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Ukuya kuma-anti-depressants: Umhlahlandlela wabaqalayo wemiphumela emibi

Ukuya kuma-anti-depressants: Umhlahlandlela wabaqalayo wemiphumela emibiImininingwane Yezidakamizwa

Uma wena, njengami, uhlushwa ukucindezeleka okulingene kuya kokukhulu, ukukhathazeka okungapheli, noma i-bipolar disorder, kungenzeka umhlinzeki wakho wezokwelapha ukunikeze umuthi wokulwa nokudangala. Ngingakutshela ngokuhlangenwe nakho ukuthi le mithi ingashintsha impilo. Ngokubambisana nokwelashwa kokukhuluma, ama-anti-depressants angelapha izimpawu ezikuvimbela ukuthi uphile impilo ephelele. Bangakukhulula ekudabukeni okujulile, ukwesaba, ukucasuka, kanye nezinye izinto eziningi eziphazamisa umsebenzi, isikole, kanye nobudlelwano bomuntu siqu.





Kunezigaba eziningana zemithi elwa nokudangala, futhi zonke zisebenza ngezindlela ezingafani. Kodwa into eyodwa abafana ngayo ukuthi bashintsha ubukhona bamakhemikhali athile ebuchosheni bakho. Lokhu kuyinto enhle, ngezindlela eziningi, njengoba kusiza ukwelapha ukudangala noma ukukhathazeka kwakho. Kepha njengayo yonke imithi, kungadala nemiphumela engemihle.



Ithimba lodokotela kanye nosokhemisi basize ekwakheni lo mhlahlandlela ophelele wemithi elwa nokudangala nemiphumela engemihle yezidambisi.

Yiziphi izinhlobo zama-anti-depressants?

Ama-anti-depressants yimithi kadokotela elapha izimpawu zokucindezeleka ngokomtholampilo, ezinye izinkinga zokukhathazeka, ukuphazamiseka kwesizini, kanye ne-dysthymia (noma ukucindezeleka okungapheli okuncane). Zonke zisebenza ngokulungisa ukungalingani kwamakhemikhali kwama-neurotransmitters ebuchosheni okuhambisana nokushintshashintsha kwemizwelo nokuziphatha.

Izidakamizwa ezahlukahlukene zokulwa nengcindezi zibhekisa kuma-neurotransmitter ahlukahlukene ebuchosheni nasezinhlelweni zezinzwa, kusho uJustin Hall, MD, udokotela wezifo zengqondo Impilo Yokuziphatha Kwe-Spectrum e-Annapolis, eMaryland. ISerotonin yi-neurotransmitter ebhekiswe kakhulu ebihambisana nokukhathazeka nokudangala.



I-Serotonin ihloselwe ngoba yi-neurotransmitter evame ukuhlotshaniswa nokudangala. Leli khemikhali line- imisebenzi ehlukahlukene emzimbeni womuntu . Odokotela abaningi nabantu abavamile bakubiza ngokuthi yikhemikhali elijabulayo, ngoba kuyaziwa ukuthi kukhulisa injabulo nomuzwa wokuphila kahle. Kepha kungathinta nokugaya ukudla kwakho, ukuhamba kwamathumbu, inkumbulo, ukulala, nezinye izinto eziningi.

Izigaba zemithi elwa nokudangala zifaka:

  • I-serotonin reuptake inhibitor ekhethiwe (SSRI)
  • ISerotonin-norepinephrine reuptake inhibitor (SNRI)
  • I-Tricyclic antidepressant (TCA)
  • I-Monoamine oxidase inhibitor (MAOI)
  • Umphikisi weSerotonin kanye ne-reuptake inhibitor (SARI)
  • I-antypical antidepressant

Ngayinye yalezi zigaba, ngisho nemithi engaphakathi kwazo, ithinta amazinga ezinzwa ezehlukene ze-neurotransmitters ngezinga elihlukile, kusho u-Alam Hallan, Pharm.D., Umqondisi wekhemisi laseGuelph General Hospital e-Ontario, eCanada.



