Zonke Ubunzima Azinjalo
Ngokuqhelekileyo ndicelwa ukuba ndicebise oko ndicinga ukuba yiyona nto ixhasayo. Yam impendulo? Lowo usebenzela wena. Umntu ngamnye uhlukile kwaye akanakho ukuphendula kumachiza afanayo.
Iqela ngalinye le-anti-depressant lisebenza kwi-chemistry yakho yengqondo ngendlela eyahlukileyo. UDkt. Abbott Lee Granoff, oyingcali entsimini yokuphazamiseka kwengxaki kunye nokudakumba, uthi oku oku: "Kukho iingu-23 ezixinzelelekileyo kwiimarike.
Inqaku elikhokelayo: Eli nani liye landa ukususela ngoDkt Granoff udliwano-ndlebe kule nqaku.) Ngamnye ukwandisa ama-neurotransmitters athile kwingqondo kwaye ngamnye unokukwenza ngokuphathelele kwiindawo ezihlukeneyo zobuchopho. enye i-serotonin ivuselelwe, enye ingadinga isilwanyana esichaphazela kokubili i-serotonin kunye ne-norepinephrin. Enye enye umntu inokufuna uhlobo oluthile lwamachiza, anticonvulsant okanye i-stabilizer efana ne-lithium. Ngaphezulu, umntu owenza kakuhle kwiyeza UZoloft akanako ukwenza kunye neProzac, nangona bobabini bekho kwiklasi efanayo.2 Umntu ngamnye uya kubahluke kakhulu kwiimfuno zabo zonyango.
Nje ngohlobo olubanzi lweengqondo, kukho iintlobo ezahlukeneyo zokuxhatshazwa. Ukuthetha ngokubanzi, ezi zilandelayo zilandelayo: i-monoamine oxidase inhibitors (ii-MAOIs), i-tricyclics (TCAs) kunye ne-serotonin reuptake inhibitors (SSRIs) ekhethiweyo.
Kukho amayeza amaninzi amatsha ahlukile kwiindlela zabo zokwenza.
I-Monoamine Oxidase Inhibitors
I-monoamine oxidase inhibitors (ii-MAOIs) yileyiphi imithi yokuqala eyayixinzelelekileyo. I-neurotransmitters ejongene nomoya, ngokuyinhloko i-norepinephrine kunye ne-serotonin, iyaziwa nangokuthi i-monoamines. I-Monoamine oxidase yi-enzyme ephula izi zinto phantsi. I-Monoamine oxidase inhibitors, njengoko igama libonisa, livimbela le enzyme, ngaloo ndlela kuvumela ukunikezwa okukhulu kwezi khemikhali ukuba zihlale zikhona.
I-MAOIs ayifumanekanga njengabadlali bokuqala abaxinzelelekileyo ngenxa yokunikezela ngamanani amaninzi kwizigulane ngokuthelekiswa namayeza amasha. Kungenzeka ukuba ukusebenzisana kweziyobisi ezinokubulawa kweziyobisi kungenziwa ngama-MAOIs xa kudibene neendidi ezinobungozi be-agonists ("i-serotonin syndrome") okanye i-norepinephrine agonists.3 Abantu bala mayeza kufuneka balandele imida yokutya echanekileyo yokutya okucebileyo kwi-tyramine4 ukuphepha ezinokuxinzeleleka kwegazi (ukunyuka kwengcinezelo yegazi). Impembelelo eyingozi enkulu eyenzeka kwi-MAOIs yedwa yindlela yokuxinzelela kwegazi (ingaphantsi kwexinzelelo lwegazi), leyo ingabonakalisa njengokukhathala kwaye inokulinganisa ukugqithisa kwesifo esixhasayo. Ngenxa yeso sizathu, uxinzelelo lwegazi kufuneka luhlale lubekwe iliso xa lisebenzisa la ma-antidepressants.5
Tricyclics
I-Tricyclics, eyaziwa nangokuthi i-heterocyclics, yabonakala ngokubanzi kwiminyaka ye-1950. Ezi zi yobisi zivimbela i-cell nerve cell to re-fetin serotonin kunye ne-norepinephrine, ngaloo ndlela evumela ukuba inani elikhulu lezinto ezimbini zifumaneke ukuze zisetyenziswe ngamaseli enyantya.
Ukongeza kokusebenza kwi-norepinephrine kunye ne-serotonin, i-tricyclics ibonisa imiphumo efanayo kwi-histamine kunye ne-acetylcholine. Le nto inoxanduva lweempembelelo ezisecaleni eziqhelekileyo esizibandakanya nala mayeza, njengomlomo owomileyo, umbono oqhaqhayo, ukufumana ubunzima kunye nokuhlalisa.6
Ngama-tricyclics, imbali yesigulane yesigulane kufuneka iqwalaselwe ngokucokisekileyo.
Ezi zonyango zingabangela i-orthostatic hypotension (ukuxakeka kwezilwanyana kwimimiselo yentliziyo ngokukhawuleza, ngamanye amaxesha kunye neengxaki zentliziyo, kwaye ingabangela ukuba iimeko zentliziyo ziyingozi.
