Masithethe ngoxinzelelo olunganyangekiyo kunyango!

Usenokuba ubuneengxaki zokudakumba kangangeenyanga, kwaneminyaka. Ukhe wabona ugqirha waza wathatha amayeza amabini kuphela ixesha elithile, kodwa intlungu yakho, ukungabi namdla kwinto ethile, okanye loo ntlungu inganyamezelekiyo ayikapheli konke konke. Emva koko usenokuba nento ebizwa ngokuba yi-"Treatment-Resistant Depression" (TRD). Musa ukoyika xa usiva elo gama, akuthethi ukuba "ayinakunyangeka." Nangona kunjalo, kungathatha ixesha ukufumana unyango olufanelekileyo kuwe. Makhe sithethe ngale nto ngokweenkcukacha nangokulula namhlanje.

Yintoni le nto kuthiwa kukudandatheka okunganyangekiyo ngonyango?

Ngamafutshane, 'uxinzelelo olunganyangekiyo ngonyango' luhlobo oluthile lweMajor Depression Disorder (MDD). Lufunyaniswa xa unesifo soxinzelelo kwaye uthatha ubuncinane amayeza amabini okuqala okudakumba, ngokwedosi ecetyiswayo kunye nexesha elicetyiswayo (ubuncinane iiveki ezi-6 ukuya kwezi-8) , kodwa iimpawu zakho aziphucuki ngokwanelisayo.

Oogqirha badla ngokuqala banike amayeza avela kwiqela le-`SSRI` (Selective Serotonin Reuptake Inhibitors) okanye iqela le-`SNRI` (Serotonin kunye ne-Norepinephrine Reuptake Inhibitors). Oku kungenxa yokuba, xa kuthelekiswa nezinye izidambisi-ntlungu, ezi zineziphumo ebezingalindelekanga ezimbalwa, kwaye iziphumo ebezingalindelekanga azibi kakhulu. Ngamanye amaxesha, nabantu ababesabela kakuhle kwiidambisi-ntlungu ngaphambili banokufumana i-`TRD` kamva. Nangona libizwa njalo, kukho unyango lwalo, kodwa kungathatha ixesha ukufumana elilungele wena.

Ixhaphake kangakanani le meko?

Ubusazi na ukuba malunga nama-30% abantu abafunyaniswe benesifo sokudakumba esikhulu (MDD) baze banyangelwe sona nabo bane-TRD? I-MDD yenye yezona meko zixhaphakileyo zempilo yengqondo ehlabathini. Ichaphazela phakathi kwe-5% kunye ne-17% yabantu ngaxa lithile ebomini babo. Ngoko ke, khumbula ukuba awuwedwa.

Zithini iimpawu zoku?

Abantu abane-`TRD` baneempawu ezifanayo nezo zine-`MDD`. Oko kukuthi, izinto ezifana nokudakumba rhoqo, ukudakumba, iingxaki zokulala (nokuba ukungalali konke konke, okanye ukungakwazi ukulala), kunye notshintsho ekutyeni (nokuba ukungaziva ngathi kukutya, okanye ukutya kakhulu).

Nangona kunjalo, ezi zinto zixhaphake kakhulu kubantu abane-`TRD`:

• Iimpawu ziya zisiba mandundu ngakumbi.
• Ukudakumba kuhlala ixesha elide.
• Imeko ebizwa ngokuba yi- "Anhedonia." Ithetha ukuba awusakwazi ukufumana naluphi na ulonwabo kwizinto ezazikuzisela uvuyo okanye ulonwabo. Khawuthelekelele, umamele ingoma oyithandayo okanye uthetha nomhlobo, kodwa awuziva mvakalelo.
• Ukwanda kweziganeko zokudakumba ebomini bomntu.
• Ukuba nexhala eligqithisileyo.
• Ingcinga yokuzibulalaKwaye amathuba amaninzi okuzama.

Kubalulekile: Ukuba wena okanye umntu omaziyo uneengcinga zokuzibulala, nceda utsalele umnxeba kwi-Suicide and Crisis Lifeline ku- 988. Kukho umntu ofumanekayo iiyure ezingama-24 ngosuku ukukunceda. Ungabona ugqirha okanye umcebisi wezempilo yengqondo ngokukhawuleza.

Kutheni oku kusenzeka? Zithini izizathu?

Enyanisweni, abaphandi abakayazi kakuhle ukuba kutheni abanye abantu bengakwazi ukuphendula kumayeza. Njengokuba kungekho sizathu sithile sokudakumba, izinto ezininzi, kuquka iimpembelelo zemfuza kunye notshintsho kwiikhemikhali zobuchopho, zinegalelo kule meko.