Ngalesi sizathu, zonke iziguli zidinga uhlelo lokwelashwa olwenzelwe umuntu ngamunye. Umenzeli omuhle wesiguli esithile yilokho okusebenzela kangcono kubo, kusho uDkt. Iziguli eziningi zivame ukuqala ngama-SSRI noma ama-SNRI. Uma bengaphenduli kulezo zidakamizwa, bangazama ama-TCA noma ama-atypicals. Ama-MAOI agcinelwe amacala amelana kakhulu ngenxa yokuhlangana okuthile okunzima.

I-serotonin reuptake inhibitors ekhethiwe (i-SSRIs) ne-Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Kokubili Ama-SSRIs futhi Ama-SNRIs kunqunyelwe ukwelapha ukudangala nezinye izinkinga zokukhathazeka. Zisebenza ngokukhomba amakhemikhali ebuchosheni bakho okuthiwa ama-neurotransmitters. Lapho ubuchopho bakho buthumela imiyalezo kusuka kwesinye iseli iye kwesinye, njengokuzizwa ujabule ngalezi zindaba, noma le movie iyahlekisa, leyo milayezo ihamba ngosizo lwama-neurotransmitters.

Ama-SSRIs abhekise kwi-neurotransmitter ebizwa nge-serotonin, kanti ama-SNRIs akhombe i-serotonin ne-norepinephrine. Imvamisa, lapho ubuchopho bakho buthumela imilayezo kusuka ku-neuron eyodwa kuya kwenye, umthumeli ukhipha kancane i-neurotransmitter ukuhambisa umyalezo, bese ubuyisela i-neurotransmitter ngemuva kokulethwa komyalezo.



Ama-anti-depressants e-SSRI asebenza ngokuvimba ukubuyiselwa kabusha kwe-serotonin ebuchosheni bakho, ngemuva kokuthi ihambise imiyalezo yayo ejabulisayo. Ngakho-ke, ubuchopho bakho buzoba ne-serotonin eningi yokuletha imiyalezo eminingi ejabulisayo. Ama-anti-depressants anqunyiwe kakhulu, ama-SSRI athathwa njengasebenza kakhulu ngemiphumela emibi kakhulu. Ezinye izibonelo zifaka phakathi uCelexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine) noZoloft (sertraline).

Ngokufanayo, ama-SNRI akhulisa amazinga womabili i-serotonin ne-norepinephrine ebuchosheni bakho.



INorepinephrine ingenye i-neurotransmitter edlala indima ekusimamiseni isimo. Ezinye izibonelo zama-SNRI zifaka phakathi iCymbalta (duloxetine), i-Effexor (venlafaxine), nePristiq (desvenlafaxine).

I-Tricyclic antidepressants (TCAs)

I-Tricyclic (noma i-tetracyclic) ye-anti-depressants ezinye zezidakamizwa zokuqala zokulwa nezidakamizwa ezakhiwe. Zisebenza kahle kakhulu, kepha futhi ziza nemiphumela emibi eminingi, ngakho-ke ziguqulwa kakhulu yimithi emisha ngaphandle uma ama-SSRI noma ama-SNRI engasebenzi.



Ama-anti-depressants e-cyclic futhi avimba ukuphinda kuthathwe kwe-neurotransmitters serotonin ne-norepinephrine, kukhulisa amazinga ala makhemikhali amabili ebuchosheni. Kodwa-ke, ama-TCAs angathinta namanye ama-neurotransmitters futhi, yingakho enemiphumela emibi eminingi kakhulu. Izibonelo zama-TCA zifaka phakathi i-amitriptyline ne-amoxapine.

I-Monoamine oxidase inhibitors (MAOIs)

Njengabanye, i-monoamine oxidase inhibitors (MAOIs) sebenza ngokuthinta ama-neurotransmitters. Ngokuqondile, ama-MAOIs athinta i-dopamine, i-serotonin, ne-norepinephrine, eyaziwa ngokuhlanganyela njenge-monoamines. Kukhona nekhemikhali ebuchosheni ebizwa nge-monoamine oxidase, esusa lawo ma-neurotransmitters. I-MAOIs isebenza ngokuvimbela i-monoamine oxidase, ngakho-ke ivumela iningi lalawo ma-neurotransmitters ukuthi ahlale ebuchosheni.



