Ake sixoxe ngokucindezeleka okumelana nokwelashwa!

Kungenzeka ukuthi ubuhlushwa ukucindezeleka izinyanga, ngisho neminyaka. Uke wabona udokotela futhi waphuza imithi emibili kuphela isikhathi esinqunyiwe, kodwa ukudabuka kwakho, ukungabi nandaba nanoma yini, noma lokho kudabuka okungabekezeleleki akukapheli nhlobo. Khona-ke ungase ube nalokho okubizwa ngokuthi "Ukucindezeleka Okumelana Nokwelashwa" (TRD). Ungakhathazeki uma uzwa lelo gama, akusho ukuthi "akunakwelashwa." Kodwa-ke, kungathatha isikhathi ukuthola ukwelashwa okufanele. Ake sixoxe ngalokhu ngokuningiliziwe nangokulula kakhulu namuhla.

Kuyini lokhu okubizwa ngokuthi ukucindezeleka okungamelani nokwelashwa?

Kalula nje, 'ukucindezeleka okumelana nokwelashwa' kuyingxenye ye-Major Depression Disorder (MDD). Kutholakala uma unesifo sokucindezeleka futhi uthatha okungenani ama-antidepressant amabili okuqala, ngesilinganiso esinconywayo kanye nesikhathi esinconywayo (okungenani amasonto ayisithupha kuya kwayisishiyagalombili) , kodwa izimpawu zakho azithuthuki ngendlela eyanelisayo.

Odokotela bavame ukuqale banikeze imithi evela eqenjini le-`SSRI` (Selective Serotonin Reuptake Inhibitors) noma i-`SNRI` (Serotonin and Norepinephrine Reuptake Inhibitors). Lokhu kungenxa yokuthi, uma kuqhathaniswa neminye imithi yokucindezeleka, le mithi inemiphumela emibi embalwa, futhi imiphumela emibi ayinzima kangako. Ngezinye izikhathi, ngisho nabantu abasabela kahle emithini yokucindezeleka bangaba ne-`TRD` kamuva. Naphezu kwegama layo, kunezindlela zokwelapha lokhu, kodwa kungathatha isikhathi ukuthola efanele wena.

Sivame kangakanani lesi simo?

Ubuwazi ukuthi cishe abantu abangu-30% abatholakale benesifo sokucindezeleka okukhulu (MDD) futhi belashelwa sona nabo bane-TRD? I-MDD ingenye yezifo zengqondo ezivame kakhulu emhlabeni. Ithinta abantu abaphakathi kuka-5% no-17% esikhathini esithile empilweni yabo. Ngakho-ke, khumbula ukuthi awuwedwa.

Ziyini izimpawu zalokhu?

Abantu abane-`TRD` banezimpawu ezifanayo nezalabo abane-`MDD`. Okusho ukuthi, izinto ezifana nokudabuka okungapheli, ukudabuka, ukuphazamiseka kokulala (kungaba ukungalali nhlobo, noma ukungakwazi ukulala), kanye nokushintsha kwesifiso sokudla (kungaba ukungazizwa sengathi ufuna ukudla, noma ukudla ngokweqile).

Kodwa-ke, lezi zinto zivame kakhulu kubantu abane-`TRD`:

• Izimpawu ziba zimbi kakhulu.
• Ukucindezeleka kuhlala isikhathi eside.
• Isimo esibizwa ngokuthi "i-Anhedonia." Kusho ukuthi awusakwazi ukuthola injabulo ezintweni ezazikulethela injabulo noma injabulo. Cabanga nje, ulalele ingoma oyithandayo noma ukhuluma nomngane, kodwa awuzizwa mizwa.
• Ukwanda kokubhekana nezimo zokucindezeleka empilweni yomuntu.
• Ukuba nokukhathazeka ngokweqile.
• Umbono wokuzibulalaFuthi amathuba amaningi okuzama.

Okubalulekile: Uma wena noma othile omaziyo ecabanga ukuzibulala, sicela ushayele i-Suicide and Crisis Lifeline ku- 988. Kukhona umuntu otholakala amahora angama-24 ngosuku ukukusiza. Ungabona nodokotela noma umeluleki wezempilo yengqondo ngokushesha okukhulu.

Kungani lokhu kwenzeka? Yiziphi izizathu?

Eqinisweni, abacwaningi abakakazi kahle ukuthi kungani ukucindezeleka kwabanye abantu kungasabeli emithini. Njengoba nje kungekho imbangela eyodwa yokucindezeleka, izici eziningi, okuhlanganisa amathonya ezakhi zofuzo kanye nezinguquko kumakhemikhali obuchopho, zinegalelo kulesi simo.

