Ko ketamine ndiyo 'chishamiso kushushikana mushonga'?

Zvinodhaka Info

Zvinotaridza kunge zvisingaite kuti ketamine, anesthetic uye yekuvaraidza bato mushonga inozivikanwawo seSpecial K, ingangoshandiswa semushonga wekushushikana-asi chinobva mumushonga, esketamine, ichangobva kugamuchirwa neU.S.Food and Drug Administration (FDA) ye kurapwa-kusagadzikana kushushikana. Uye kutsvagurudza kunoratidza kuti ketamine inogona kuve kurapwa kunoshanda kwekushushikana kwakanyanya uye kwenguva refu.

Kushungurudzika ndechimwe chezvinhu zvakajairika zvehutano hwepfungwa munyika ino, zvinokanganisa vamwe 17.3 mamirioni Vakuru veAmerica, inodaro National Institute of Mental Health. Zviratidzo zvekuora mwoyo zvinogona kusanganisira:

• Kuramba uchinzwa kusuwa, kusava netariro uye kusava nebasa
• Kupera kwesimba, kana kuneta
• Kusadzikama
• Zvakaoma kuisa pfungwa
• Nzara uye hope zvinoshanduka

Vanhu vane kurapwa-kusagadzikana kushushikana , rudzi rwekushungurudzika runoramba ruchiripo zvisinei nekushandisa kanenge maviri akasiyana mwero antidepressants pachiyero chakaringana kwenguva yakakwana. Kunze kwekubatsira nekurapa-kusagadzikana kushushikana, ketamine iri kurumbidzwa nevaya vari munharaunda yepfungwa sevashanduri pakurapa kushungurudzika uye kumwe kusagadzikana kwepfungwa, senge kushushikana , kukanganisa kusagadzikana kusagadzikana (OCD) , bipolar kusagadzikana , uye post inoshungurudza kusagadzikana kusagadzikana (PTSD) .

Chii chinonzi ketamine?

Ketamine dissociative anesthetic iyo dzimwe nguva inoshandiswa kuregedza sekutapudza marwadzo mune mashoma madosi. Inoshungurudzwawo seyodzikamisa uye psychedelic kirabhu zvinodhaka. Iyo dissociative chinodhaka inoita kuti unzwe kubviswa kubva mumuviri wako nepfungwa dzako. Ketamine iri mukirasi imwechete yemishonga se phencyclidine (PCP) uye inogona kuve nemhedzisiro yakafanana. Inowanzoshandiswa seanesthetic mumakiriniki ezvokurapa uye, dzimwe nguva, muzvirongwa zvechipatara.

Zvinoenderana ne National Institute pamusoro pekushandisa zvinodhaka , mune yakakwira doses, ketamine inogadzira zviroto-senge nyika uye fungidziro. Mune madosi epasi, zvinogona kukanganisa ndangariro yako, kutarisisa, uye kugona kwako kuita basa. Zvimwe zvinokanganisa zvinosanganisira kukwira kweropa uye matambudziko ekufema.

Kana ichishandiswa pakurapa, ketamine inowanzojowa mumhasuru kana kupihwa mukati. Iyo inovhara maNMDA receptors kukurudzira kurasikirwa kwekuziva, ndosaka ichiwanzoshandiswa panguva yekuvhiya. Kana ichishandiswa kutandara, inowanzo svinwa, kusvuta, kana kumedzwa uye kazhinji inoita kuti munhu anzwe kumusoro, anofara, akasununguka, uye dzimwe nguva abviswa mumiviri yavo.

Ko ketamine inoshandiswa sei kushushikana?

Zvidzidzo zvakaona kuti ketamine kurapwa kunoshanda pamatambudziko e kuora mwoyo izvo zvakaramba zvichipesana neyakajairwa yemumuromo antidepressants, hurukuro yekurapa, uye kunyangwe electroconvulsive therapy. Zvinoenderana nekutsvaga kwazvino mu Zvinyorwa zveManaged Care & Specialty Pharmacy , mumwe muvatatu vane chirwere chikuru chekushungurudzika (MDD), kushushikana kwakanyanya kunoratidzwa nekunzwa kusingagumi kwekusuwa, kusava netariro, uye pfungwa yekuzviuraya, vane kushushikana kwekurapa.