Lawa kwakungamaphilisi okuqala okulwa nezidambisi, akhiwa ngawo-1950. Babephumelela ekwelapheni ukuphazamiseka okukhulu kokudangala. Kodwa-ke, njengama-TCAs, eza nemiphumela emibi eminingi. Kunokuxhumana okuningi okuyingozi kwezidakamizwa phakathi kwama-MAOI nezinye izidakamizwa, okwenza kube nzima ukwelapha abantu abanezinkinga zempilo yengqondo kanye nezinye izimo zezokwelapha. Ezinye izibonelo zifaka iNardil (phenelzine) neMarplan (isocarboxazid).

Umphikisi weSerotonin kanye nama-reuptake inhibitors (ama-SARIs)

Umphikisi weSerotonin kanye nama-reuptake inhibitors (ama-SARIs) zivunyelwe yi-FDA njengemithi elwa nokudangala, kepha zisetshenziswa kakhulu ngaphandle kwelebula njengezinsiza zokulala. Njengama-SSRI, basebenza ngokuvimbela ukuphinda kuthathwe kabusha kwe-serotonin. Kodwa futhi basebenza njengabaphikisi, bevimbela i-receptor ethile ye-serotonin ebizwa nge-5HT2a, evimba ukusebenza kweprotheyini ye-serotonin transporter.

Ezinye izibonelo zama-SARIs zifaka i-Desyrel (trazodone) ne-Serzone (nefazodone).

Ama-anti-depressants atypical

Ama-antidepressant atypical afana nokuthi azwakala-hhayi ejwayelekile. Lokhu kusho ukuthi azingeni kwezinye izigaba ze-antidepressants, futhi zisebenza ngezindlela ezihlukile. Yize ingekho indlela yokufingqa ukuthi lezi zidakamizwa zisebenza kanjani, kwanele ukusho ukuthi zonke ziguqula ukwakheka kwama-neurotransmitter athile ebuchosheni bakho, kufaka phakathi i-dopamine, i-serotonin, kanye / noma i-norepinephrine. Ezinye izibonelo zama-antidepressants atypical yi-Wellbutrin (bupropion) neRemeron (mirtazapine).

Ukuqonda imiphumela emibi ye-anti-depressants

Ngenkathi kunemiphumela engemihle ebanzi engathathwa yimithi elwa nokudangala ingadalwa, yilezi ezivame kakhulu:

  • Ukwehla kwesisindo noma ukuzuza
  • Izinkinga zocansi, kufaka phakathi ukulahleka kwesifiso sobulili, ukungasebenzi kahle kwe-erectile, nezinye
  • Ukuqwasha
  • Ukozela
  • Ukukhathala
  • Ukuphathwa ikhanda
  • Isicanucanu
  • Umlomo owomile
  • Ukubona okufiphele
  • Ukuqunjelwa
  • Isiyezi
  • Ukuyaluza
  • Ukuthukuthela
  • Ukukhathazeka
  • Ukushaya kwenhliziyo okungajwayelekile

Ngaphezu kwalokhu, kunemiphumela emibi yesikhathi eside neyesikhashana yemithi elwa nokudangala.

Imiphumela emibi yesikhathi eside yama-anti-depressants

Yize imiphumela emibi eminingi elwa nokucindezelwa isisikhashana, kukhona okumbalwa okuhlala isikhathi eside — le miphumela emibi iyivelakancane futhi ingahle ilawulwe ngezindlela eziningi, echazwe ngezansi. Imiphumela emibi engaba khona yesikhathi eside ifaka phakathi ukushintsha kwesisindo, izinkinga zocansi, ukuqwasha, ukozela nokukhathala.

Ukuzuza kwesisindo

Isizathu sokuzuza kwesisindo ngenkathi uthatha imishanguzo yesikhathi eside asikacaci. Kungenzeka ukuthi iziguli ezake zadla okuncane kakhulu ngenkathi zicindezelekile zizwa inkanuko yazo ibuya nokwelashwa, uDkt Hallan uphakamisa, noma imishanguzo ingadala ushintsho ekuguqulweni komzimba. Ezimweni eziningi, ibalelwa cishe kumakhilogremu amahlanu noma njalo ngonyaka.

Ezinye izifundo zezokwelapha zikhombisile ukuthi ukusetshenziswa kwesikhathi eside kwezidambisi kungakhuphula ubungozi bakho bokugula okuhlobene nokuzuza kwesisindo, okufana thayipha 2 sikashukela .

