Ama-Antidepressants yimithi esetshenziselwa ukwelapha ukuphazamiseka kwemizwa okuhlukahlukene, njengokucindezeleka, ukukhathazeka, nesifo esicindezelayo. Kunezinhlobo ezahlukene zama-antidepressants, ngalinye linezici zalo kanye nemiphumela yalo emzimbeni. Kulo mbhalo, sizohlola izinhlobo eziyinhloko zama-antidepressants, izinkomba zabo, imiphumela emibi, kanye nendlela abenza ngayo ebuchosheni ukuze bakhuthaze ukukhululeka ezimpawu zokucindezeleka.
Izici zemithi elwa nokucindezeleka: okudingeka ukwazi ngale mithi.
Ama-antidepressants asetshenziselwa ukwelapha ukudangala kanye nezinye iziyaluyalu ezingokwengqondo, esiza ukulawula ama-neurotransmitters ebuchosheni futhi athuthukise isimo sengqondo nenhlalakahle yesiguli. Kunezinhlobo ezahlukene zama-antidepressants, ngalinye linezici zalo kanye nemiphumela yalo.
Ama-antidepressants angahlukaniswa ngezigaba eziningana, njenge-serotonin reuptake inhibitors (SSRIs) ekhethiwe, i-serotonin norepinephrine reuptake inhibitors (SNRIs), i-monoamine oxidase inhibitors (MAOIs), kanye nama-antidepressants e-tricyclic. Uhlobo ngalunye lwe-antidepressant lusebenza ngendlela ehlukile ebuchosheni, kodwa bonke banomgomo ofanayo wokulawula amazinga e-neurotransmitter kanye nokwenza ngcono izimpawu zokucindezeleka.
Kubalulekile ukuqonda ukuthi ama-antidepressants awanawo umthelela osheshayo futhi angathatha amasonto ambalwa ukuze aqale ukusebenza. Ngaphezu kwalokho, kubalulekile ukulandela imiyalelo kadokotela wakho futhi ungayeki ukwelashwa ngaphandle kokugadwa uchwepheshe wezempilo. Ukumisa kungazelelwe ama-antidepressants kungabangela izimpawu zokuhoxa futhi kubhebhethekise ukucindezeleka.
Eminye imiphumela emibi evamile yama-antidepressants ihlanganisa isicanucanu, umlomo owomile, ukuqwasha, ukozela, nokushintsha kwesisindo. Kubalulekile ukubika noma yimiphi imiphumela emibi ebangela ukungakhululeki kudokotela wakho ukuze akwazi ukulungisa imithi yakho noma bathole ezinye izindlela.
Kubalulekile ukuqaphela izici nemiphumela yale mithi, ulandele iseluleko sezokwelapha, futhi ubike noma yiziphi izimpawu noma imiphumela engemihle kuchwepheshe wezokunakekelwa kwempilo obhekele ukwelashwa kwakho.
Ukuhlukaniswa kwama-antidepressants: qonda ukuthi imithi yokucindezeleka ihlukaniswa kanjani.
Ama-Antidepressants yimithi esetshenziselwa ukwelapha ukudangala nezinye izifo ezingokwengqondo. Kunezinhlobo ezahlukene zama-antidepressants, ahlukaniswa ngokomphumela wawo emzimbeni kanye nemiphumela yawo. Kubalulekile ukuqonda ukuthi le mithi ihlukaniswa kanjani ukuze ukhethe ofaneleka kakhulu esimweni ngasinye.
Ama-Antidepressants angahlukaniswa ngezigaba eziningana, eziyinhloko yilezi:
Ama-Selective serotonin reuptake inhibitors (SSRIs) : Lolu hlobo lwe-antidepressant lusebenza ngokwandisa amazinga e-serotonin ebuchosheni, luthuthukise isimo sengqondo futhi lunciphise ukukhathazeka.
I-Serotonin kanye ne-norepinephrine reuptake inhibitors (SNRIs) : Le mithi isebenza ngokwandisa amazinga e-serotonin kanye ne-norepinephrine ebuchosheni, ihlinzeka ngomphumela osebenza kahle kakhulu wokucindezeleka.
