Waukulu >> Zambiri Zamankhwala >> Kupita kumankhwala opatsirana pogonana: Chitsogozo cha oyamba pazotsatira zoyipa

Kupita kumankhwala opatsirana pogonana: Chitsogozo cha oyamba pazotsatira zoyipa

Kupita kumankhwala opatsirana pogonana: Chitsogozo cha oyamba pazotsatira zoyipaZambiri Zamankhwala

Ngati inu, monga ine, mukudwala matenda opsinjika pang'ono, nkhawa yayikulu, kapena matenda amisala, mwina ndi omwe amakupatsani mankhwala ochepetsa kupsinjika. Ndikukuwuzani kuchokera pazochitikira kuti mankhwalawa akhoza kusintha moyo. Pamodzi ndi chithandizo chamankhwala, opatsirana pogonana amatha kuthana ndi zizindikilo zomwe zimakulepheretsani kukhala moyo wathunthu. Amatha kukumasulani ku chisoni chachikulu, mantha, kukwiya, komanso ziwonetsero zina zambiri zomwe zimasokoneza ntchito, sukulu, komanso maubale.





Pali mitundu ingapo ya mankhwala opondereza kupsinjika, ndipo onse amagwira ntchito m'njira zosiyanasiyana. Koma chinthu chimodzi chofanana ndi chakuti amasintha kupezeka kwa mankhwala ena muubongo wanu. Ichi ndi chinthu chabwino, m'njira zambiri, chifukwa zimathandiza kuthana ndi kukhumudwa kapena nkhawa. Koma monga mankhwala onse, amathanso kuyambitsa mavuto.



Gulu la asing'anga ndi asayansi adathandizira kupanga chitsogozo chokwanira cha mankhwala ochepetsa nkhawa komanso zoyipa za antidepressants.

Kodi mitundu ya antidepressants ndi iti?

Antidepressants ndi mankhwala akuchipatala omwe amathandizira kuzindikiritsa kukhumudwa kwamankhwala, zovuta zina, kusokonezeka kwa nyengo, ndi dysthymia (kapena kupsinjika pang'ono). Zonsezi zimagwira ntchito pokonza kusamvana kwamankhwala kwama neurotransmitters muubongo omwe amakhudzana ndikusintha kwamachitidwe ndi machitidwe.

Mankhwala osiyanasiyana opatsirana pogonana amalimbana ndi ma neurotransmitters osiyanasiyana muubongo ndi dongosolo lamanjenje, atero a Justin Hall, MD, azachipatala omwe ali ndi Makhalidwe Abwino a Spectrum ku Annapolis, Maryland. Serotonin ndiye neurotransmitter yodziwika kwambiri yomwe yakhala ikukhudzana ndi nkhawa komanso kukhumudwa.



Serotonin imayang'aniridwa chifukwa ndi neurotransmitter yomwe imakonda kugwirizanitsidwa ndi kukhumudwa. Mankhwalawa ali ndi ntchito zosiyanasiyana mthupi la munthu . Madokotala ambiri komanso anthu wamba amatcha mankhwala osangalatsa, chifukwa amadziwika kuti amawonjezera chisangalalo komanso kukhala ndi thanzi labwino. Koma zimathanso kusokoneza chimbudzi chanu, matumbo anu, kukumbukira kwanu, kugona kwanu, ndi zina zambiri.

Maphunziro a mankhwala opatsirana pogonana ndi awa:

  • Kusankha serotonin reuptake inhibitor (SSRI)
  • Serotonin-norepinephrine reuptake inhibitor (SNRI)
  • Tricyclic antidepressant (TCA)
  • Monoamine oxidase inhibitor (MAOI)
  • Wotsutsana ndi Serotonin ndi reuptake inhibitor (SARI)
  • Matenda osokoneza bongo

Alam Hallan, Pharm.D., Director of pharmacy ku Guelph General Hospital ku Ontario, Canada.