Kodwa, bacabanga ukuthi, ukucindezeleka okungapheli kungaba nomthelela omkhulu kulokhu. Wazi kanjani? Sinesimiso esibalulekile emizimbeni yethu esibizwa ngokuthi i-'Hypothalamic-Pituitary-Adrenal (HPA) axis. Yilokhu okusisiza ukuba sizivumelanise nokucindezeleka. Ngakho-ke, ukucindezeleka okuqhubekayo kungashintsha ukusebenza kwale axis 'ye-HPA'. Uma lokho kwenzeka, ukucindezeleka kuba nzima kakhulu futhi kube nzima ukukwelapha.

Ubani osengozini enkulu?

Ucwaningo lukhombisile ukuthi, uma kuqhathaniswa nabantu abane-MDD abasabela emithini, abantu abane-TRD banamathuba amaningi okuba nezimo ezilandelayo zomzimba:

• Izifo ezizenzakalelayo (okungukuthi, izifo lapho amasosha omzimba ezihlasela khona).
• Isifo se-thyroid.
• Isifo senhliziyo.
• Isifo semithambo yegazi (okungukuthi, izifo ezenzeka emithanjeni ehambisa igazi ebuchosheni).

Akuwona wonke umuntu onalezi zifo ozoba ne-TRD, kodwa lezi zingaba yizinto eziyingozi.

Odokotela bakuthola kanjani lokhu ngokunembile?

Ukuxilongwa kwe-'TRD' akucaci kahle. Kodwa-ke, odokotela abaningi baxilonga lesi simo uma ungakaboni ukuthuthuka ezimpawini zakho zokucindezeleka ngemva kokuthatha okungenani ezimbili zemithi yokucindezeleka oyisebenzisayo njengamanje. Odokotela bavame ukubheka okulandelayo njengemithi yokucindezeleka yokuqala:

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

Ngokuvamile, udinga ukusebenzisa umuthi okungenani amasonto ayisithupha kuya kwayisishiyagalombili ukuze ubone ukuthi uyasebenza noma cha.

Uma uphuza imithi emibili kodwa ungazizwa ungcono, udokotela wakho angakudlulisela kudokotela wezifo zengqondo . Lapho, uzothatha umlando ophelele wezokwelapha kanye nempilo yengqondo. Lokhu kungafaka:

• Yonke imithi oyithathayo njengamanje (eyalelwe udokotela, ethengiswa ngaphandle kwemithi kadokotela, imithi yamakhambi, ngisho nemithi yokwelapha izidakamizwa)Buza ngalokhu. Ngoba eminye imithi ingaphazamisa ukusebenza kahle kwemithi yokucindezeleka noma yenze ukucindezeleka kube kubi nakakhulu.
• Bazoxoxa ngokuthi uthatha imithi yokucindezeleka kanye neminye imithi ngendlela efanele futhi njengoba uyalelwe .
• Bazohlola ukuthi ngabe uke wathola ukwelashwa kwengqondo noma ukwelashwa ngokukhuluma nokuthi ngabe kukusizile yini ekucindezelekeni kwakho.
• Ezinye izimo zomzimba, njengesifo se-thyroid kanye nobuhlungu obungapheli, zingabangela noma zibhebhethekise ukucindezeleka, ngakho-ke ziyahlolwa.
• Bahlola izinkinga ezifana nokusebenzisa izidakamizwa .
• Cabanga ukuthi izimpawu zakho zingase zitholakale zinesinye isimo sempilo yengqondo (isib., i-bipolar disorder noma i-personality disorder) .

Ngemva kokuxoxa ngakho konke lokhu nokwenza izivivinyo ezidingekayo, udokotela wakho uzonquma ukuthi une-'TRD' noma cha. Ngemuva kwalokho, uzokusiza ukuthola inketho yokwelashwa engcono kakhulu kuwe.

Ngakho-ke yiziphi izindlela zokwelapha lokhu?

Kunezindlela eziningana zokulawula i-'TRD'. Kungathatha isikhathi ukuthola imiphumela oyifunayo, kodwa ungalilahli ithemba.

Okokuqala, udokotela wakho wezifo zengqondo angase azame lezi zinto:

• Nika umuthi wokucindezeleka isikhathi esengeziwe osithathayo njengamanje.
• Khulisa umthamo womuthi wokucindezeleka womugqa wokuqala owusebenzisayo njengamanje.
• Faka umuthi wokucindezeleka ovela kwelinye ikilasi. Bese uthatha imithi emibili ngesikhathi esisodwa.
• Zikhuthaze ukuthi uhlangane nodokotela wengqondo bese uthola ukwelashwa kwengqondo . Kungathatha isikhathi ukuthola uchwepheshe wezokwelapha "ozokuqondisisa." Futhi, kunezinhlobo ezahlukene zezokwelapha kwengqondo.

Yini oyenzayo ngokulandelayo uma ukwelashwa okuvamile kungasebenzi?