Uma ukuphatha lo mphumela wecala ngokudla nokuvivinya umzimba kungasebenzi, uDkt Hallan uphakamisa ukuzama umuthi omusha. Yonke le mithi isebenza ngokuhlukile kubantu abahlukene, ngakho-ke umuthi owodwa ungahle ungadaleli imithelela emibi efanayo kuwo wonke umuntu, noma ngabe kwaziwa ngokujwayelekile ukuthi kubangele leyo miphumela emibi.

Ukuhlukunyezwa ngokocansi

Imiphumela emibi yezocansi imvamisa iyimiphumela emibi ejwayelekile engaholela ekutheni abantu bayeke imishanguzo yabo yize benza kahle emithini, kusho uDkt.

Eqinisweni, okungenani isigamu sazo zonke iziguli ezithatha ama-SSRI zingahle zithole imiphumela emibi yocansi, kufaka phakathi ukwehla kwesondo lokushayela, ukwehla kwamandla okuba ne-orgasm, ukoma kwesitho sangasese sowesifazane, noma ukungasebenzi kahle kwe-erectile.

Ngenkathi eminye imiphumela emibi ihlala isikhathi esifushane, le miphumela emibi yocansi ingaqhubeka sonke isikhathi lapho isiguli sithatha imishanguzo yokulwa nezingcindezi. Kodwa-ke, akufanele zenze buthakathaka noma zibe yingozi. Uma kukukhathaza kuze kufike ezingeni lapho ungakhetha ukungayiphuzi khona le mishanguzo, uDkt. Hall uncoma ukuthi ukhulume nodokotela wakho onqumayo ngokunciphisa umthamo, ukuthatha umuthi ngesikhathi esihlukile sosuku, noma ukushintshela komunye umuthi.

Izinkinga zokulala

Ukushintshashintsha komuthi kuya komunye nesiguli kuya kwesiguli, izidakamizwa eziningi zokulwa nengcindezi zibangela ubunzima ngokulala — kungaba ukuqwasha noma ukozela. Uma uhlangabezana nalo mphumela wecala, uDkt Hall uncoma ukubeka isikhathi semithi yakho kuye ngokuthi ikuthinta kanjani ukulala kwakho: Uma i-antidepressant yakho ikwenza wozele, yithathe ngaphambi kokulala. Uma ikugcina uphapheme, yithathe ekuseni. Imvamisa, imiphumela yokuvuka noma ukulala komuthi izophela ngemuva kwamahora ambalwa.

Imiphumela emibi yesikhathi esifushane yama-anti-depressants

Ngenkathi abantu abaningi bengenazo izimpawu kuma-anti-depressants, akuyona into engavamile ukuhlangabezana nemiphumela emibi yesikhashana egcina izinsuku ezimbalwa noma amasonto ambalwa. Lokhu kungafaka isicanucanu, ukuphathwa ikhanda, umlomo owomile, ukungaboni kahle, ukuqunjelwa, nentukuthelo noma ukucasuka.

Isicanucanu

I-nausea yenzeka cishe ezigidini ezingama-25 zeziguli ezilwa nokudangala. Imvamisa iqala ngokushesha ngemuva kokuqala ukwelashwa bese yehla ngemuva kwamasonto amabili noma amathathu. Kodwa-ke, kuyaqhubeka kulo lonke ukwelashwa cishe ingxenye eyodwa kwezintathu zalabo bantu. I-nausea ivame kakhulu nge-venlafaxine nama-SSRIs kunama-atypicals afana ne-bupropion, mirtazapine, noma i-reboxetine. Ngokuvamile kungalawulwa ngokuthatha imishanguzo yakho esiswini esigcwele.

Ukuphathwa ikhanda

Ucwaningo olushicilelwe kumagazini Ukwelashwa Kwemitholampilo ithole ukuthi ukuphathwa yikhanda bekungumphumela ovelele kakhulu wabantu abangama-40,000 abasanda kuqala ukuthatha imishanguzo yokulwa nengcindezi. Labo abathathe ama-TCAs nama-SSRI babenamathuba amaningi kunalabo abathatha ama-SNRI noma i-bupropion ukuzwa ikhanda. Kodwa-ke, abantu abaningi bakha ukubekezelelana kwale miphumela emibi, futhi bayahamba ngemuva kwesikhashana.