Pachifukwachi, odwala onse amafunika dongosolo lamankhwala. Wothandizira wodwala winawake ndi amene amawathandiza, atero Dr. Hallan. Odwala ambiri nthawi zambiri amayamba ndi ma SSRIs kapena SNRIs. Ngati samvera mankhwalawa, atha kuyesa ma TCA kapena ma atypical. MAOIs amasungidwira milandu yolimbana kwambiri chifukwa chothandizana kwambiri.

Kusankha serotonin reuptake inhibitors (SSRIs) ndi Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Onse SSRIs ndipo SNRIs Amalangizidwa kuti athetse kukhumudwa komanso zovuta zina. Amagwira ntchito yolunjika mankhwala muubongo wanu otchedwa ma neurotransmitters. Ubongo wanu ukamatumiza uthenga kuchokera pa selo imodzi kupita ku ina, monga kukhala wokondwa ndi nkhaniyi, kapena kanemayu ndiwoseketsa, mauthenga amenewo amayenda mothandizidwa ndi ma neurotransmitters.

SSRIs imayang'ana neurotransmitter yotchedwa serotonin, ndipo SNRIs imayang'ana serotonin ndi norepinephrine. Nthawi zambiri, ubongo wanu ukamatumiza mauthenga kuchokera ku neuron kupita ku ina, wotumizayo amatulutsa khunyu kuti atenge uthengawo, kenako umabwezeretsanso neurotransmitter uthengawo utaperekedwa.



SSRI antidepressants imagwira ntchito poletsa kubwezeretsanso (kapena kubwezeretsanso) kwa serotonin muubongo wanu, ikatha kupereka mauthenga ake osangalatsa. Chifukwa chake, ubongo wanu uzikhala ndi serotonin yochulukirapo yopereka mauthenga achimwemwe. Ma anti-depressants omwe amalembedwa kwambiri, ma SSRI amaonedwa kuti ndi othandiza kwambiri pazotsatira zochepa. Zitsanzo zina ndi monga Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine) ndi Zoloft (sertraline).

Mofananamo, SNRIs imakulitsa magawo onse a serotonin ndi norepinephrine muubongo wanu.



Norepinephrine ndi njira ina yothetsera ubongo yomwe imathandizira kukhazika mtima pansi. Zitsanzo zina za SNRIs ndi Cymbalta (duloxetine), Effexor (venlafaxine), ndi Pristiq (desvenlafaxine).

Tricyclic antidepressants (TCAs)

Tricyclic (kapena tetracyclic) antidepressants anali ena mwa mankhwala opatsirana akale omwe adapangidwa. Ndizothandiza kwambiri, komanso amabwera ndi zovuta zingapo, chifukwa chake zimasinthidwa makamaka ndi mankhwala atsopano pokhapokha SSRIs kapena SNRIs sizigwira ntchito.



Ma cyclic antidepressants amalepheretsanso kubwezeretsanso kwa ma neurotransmitters serotonin ndi norepinephrine, kukulitsa kuchuluka kwa mankhwala awiriwa muubongo. Komabe, ma TCA atha kukhudzanso ma neurotransmitter ena, ndichifukwa chake amakhala ndi zovuta zina zambiri. Zitsanzo za ma TCA zimaphatikizapo amitriptyline ndi amoxapine.

Monoamine oxidase inhibitors (MAOIs)

Monga enawo, monoamine oxidase inhibitors (MAOIs) ntchito pokhudzidwa ndi ma neurotransmitters. Makamaka, MAOIs amakhudza dopamine, serotonin, ndi norepinephrine, omwe onse amadziwika kuti monoamines. Palinso mankhwala muubongo otchedwa monoamine oxidase, omwe amachotsa ma neurotransmitters amenewo. MAOIs amagwira ntchito poletsa monoamine oxidase, motero amalola ambiri mwa ma neurotransmitter kuti azikhala muubongo.



