithium hamwe n'umuti ugabanya ubukana bw'indwara (urugero: citalopram) bishobora kongera TRD.
• `MAOI` (Indagihe zo kurwanya indwara za Monoamine oxidase): Iyi ni yo miti ya mbere igabanya ubukana bw'indwara zo kwiheba yavumbuwe. Ariko, kubera ko hari amategeko menshi ku bijyanye no gufata ibiryo, ingaruka mbi, ndetse n'ibibazo by'umutekano, abaganga bayitanga gusa iyo indi miti yose igabanya ubukana bw'indwara zo kwiheba yananiwe.
• Pramipexole (Mirapex®): Uyu ni umuti wemewe na FDA uvura indwara ya Parkinson. Ubushakashatsi bwagaragaje ko ushobora kugabanya ibimenyetso by'indwara yo kwiheba ku ndwara ya Parkinson. Ushobora kandi gufasha abantu barwaye TRD.
• Gukangura imitsi yo mu nda y'umura (VNS):Aha, hashyirwamo igikoresho cyohereza amashanyarazi ahoraho kandi yoroshye mu bwonko bwawe binyuze mu mutsi wa vagus uri mu ijosi ryawe. Ibi bishobora guhindura urwego rwa 'neurotransmitters' zimwe na zimwe mu bwonko bwawe zigenzura uko wumva umerewe.

Abashakashatsi barimo kwiga kuri psilocybin, ikintu cyakuwe mu bihumyo bitera indwara z’ubwonko, nk'umuti uvura TRD.

Ese hari ingaruka mbi kuri ubu buryo bwo kuvura?

Muri rusange, imiti n'imiti ivura `TRD` bishobora kugira ingaruka mbi nyinshi kurusha imiti igabanya ubukana bwa mbere. Nanone, izo ngaruka mbi zishobora gutandukana cyane. Muganga wawe azakubwira ingaruka mbi zishobora guterwa na buri buryo bwo kuvura. Ntutinye kubaza ibibazo.

Ese iki kibazo gishobora kwirindwa kubaho?

Kubera ko abahanga mu bya siyansi batazi neza icyatera TRD, akenshi biragoye kuyirinda. Ariko, kubera ko stress idakira ishobora kuyitera, ushobora gukora ibi bikurikira kugira ngo ucunge stress yawe:

• Siporo buri gihe. Ndetse no kugenda n'amaguru make bishobora gutuma wumva umerewe neza.
• Gira ibitotsi byiza. Ibi ni ingenzi ku buzima muri rusange.
• Gerageza ibintu nko gutekereza cyane, yoga, imyitozo ngororamubiri yo guhumeka, n'imyitozo yo kuruhuka imitsi .
• Shyiraho intego z'umunsi wawe, icyumweru, n'ukwezi. Iyo wibanda ku bintu bito, uzumva ko ufite ububasha ku gihe n'igihe kirekire.
• Itoze gutekereza neza no gushimira . Tekereza ku bintu byiza byo mu buzima bwawe.
• Igire akamenyero ko kuvuga "oya" ku nshingano z'inyongera iyo ufite akazi kenshi cyangwa ufite stress.
• Komeza kugirana umubano n'abantu bagufasha gutuza, bagushyigikira mu buryo bw'amarangamutima, kandi bagufasha mu bintu bifatika.
• Tekereza kuganira n'umuvuzi cyangwa muganga wawe ku bijyanye n'imihangayiko.

Niba ufite ikibazo cyo kwiheba kidakira imiti, ni iki wakora mu rugo?

Uretse gushaka ubufasha bw'inzobere mu by'ubuvuzi kuri TRD, hari ibintu byinshi ushobora gukora mu rugo bishobora kugufasha kugabanya ibimenyetso by'indwara:

• Gukora imyitozo ngororamubiri buri gihe.
• Gusinzira neza (nta gusinzira cyane cyangwa gusinzira bihagije).
• Kurya indyo yuzuye.
• Irinde inzoga n'ibiyobyabwenge bitari ibya muganga. Inzoga ni umuti ugabanya kwiheba.
• Kumarana umwanya n'abo ukunda kandi ukunda.

Ni ryari ukwiye kujya kwa muganga?

Kugeza igihe uzabona gahunda nziza yo kuvura TRD ikubereye, reba uko ikora.Ugomba kujya kwa muganga wawe buri gihe.

Uretse ibyo, vugana na muganga wawe muri ibi bihe:

• Niba ugize ingaruka mbi ziguhangayikishije.
• Niba ibimenyetso byawe bitagenze neza, cyangwa niba birushaho kwiyongera.
• Niba utekereza guhagarika imiti yawe (ntuzigere uhagarika gufata imiti utabanje kugisha inama muganga).

Ikintu cy'ingenzi ugomba kuvuga

Niba ufite `TRD`, banza wibuke ko utari wenyine . Abantu bagera kuri 30% bafite ikibazo cyo kwiheba gukomeye bafite iyi ndwara. Hari uburyo bwinshi bwo kuvura `TRD`, ariko bishobora gufata igihe kugira ngo ubone igufitiye akamaro. Muganga wawe cyangwa umuganga w’indwara zo mu mutwe bazagufasha muri urwo rugendo. Ntugacike intege. Ufite ubufasha n’ubuvuzi bikwiye, ushobora kwihanganira iki kibazo no kubaho ubuzima bwiza.

Ihungabana ridashobora kuvurwa, ihungabana, ubuzima bwo mu mutwe, TRD, MDD, ubuvuzi bw'ihungabana, indwara zo mu mutwe