Kodwa, bacinga ukuba, uxinzelelo olungapheliyo lunokuba nefuthe elikhulu koku. Uyazi njani? Sinenkqubo ebalulekileyo emizimbeni yethu ebizwa ngokuba yi-'Hypothalamic-Pituitary-Adrenal (HPA) axis. Yile nto isinceda sikwazi ukuziqhelanisa noxinzelelo. Ngoko ke, uxinzelelo oluqhubekayo lunokutshintsha ukusebenza kwale axis ye-'HPA'. Xa oko kusenzeka, uxinzelelo luba nzima ngakumbi kwaye kube nzima ukulunyanga.

Ngubani osengozini enkulu?

Uphando lubonise ukuba, xa kuthelekiswa nabantu abane-MDD abasabela kumayeza, abantu abane-TRD banamathuba amaninzi okuba nezi meko zilandelayo zomzimba:

• Izifo ezizikhusela ngokwazo emzimbeni (oko kukuthi, izifo apho inkqubo yomzimba yokuzikhusela izihlasela khona).
• Isifo se-thyroid.
• Isifo sentliziyo.
• Isifo semithambo yegazi (oko kukuthi, izifo ezenzeka kwimithambo yegazi ehambisa igazi engqondweni).

Akuyena wonke umntu onesi sifo oza kuba ne-TRD, kodwa ezi zinokuba zizinto ezinobungozi.

Oogqirha bayixilonga njani le nto ngokuchanekileyo?

Ukuxilongwa kwe-'TRD' akucaci kakuhle. Nangona kunjalo, uninzi loogqirha lufumanisa le meko xa ungakhange ubone tshintsho kwiimpawu zakho zokudakumba emva kokusela ubuncinane amayeza amabini okudakumba owasebenzisayo ngoku. Oogqirha badla ngokujonga oku kulandelayo njengemithi yokudakumba yokuqala:

• `Ii-SSRI`
• `Ii-SNRI`
• I-Bupropion
• I-Mirtazapine

Ngokwesiqhelo, kufuneka usebenzise iyeza ubuncinane iiveki ezintandathu ukuya kwezisibhozo ukuze ubone ukuba liyasebenza okanye alisebenzi.

Ukuba usela amayeza amabini kodwa awukaziva bhetele, ugqirha wakho angakuthumela kwingcali yezengqondo . Apho, uya kuhlola imbali yezonyango neyempilo yengqondo. Oku kungabandakanya:

• Onke amayeza owasebenzisayo ngoku (amiselwe ngugqirha, athengiswa ngaphandle kwemvume kagqirha, amayeza esintu, kwaneziyobisi)Buza ngale nto. Kuba amanye amayeza anokuphazamisa ukusebenza kakuhle kwemithi yokudakumba okanye ade enze ukudakumba kube mandundu.
• Baza kuxoxa ngokuba uthatha amayeza okudakumba kunye namanye amayeza ngokuchanekileyo na njengoko kumiselwe .
• Baza kujonga ukuba ufumene unyango lwe-psychotherapy okanye unyango lokuthetha na , kwaye ukuba lukuncedile na kwingxaki yakho yokudakumba.
• Ezinye izifo zomzimba, ezifana nesifo se-thyroid kunye neentlungu ezingapheliyo, zinokubangela okanye ziyenze mandundu ingcinezelo, ngoko ke ziyahlolwa.
• Bajonga iingxaki ezifana nokusetyenziswa kweziyobisi .
• Cinga ukuba iimpawu zakho zinokuthi zifunyaniswe zinenye imeko yempilo yengqondo (umz., isifo sengqondo esibizwa ngokuba yi-bipolar disorder okanye isifo sobuntu) .

Emva kokuxoxa ngako konke oku nokwenza uvavanyo olufunekayo, ugqirha wakho uya kugqiba ukuba unayo na i-'TRD' okanye akunjalo. Emva koko, uya kukunceda ufumane olona nyango lufanelekileyo kuwe.

Ngoko ke zeziphi iindlela zonyango zoku?

Kukho iindlela ezahlukeneyo zokulawula i-'TRD'. Kungathatha ixesha ukufumana iziphumo ezifunekayo, kodwa ungalahli ithemba.

Okokuqala, ugqirha wakho wengqondo angazama ezi zinto:

• Nika i-antidepressant ixesha elingakumbi othatha ngalo ukusebenza.
• Nyusa umthamo weyeza lokuqala lokudakumba olisebenzisayo ngoku.
• Yongeza iyeza lokuthomalalisa uxinezeleko elivela kolunye uhlobo. Emva koko uthatha amayeza amabini ngaxeshanye.
• Zikhuthaze ukuba udibane nogqirha wengqondo uze ufumane unyango lwengqondo . Kungathatha ixesha ukufumana ugqirha wengqondo "oza kukuqonda." Kwakhona, kukho iintlobo ezahlukeneyo zonyango lwengqondo.