I-Monoamine oxidase inhibitors (MAOIs) : I-MAOIs yimithi yokucindezeleka endala engasetshenziswa kakhulu namuhla ngoba idinga ukudla okulinganiselwe futhi ingasebenzisana neminye imithi.
Ama-antidepressant e-Tricyclic : Le mithi isebenza ngokwandisa amazinga e-serotonin kanye ne-norepinephrine ebuchosheni, okwenza isebenze kahle ekwelapheni ukucindezeleka, kodwa inemiphumela emibi eminingi.
Ama-antidepressant angavamile : Lesi sigaba sihlanganisa imithi esebenza ngendlela ehlukile kweyendabuko, enikeza inketho yeziguli ezingasabeli kahle kwezinye izinhlobo zama-antidepressant.
Kubalulekile ukugcizelela ukuthi i-antidepressant efanele kufanele ikhethwe udokotela okhethekile, ozocabangela isimo somtholampilo nezimpawu zesiguli. Ngaphezu kwalokho, ukusetshenziswa kwama-antidepressant kufanele kuqashwe ngokucophelela ukuze kuqinisekiswe ukusebenza kahle nokuphepha kwawo.
Njalo thintana nodokotela ngaphambi kokuqala noma yimuphi umuthi.
Izinhlobo zemithi yokucindezeleka: funda mayelana nezinketho ezitholakalayo okwamanje emakethe.
Kunezinhlobo ezimbalwa zemithi yokucindezeleka etholakalayo emakethe namuhla, ngayinye enezici ezithile kanye nemiphumela. Kubalulekile ukubonana nodokotela ukuze bakwazi ukuncoma ukwelashwa okufanele kakhulu esimweni ngasinye.
Imithi yokucindezeleka iyimithi eyinhloko esetshenziswa ekwelapheni ukucindezeleka. Ingahlukaniswa ngezigaba ezahlukene, njengemithi yokuvimbela ukuphinda i-serotonin (SSRIs) ekhethiwe , imithi yokuvimbela ukuphinda i-serotonin-norepinephrine (SNRIs), imithi yokuvimbela ukuphinda i-monoamine oxidase (MAOIs), phakathi kwezinye.
Ama-SSRI ama-antidepressants avame kakhulu futhi avame ukunikezwa njengokwelashwa komugqa wokuqala. Basebenza ngokwandisa amazinga e-serotonin ebuchosheni, ukusiza ukuthuthukisa isimo sengqondo nokunciphisa izimpawu zokucindezeleka.
Ama-SNRI, wona, asebenza kukho kokubili i-serotonin ne-norepinephrine, ehlinzeka ngomphumela ophelele wokuqeda ukucindezeleka. Ngakolunye uhlangothi, ama-MAOI awavamile ukunikezwa ngenxa yemiphumela yawo emibi kanye nokusebenzisana kwezidakamizwa.
Ngaphezu kwemithi yokucindezeleka yendabuko, kunezinye izindlela zokwelapha, njengeziqinisi zemizwa kanye nemithi yokwelapha ingqondo engavamile . Le mithi ingasetshenziswa ezimweni zokucindezeleka ezingamelani nokwelashwa okuvamile.
Kubalulekile ukugcizelela ukuthi umuntu ngamunye angasabela ngendlela ehlukile emithini, ngakho-ke kubalulekile ukulandela imiyalelo kadokotela wakho futhi uhlolwe njalo ukuze ulungise umthamo kanye nohlobo lwe-antidepressant, uma kunesidingo.
Thola imishanguzo engu-10 engcono kakhulu yokwelapha ukucindezeleka.
Ama-antidepressants asetshenziswa kakhulu ukwelapha ukucindezeleka. Kunezinhlobo eziningana zama-antidepressants atholakalayo emakethe, ngalinye linezici zalo kanye nemiphumela yalo. Ukuthola imithi engcono kakhulu yokwelapha ukudangala ngokuphumelelayo kungabaluleka enhlalakahleni yesiguli.