Umlomo owomile

Izwa umlomo owomile ? Lokhu kungenzeka ngoba izidakamizwa zivimbela kafushane ukukhiqizwa kwamathe komzimba wakho. Ama-TCAs kungenzeka ukuthi abangele umlomo owomile kunama-SSRI.

UDkt. Hallan uncoma ukuncela ama-ice chips, ukuthatha iziphuzo zamanzi njalo, ukuhlafuna ushungamu, ukusebenzisa iminti noma ukuxubha amazinyo.

Izinkinga zombono

Abantu abanombono ofiphele bakuchaza njengokuntuleka kokucija noma ukucaciseleka kumbono wabo. Umbono ofiphele uvame kakhulu kuma-TCA. Abantu bangahle bezwe ukushiswa, ukulunywa, nokubomvu kweso, noma ukuzwa okunamandla esweni. Ngaphezu kwalokho, abanye abantu bathi amehlo abo azwela kakhulu ekukhanyeni.

Uma uthatha imishanguzo yokulwa nezingcindezi futhi ubona ukungaboni kahle, qala ngokuhlolwa iso ukuze ukhiphe ezinye izinkinga zombono. Ungazama futhi ukusebenzisa amaconsi wamehlo ne-humidifier ukuthambisa amehlo akho. Khuluma nomhlinzeki wakho ngokushintsha umthamo wakho uma lo mphumela wecala uqhubeka ngaphezu kwamasonto ambalwa.

Ukuqunjelwa

I-neurotransmitter serotonin inemisebenzi eminingi ngaphandle kokwenza uzizwe ujabulile — ingathinta nokuhamba kwamathumbu akho, futhi, ngoba i-serotonin ikhona emathunjini akho. Kwesinye isikhathi, ama-SSRI athile nama-TCA angadala ukuqunjelwa esikhathini esifushane. Iziguli zingayilawula ngokusebenzisa laxatives, ukuphuza amanzi amaningi, nokudla ifayibha eyengeziwe.

Isiyezi

Isizungu sivame kakhulu ngama-TCAs nama-MAOIs kunezinye izigaba ze-anti-depressants. Isizathu sokuthi le mithi kwesinye isikhathi ibangele isiyezi yingoba inganciphisa umfutho wegazi lakho. UDkt Hall uncoma ukuphuza imithi yakho ngesikhathi sokulala ukusiza ukulawula lo mphumela ohlangothini.

Ukuthukuthela noma ukukhathazeka

Kokubili ukucasuka nokukhathazeka kuyimiphumela engemihle neze ye-anti-depressants, kepha kwenzeka ezigulini ezimbalwa. Isizathu mhlawumbe sihlobene ne-serotonin. Njengoba sekushiwo, amazinga aphansi e-serotonin ebuchosheni angaholela ekucindezelekeni nasekukhathazekeni, yingakho le mithi yonke isebenza ukukhulisa amazinga e-serotonin ngandlela thile. Ezinsukwini zokuqala zokwelashwa, umzimba wakho usebenza ukulungisa amazinga akho e-serotonin, okudala ukuthi aguquke. Lokhu kungadala ukuqhuma okufushane kokukhathazeka okwengeziwe noma ukucasuka. Njengoba amazinga akho e-serotonin eba namandla ngokwengeziwe, lezi zimpawu kufanele zehle.

Umphumela oseceleni I-SSRI SNRI TCA MAOI I-SARI I-Wellbutrin Remeron
Ukuzuza kwesisindo X X X X X
Ukungasebenzi ngokocansi X X X X X
Izinkinga zokulala X X X X X X X
Isicanucanu X X X X X X X
Ubuhlungu bekhanda X X X X X X X
Umlomo owomile X X X X X X X
Izinkinga zombono X X X X X X X
Ukuqunjelwa X X X X X X
Isiyezi X X X X X X X
Ukuthukuthela X X X X X X
Ukukhathazeka X X X X X X
Ukujuluka okweqile X X X X
Ukugcinwa komchamo X X X
Umfutho wegazi ophansi X X X X

Imiphumela emibi ye-anti-depressants

Kuze kube manje, yonke imiphumela emibi ejwayelekile esixoxe ngayo ayinabungozi kangako, noma ngabe iyahlupha. Kodwa-ke, kunemiphumela emibi embalwa kakhulu engajwayelekile, kodwa futhi ebucayi kakhulu, engahle yenzeke lapho uthatha imishanguzo yokulwa nengcindezi. Kubandakanya ukuzibulala, i-serotonin syndrome, ne-hyponatremia.