Yintoni oyenzayo emva koko xa unyango oluqhelekileyo lungasebenzi?

Ukuba ezi ndlela zisisiseko azisebenzi, ugqirha wakho wengqondo uya kucebisa uhlobo olwahlukileyo lwamayeza, indibaniselwano yamayeza, okanye indlela eyahlukileyo yonyango.

Okwangoku, i-US Food and Drug Administration (FDA) ivumile amayeza amahlanu e-TRD:

• I-Aripiprazole (Abilify®) kunye neBrexpiprazole (Rexulti®): La ngamayeza e-antipsychotic esizukulwana sesithathu. Anganciphisa iimpawu zokudakumba ngokuchaphazela amanqanaba e-serotonin kunye ne-norepinephrine engqondweni yakho.
• I-Quetiapine (Seroquel®) kunye ne-Olanzapine (Zyprexa®): Ezi zii-antipsychotics zesizukulwana sesibini. I-Quetiapine ivunyiwe njengonyango oluncedisayo lwe-TRD kunye namayeza okudakumba. I-Olanzapine ivunyiwe xa inikwa kunye ne-Fluoxetine (Prozac®). Zinceda ekunciphiseni iimpawu zokudakumba ngokuchaphazela amanqanaba e-dopamine engqondweni. La mayeza anokubangela ukozela.
• I-Esketamine nasal spray (Spravato®): Le yenziwe ngento ebizwa ngokuba yi-ketamine. I-FDA iyivumile ngo-2019 njengonyango olongezelelweyo kubantu abadala abane-TRD, kunye ne-oral antidepressant. I-Esketamine inokuqala ukunciphisa iimpawu zokudakumba kwiiyure ezimbini emva kokuyithatha. Nangona kunjalo, kuba inokubangela ukozela kakhulu (ukuthomalalisa), ukwahlukana (ukulahlekelwa kukwazi ukuba ukuphi okanye kwenzeka ntoni), kwaye kuba inokusetyenziswa gwenxa, le mayeza anikwa kuphela phantsi kweliso likagqirha ekliniki. Oogqirha baya kukujonga iiyure ezimbini emva kokuthabatha iyeza.

Zeziphi ezinye iindlela zonyango ezivunyiweyo yi-FDA?

I-FDA ikwavumile olu nyango lwe-TRD:

• Unyango lwe-Electroconvulsive (ECT): Le yinkqubo yezonyango. Kule nkqubo, iimpembelelo zombane ezithambileyo zithunyelwa ngengqondo yakho, zibangele ukuxhuzula okuncinci. Oku kuvuselela iiseli zemithambo-luvo kwaye kunokubangela utshintsho kwingqondo oluphucula indlela ovakalelwa ngayo.
• Ukuvuselela i-transcranial magnetic stimulation (rTMS) okuphindaphindwayo: Olu lunyango olungangenisi gazi. Kolu nyango, i-magnetic coil isetyenziselwa ukuphembelela umsebenzi wombane wendalo wengqondo yakho. Oku kunokubangela utshintsho kwiindawo ezithile zengqondo ezichaphazela imeko yakho yeemvakalelo.

Ngaba zikho ezinye iindlela zonyango?

Kukho ezinye iindlela zonyango ze-TRD, kodwa ezi zisenokungafumaneki ngokubanzi okanye zisesekwinqanaba lophando:

• Ukuvuselelwa kwengqondo okunzulu (i-DBS): Le ikwayindlela yezonyango. Apha, umbane othambileyo uthunyelwa kwinxalenye ethile yengqondo yakho. Lo mbane uvuselela iiseli zengqondo kuloo ndawo, nto leyo enokubonelela ngoncedo kwiimeko ezahlukeneyo, kuquka ne-TRD.
• ILithium (Eskalith®): Uphando lubonise ukuba ukuthatha i-lithium kunye neyeza lokudakumba (umz., i-citalopram) kunokuphucula i-TRD.
• `MAOI` (i-Monoamine oxidase inhibitors): Ezi yayizizo zokuqala izidambisi-ntlungu ezafunyanwayo. Nangona kunjalo, ngenxa yemiqathango emininzi yokutya, iziphumo ebezingalindelekanga, kunye neenkxalabo zokhuseleko, oogqirha bazinika kuphela xa zonke ezinye izidambisi-ntlungu zingaphumelelanga.
• IPramipexole (Mirapex®): Eli liyeza elivunyiweyo yi-FDA lesifo sikaParkinson. Izifundo zibonise ukuba linokunciphisa iimpawu zokudakumba kwisifo sikaParkinson. Linokunceda nabantu abane-TRD.
• Ukuvuselelwa kwemithambo-luvo yeVagus (VNS):Apha, kufakelwa isixhobo esithumela ii-pulses zombane eziqhelekileyo nezithambileyo kwi-brainstem yakho nge-vagus nerve entanyeni yakho. Oku kunokutshintsha amanqanaba 'ee-neurotransmitters' ezithile engqondweni yakho ezilawula imeko yakho yeemvakalelo.