Phakathi kwemithi ephezulu ye-10 yokwelapha ngokuphumelelayo ukucindezeleka, singagqamisa i-Prozac, i-Zoloft, i-Lexapro, i-Paxil, i-Celexa, i-Wellbutrin, i-Cymbalta, i-Effexor, i-Remeron, ne-Trazodone. Le mithi ingeyezigaba ezihlukene zama-antidepressants, njenge-SSRIs, SNRIs, MAOIs, nezinye.
Ngayinye yale mithi inezici zayo kanye nemiphumela emibi. Ezinye zingabangela ukozela, umlomo owomile, ukukhuluphala, nokunye. Kubalulekile ukubonana nodokotela ngaphambi kokuqala ukwelashwa nganoma yimiphi yale mithi ukuze banqume ukuthi iyiphi engcono kakhulu kuwe.
Kubalulekile ukugcizelela ukuthi ukusebenza kwama-antidepressants kungahluka kumuntu nomuntu. Umuthi osebenza kahle kumuntu oyedwa ngeke uhlale unomphumela ofanayo komunye. Ngakho-ke, kubalulekile ukulandela imiyalelo kadokotela wakho futhi ubike noma yimiphi imiphumela emibi engase ivele ngesikhathi sokwelashwa.
Ukuthola imithi eyi-10 engcono kakhulu yokwelapha ukucindezeleka kungenza umehluko ezingeni lempilo yesiguli.
Izinhlobo zama-antidepressants: izici nemiphumela
Ukuphazamiseka kwemizwa, ngemva kokuphazamiseka kokukhathazeka, kwande kakhulu kubantu. Ngaphakathi kwalezi zinhlobo zokuphazamiseka, ukucindezeleka yikhona okwaziwayo kakhulu futhi kuvame kakhulu.
Kuyisifo esidala izinkinga ezibalulekile cishe kuzo zonke izici zokuphila komuntu, okuthinta kokubili ukusebenza kwengqondo nemizwa. Ngakho-ke, ukwelashwa kwayo kuwumgomo oyinhloko we-psychology kanye nengqondo, ukuthuthukisa izinhlobo ezahlukene zokwelapha, okuhlanganisa ukwelapha kwengqondo, ukuqonda-ukuziphatha, kanye nemithi, kuhlanganise nama-antidepressants.
Ngokuphathelene nalokhu kwamuva, ucwaningo kulo lonke umlando luye lwakhiqiza izinhlobo ezahlukene zemithi yokucindezeleka ukuze kuthuthukiswe izimpawu zokucindezeleka ngenkathi kugwenywa imiphumela emibi engaba khona.
Ukukhumbula imiqondo: kuyini ukucindezeleka?
Umgomo oyinhloko wezinhlobo ezahlukene zemithi yokucindezeleka ukwelapha ukucindezeleka . Ngokusekelwe kulesi sizathu, isibuyekezo esifushane salokho esikubheka njengokucindezeleka kufanelekile. Ezingeni lezokwelapha, ukucindezeleka kubhekwa njengesimo lapho kukhona khona isimo sengqondo esidabukisayo (esingabonakala njengokucasuka endabeni yokucindezeleka kobuntwana), kanye nokuntuleka kwesisusa kanye nesipiliyoni senjabulo, kanye nezinye izimpawu ezifana nezinkinga zokulala noma zesisindo.
Abantu abacindezelekile bavame ukuba nezinga eliphezulu lokungenzi lutho ezingeni elibalulekile, benomuzwa wokuthi abakwazi ukulawula ukuphila kwabo futhi ngokuvamile babonakala benemizwa yokuphelelwa ithemba. Ngakho-ke, labo abahlushwa ukucindezeleka banezinga eliphezulu lokuthinta okungalungile, kanye nezinga eliphansi lokuthinta okuhle, futhi ngokuvamile banezinga eliphansi lokusebenza, kokubili ngokwengqondo nangokomzimba.
Ngakho-ke, izinhlobo ezahlukene zochwepheshe abanomthwalo wemfanelo wokusebenza ukuthuthukisa isimo salaba bantu kudingeka bathole izindlela nezindlela ezibavumela ukuthi babhekane nalezi zinkinga, njengoba bedale izinhlobo ezahlukene zemithi yokucindezeleka echazwe ku-pharmacology ziyaqhubeka.
