nkhani

Pamene zovuta za ntchito, mavuto a ubale, ndi zitsenderezo za anthu zikuchulukirachulukira, kupsinjika maganizo kungapitirire. Kwa odwala omwe amathandizidwa ndi antidepressants kwa nthawi yoyamba, ochepera theka amapeza chikhululukiro chokhazikika. Malangizo amomwe mungasankhire mankhwala pambuyo pa kulephera kwachiwiri kwa mankhwala ovutika maganizo amasiyana, kusonyeza kuti ngakhale pali mankhwala ambiri, pali kusiyana kochepa pakati pawo. Mwa mankhwalawa, pali umboni wochirikiza kwambiri wowonjezera ma antipsychotic atypical.

Pakuyesa kwaposachedwa, zoyeserera za ESCAPE-TRD zimanenedwa. Mlanduwu unaphatikizapo odwala 676 omwe ali ndi vuto la maganizo omwe sanayankhe kwambiri kwa osachepera awiri oletsa kuvutika maganizo ndipo anali kutengabe serotonin reuptake inhibitors kapena serotonin-norepinephrine reuptake inhibitors, monga venlafaxine kapena duloxetine; Cholinga cha mayeserowo chinali kuyerekeza mphamvu ya esketamine nasal spray ndi quetiapine kumasulidwa kosalekeza. Mapeto oyambirira anali kukhululukidwa pa masabata a 8 pambuyo pa randomisation (yankho laifupi), ndipo mapeto ofunikira achiwiri sanali kubwereranso pa masabata a 32 pambuyo pa chikhululukiro pa masabata a 8.

Zotsatira zinasonyeza kuti palibe mankhwala omwe amasonyeza kuti ali ndi mphamvu zabwino kwambiri, koma esketamine nasal spray inali yothandiza pang'ono (27.1% vs. 17.6%) (Chithunzi 1) ndipo anali ndi zotsatira zochepa zomwe zinachititsa kuti asiye chithandizo chamankhwala. Mphamvu ya mankhwala onsewa idakula pakapita nthawi: pofika sabata 32, 49% ndi 33% ya odwala omwe ali mu Esketamine nasal spray ndi quetiapine-amasulidwa magulu apeza chikhululukiro, ndipo 66% ndi 47% adayankha chithandizo, motsatana (Chithunzi 2). Panali ochepa kubwereranso pakati pa masabata 8 ndi 32 m'magulu onse a chithandizo

Chochititsa chidwi cha phunziroli chinali chakuti odwala omwe adasiya kuyesedwa adayesedwa kuti alibe zotsatira zabwino (ie, ophatikizidwa ndi odwala omwe matenda awo sanakhululukidwe kapena kubwereranso). Odwala ambiri omwe amasiya chithandizo mu gulu la quetiapine kusiyana ndi gulu la esketamine (40% vs. 23%), zotsatira zomwe zingasonyeze nthawi yaifupi ya chizungulire ndi kupatukana zotsatira zokhudzana ndi Esketamine nasal spray ndi nthawi yayitali ya sedation ndi kulemera kwa thupi komwe kumagwirizanitsidwa ndi quetiapine kumasulidwa kosalekeza.

Unali kuyesa kwa zilembo zotseguka, kutanthauza kuti odwala amadziwa mtundu wa mankhwala omwe amamwa. Owunika omwe adachita zoyankhulana zachipatala kuti adziwe zambiri za Montgomery-Eisenberg Depression Rating Scale anali madokotala am'deralo, osati ogwira ntchito kutali. Pali kusowa kwa njira zothetsera vuto lalikulu lakhungu ndi kuyembekezera zomwe zingatheke m'mayesero a mankhwala omwe ali ndi zotsatira za nthawi yochepa ya psychoactive. Choncho, m'pofunika kufalitsa deta yokhudzana ndi zotsatira za mankhwala pa ntchito ya thupi ndi umoyo wa moyo kuti zitsimikizire kuti kusiyana komwe kumawoneka bwino sikungokhala zotsatira za placebo, komanso kuti kusiyana kwake kuli ndi tanthauzo lachipatala.