Abaphandi bafunda ne -psilocybin, into eqokelelwe kwiikhowa ezibangela i-hallucinogenic, njengonyango lwe-TRD.

Ngaba kukho naziphi na iziphumo ebezingalindelekanga kwezi ndlela zonyango?

Ngokubanzi, amayeza kunye nonyango lwe-'TRD' lunokuba nemiphumo emibi engaphezulu kune-first list antidepressants. Kwakhona, loo miphumo emibi inokwahluka kakhulu. Ugqirha wakho uza kuthetha nawe ngemiphumo emibi okanye iingxaki ezinokubakho zokhetho ngalunye lonyango. Musa ukuthandabuza ukubuza imibuzo.

Ngaba le meko ingathintelwa ukuba ingenzeki?

Ngenxa yokuba izazinzulu aziyazi kakuhle into ebangela i-TRD, kudla ngokuba nzima ukuyithintela. Nangona kunjalo, ekubeni uxinzelelo olungapheliyo lunokuba negalelo kuyo, ungenza ezi zinto ukulawula uxinzelelo lwakho:

• Zilolonge rhoqo. Nokuba uhamba nje kancinci kunokuphucula indlela ovakalelwa ngayo.
• Lala kakuhle. Oku kubalulekile kwimpilo yakho iyonke.
• Zama izinto ezinje ngokucamngca, i-yoga, umthambo wokuphefumla, kunye nomthambo wokuphumla kwemisipha .
• Zibekele iinjongo zosuku lwakho, iveki, kunye nenyanga. Xa ugxila kwizinto ezincinci, uya kuziva ngathi unolawulo lwexesha kunye nexesha elide.
• Ziqhelise ukuqaphela izinto nombulelo . Cinga ngezinto ezilungileyo ezenzekayo ebomini bakho.
• Ziqhelise ukuthi "hayi" kwiimbopheleleko ezongezelelweyo xa uxakekile okanye uxinezelekile.
• Gcina ubudlelwane nabantu abakugcina uzolile, abakuxhasayo ngokweemvakalelo, nabakuncedayo ngezinto eziphathekayo.
• Cinga ngokuthetha nogqirha wakho okanye nogqirha wakho malunga noxinzelelo.

Ukuba unesifo sokudakumba esinganyangekiyo ngonyango, yintoni onokuyenza ekhaya?

Ukongeza ekufuneni uncedo lobuchwephesha lwezonyango kwi-TRD, kukho izinto ezininzi onokuzenza ekhaya ezinokukunceda ukunciphisa iimpawu zakho:

• Ukuzilolonga rhoqo.
• Ukulala kakuhle (kungekhona ukulala kakhulu okanye ukulala ngokwaneleyo).
• Ukutya ukutya okunempilo.
• Ziphephe iziyobisi ezingezizo ezonyango. Utywala buyakudambisa uxinzelelo.
• Chitha ixesha nabantu obathandayo nabakhathaleleyo.

Ufanele uye nini kugqirha?

Ude ufumane isicwangciso sonyango esisebenzayo se-TRD esikusebenzelayo, jonga indlela esisebenza ngayo.Ufanele ubonane nogqirha wakho rhoqo.

Ngaphandle koko, thetha nogqirha wakho kwezi meko zilandelayo:

• Ukuba ufumana iziphumo ebezingalindelekanga ezikhathazayo.
• Ukuba iimpawu zakho aziphucuki, okanye ukuba ziya zisiba mandundu.
• Ukuba ucinga ngokuyeka amayeza akho (ungaze uyeke ukuwasela ngaphandle kwengcebiso kagqirha).

Eyona nto ibalulekileyo ekufuneka uyithethe

Ukuba une-'TRD', khumbula kuqala ukuba awuwedwa . Malunga nama-30% abantu abanesifo sokudakumba okukhulu banale meko. Kukho iindlela ezahlukeneyo zonyango lwe-'TRD', kodwa kungathatha ixesha ukufumana elona lilungele wena. Ugqirha wakho kunye/okanye ugqirha wengqondo baya kukuxhasa kolo hambo. Ungaze ulahle ithemba. Ngenkxaso kunye nonyango olufanelekileyo, ungayilawula le meko kwaye uphile ubomi obungcono.

Uxinzelelo olunganyangekiyo kunyango, uxinzelelo, impilo yengqondo, i-TRD, i-MDD, unyango lokudakumba, isifo sengqondo