Ngenhlanhla, le miphumela emibi ayivamile, futhi izingozi zinkulu kakhulu ngenyanga yokuqala yokwelashwa.

Imicabango yokuzibulala

Ngokwengxenye enkulu, ama-anti-depressants asiza ukunciphisa zonke izimpawu zokudangala, kufaka phakathi ukuzibulala. Kodwa-ke, inani elincane leziguli ezisengozini-imvamisa abantu abadala abasebasha-libhekana nengozi enkulu yokwanda kwemibono yokuzibulala.

Ngokusho kukaDkt. Hallan, lokhu kwenzeka kuphela ezimweni ezithile. Isibonelo, umuntu ocindezeleke kakhulu ongazinikeli ngemithi kungenzeka ukuthi uhlangabezana nemicabango yokuzibulala. Kepha izimpawu zakhe zokudangala zicishe zimvikele ekusebenzeni kuleyo micabango ngoba futhi zimenza azizwe ekhathele kakhulu futhi ephelelwe ngamandla. Lapho eseqale ukwelashwa, amandla nokukhathala kwakhe kungathuthuka ngokwanele ukumnika amandla okulandela imicabango yakhe yokuzibulala.

Ukuze ugweme lo mphumela ohlangothini, kufanele wabelane nganoma yimiphi imicabango yokuzibulala oye waba nayo nomhlinzeki wakho wezokunakekelwa kwempilo ngaphambi kokuqala ukwelashwa.

Isifo se-Serotonin

I-Serotonin syndrome iyisimo esiphuthumayo esisongela impilo esenzeka ezigulini ezimbalwa kakhulu, kusho uDkt Hallan. Kuyingozi ethile kulabo abasebenzisa imishanguzo engaphezu kweyodwa ye-serotonergic. Iqembu lezimpawu lifaka ukuyaluza, ukuqhaqhazela, ukujuluka kanye ne-hyperthermia. Ukuthatha izithasiselo ezithile, njenge-St. John's Wort, kungakhuphula ubungozi balesi simo.

Uma uhlangabezana nalezi zimpawu ngenkathi uthatha i-anti-depressant, funa usizo lwezokwelapha ngokushesha. Bazomisa imishanguzo yakho, banikeze ama-ejenti wokuguqula, futhi basize ukuphatha izimpawu zakho.

I-Hyponatremia

IHyponatremia ngomunye umphumela oyingozi futhi ubonakala ezigulini ezi-1 kweziyi-2 000 ezithatha ama-SSRIs, kuchaza uDkt Hallan. Ekhuluma ngokushoda kwe-sodium egazini, i-hyponatremia kucatshangwa ukuthi ingenxa yokukhuphuka kokukhiqizwa kwehomoni ekhipha isisu, okwenza umzimba ugcine amanzi amaningi, ngaleyo ndlela kuhlanjululwe inani le-sodium emzimbeni, usho kanjalo. Iziguli, ikakhulukazi iziguli ezindala, ezisengozini kufanele ziqashwe kusetshenziswa ukuhlolwa kwelebhu.

Izimpawu zokuhoxiswa kwe-antidepressant

Ngaphandle kokuthi uhlangane nemiphumela eyingozi ye-anti-depressants futhi ubonane nodokotela wakho, akuwona umqondo omuhle ukuyeka ukuyisebenzisa turkey ebandayo. Ukuyekiswa kwe-anti-depressants kungadala izimpawu zokuhoxa, njenge:

  • Ukukhathazeka
  • Ukuqwasha noma amaphupho acacile
  • Kuduma ikhanda
  • Ukuphathwa ikhanda
  • Isiyezi
  • Ukukhathala
  • Izimpawu ezinjengomkhuhlane
  • Isicanucanu
  • Ukuthukuthela

Uma kufanele uyeke ukusebenzisa ama-anti-depressants, noma ushintshe umthamo wakho, kubalulekile ukuthi ukhulume nomhlinzeki wakho kuqala. Angakunika uhlelo lokuzikhipha emithini ukuze unciphise izimpawu zokuhoxa.