Awa anali mankhwala opatsirana akale kwambiri, opangidwa m'ma 1950. Anali othandiza kuthana ndi zovuta zazikulu. Komabe, monga ma TCA, amabwera ndi zovuta zambiri. Pali machitidwe angapo owopsa a mankhwala pakati pa MAOIs ndi mankhwala ena, zomwe zimapangitsa kuti zikhale zovuta kuchiza anthu omwe ali ndi mavuto amisala yam'magazi komanso matenda ena. Zitsanzo zina ndi monga Nardil (phenelzine) ndi Marplan (isocarboxazid).

Wotsutsana ndi Serotonin ndi reuptake inhibitors (SARIs)

Wotsutsana ndi Serotonin ndi reuptake inhibitors (SARIs) amavomerezedwa ndi FDA ngati mankhwala opatsirana pogonana, koma amagwiritsidwa ntchito kwambiri ngati ma tepi ngati zothandizira kugona. Monga SSRIs, amagwira ntchito poletsa kubwezeretsanso serotonin. Koma amakhalanso otsutsana, kuletsa mtundu wina wa serotonin receptor wotchedwa 5HT2a, womwe umalepheretsa kugwira ntchito kwa protein yotumiza serotonin.

Zitsanzo zina za ma SAR ndi monga Desyrel (trazodone) ndi Serzone (nefazodone).

Mankhwala opatsirana pogonana

Mankhwala oletsa kupsinjika maganizo ali monga momwe amamvekera - osati wamba. Izi zikutanthauza kuti sagwirizana ndi magulu ena aliwonse opatsirana, ndipo amagwira ntchito m'njira zosiyanasiyana. Ngakhale palibe njira yowerengera momwe mankhwalawa amagwirira ntchito, ndikwanira kunena kuti onse amasintha mapangidwe a ma neurotransmitter ena muubongo wanu, kuphatikiza dopamine, serotonin, ndi / kapena norepinephrine. Zitsanzo zina za antidepressants atypical ndi Wellbutrin (bupropion) ndi Remeron (mirtazapine).

Kumvetsetsa zoyipa za antidepressants

Ngakhale pali zovuta zingapo zomwe zimayambitsa kumwa mankhwala opatsirana pogonana, izi ndizofala kwambiri:

  • Kuchepetsa thupi kapena phindu
  • Zovuta zakugonana, kuphatikiza kutaya chilakolako chogonana, kulephera kwa erectile, ndi ena
  • Kusowa tulo
  • Kusinza
  • Kutopa
  • Kupweteka mutu
  • Nseru
  • Pakamwa pouma
  • Masomphenya olakwika
  • Kudzimbidwa
  • Chizungulire
  • Kusokonezeka
  • Kukwiya
  • Kuda nkhawa
  • Kugunda kwamtima kosasintha

Kuphatikiza pa izi, pali zovuta zakanthawi yayitali komanso zazifupi zamankhwala ochepetsa nkhawa.

Zotsatira zoyipa za antidepressants

Ngakhale mavuto omwe amabwera chifukwa cha kupsinjika maganizo amakhala a kanthawi kochepa, pali ochepa omwe amakhala nthawi yayitali-zotsatirapo zake ndizochepa ndipo nthawi zambiri zimatha kuyendetsedwa m'njira zingapo, zofotokozedwa pansipa. Zotsatira zoyipa zazitali zimaphatikizapo kusintha kunenepa, mavuto azakugonana, kugona tulo, kugona, ndi kutopa.

Kulemera

Chifukwa cha kunenepa mukamamwa mankhwala opanikizika kwa nthawi yayitali sichikudziwika. Atha kukhala kuti odwala omwe adadya pang'ono pomwe anali ndi nkhawa amakhala ndi chidwi chobwereranso ndi mankhwala, a Dr. Hallan akuwonetsa, kapena mankhwalawo atha kusintha kagayidwe kake kagayidwe. Nthawi zambiri, imakhala pafupifupi mapaundi asanu kapena pachaka.

Kafukufuku wina wasonyeza kuti kugwiritsa ntchito mankhwala opatsirana kwanthawi yayitali kumakulitsa chiopsezo chanu cha matenda okhudzana ndi kunenepa, monga mtundu wa 2 shuga .