Chododometsa chofunikira cha mayesero oterowo ndi chakuti mankhwala oletsa kuvutika maganizo amawoneka kuti akusintha mwadzidzidzi maganizo ndikuwonjezera zikhumbo zodzipha mwa odwala ochepa. SUSTAIN 3 ndi kafukufuku wanthawi yayitali, wotseguka wowonjezera wa mayeso a Phase 3 SUSTAIN, momwe kutsatiridwa kwa odwala 2,769 - 4.3% adapezeka kuti adakumana ndi vuto lalikulu lamisala pambuyo pa zaka. Komabe, potengera deta kuchokera ku mayesero a ESCAPE-TRD, chiwerengero chofanana cha odwala m'magulu a esketamine ndi quetiapine anakumana ndi zochitika zazikulu zamaganizo.

Kuchita bwino ndi esketamine nasal spray ndikulimbikitsanso. Cystitis ndi kuwonongeka kwa chidziwitso kumakhalabe kongoyerekeza osati zoopsa zenizeni. Mofananamo, popeza kuti mankhwala opopera a m'mphuno ayenera kuperekedwa kwa odwala kunja, kugwiritsira ntchito mopitirira muyeso kungapewedwe, zomwe zimawonjezera mwayi wobwereza nthawi zonse. Mpaka pano, kuphatikiza kwa racemic ketamine kapena mankhwala ena omwe angagwiritsidwe ntchito molakwika pakugwiritsa ntchito esketamine nasal spray ndi zachilendo, komabe ndikwanzeru kuyang'anitsitsa izi.

Kodi zotsatira za kafukufukuyu pazachipatala ndi zotani? Uthenga wofunika kwambiri ndi wakuti wodwala akapanda kuyankha osachepera awiri antidepressants, mwayi wopeza chikhululukiro chathunthu mkati mwa miyezi iwiri ndi kuwonjezera kwa mankhwala ochiritsira kumakhalabe kochepa. Chifukwa cha kuthedwa nzeru kwa odwala ena ndi kukana kwawo mankhwala, chidaliro chamankhwala chingafooke mosavuta. Kodi munthu amene ali ndi vuto lalikulu la kuvutika maganizo amayankha mankhwala? Kodi wodwalayo sakusangalala ndi mankhwala? Kuyesedwa uku ndi Reif et al. ikuwonetsa kufunikira kwa madokotala kusonyeza chiyembekezo ndi kusasunthika pa chithandizo chawo, popanda zomwe odwala ambiri salandira chithandizo.

Pamene kuli kwakuti kuleza mtima n’kofunika, momwemonso liŵiro liŵiro limene vuto la kupsinjika maganizo limachirikizidwa nalo. Odwala mwachibadwa amafuna kuti achire mwamsanga. Popeza mwayi wopindula wa wodwalayo umachepa pang'onopang'ono ndi kulephera kulikonse kwa mankhwala ochepetsa kupsinjika maganizo, kulingalira kuyenera kuperekedwa ku kuyesa chithandizo chamankhwala chothandiza kwambiri choyamba. Ngati zodziwikiratu zomwe antidepressants angasankhe pambuyo pa kulephera kwa mankhwala awiri ndizothandiza komanso chitetezo, ndiye kuti kuyesa kwa ESCAPE-TRD kungatsimikizire kuti esketamine nasal spray iyenera kusankhidwa ngati chithandizo chamzere wachitatu. Komabe, chithandizo chokonzekera ndi esketamine nasal spray nthawi zambiri chimafuna maulendo a sabata kapena kawiri pamlungu. Chifukwa chake, mtengo ndi zovuta zitha kukhala zinthu zomwe zimakhudza kugwiritsa ntchito kwawo.

Esketamine nasal spray sikhala yekhayo wotsutsa glutamate kulowa muzochita zamankhwala. Kusanthula kwaposachedwa kwa meta kumasonyeza kuti ketamine yothamanga m'mitsempha ingakhale yothandiza kwambiri kuposa esketamine, ndipo mayesero awiri akuluakulu a mutu ndi mutu amathandizira kugwiritsa ntchito ketamine yamtundu wa racemic ketamine pambuyo pake mu njira ya chithandizo monga njira kwa odwala omwe amafunikira electroconvulsive therapy. Zikuoneka kuti zimathandiza kupewa kuvutika maganizo kwina komanso kulamulira moyo wa wodwalayo.