Kana ichishandiswa kurapa kushushikana, yakaderera kwazvo doses ye ketamine (yakaderera pane madosi anoshandiswa kweanesthesia) inowanzoendeswa mune imwe yemhando mbiri: nekumukisa kana kuburikidza neanal spray. Ose ari maviri anogona chete kupihwa kumakiriniki ehutano kana kumahofisi echiremba uye ese ari maviri anopa kukurumidza-kuita zororo kubva mukushushikana kwakanyanya, kunyangwe kurapwa kwakadzokororwa kuchidikanwa.

Ketamine infusions

Racemic ketamine inowanzo shandiswa mune infusions. Yakaputirwa ketamine yakashandiswa off-label yekuramba uchishungurudzika kweanoverengeka makore. Inopihwa kukiriniki kuburikidza neIV mune ruoko. Mamwe makiriniki ane vashandi vehutano hwepfungwa kune vashandi; vamwe havana asi vanoshanda vari tandem nachiremba wako. Varwere vanowanzo tanga ne matatu infusions pasvondo uye zvishoma nezvishoma vanodzikisa iyo nhamba kusvikira vadzikira kune kumwe kumwe infusion pamwedzi. Zvidiki zvemakiriniki ekuedzwa vakaratidza kuti kuiswa ketamine kunogona kuvandudza kushushikana kwezviratidzo mukati memaviri kusvika mana maawa, nehurefu hwepamusoro hwakawanikwa mumaawa makumi maviri nemana.

Esketamine nasal mapiritsi

Muna Kurume 2019, iyo FDA yakabvumidza iyo esketamine yemushonga (kemikari inowanikwa mu ketamine) yekurapa-kusagadzikana kushushikana muvakuru. Mushonga, unotengeswa pasi pezita Rudyi , Inopihwa kuburikidza nemhino kuburikidza nespray uye inoshandiswa pamwe neanoriramwa ekudzvinyirira emuromo mazuva ese. Rudyi inopihwa kaviri pavhiki kwemavhiki mana ekutanga, uye kamwe pavhiki kwemwedzi unotevera, kamwe kamwe pavhiki kana kamwe chete pavhiki mbiri. Nekuda kwekupindwa muropa ne ketamine pamwe nekugona kwayo kushungurudza - pamwe nekunyaradza kunokonzerwa nemushonga - mushonga unongoshandiswa munzvimbo yekurapa pasi pekutarisirwa nenyanzvi yehutano. Haisi kuwanikwa kwekushandisa-kumba. Varwere vanozvimiririra-avo vanopa pfapfaidzo yemumhino mushure mekurairwa kubva kune nyanzvi yehutano uyezve vanoongororwa kweanenge maawa maviri vasati vabva kukiriniki.

Nepo Spravato ichishandisa mashoma madosi esketamine, ichiri mushonga une simba. Iyo inouya neBoxed Yambiro ichicherekedza mhedzisiro senge isina kukodzera kutonga uye kunetseka kuisa pfungwa mushure mekutonga. Varwere nevarairidzi vavo vanofanirwa kusaina izvo zvinozivikanwa sePatient Kunyoresa Fomu, vachitaura kuti mapato ese anoziva mushonga unokonzeresa uye varwere havafanirwe kutyaira kana kushandisa michina inorema pazuva ravanowana kurapwa. Muchokwadi, varwere vanofanirwa kutasva kuenda kumba kubva kukiriniki uko kupihwa mushonga. Akaverengeka epfupi-kwenguva emakiriniki miedzo akawana kuti mushonga uyu wakachengeteka, asi hazvikurudzirwe kune chero munhu ane risingadzorwe rakakwira BP kana kusagadzikana kwevascular, sezvo varwere ava vangave vari panjodzi huru yezviitiko zvakashata senge kurwisa kwemoyo uye sitiroko. Izvo hazvifanirwe zvakare kushandiswa nevana, vanhu vane nhoroondo ye psychosis, vakadzi vane nhumbu, vakadzi vanoda kuve nepamuviri, kana vakadzi vari kuyamwisa.

Kunze kwekushanda, Spravato, senge yakaiswa ketamine, yakaratidza kuti inokurumidza-kuita. Ipo echinyakare antidepressants, senge inosarudza serotonin reuptake inhibitors (SSRIs) Prozac uye Lexapro , inogona kutora mavhiki kuti ishande, Spravato inoshanda kubvisa kushushikana mune imwe nyaya yemaawa kusvika mazuva. Icho chinhu chakakura kwazvo kune chero munhu ari kushushikana zvakanyanya, asi kunyanya kune avo vanogona kunge vari kuzviuraya.