Ngati kuthana ndi vutoli ndi zakudya komanso masewera olimbitsa thupi sikugwira ntchito, a Dr. Hallan akuwonetsa kuyesa mankhwala atsopano. Mankhwala onsewa amagwira ntchito mosiyanasiyana mwa anthu osiyanasiyana, motero mankhwala amodzi sangapangitse aliyense kukhala ndi zotsatirapo zake, ngakhale zitadziwika kuti zimayambitsa mavutowo.

Zovuta zakugonana

Zotsatira zakugonana nthawi zambiri zimakhala zoyipa zomwe zimatha kuchititsa kuti anthu asiye mankhwala awo ngakhale akuchita bwino pamankhwala, Dr. Hall akutero.

M'malo mwake, pafupifupi theka la odwala omwe amatenga ma SSRIs atha kukhala ndi zovuta zina, kuphatikizapo kuchepa kwa kuyendetsa zogonana, kutha kukhala ndi vuto louma, ukazi wouma, kapena kuwonongeka kwa erectile.

Ngakhale zovuta zina sizikhala zazifupi, zotsatirazi zogonana zimatha kupitilira nthawi yonse yomwe wodwalayo amamwa mankhwala opatsirana. Komabe, sayenera kufooketsa kapena kuwopsa. Ngati akukuvutitsani mpaka pomwe simukufuna kumwa mankhwalawa, a Dr. Hall amalimbikitsa kuti mukalankhule ndi dokotala wanu wokhudzana ndi kuchepetsa kuchuluka kwa mankhwala, kumwa mankhwalawo munthawi ina ya tsiku, kapena kusintha mankhwala ena.

Mavuto ogona

Kusinthasintha kwa mankhwala osokoneza bongo ndi kuleza mtima mpaka kuleza mtima, mankhwala ambiri opewetsa kupanikizika amachititsa kuti anthu azigona tulo tofa nato kapena tulo. Ngati mukumva izi, Dr. Hall amalimbikitsa kuti musamamwe mankhwala anu molingana ndi momwe amakukhudzirani tulo: Ngati wodwalayo amakupangitsani kugona, tengani musanagone. Ngati kukupangitsani kugona, tengani m'mawa. Nthawi zambiri, kudzuka kapena kugona kwa mankhwalawa kumatha pambuyo maola angapo.

Zotsatira zakanthawi kochepa za antidepressants

Ngakhale kuti anthu ambiri alibe chizindikiro cha mankhwala opatsirana pogonana, sizachilendo kupeza zovuta zina zomwe zimatenga masiku ochepa kapena milungu ingapo. Izi zitha kuphatikizira nseru, mutu, mkamwa wowuma, kusawona bwino, kudzimbidwa, kupsa mtima kapena kukwiya.

Nseru

Nausea imapezeka pafupifupi 25% mwa odwala opatsirana pogonana. Nthawi zambiri imayamba atangoyamba kumene mankhwala ndipo imatha pambuyo pa milungu iwiri kapena itatu. Komabe, zimapitilira chithandizo chonse mu gawo limodzi mwa atatu mwa anthu amenewo. Nausea imafala kwambiri ndi venlafaxine ndi ma SSRIs kuposa ma atypical ngati bupropion, mirtazapine, kapena reboxetine. Itha kuyang'aniridwa ndikungotenga mankhwala anu m'mimba monse.

Kupweteka mutu

Kafukufuku wofalitsidwa munyuzipepalayi Zachipatala adapeza kuti kupweteka kwa mutu ndizomwe zimafala kwambiri kwa anthu 40,000 omwe angoyamba kumene kumwa mankhwala opatsirana pogonana. Omwe adatenga ma TCA ndi ma SSRIs anali othekera kwambiri kuposa omwe amatenga SNRIs kapena bupropion kuti adziwe mutu. Komabe, anthu ambiri amalola kulekerera zotsatirazi, ndipo zimapita patangopita nthawi yochepa.

Pakamwa pouma

Zochitika pakamwa pouma ? Izi zikhoza kukhala chifukwa chakuti mankhwalawa amaletsa mwachidule matupi a thupi lanu. Ma TCA amatha kuyambitsa mkamwa mouma kuposa ma SSRIs.