I-Serotonin Reuptake Inhibitors
Iimangalo zeempembelelo zecala elinciphileyo kunye nokunyuka koxinzelelo lwezonyango ezikhulile zenze le klasi ye-anti-depressant ithandwa kakhulu kwiminyaka yamuva. Izidakamizwa zeli klasi ziquka i-fluoxetine (Prozac), i-citalopram (Celexa) escitalopram (Lexapro), i-fluvoxamine (i-Luvox), i-sertraline (i-Zoloft) kunye ne-paroxetine (Paxil).
I-SSRI imele i-Selective Serotonin Reuptake Inhibitor. Ezi zonyango zisebenza, njengoko igama lithetha, ngokuthintela i-presynaptic serotonin transporter receptor.8 Esi sizahlukileyo sihluke kwii-tricyclic inokuthi isenzo saso sisodwa kwi-serotonin kuphela. Isiphumo salo kwi-norepinephrin ayilunganga ngqo, ngenxa yokuba ukuwa kwe-serotonin "kuvumela" i-norepinephrine ukuba ihlale igcina i-serotonin igcina i-norepinephrine.9 I-SSRIs, ngokubaluleka kwayo, inokuba yinzuzo yokungathinti i-histamine kunye ne-acetylcholine. Oku kuthetha ukuba nangona bengenazo iziphumo ezichaphazelayo, abayikudala i-side effects effects as tricyclics.
Iinkqubo ezintsha
Amachiza amahlanu amatsha angangena kumagumbi angentla apha: i-bupropion (Wellbutrin), nefazodone (Serzone), i-trazodone (Desyrel), i-venlafaxine (i-Exexor) kunye ne-mirtazapine (i-Remeron). Indlela yokwenza ulwaphulo oluxhatshazwayo aluyiqondwa kakuhle, kodwa kucatshangelwa ukuba yongqinisiswa ngeendlela ezingaqhelekanga okanye ze-dopaminergic okanye zombini. Eli nyanga alinayo imiphumo yecala yezesondo exhaphakileyo kwi-SSRI kwaye iyathandwa kwizigulane ezibonisa ukungabi namandla , ingqondo yengqondo kunye nokulala ngokweqile.
I-Nefazodone kunye ne-precursor trazodone yabo inqanda ukubuyiswa kwakhona kwe-serotonin kunye ne-norepinephrine. Bakhusela i-postsynaptic 5-HT2 receptors. I-Nefazodone inobuthakathaka obuthakathaka be-cholingeric kunye ne-a1- adrenergic receptors kwaye, ngoko ke, idibene ne-sedation kunye ne-orthostasis ngaphezu kwe-trazodone.11
I-Venlafaxine yinkomfa engahambelananga nezinye izidakamizwa zokulwa nezidakamizwa.12 Njengama-TCA, i-venlafaxine inqanda i-neuronal uptake kokubili i-serotonin kunye ne-norepinepherine. I-Venlafaxine inexhomekeke kwintsholongwane, iziphumo ezilandeleleneyo kwiipompo zokufumana i-serotonin kwaye i-norepinephrine .. Kwi-75 mg / ngosuku, i-venlafaxine ininzi i-serotonin reuptake inhibitor (SRI) njenge-SSRIs.
Ngama-375 mg / ngosuku, ivelisa i-norepinephrin engqinelanayo yokuthintela kwi-NSRI njenge-desipramine.13
I-Mirtazapine yiyona nto iphuma kutshatyalalwa kwezi ezine kwaye ngowokuqala u-a2-antagonist athengiswa njenge-anti-depressant.14 Indlela ekhethekileyo ye-action ye-Mirtazapine ayiququzeleli i-enzyme inhibition okanye i-blockade ye-neurotransmitter reuptake. I-Mirtazapine yandisa ukukhululwa kwe-norepinepherine ukusuka kwi-neurrenergic neurons ephakathi kunye nokuvimbela i-presynaptic inhibitory alpha-2 autoreceptors. Ivumela i-alpha-1 receptor ye-alpha-1 kwaye ke iziphumo ekunyusweni kwe-noradrenergic. Njengomsebenzi wesibini wokukhusela i-presynaptic receptor, i-mirtazapine inqanda i-alpha-2 hteroreceptors engavimbelayo kwi-neurons ye-serotonergic, eyenza ukwanda kwe-serotonin. I-postsynaptically, i-mirtazapine inamalingani aphantsi kwe-5-HT1A receptor, ngaloo ndlela ivumela ukuba i-serotonin ikhutshwe kwi-synapse ukuze ibophe kwaye ivuselele lo myalezo.
Nangona kunjalo, ivimba i-postsynaptic 5-HT2 kunye ne-5-HT3 receptors. Ukukhuthazwa kwe-receptor ye-5-HT2 kucingelwa ukuba ixanduva lweempembelelo ze-serotonergic zokungazinzi, ukuphazamiseka, kunye nokungasebenzi kwezesondo ezibonwayo nge-SSRI kunye ne-5-HT3 yokuvuselela ukufumana ukuvuthwa kucingelwa ukuba kulandelelanise i-nudea ebonwe ngala majelo.15, 16, 17. Ngenxa yoko, i-mirtazapine ye-receptor blocking profile ikhusela iziphumo ezibhekiselele kwi-activation ye-serotonin eyenziwa ngamacwecwe aphuculweyo.