Ingabe i-ketamine 'isidakamizwa sokudangala okuyisimangaliso'?

Imininingwane Yezidakamizwa

Kubukeka kungeke kwenzeke ukuthi i-ketamine, umuthi wephathi wokubulala izinzwa nowokuzithokozisa owaziwa nangokuthi i-Special K, ungasetshenziswa njengokwelashwa kwengcindezi-kodwa okutholakala komuthi, i-esketamine, kusanda kuvunywa yi-US Food and Drug Administration (FDA) ukucindezeleka okungazweli ekwelashweni. Futhi ucwaningo lukhombisa ukuthi i-ketamine ingaba ukwelashwa okusebenzayo kokudangala okunzima nokuhlala isikhathi eside.

Ukudangala kungenye yezinkinga ezivame kakhulu zempilo yengqondo kuleli, ezithinta abanye 17.3 million Abantu abadala baseMelika, kusho iNational Institute of Mental Health. Izimpawu zokucindezeleka zingafaka:

• Imizwa eqhubekayo yosizi, ukuphelelwa ithemba nokuphelelwa yithemba
• Ukwehla kwamandla, noma ukukhathala
• Ukungahlaliseki
• Kunzima ukugxila
• Ukudla nokulala kuyashintsha

Abantu abane ukucindezeleka okungazweli ekwelashweni , uhlobo lokucindezeleka oluqhubekayo naphezu kokusebenzisa okungenani ama-anti-depressants ejwayelekile amabili esilinganisweni esanele isikhathi esanele. Ngaphezu kokusiza ngokudangala okungazweli ekwelashweni, ketamine unconywa yilabo abasemphakathini wezifo zengqondo njengabavukeli ekwelapheni ukucindezeleka nezinye izifo zemizwelo, njenge ukukhathazeka , ukukhathazeka ngokweqile (OCD) , ukuphazamiseka kwengqondo okuguquguqukayo , futhi i-post traumatic stress disorder (PTSD) .

Yini i-ketamine?

I-Ketamine iyi-anesthetic ehlukanisayo kwesinye isikhathi esetshenziswa ngaphandle kwelebula njengokudambisa izinhlungu ngamanani aphansi. Iphinde ihlukunyezwe njengesidakamizwa sokuthula nesidakamizwa seklabhu yengqondo. Isidakamizwa esizihlukanisayo sikwenza uzizwe unqamukile emzimbeni wakho nasemicabangweni yakho. I-Ketamine ikwisigaba esifanayo semithi njenge-phencyclidine (PCP) futhi ingaba nemiphumela efanayo. Kuvame ukusetshenziswa njenge-anesthetic emitholampilo yezilwane futhi, kwesinye isikhathi, ezindaweni zesibhedlela.

Ngokusho kwe- Isikhungo Sikazwelonke Sokuhlukumeza Izidakamizwa , ngemithamo ephezulu, i-ketamine ikhiqiza amazwe afana namaphupho nemibono. Ngamanani aphansi, kungaphazamisa inkumbulo yakho, ukunaka kwakho, kanye nekhono lakho lokusebenza. Eminye imiphumela emibi ibandakanya umfutho wegazi ophakeme nezinkinga zokuphefumula.

Uma isetshenziswa kwezokwelapha, i-ketamine ngokuvamile ijojowe emsipheni noma inikezwe ngemithambo yegazi. Ivimbela ama-receptors e-NMDA ukwenza ukuthi umuntu alahlekelwe ukwazi, yingakho kuvame ukusetshenziswa ngesikhathi senqubo yokuhlinzwa. Uma isetshenziselwa ukuzithokozisa, ivamise ukukhonjiswa, ukubhema, noma ukugwinya futhi ngokuvamile kwenza umuntu azizwe ephakeme, ejabule, ekhululekile, futhi kwesinye isikhathi esuswe emzimbeni wakhe.

I-ketamine isetshenziswa kanjani ekucindezelekeni?

Ucwaningo luthole ukuthi ukwelashwa kwe-ketamine kuyasebenza uma kuqhathaniswa namacala we ukudana eziphikisane ngenye indlela nemithi yendabuko yokulwa nezingcindezi, ukwelashwa kokukhuluma, ngisho nokwelashwa okubangelwa amandla kagesi. Ngokuya ngocwaningo lwakamuva ku Ijenali Yokunakekelwa Okulawulwayo Nekhethelo Ikhemisi , umuntu oyedwa kwabathathu onesifo sokucindezeleka esikhulu (i-MDD), isimo esibi kakhulu sokucindezeleka esimakwe yimizwa engapheli yosizi, ukungabi nathemba, kanye nemibono yokuzibulala, unokudangala okungazweli ekwelashweni.