Uma lezi zindlela eziyisisekelo zingasebenzi, udokotela wakho wezifo zengqondo uvame ukuncoma uhlobo oluhlukile lomuthi, inhlanganisela yemithi, noma indlela ehlukile yokwelapha.

Njengamanje, i-US Food and Drug Administration (FDA) ivumile imithi emihlanu ye-TRD:

• I-Aripiprazole (Abilify®) kanye ne-Brexpiprazole (Rexulti®): Le yimithi yokulwa nokuphazamiseka kwengqondo yesizukulwane sesithathu. Inganciphisa izimpawu zokucindezeleka ngokuthinta amazinga e-serotonin kanye ne-norepinephrine ebuchosheni bakho.
• I-Quetiapine (Seroquel®) kanye ne-Olanzapine (Zyprexa®): Lezi ziyimithi yokulwa nokuphazamiseka kwengqondo yesizukulwane sesibili. I-Quetiapine ivunyelwe njengokwelashwa okungeziwe kwe-TRD enemithi yokucindezeleka. I-Olanzapine ivunyelwe uma inikezwa kanye ne-Fluoxetine (Prozac®). Zisiza ekunciphiseni izimpawu zokucindezeleka ngokuthinta amazinga e-dopamine ebuchosheni. Le mithi ingabangela ukozela.
• Isifutho sekhala se-Esketamine (i-Spravato®): Lesi senziwe ngento ebizwa ngokuthi i-ketamine. I-FDA yasivuma ngo-2019 njengokwelashwa okwengeziwe kwabantu abadala abane-TRD, kanye nomuthi wokucindezeleka ophuzwayo. I-Esketamine ingaqala ukunciphisa izimpawu zokucindezeleka zingakapheli amahora amabili ngemva kokuyithatha. Kodwa-ke, ngoba ingabangela ukozela ngokweqile (ukudambisa), ukuhlukana (ukulahlekelwa ukwazi ukuthi ukuphi noma kwenzekani), futhi ngoba ingasetshenziswa kabi, lo muthi unikezwa kuphela ngaphansi kokuqondisa kukadokotela emtholampilo. Odokotela bazokuqapha amahora amabili ngemva kokuthatha umuthi.

Yiziphi ezinye izindlela zokwelapha ezivunyelwe yi-FDA?

I-FDA iphinde yagunyaza lezi zindlela zokwelapha ze-TRD:

• Ukwelashwa nge-electroconvulsive (ECT): Lena inqubo yezokwelapha. Kulokhu, imizwelo kagesi emnene kakhulu ithunyelwa ebuchosheni bakho, okubangela ukuxhuzula okuncane. Lokhu kuvuselela amangqamuzana ezinzwa futhi kungabangela izinguquko ebuchosheni ezithuthukisa isimo sakho sengqondo.
• Ukuvuselela okuphindaphindwayo kwe-transcranial magnetic stimulation (rTMS): Lokhu kuyindlela yokwelapha engahlaseli. Kulokhu kwelashwa, i-magnetic coil isetshenziswa ukuthonya umsebenzi kagesi wemvelo wobuchopho bakho. Lokhu kungabangela izinguquko ezindaweni ezithile zobuchopho ezithinta isimo sakho sengqondo.

Ingabe zikhona ezinye izindlela zokwelapha?

Kunezinye izindlela eziningana zokwelapha i-TRD, kodwa lezi zingase zingatholakali kabanzi noma zisesesigabeni socwaningo:

• Ukushukunyiswa kobuchopho okujulile (i-DBS): Lokhu futhi kuyinqubo yezokwelapha. Lapha, ugesi omnene ulethwa engxenyeni ethile yobuchopho bakho. Lo gesi uvuselela amangqamuzana obuchopho kuleyo ndawo, okunganikeza impumuzo ezimweni eziningana, okuhlanganisa ne-TRD.
• I-Lithium (Eskalith®): Ucwaningo lukhombisile ukuthi ukuthatha i-lithium nomuthi wokucindezeleka (isib. i-citalopram) kungathuthukisa i-TRD.
• `MAOI` (i-Monoamine oxidase inhibitors): Lawa kwakuyimithi yokuqala yokucindezeleka eyatholakala. Kodwa-ke, ngenxa yemikhawulo eminingi yokudla, imiphumela emibi, kanye nokukhathazeka ngokuphepha, odokotela bayayinikeza kuphela uma yonke eminye imithi yokucindezeleka yehlulekile.
• I-Pramipexole (Mirapex®): Lona umuthi ovunyelwe yi-FDA wesifo sikaParkinson. Izifundo zikhombisile ukuthi unganciphisa izimpawu zokucindezeleka kwesifo sikaParkinson. Kungasiza futhi abantu abane-TRD.
• Ukuvuselelwa kwemizwa ye-vagus (VNS):Lapha, kufakwa idivayisi ethumela ukushaya kwenhliziyo okuvamile nokuthambile ebuchosheni bakho nge-vagus nerve entanyeni yakho. Lokhu kungashintsha amazinga 'ama-neurotransmitter' athile ebuchosheni bakho alawula isimo sakho sengqondo.