Dr.Hallan amalimbikitsa kuyamwa tchipisi cha ayisi, kumwa madzi pafupipafupi, kutafuna chingamu, kugwiritsa ntchito timbewu tonunkhira, kapena kutsuka mano.

Mavuto masomphenya

Anthu omwe ali ndi vuto lowonera amafotokoza izi ngati kusowa kwakuthwa kapena kumveka bwino m'masomphenya awo. Maso owoneka bwino amapezeka kwambiri ndi ma TCA. Anthu amathanso kumva kutentha, kuyabwa, ndi kufiyira kwa diso, kapena kumva kwamaso m'maso. Kuphatikiza apo, anthu ena amati maso awo amawunikira kuwala.

Ngati mukumwa mankhwala opatsirana pogonana ndipo mukuwona masomphenya, choyamba pitani kuyezetsa maso kuti muwone zovuta zina zamasomphenya. Mungayesenso kugwiritsa ntchito madontho a diso ndi chopangira chinyezi kuti musunthire maso anu. Lankhulani ndi omwe amakupatsani zakusintha mlingo wanu ngati zotsatirazi zikupitilira milungu ingapo.

Kudzimbidwa

Serotonin yotchedwa neurotransmitter serotonin imakhala ndi ntchito zingapo kupatula kukupangitsani kukhala osangalala-imathanso kukhudza matumbo anu, chifukwa serotonin imapezeka m'matumbo mwanu. Nthawi zina, ma SSRIs ndi ma TCA amatha kuyambitsa kudzimbidwa kwakanthawi kochepa. Odwala amatha kuyisamalira pogwiritsa ntchito mankhwala otsegulitsa m'mimba, kumwa madzi ambiri, komanso kudya michere yambiri.

Chizungulire

Chizungulire chimakonda kwambiri ma TCAs ndi MAOIs kuposa magulu ena a antidepressants. Chifukwa chomwe ma medswa nthawi zina amachititsa chizungulire ndi chifukwa choti amachepetsa kuthamanga kwa magazi. Dr. Hall amalimbikitsa kumwa mankhwala anu nthawi yogona kuti muthane ndi zotsatirazi.

Kukwiya kapena nkhawa

Kukwiya komanso kuda nkhawa ndizovuta zomwe zimachitika chifukwa chothana ndi nkhawa, koma zimachitika mwa ochepa odwala. Chifukwa chake mwina chikugwirizana ndi serotonin. Monga tanena kale, kuchepa kwa serotonin muubongo kumatha kubweretsa kupsinjika ndi nkhawa, ndichifukwa chake mankhwalawa onse amagwira ntchito kukulitsa kuchuluka kwa serotonin mwanjira ina. M'masiku oyambilira amachiritso, thupi lanu likuyesetsa kusintha magawo anu a serotonin, omwe amawapangitsa kuti asinthe. Izi zitha kuyambitsa nkhawa yayitali kapena kukwiya. Magulu anu a serotonin akamakhala okhazikika, zizindikirazi ziyenera kuchepa.

Zotsatira zoyipa SSRI SNRI TCA MAOI SARI Wellbutrin Chikumbutso
Kulemera X X X X X
Kulephera kugonana X X X X X
Mavuto ogona X X X X X X X
Nseru X X X X X X X
Mutu X X X X X X X
Pakamwa pouma X X X X X X X
Mavuto masomphenya X X X X X X X
Kudzimbidwa X X X X X X
Chizungulire X X X X X X X
Kukwiya X X X X X X
Kuda nkhawa X X X X X X
Kutuluka thukuta kwambiri X X X X
Kusungira mkodzo X X X
Kuthamanga kwa magazi X X X X

Zotsatira zoyipa za antidepressants

Pakadali pano, zovuta zonse zomwe tafotokozazi sizowopsa, ngakhale zitakhala zovuta. Komabe, pali zochepa zochepa, komanso zowopsa kwambiri, zomwe zingachitike mukamamwa mankhwala opatsirana pogonana. Amaphatikizapo kudzipha, matenda a serotonin, ndi hyponatremia.