Izinhlobo eziyinhloko zama-antidepressants
Ama-antidepressants ahlukene anezinqubo ezihlukene zokwenza, kodwa imibono eyinhloko kanye nokwelashwa kuchaza ukucindezeleka ngokuwohloka kwe-monoamines kanye/noma i-serotonin, okudalwe ngayo ama-antidepressants agxile kakhulu ekuvimbeleni ukuwohloka kwalezi zinto nokuzigcina isikhathi eside. isikhathi endaweni ye-synaptic.
1. I-Monoamino Oxidase Inhibitors noma i-MAOIs
Yiyona yokuqala etholakele ngomuthi wokucindezeleka. Isenzo sayo sisekelwe, njengakwezinye izinhlobo zemithi yokucindezeleka, ekuvimbeleni ukuwohloka kwama-monoamine, sigxile ku-enzyme ethile . Le enzyme yi-monoamine oxidase, ekhishwa yi-neuron ye-presynaptic lapho ibamba ama-monoamine amaningi ku-synapse yobuchopho ukuze kususwe okungaphezulu. Ngakho-ke, ukususwa noma ukuvimba le enzyme kuvimbela ukuwohloka kwama-monoamine esikhaleni se-synaptic, okuholela ekutholakaleni okukhulu kwalawa ma-neurotransmitter.
Kodwa-ke, lolu hlobo lwe-antidepressant lubeka ingozi enkulu empilweni ngoba, uma lusebenzisana nezinto eziqukethe i-thiamine (into etholakala kalula ekudleni okuhlukahlukene), lungabangela izinkinga zomfutho wegazi ophakeme, ngaphezu kweminye imiphumela emibi engathandeki. Ngakho-ke, lusetshenziswa kakhulu ezimweni lapho eminye imithi yokucindezeleka ingasebenzi kahle.
Izinhlobo ze-MAOIs
Ngaphakathi kwe-MAOIs, singathola izinhlobo ezimbili. Uhlobo lokuqala yilolo lwezithibi ze-monoamine oxidase ezingaguquki , ezisebenza kakhulu ukubhujiswa okuphelele kwale enzyme, ukuze, kuze kube yilapho ivuselelwa, ukusebenza kwayo okuyisisekelo kulahleke. Lolu hlobo lwe-antidepressant lubeka ingozi enkulu, njengoba ukusebenzisana kwalo nezinye izinto ezicebile ku-thiamine kuyingozi, futhi ukuqapha ngokucophelela ukudla okudliwayo kuyadingeka ukuze kugwenywe izinkinga ezinkulu zempilo.
Iqembu elincane lesibili i-monoamine oxidase inhibitors (RIMs) ehlehliswayo, ekhethwayo kunezinye izinhlobo zama-MAOI ngoba azibeki engcupheni enkulu noma ajwayele ukusebenzisana nokudla. Isenzo sabo sisekelwe ekuvinjweni kwesikhashana komsebenzi wama-enzyme. I-Moclobemide ingenye yezinto ezakha lolu hlobo lwe-antidepressant.
2. Ama-antidepressants e-Tricyclic kanye ne-tetracyclic
Le mithi, ngemva kwe-MAOIs, imidala kunayo yonke futhi, isikhathi eside, imithi yokucindezeleka esetshenziswa kakhulu. Indlela yabo yokusebenza isekelwe ekuvimbeleni ukutholwa kabusha kwe-serotonin ne-norepinephrine. Kodwa-ke, isenzo sabo asiqondile, sithinta amanye amahomoni anjenge-acetylcholine, i-histamine, ne-dopamine. Ngenxa yalesi sizathu, bangaba nemiphumela emibi kakhulu futhi babe umlutha.
Ukweqisa umthamo walolu hlobo lwento kuyabulala . Ngenxa yalezi zizathu, nangaphambi kokuba ukutholakala kwezinto ezintsha kunciphe, kusengenzeka ukuzithola emtholampilo ngenxa yomphumela wazo omkhulu ezimweni zokucindezeleka okukhulu.
