Ngaba i-ketamine 'sisiyobisi sokudakumba ngokungummangaliso'?

Ulwazi lweziyobisi

Kubonakala ngathi akunakulindeleka ukuba i-ketamine, iyeza lokuthomalalisa iintlungu kunye nelokuzonwabisa elaziwa njenge-Special K, lingasetyenziswa njengonyango loxinzelelo-kodwa isiphumo seziyobisi, i-esketamine, sisandula ukuvunywa yi-US Food and Drug Administration (FDA) Unyango olunganyangekiyo. Kwaye uphando lubonisa ukuba i-ketamine inokuba lunyango olusebenzayo kuxinzelelo olukhulu kunye nokuhlala ixesha elide.

Ukudakumba sesinye sezona ngxaki zixhaphakileyo kwezempilo yengqondo kweli, zichaphazela abanye 17.3 yezigidi Abantu abadala baseMelika, litsho iZiko leSizwe lezeMpilo yeNgqondo. Iimpawu zoxinzelelo zinokubandakanya:

• Ukuqhubeka kosizi, ukungabi nathemba kunye nokuziva kungekho yakho
• Ukuncipha kwamandla, okanye ukudinwa
• Ukungazinzi
• Kunzima ukugxila
• Ukutya kunye nokulala kutshintsho

Abantu abane Unyango olunganyangekiyo , uhlobo loxinzelelo oluqhubekayo ngaphandle kokusebenzisa ubuncinci imilinganiselo emibini yoxinzelelo kuxinzelelo olwaneleyo lwexesha elaneleyo. Ukongeza ekuncedeni uxinzelelo olunganyangekiyo kunyango, iketamine Banconywa ngabo bakwimeko yengqondo njengabavukeli kunyango loxinzelelo kunye nokunye ukuphazamiseka kwemood, njenge ixhala , Ukuphazamiseka okungafunekiyo (OCD) , ukuxhuzula , kunye uxinzelelo lwasemva koxinzelelo (PTSD) .

Yintoni i-ketamine?

I-Ketamine yi-dissociative anesthetic ethi ngamanye amaxesha isetyenziswe ngaphandle kwelebheli njengokuthomalalisa iintlungu kwiidosi eziphantsi. Ikwaphethwe gadalala njengesixhobo sokuthomalalisa kunye neziyobisi zeklabhu yengqondo. Iyeza elahlulayo likwenza uzive unqanyuliwe emzimbeni wakho nakwiingcinga zakho. I-Ketamine ikudidi olunye lwamachiza njenge-phencyclidine (PCP) kwaye inokuba neziphumo ezifanayo. Ngokuqhelekileyo isetyenziswa njenge-anesthetic kwiiklinikhi zezilwanyana kwaye, ngamanye amaxesha, kwizicwangciso zesibhedlele.

Ngokwe- Iziko leLizwe leSizwe ngokuSetyenziswa gwenxa kweziyobisi , kwiidosi eziphezulu, i-ketamine ivelisa amazwe afana nephupha kunye nemibono. Kwiidosi ezisezantsi, inokuphazamisa inkumbulo yakho, ingqalelo, kunye nokukwazi kwakho ukusebenza. Ezinye iziphumo ebezingalindelekanga zibandakanya uxinzelelo lwegazi kunye neengxaki zokuphefumla.

Xa isetyenziswa kwezonyango, i-ketamine ngokubanzi itofelwe kwimisipha okanye inikezwe ngaphakathi. Ibhloka ii-receptors ze-NMDA ukwenza ilahleko yokuqonda, yiyo loo nto ihlala isetyenziswa ngexesha lotyando. Xa isetyenziselwa ukuzonwabisa, ihlala itsalwa, itshaywa, okanye iginyiwe kwaye ngokubanzi yenza ukuba umntu azive ephezulu, onwabile, ekhululekile, kwaye ngamanye amaxesha asuswe kwimizimba yakhe.

Isetyenziswa njani i-ketamine yoxinzelelo?

Izifundo zifumanise ukuba unyango lwe-ketamine luyasebenza ngokuchasene neemeko ze ukudakumba eziye zanyangeka kunyango lwesiko lokuthomalalisa uxinzelelo, unyango lwentetho, kunye nonyango lwe-electroconvulsive. Ngokophando lwamva nje kwifayile ye- Ijenali yoKhathalelo oluLawulwayo kunye noKhethekileyo kwiFama , umntu omnye kwabathathu onesifo sokudakumba (MDD), imeko yokudakumba eqatha ephawulwe ziimvakalelo ezingapheliyo zosizi, ukungabi nathemba, kunye nembono yokuzibulala, unoxinzelelo olunganyangekiyo.