Vanenge zvikamu zviviri kubva muzvitatu zvevarwere vane kushushikana kukuru kwekushushikana vanoona kiriniki inovandudzika muzviratidzo mukati memaawa matatu, anodaro William Coryell , MD, munyori we Iyo Merck Manuals uye purofesa wezvepfungwa paUniversity yeIowa's Carver College yeMishonga. Kune vazhinji, zvakadaro, izvi mhedzisiro inoderera zvakanyanya pamusoro pemazuva akati wandei anotevera. Nechikonzero ichi, akateedzana marapirwo anowanzo shandiswa uye izvi zvinopa kubatsirwa kwakasimba kwevarwere vazhinji.

Dr. Corywell vanonyevera nezvekuyedza ketamine yekuvaraidza yekusunungurwa kwekushushikana.Iyo antidepressant mhedzisiro inoita seinoshanda chete mukati meimwe, sub-anesthetic dose renji, anodaro. Kushandisa kwekuvaraidza kunogona kupfuudza iyi renji uye kune njodzi yakakura yekushungurudzwa.

Chii chinoita kuti ketamine ibudirire?

Kushungurudzika kushushikana kwepfungwa kunokonzerwa nemaurotransmitters- makemikari vatumwa muuropi anogona kudzora manzwiro, kurara, uye mamwe mabasa. Nyanzvi hadzina chokwadi zvachose kuti ketamine kana esketamine muSpravato inoshanda sei kugadzirisa kushushikana kwakanyanya, asi ivo vanofungidzira kuti inogona kunge iine chekuita nemabatiro avanoita iyo neurotransmitter glutamate kubva pakubatanidza kune imwe receptor (inonziN-methyl-D-aspartate, kana NMDA)pamitsipa.Esketamine isati yavapo, mishonga inogamuchirwa kuti ishandiswe seanodzvinyirira mhedzisiro yakave nemhedzisiro yayo kuburikidza neshanduko mune maurotransmitter serotonin, norepinephrine, uye dopamine, anotsanangura Dr. Coryell. Esketamine, mukupesana, inoita kunge inoshanda zvakanyanya kuburikidza nemhedzisiro yayo pane iyo neurotransmitter glutamate.Vatsvagiri vari kutora izvo zvavanoziva nezve ketamine uye vachitarisa nzira dzavanogona kugadzira glutamate inhibitors iyo isina yakaipa mhedzisiro ye ketamine.

Ko ketamine yakachengeteka here kushandisa kushushikana uye kushushikana?

Kushandiswa kwenguva refu kwe ketamine hakuna kunyatso kutsvagiswa, asi kubvumirana kwese kuri kuti kwakachengeteka kushandisa munguva pfupi. Mhedzisiro, inowanzo gara isingapfuure maawa mashoma, inosanganisira:

• Kukotsira
• Dzungu
• Nausea
• Kusiyanisa
• Yakawedzera BP
• Kuona kwakashata
• Kunzwa kwemuviri, sekunzwa kushamisa kana kusanzwisisika

Ndekupi kwandingawane ketamine?

Kana iwe uri kusangana nekusingaperi, kushushikana kukuru kusiri kuvandudzika nemishonga yako yazvino, taura nemupi wako wezvehutano. Kune makiriniki ekumuputira akatenderedza nyika ayo anopa ketamine nemutemo wechiremba, asi izvi zvinoonekwa sekushandisa zvisiri pamutemo. Iyo nasal spray Spravato ndiyo yega FDA-inogamuchirwa ketamine-senge mushonga unowanikwa pakurapa-kusagadzikana kushushikana. Inongowanikwa chete kumakiriniki ezvehutano uye kuburikidza nemahofisi echiremba-uye mutengo wacho wakakwira, unosvika pakati pe $ 600- $ 800 pachiyero chimwe chete che ketamine, anodaro Dr. Coryell. Infusions yakafanana nemutengo.

Izwi rekupedzisira renyevero: Usaedze kubvisa ketamine kubva mumugwagwa. Ketamine chinhu chinodzorwa uye nyanzvi yezvokurapa inoda kuona chakakodzera dhizaini uye nekukutarisa iwe mhedzisiro, mamwe acho anogona kunge akakomba.