3. Ama-serotonin reuptake inhibitors akhethiwe noma ama-SSRI
Njengamanje, i-serotonin reuptake inhibitors (SSRIs) ekhethiwe iwuhlobo olusetshenziswa kakhulu lwe-antidepressant emisebenzini yomtholampilo, okuyindlela yokwelapha yokuzikhethela ezimweni zokucindezeleka, phakathi kwezinye izinto, ngoba imiphumela engemihle ekhiqizwayo ayinamandla njengeminye imithi esetshenziselwa injongo efanayo.
Lezi izidakamizwa ezithinta ingqondo ezisebenza ngokuvimbela ngqo ukumuncwa kabusha kwe-serotonin , ngaphandle kokuthinta ezinye izinzwa. Nakuba zingadala imiphumela emibi, ngokuvamile zincane (isicanucanu, ukuhlanza, noma ukudambisa ubuhlungu okuncane, phakathi kwezinye), futhi zingenye yezinhlobo eziphephile kakhulu, ezisetshenziswa ezigulini ezingakaze zixhumane nemithi yokucindezeleka ngaphambilini.
Ngaphezu kwalokho, ubudlelwano phakathi kokudangala nokukhathazeka kanye nendlela ethile yokwenza ama-SSRIs kusho ukuthi ibuye yasetshenziswa njengokwelashwa okukhethwa kukho kwezinye izinkinga zokukhathazeka.
4. I-serotonin ekhethiwe ne-norepinephrine reuptake inhibitors noma ama-SNRIs
Lolu hlobo lwe-antidepressant, lapho i-venlafaxine kanye ne-duloxetine kuyizibonelo zalo ezaziwayo, lusebenza ku-serotonin kanye ne-norepinephrine, njengoba kunjalo ngama-antidepressant e-tricyclic . Umehluko omkhulu ngalolu hlobo lwe-antidepressant usekuqondeni kwalo; okungukuthi, ngenkathi ama-serotonin amabili kanye nama-norepinephrine inhibitors ethinta kuphela la ma-neurotransmitter amabili, ama-tricyclic antidepressants athinta ezinye izinto, njenge-acetylcholine, futhi angadala imiphumela emibi.
Njengoba ingasebenzi nge-serotonin kuphela kodwa futhi ne-norepinephrine, le mithi inomphumela oshesha kakhulu kunezinye izinto.
5. I-dopamine ekhethiwe kanye ne-norepinephrine reuptake inhibitor: i-bupropion
Nakuba lesi sidakamizwa saziwa kakhulu ngokuba usizo kakhulu ekususeni ubuthi e-nicotine nakwezinye izinto, i-bupropion iboniswe ukuthi inemiphumela emihle ezimweni zokucindezeleka , isebenza ngokuvimbela ukuthuthwa kwe-dopamine ne-norepinephrine.
Izingozi nemiphumela emibi
Njengayo yonke imithi ye-psychotropic, ukusetshenziswa kwezinhlobo ezahlukene zama-antidepressants kungaba nezingozi ezihlukahlukene kanye nemiphumela emibi. Kufanele kuqashelwe ukuthi, ngokuvamile, kungathatha phakathi kwamasonto amabili namane phakathi kokuphathwa kokuqala kwe-antidepressant kanye nomphumela wayo wokwelapha, ngoba ama-neurons adinga ukwenza inqubo yokujwayela nokuguqulwa kwama-receptors awo, ikakhulukazi mayelana ne-serotonin.
Kodwa-ke, imiphumela emibi ingenzeka ngaphambi kokuba kubonakale imiphumela yokwelapha , yingakho ukwelashwa ngemithi yokucindezeleka kuvame ukuyekwa futhi kuvame ukushiywa. Ezinye zezimpawu nezingozi zokusebenzisa izinhlobo ezahlukene zemithi yokucindezeleka etholakalayo yilezi ezilandelayo.