Lapho isetshenziselwa ukwelapha ukucindezeleka, amanani aphansi kakhulu e-ketamine (aphansi kunamanani asetshenziselwa i-anesthesia) ngokuvamile ahanjiswa ngenye yezindlela ezimbili: ngokumnika noma nge-spray yamakhala. Zombili zinganikezwa kuphela emitholampilo yezempilo noma emahhovisi odokotela futhi zombili zinikeza usizo olusheshayo olusebenzayo ekucindezelekeni okukhulu, yize kudingeka ukwelashwa okuphindaphindwayo.

Ukufakwa kwe-ketamine

I-racemic ketamine ivame ukusetshenziselwa ukumnika. Kusetshenziswe i-ketamine efakiwe off-ilebula ngokudangala okungapheli iminyaka eminingana. Inikezwa emtholampilo nge-IV engalweni. Eminye imitholampilo inabasebenzi bezempilo yengqondo; ezinye azenzi kodwa zizosebenza ngokubambisana nodokotela wakho. Iziguli zivame ukuqala ngokufakwa okuthathu ngeviki futhi zinciphise inani kancane kancane zize zehle kube ukumnika okukodwa ngenyanga. Izilingo ezincane zomtholampilo kukhombisile ukuthi i-ketamine efakiwe ingathuthukisa izimpawu zokucindezeleka kungakapheli amahora amabili kuya kwamane, ngokukhululeka okuphezulu kufinyelelwe emahoreni angama-24.

Izifutho ze-Esketamine acinene

Ngo-Mashi 2019, i-FDA ivume i-esketamine yezidakamizwa (ikhemikhali elitholakala ku-ketamine) lokudangala okungazweli ekwelashweni kubantu abadala. Isidakamizwa, simakethwa ngaphansi kwegama Kwesokudla , inikezwa ngekhala ngokusebenzisa isifutho futhi isetshenziswa kanye ne-anti-depressant yomlomo yansuku zonke. Kwesokudla unikezwa kabili ngesonto emavikini amane okuqala, bese kuthi kanye ngesonto enyangeni elandelayo, bese kuthi kanye ngesonto noma kanye njalo emavikini amabili. Ngenxa yesimo sokulutha se-ketamine kanye namandla aso okuhlukumeza-kanye nokuthamba okubangelwa yisidakamizwa-umuthi usetshenziswa kuphela esimweni sezokwelapha ngaphansi kweso lengcweti kwezempilo. Akutholakali ukuze kusetshenziswe ukugoduka. Iziguli zizilawula ngokwazo isifutho samakhala ngemuva kokufundiswa ngungoti wezokunakekelwa kwezempilo bese zibhekwa okungenani amahora amabili ngaphambi kokuphuma emtholampilo.

Ngenkathi iSpravato isebenzisa imithamo ephansi ye-esketamine, kusengumuthi onamandla. Kuza nemiphumela engemihle yokuxwayisa nge-Boxed efana nokwahlulela okungafanelekile nobunzima bokugxila ngemuva kokuphathwa. Iziguli nabazinikezeli bazo kudingeka basayine lokho okwaziwa njengeFomu Lokubhaliswa Kweziguli, besho ukuthi zonke izinhlaka ziyabona ukuthi lesi sidakamizwa sidala isidumbu futhi iziguli akufanele zishayele noma zisebenzise imishini esindayo ngosuku ezithola ngayo ukwelashwa. Eqinisweni, iziguli kufanele zigibele ziye ekhaya zisuka emtholampilo lapho kunikezwa khona umuthi. Izilingo eziningi zemitholampilo zesikhashana esifushane zithole ukuthi umuthi uphephile, kepha akunconyelwa noma ngubani one-high blood pressure engalawuleki noma ukuphazamiseka kwemithambo, njengoba lezi ziguli zingaba sengozini enkulu yemicimbi emibi njengokuhlaselwa yinhliziyo nokushaywa unhlangothi. Akufanele futhi isetshenziswe yizingane, abantu abanomlando wokugula ngengqondo, abesifazane abakhulelwe, abesifazane abafuna ukukhulelwa, noma abesifazane abancelisayo.

Ngaphandle kokusebenza ngempumelelo, iSpravato, njenge-ketamine efakiwe, ikhombisile ukuthi isebenza ngokushesha. Ngenkathi imishanguzo yendabuko, njenge-serotonin reuptake inhibitors ekhethiwe (SSRIs) I-Prozac futhi I-Lexapro , kungathatha amasonto ukusebenza, iSpravato isebenza ukudambisa ukudangala ngendaba yamahora nezinsuku. Lokho kuyisibusiso esikhulu kunoma ngubani ohlangabezana nokudangala okukhulu, kepha ikakhulukazi kulabo okungenzeka babhekene nokuzibulala.