Xa isetyenziselwa ukunyanga uxinzelelo, amathamo asezantsi kakhulu e-ketamine (asezantsi kunedosi esetyenziselwa i-anesthesia) ahanjiswa ngokubanzi kwifom ezimbini: ngokufakwa okanye ngokutshizwa ngeempumlo. Zombini zinokulawulwa kuphela kwiiklinikhi zempilo okanye kwiiofisi zikagqirha kwaye zombini zibonelela ngoncedo olusebenzayo olukhawulezileyo kuxinzelelo olukhulu, nangona unyango oluphindaphindiweyo luyafuneka.

Ukufakwa kwi-Ketamine

I-ketamine yobuhlanga ihlala isetyenziswa kwi-infusions. Kusetyenziswe i-ketamine esetyenzisiweyo off-ileyibheli yoxinzelelo olungapheliyo iminyaka eliqela. Inikwa kwikliniki nge-IV engalweni. Ezinye iiklinikhi zineengcali zempilo yengqondo kubasebenzi; ezinye azenzi kodwa ziya kusebenza ngokubambisana nogqirha wakho. Izigulana zihlala ziqala ngokungeniswa kathathu ngeveki kwaye ngokuthe ngcembe zinciphise inani de zibe phantsi ukuya kufakwa kwinyanga enye ngenyanga. Uvavanyo oluncinci lweklinikhi Ndibonisile ukuba ukungenisa i-ketamine kunokuphucula uxinzelelo ngaphakathi kweeyure ezimbini ukuya kwezine, kunye nokukhululeka okuphunyeziweyo kwiiyure ezingama-24.

Ukutshiza ngeempumlo ze-Esketamine

Ngo-Matshi 2019, i-FDA ivume i-esketamine yeziyobisi (ikhemikhali efumaneka kwi-ketamine) yoxinzelelo olunganyangekiyo kunyango kubantu abadala. Iyeza lithengiswa phantsi kwegama Kunene , inikwa ngeempumlo ngokusebenzisa isitshizi kwaye isetyenziswa kunye neyeza lokuthomalalisa uxinzelelo lomlomo mihla le. Kunene unikwa kabini ngeveki kwiiveki ezine zokuqala, emva koko kanye ngeveki kwinyanga elandelayo, kube kanye ngeveki okanye kube kanye kwiiveki ezimbini. Ngenxa yobume bokulutha kwe-ketamine kunye namandla ayo okuphathwa gadalala-kunye nokudakumba okubangelwa sisiyobisi-amayeza asetyenziswa kuphela kuseto lonyango phantsi kolawulo lweengcali zonyango. Ayifumaneki ukuze isetyenziselwe ukugoduka. Izigulana ziyazilawula ngokwazo ukutshiza kwempumlo emva komyalelo ovela kugqirha kwezonyango kwaye emva koko zijongwe ubuncinci iiyure ezimbini ngaphambi kokuba zishiye ikliniki.

Ngelixa i-Spravato isebenzisa iidosi ezisezantsi ze-esketamine, iselichiza elinamandla. Kuza nesilumkiso esiqwalaselweyo njengemiphumela yokugweba kunye nobunzima bokugxila emva kolawulo. Izigulana kunye nabagqirha bazo kufuneka batyikitye into eyaziwa ngokuba yiFomu yokuBhalisa abaguli, besithi onke amaqela ayaqonda ukuba iziyobisi zibangela isidumbu kwaye abaguli akufuneki baqhube okanye basebenzise oomatshini abanzima ngosuku abafumana ngalo unyango. Ngapha koko, abaguli kufuneka babe nokugibela ukuya kwikliniki apho kunikwa khona iyeza. Uvavanyo lweklinikhi lwexeshana elifutshane lifumanise ukuba ichiza likhuselekile, kodwa ayikhuthazwa nakubani na onengxaki yokulawula uxinzelelo oluphezulu lwegazi okanye ukuphazamiseka kwemithambo, njengoko ezi zigulana zinokuba semngciphekweni omkhulu weziganeko ezichaseneyo njengokuhlaselwa kwentliziyo kunye nokubetha. Akufanelekanga ukuba isetyenziswe ngabantwana, abantu abanembali yengqondo yengqondo, abafazi abakhulelweyo, abafazi abafuna ukukhulelwa, okanye abafazi abancancisayo.

Ngaphandle kokusebenza, iSpravato, njengokufaka i-ketamine, ibonakalise ukuba isebenza ngokukhawuleza. Ngelixa izidambisi mayeza zesiko, ezinje nge-serotonin reuptake inhibitors (SSRIs) ekhethiweyo Iprozac kwaye ILexapro , inokuthatha iiveki ukusebenza, iSpravato isebenza ukunciphisa uxinzelelo kumcimbi weeyure ukuya kwiintsuku. Oko kuyintsikelelo enkulu kuye nakubani na ohlangabezana nokudakumba okunzima, kodwa ngakumbi kwabo banokuba befumana ukuzibulala.