Ukuncika
Ezinye izinhlobo zemithi yokucindezeleka zingaholela ekubekezeleleni nasekuthembeleni , kanti imithi yokucindezeleka ye-tricyclic iyisibonelo esisodwa. Ngaphezu kwalokho, ukuyeka ukusetshenziswa kwayo ngokuzumayo kungabangela izimpawu zokuhoxa kanye nemiphumela yokubuyela emuva, okwenza kube nesidingo sokuqondisa kokubili ukusetshenziswa kwayo kanye nokuyeka kwayo. Yingakho, ngezinye izikhathi, ukuyeka ngokuzumayo kunganconywa, kodwa kunalokho kancane kancane okuvumela umzimba ukuthi uzivumelanise nesimo esisha.
ukweqisa izidakamizwa
Ukuthatha inani elikhulu lemithi yokucindezeleka kungaholela ekufakweni ubuthi kanye nokweqisa izidakamizwa , okungabangela ukubulala. Imithi yokucindezeleka ye-Tricyclic iphakathi kwemithi ebikwe ukuthi inalesi simo, futhi yathuthukiswa ukuze ihlole ukusebenza kwayo lapho yelapha iziguli ezinesifiso sokuzibulala.
Inkinga ye-hypertensive
Lolu hlobo lomphumela ongemuhle lungenye yezingozi ezinkulu ezibangelwa yi-MAOIs. Kungenxa yokusebenzisana kwalesi sidakamizwa nokudla okucebile ngamaprotheni kanye nokucebile nge-thiamine, okuvame kakhulu ekudleni. Ngakho-ke, ukulawulwa okuqinile kokudla kanye nokuhlolwa kwegazi kuyadingeka ukuze kugwenywe izinkinga.
Izimpawu zocansi nezitho zangasese
Ukuthatha imithi yokucindezeleka ngezinye izikhathi kungabangela ukwehla kwesifiso sobulili kulabo abayithathayo, okunciphisa isifiso noma kubangele izimo ezifana ne-anorgasmia noma ukuphuphuma kwesisu okulibazisekile. Lokhu kwenzeka ngoba ukungalingani kwamahomoni okubangelwa ukusetshenziswa kwalezi zinto kubonakala kakhulu ekuziphatheni kocansi, njengoba kuzwela kakhulu kulezi zinhlobo zezinguquko.
Izinkinga zokozela nokulala
Izinhlobo eziningi zemithi yokucindezeleka zibangela ukozela kanye nokudambisa ubuhlungu njengophawu lwesibili. Ezinye, njenge-MAOIs, zingacindezela ukulala kwe-REM , futhi zibangele izinkinga ekuhlanganiseni ulwazi olusha.
Izimpawu ze-Manic
Ezinye izinto zingakubangela ukuthi uguquke usuke esimweni sokucindezeleka uye kwesamanic. Isibonelo esisodwa yi-bupropion.
Ezinye izimpawu ze-somatic kanye ne-gastrointestinal
Isicanucanu nokuhlanza kuvamile lapho umuntu edla lezi zinto, njengoba kunjalo nangekhanda elibuhlungu kanye nokuthuthumela. Eqinisweni, lezi zinhlobo zezimpawu ziyizimpawu zesibili ezivame kakhulu ngesikhathi sokusetshenziswa kwemithi yokucindezeleka, futhi ngokuvamile zincane. Eziningi zalezi zinguquko ziqala ukubonakala futhi zinyamalale njengoba ukubekezelela le nto kukhula.
Izinkomba ze-Bibliographic:
- I-Azanza, JR (2006), Umhlahlandlela Osebenzayo we-Pharmacology yoHlelo Olumaphakathi Lwezinzwa. Madrid: Ed. Indalo kanye nomklamo.
- Grosso, P. (2013). Ama-antidepressants. Isikole seNyuvesi Yezobuchwepheshe Bezokwelapha. Inyuvesi yaseRiphabhulikhi yaseParaguay.
- Salazar, M.; Peralta, C.; Umfundisi, J. (2006). Incwadi ye-Psychopharmacology. I-Madrid, i-Pan-American Medical Editorial.
- UThase, M.E. (1992). Ukwelashwa kwesikhathi eside kokucindezeleka okuphindaphindiwe. J. Clin. I-Psychiatry; 53