Cishe izingxenye ezimbili kwezintathu zeziguli ezinesifo sokucindezeleka ezinkulu zithola ukuthuthuka okuphawulekayo emitholampilo kungakapheli amahora amathathu, kusho UWilliam Coryell , MD, umbhali we Izincwadi Zama-Merck kanye noprofesa wezifo zengqondo e-University of Iowa's Carver College of Medicine. Kwabaningi, noma kunjalo, le miphumela yehla kakhulu ezinsukwini ezimbalwa ezilandelayo. Ngalesi sizathu, uchungechunge lwezindlela zokwelapha luvame ukusetshenziswa futhi lokhu kuveza inzuzo ehlala njalo ezigulini eziningi.

UDkt. Corywell uxwayisa ngokuzama i-ketamine yokuzijabulisa yokuthola ukukhululeka kwengcindezi.Imiphumela ye-antidepressant ibonakala isebenza kuphela ngaphakathi kwebanga elithile, elingaphansi kwe-anesthetic dose, uyaphawula. Ukusetshenziswa kwezokungcebeleka kungenzeka kudlule leli banga futhi kunengozi enkulu yokuhlukunyezwa.

Yini eyenza i-ketamine iphumelele?

Ukudangala kuyisimo sokuphazamiseka kwemizwelo esithonywe ama-neurotransmitters — izithunywa zamakhemikhali ebuchosheni ezingalawula imizwa, ukulala neminye imisebenzi. Ochwepheshe abaqiniseki ngokuphelele ukuthi i-ketamine noma i-esketamine e-Spravato isebenza kanjani ukuthuthukisa ukucindezeleka okunzima, kepha basola ukuthi kungenzeka ukuthi inokuthile kokuthi bayivimba kanjani i-neurotransmitter glutamate ekuhlanganiseni ne-receptor ethile (ebizwa ngokuthiI-N-methyl-D-aspartate, noma i-NMDA)ngezinzwa.Ngaphambi kokuthi i-esketamine itholakale, izidakamizwa ezivunyelwe ukusetshenziswa njenge-anti-depressants zaba nemiphumela yazo ngokushintsha kwe-neurotransmitters serotonin, norepinephrine, ne-dopamine, kuchaza uDkt Coryell. I-Esketamine, ngokuhlukile, ibonakala isebenza ikakhulu ngemiphumela yayo kwi-neurotransmitter glutamate.Abaphenyi bathatha abakwaziyo nge-ketamine futhi babheka izindlela abangakha ngazo i-glutamate inhibitors ezingenayo imiphumela emibi ye-ketamine.

Ingabe i-ketamine iphephile ukuyisebenzisela ukucindezeleka nokukhathazeka?

Ukusetshenziswa kwesikhathi eside kwe-ketamine akukacwaningiswanga kahle, kepha ukuvumelana okujwayelekile ukuthi kuphephile ukusetshenziswa esikhathini esifushane. Imiphumela emibi, evame ukuhlala isikhathi esingaphezu kwamahora ambalwa, ifaka:

• Ukozela
• Isiyezi
• Isicanucanu
• Ukuzihlukanisa
• Umfutho wegazi ophakeme
• Ukubona okufiphele
• Imizwa yomzimba, njengokuzizwa ungajwayelekile noma iluphu

Ngingayitholaphi i-ketamine?

Uma uhlangabezana nokucindezeleka okungapheli, okukhulu okungathuthuki ngemithi yakho yamanje, khuluma nomhlinzeki wakho wezokunakekelwa kwempilo. Kunemitholampilo yokumnika ezweni lonke elawula i-ketamine nge-oda likadokotela, kepha lokhu kuthathwa njengokusetshenziswa kwelebula engekho. Isifutho samakhala i-Spravato ukuphela kwesidakamizwa esivunyelwe i-ketamine esinjenge-FDA esitholakalayo sokudangala okumelana nokwelashwa. Itholakala kuphela emitholampilo yezempilo nangamahhovisi odokotela — futhi izindleko ziphakeme, zisukela phakathi kuka- $ 600- $ 800 ngomthamo owodwa we-ketamine, kusho uDkt Coryell. Ama-infusions afana ngentengo.

Izwi elilodwa lokugcina lesexwayiso: Ungazami ukukhipha i-ketamine emgwaqweni. I-Ketamine yinto elawulwayo futhi nodokotela udinga ukunquma umthamo ofanele futhi akuqaphele imiphumela emibi, eminye yayo engaba mibi kakhulu.