Mwamwayi, zotsatirapo zowopsa izi sizachilendo, ndipo zoopsa zake zimakhala zazikulu mwezi woyamba wa chithandizo.

Malingaliro odzipha

Kawirikawiri, mankhwala opatsirana pogonana amathandiza kuchepetsa zizindikilo zonse za kupsinjika, kuphatikizapo kudzipha. Komabe, odwala ochepa omwe ali pachiwopsezo-omwe nthawi zambiri amakhala achikulire-amakhala pachiwopsezo chachikulu chofuna kudzipha.

Malinga ndi Dr. Hallan, izi zimangochitika mwazinthu zenizeni. Mwachitsanzo, munthu wovutika maganizo kwambiri yemwe alibe mankhwala akhoza kukhala ndi malingaliro ofuna kudzipha. Koma zizindikilo zake zakukhumudwa zimamuteteza kuti asachite izi chifukwa zimamupangitsa kuti azimva kutopa kwambiri komanso kutaya mphamvu. Akangoyamba kulandira chithandizo, mphamvu zake ndi kutopa kwake zimatha kumangomupatsa mphamvu kuti atsatire malingaliro ake ofuna kudzipha.

Pofuna kupewa izi, muyenera kugawana nawo malingaliro ofuna kudzipha omwe mudakhala nawo ndi omwe amakuthandizani musanalandire chithandizo.

Matenda a Serotonin

Matenda a Serotonin ndizowopsa zoopsa zachipatala zomwe zimachitika mwa ochepa odwala, atero Dr. Hallan. Ndizowopsa makamaka kwa iwo omwe ali ndi mankhwala opitilira umodzi a serotonergic. Gulu la zizindikilozo limaphatikizapo kusakhazikika, kunjenjemera, thukuta, ndi hyperthermia. Kutenga zowonjezera zina, monga St. John's Wort, kumatha kuwonjezera ngozi ya vutoli.

Ngati mukumane ndi izi mukamamwa mankhwala opondereza, pitani kuchipatala nthawi yomweyo. Adzasiya kugwiritsa ntchito mankhwala anu, kukupatsani mankhwala obwezeretsa, ndikuthandizani kuthana ndi matenda anu.

Hyponatremia

Hyponatremia ndi ngozi ina yowopsa ndipo imawoneka pafupifupi 1 mwa odwala 2,000 omwe amatenga ma SSRIs, a Dr. Hallan akufotokoza. Ponena zakusowa kwa sodium m'magazi, hyponatremia imaganiziridwa kuti imabwera chifukwa cha kuchuluka kwa mahomoni otulutsa magazi, omwe amapangitsa kuti thupi lizisunga madzi ambiri, motero imachepetsa kuchuluka kwa sodium m'thupi, akutero. Odwala, makamaka okalamba, omwe ali pachiwopsezo ayenera kuyang'aniridwa pogwiritsa ntchito mayeso a labu.

Zizindikiro zothanirana ndi nkhawa

Pokhapokha mutakumana ndi zoopsa za mankhwala opatsirana pogonana ndipo mwaonana ndi dokotala, sibwino kusiya kuwagwiritsa ntchito ozizira. Kusiya kwa mankhwala opatsirana pogonana kungayambitse zizindikiro zakusiya, monga:

  • Kuda nkhawa
  • Kusowa tulo kapena maloto owoneka bwino
  • Kumveka mutu
  • Kupweteka mutu
  • Chizungulire
  • Kutopa
  • Zizindikiro ngati chimfine
  • Nseru
  • Kukwiya

Ngati mukuyenera kusiya kugwiritsa ntchito mankhwala opatsirana pogonana, kapena kusintha mlingo wanu, ndikofunikira kuti muyambe mwalankhula ndi omwe akukuthandizani. Atha kukupatsirani ndandanda yodzichotsera pamankhwala kuti muchepetse zizindikiritso zakusiya.