Phantse ezibini kwizithathu zezigulana ezinengxaki yokudakumba enkulu yokuphucuka okubonakalayo kweempawu ngaphakathi kweeyure ezintathu, utshilo UWilliam Coryell , MD, umbhali we Iincwadi zeMerck kunye noprofesa wezifo zengqondo kwiYunivesithi yaseIowa's Carver College of Medicine. Uninzi uninzi, nangona kunjalo, ezi ziphumo zincipha kakhulu kwezi ntsuku zilandelayo. Ngesi sizathu, uthotho lonyango luhlala lusetyenziswa kwaye oku kuvelisa izibonelelo ezizinzileyo kwizigulana ezininzi.

UGqr. Corywell ulumkisa ngokuzama ukuzonwabisa nge-ketamine yokuphelisa uxinzelelo.Iziphumo ezichasene noxinzelelo zibonakala zisebenza kuphela ngaphakathi kwinqanaba elithile, le-sub-anesthetic dose range, uyaphawula. Ukuzonwabisa ngokuzonwabisa kunokwenzeka ukuba kudlule kolu luhlu kwaye kukho umngcipheko omkhulu wokuphathwa gadalala.

Yintoni ebangela ukuba i-ketamine isebenze?

Uxinzelelo kukuphazamiseka kwemood okuchatshazelwa zii-neurotransmitters -iikhemikhali ezithunyelwa kwingqondo ezinokulawula imood, ukulala kunye neminye imisebenzi. Iingcali aziqinisekanga ngokupheleleyo ukuba i-ketamine okanye i-esketamine e-Spravato isebenza njani ukuphucula uxinzelelo olunzima, kodwa bayakrokrela ukuba inokuba nento yokwenza nendlela ababhloka ngayo kwi-neurotransmitter glutamate ekubambeni kwi-receptor ethile (ebizwa ngokubaN-methyl-D-aspartate, okanye i-NMDA)kwimithambo-luvo.Phambi kokuba i-esketamine ifumaneke, iziyobisi ezivunyiweyo ukuba zisetyenziswe njenge-anti-depressants zineziphumo zazo kutshintsho lwe-neurotransmitters serotonin, norepinephrine, kunye ne-dopamine, ucacisa uGqirha Coryell. I-Esketamine, ngokuchaseneyo, ibonakala ngathi isebenza ikakhulu kwiziphumo zayo kwi-neurotransmitter glutamate.Abaphandi bathatha into abayaziyo malunga ne-ketamine kwaye bajonge iindlela abanokuthi baphuhlise ngayo i-glutamate inhibitors ezingenaziphumo zibi ze-ketamine.

Ngaba i-ketamine ikhuselekile ukuyisebenzisa kuxinzelelo kunye noxinzelelo?

Ukusetyenziswa kwexesha elide kwe-ketamine akuzange kuphandwe kakuhle, kodwa ukuvumelana ngokubanzi kukuba kukhuselekile ukusebenzisa kwixesha elifutshane. Iziphumo ebezingalindelekanga, ezihlala zihlala ngaphezulu kweeyure ezimbalwa, zibandakanya:

• Ukozela
• Ukuba nesiyezi
• Isicaphucaphu
• Ukwahlukana
• Uxinzelelo lwegazi oluphakamileyo
• Umbono omfiliba
• Imvakalelo yomzimba, njengokuziva ungaqhelekanga okanye ungaziva

Ndingayifumana phi ketamine?

Ukuba ufumana isifo esinganyangekiyo, uxinzelelo olukhulu olungaphuculiyo kunyango lwakho lwangoku, thetha nomboneleli wakho wezempilo. Kukho iiklinikhi zokumnika elizweni lonke ezenza i-ketamine ngomyalelo kagqirha, kodwa oku kuthathwa njengokusetyenziswa kwelebheli engekhoyo. Isipreyi sempumlo i-Spravato kuphela kwesiyobisi esivunyiweyo se-ketamine esifana noxinzelelo olunganyangekiyo kunyango. Ifumaneka kuphela kwiiklinikhi zezempilo kwaye idlula kwiiofisi zikagqirha- kwaye indleko ziphezulu, zisuka phakathi kwe- $ 600- $ 800 yedosi enye ye-ketamine, utshilo uGqirha Coryell. I-infusions ziyafana kwixabiso.

Ilizwi lokugqibela elilumkisayo: Sukuzama ukufumana i-ketamine esitratweni. I-Ketamine yinto elawulwayo kwaye ingcali yezonyango kufuneka ichonge idosi efanelekileyo kwaye ikubeke iliso kwiziphumo ebezingalindelekanga, ezinye zazo ezinokuba mandundu kakhulu.