Abacwaningi bafunda ne-psilocybin, inhlanganisela ehlukaniswe kumakhowe abangela i-hallucinogenic, njengendlela yokwelapha i-TRD.

Ingabe ikhona imiphumela emibi kulezi zindlela zokwelapha?

Ngokuvamile, imithi kanye nokwelashwa kwe-'TRD' kungaba nemiphumela emibi eminingi kunemithi yokucindezeleka yomugqa wokuqala. Futhi, leyo miphumela emibi ingahluka kakhulu. Udokotela wakho uzokhuluma nawe ngemiphumela emibi engaba khona noma izinkinga zendlela ngayinye yokwelashwa. Unganqikazi ukubuza imibuzo.

Ingabe lesi simo singavinjelwa ukuthi singenzeki?

Ngenxa yokuthi ososayensi abazi kahle ukuthi yini ebangela i-TRD, ngokuvamile kunzima ukuyivimbela. Kodwa-ke, njengoba ukucindezeleka okungapheli kungaba nomthelela kukho, ungenza lezi zinto ukuze ulawule ukucindezeleka kwakho:

• Vivinya umzimba njalo. Ngisho nokuhamba ibanga elifushane kungathuthukisa isimo sakho sengqondo.
• Lala kahle. Lokhu kubalulekile empilweni yonke.
• Zama izinto ezifana nokuzindla, i-yoga, ukuzivocavoca ngokuphefumula, kanye nokuzivocavoca ngokuphumula kwemisipha .
• Zibekele imigomo yosuku lwakho, isonto, kanye nenyanga. Uma ugxila ezintweni ezincane, uzozizwa sengathi unamandla okulawula isikhathi kanye nesikhathi eside.
• Zijwayeze ukuqaphela nokubonga . Cabanga ngezinto ezinhle osukwini lwakho noma empilweni yakho.
• Zijwayeze ukuthi "cha" emithwalweni eyengeziwe uma umatasa noma ucindezelekile.
• Gcina ubudlelwano nabantu abakugcina uzolile, abakusekelayo ngokomzwelo, futhi abakusiza ngezinto ezingokoqobo.
• Cabanga ukukhuluma nodokotela wakho noma nodokotela wakho mayelana nokucindezeleka.

Uma unesifo sokucindezeleka esingamelani nokwelashwa, yini ongayenza ekhaya?

Ngaphezu kokufuna usizo lochwepheshe lwezokwelapha lwe-TRD, kunezinto eziningana ongazenza ekhaya ezingasiza ekunciphiseni izimpawu zakho:

• Ukuzivocavoca njalo.
• Ukulala kahle (hhayi ukulala kakhulu noma ukulala ngokwanele).
• Ukudla ukudla okunempilo.
• Gwema utshwala nezidakamizwa ezingezona ezokwelapha. Utshwala buyadambisa ukucindezeleka.
• Ukuchitha isikhathi nalabo obathandayo nabakhathalelayo.

Kufanele ubonane nini nodokotela?

Kuze kube yilapho uthola uhlelo lokwelapha olusebenzayo lwe-TRD olukusebenzelayo, bona ukuthi lusebenza kanjani.Kufanele ubonane nodokotela wakho njalo.

Ngaphandle kwalokho, khuluma nodokotela wakho kulezi zimo:

• Uma uhlangabezana nemiphumela emibi ekhathazayo.
• Uma izimpawu zakho zingathuthuki, noma uma ziba zimbi kakhulu.
• Uma ucabanga ukuyeka imithi yakho (ungalokothi uyeke ukuthatha imithi ngaphandle kweseluleko sikadokotela).

Into ebaluleke kakhulu okufanele uyisho

Uma une-'TRD', qala ukhumbule ukuthi awuwedwa . Cishe abantu abangu-30% abanokucindezeleka okukhulu banalesi simo. Kunezindlela eziningana zokwelapha i-'TRD', kodwa kungathatha isikhathi ukuthola okusebenzela kahle kakhulu. Udokotela wakho kanye/noma udokotela wezifo zengqondo uzokusekela kulolo hambo. Ungalokothi ulahle ithemba. Ngokusekelwa nokwelashwa okufanele, ungaphatha lesi simo futhi uphile impilo engcono.

Ukucindezeleka okumelana nokwelashwa, ukucindezeleka, impilo yengqondo, i-TRD, i-MDD, ukwelashwa kokucindezeleka, ukugula kwengqondo