Bokooa Bohle ha bo Tšoanang
Hangata ke kōptjoa hore ke buelle seo ke nahanang hore ke sona se nepahetseng ka ho fetisisa se sithabetsang. Karabo ea ka? E leng e sebetsang bakeng sa hau. Motho e mong le e mong o ikhetha ebile ha a arabele meriana e tšoanang.
Sehlopha se seng le se seng sa ho tepella maikutlo se sebetsa bokong ba boko ba hao ka tsela e fapaneng. Dr. Abbott Lee Granoff, setsebi sa tšabo ea ho tšoha le ho tepella maikutlong, o re: "Hona joale ho na le li-anti-depressing tse 23 tsa 'marakeng.
(Tlhokomeliso ea Tataiso: Setšoantšo sena se eketsehile ho tloha ho Dr. Granoff se ileng sa buisanoa le sehlooho sena.) Ho eketseha ha li-neurotransmitter tse itseng bokong 'me e mong le e mong a ka etsa sena likarolong tse sa tšoaneng tsa boko. "Kahoo, ha motho a le mong a ka fumana khatholoho ea ho ba le ba bang ba ka 'na ba hloka lithethefatsi tse amang serotonin le norepinephrine. Motho e mong a ka' na a hloka meriana e fapaneng ka ho feletseng, e kang anticonvulsant kapa maikutlo a tsitsitseng joaloka lithium. Ho feta moo, motho ea etsang hantle ka meriana e kang Zoloft a ka 'na a se ke a etsa hantle le Prozac, le hoja ka bobeli ba le sehlopheng se tšoanang.2 Motho e mong le e mong o tla fapane haholo le litlhoko tsa meriana.
Feela joaloka boko ba mefuta e fapa-fapaneng, ho na le mefuta e fapa-fapaneng ea li-anti-depressing. Ha e le hantle, tsena li oela lihlopha tse latelang: monoamine oxidase inhibitors (MAOIs), tricyclics (TCAs) le selectional reuptake inhibitors (SSRIs) e khethollang.
Hape ho na le meriana e mengata e ncha e ikhethang ka mekhoa ea bona ea liketso.
Monoamine Oxidase Inhibitors
Monoamine oxidase inhibitors (MAOIs) e ne e le tse ling tsa meriana ea pele e imetsoeng ho imeloa. Li-neurotransmitters tse nang le maikutlo a maikutlo, haholo-holo norepinephrine le serotonin, le tsona li tsejoa e le monoamine. Monoamine oxidase ke enzyme e senyang lintho tsena fatše. Monoamine oxidase inhibitors, kamoo lebitso le bolelang kateng, e thibela enzyme ena, ka tsela eo ho lumella hore phepelo e kholo ea lik'hemik'hale tsena e lule e fumaneha.
MAOIs ha e amohelehe joaloka li-anti-depressants tsa pele hobane li fana ka likotsi tse ngata ho bakuli ha li bapisoa le meriana e ncha. Ho ka 'na ha e-ba le likamano tse ngata tse bolaeang lithethefatsi tsa lithethefatsi tse ka hlahang le MAOI ha li kopantsoe le lithethefatsi tse sa tšoaneng tse serotonin agonists ("serotonin syndrome") kapa agonists ea norepinephrine.3 Batho ba nang le meriana ena ba boetse ba latela lithibelo tse matla tsa lijo tse nang le tyramine4 ho qoba e ka 'nang ea e-ba le tšoaetso ea mali e phahameng (khatello ea mali e phahameng) mathata. Tšusumetso e mpe e bakoang ke MAOI feela ke hypotension (khatello e tlaase ea mali), e ka hlahisang e le mokhathala 'me e ka etsisa ho mpefala ha lefu lena le tepeletseng. Ka lebaka lena, khatello ea mali e lokela ho lula e lebelloa ha e sebelisa li-anti-depressants tsena.5
Tricyclics
Li-tricyclics, tse tsejoang hape e le heterocyclics, li ile tsa sebelisoa haholo lilemong tsa bo-1950. Lithethefatsi tsena li thibela bokhoni ba sele ea methapo ea ho khutlisetsa li-serotonin le norepinephrine, ka hona ho lumella hore boholo ba lintho tsena tse peli li fumanehe bakeng sa ho sebelisoa ke lisele tsa methapo.
Ntle le ho sebetsa ka norepinephrine le serotonin, li-tricyclics li bontša liphello tse tšoanang ho histamine le acetylcholine. Sena se ikarabella bakeng sa litla-morao tse bohloko tse atisang ho amahanya le meriana ena, e kang molomo o omeletseng, pono e hlakileng, boima ba boima le sedation.6
Ka li-tricyclics, histori ea bongaka ea mokuli e lokela ho nkoa e le ea bohlokoa haholo.
Meriana ena e ka 'na ea baka orthostatic hypotension (ho ba le bothata ba ho ba le pelo e potlakileng, ka linako tse ling ka liphallelo,' me ho ka 'na ha etsa hore maemo a pelo a ferekane.) Bakuli ba nang le bothata ba ho tsieleha kapa ho ntša kotsi e ka ba hlokolosi ha meriana ena e ka baka tšoaetso.
Selective Serotonin Reuptake Inhibitors
Liphoso tsa ho fokotsa liphello tsa litla-morao le ts'ireletso e eketsehileng mabapi le meriana ea khale e entse hore sehlopha sena sa ho tepella maikutlo se ratoe haholo lilemong tsa morao tjena. Lithethefatsi tsa sehlopha sena li kenyelletsa fluoxetine (Prozac), citalopram (Celexa) escitalopram (Lexapro), fluvoxamine (Luvox), sertraline (Zoloft) le paroxetine (Paxil).
SSRI e emela Serotonin Reuptake Inhibitor e khethollang. Meriana ena e sebetsa, kamoo lebitso le bolelang kateng, ka ho thibela receynora ea presynaptic serotonin e fetisang mokokotlo.8 Meriana ena e fapana le tricyclics ka hore ketso ea eona e totobetse ho serotonin feela. Phello ea eona ho norepinephrine e sa tobang, ka hore ho theoha serotonin "ho lumella" norepinephrine ho oela serotonin e sireletsang joalo ho sireletsa norepinephrine.9 SSRIs, ka ho khetheha, e na le molemo oa hore e se ke ea ama histamine le acetylcholine. Se boleloang ke hore le hoja ba se na litla-morao, ha ba hlahise litla-morao tse ts'oanang tsa khathatso joaloka tricyclics.
Mekhoa e mecha
Meriana e mehlano e mecha e sa keneleng likarolong tse ka holimo ke: bupropion (Wellbutrin), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor), le mirtazapine (Remeron). Mokhoa oa phekolo ea ho phefumoloha ha bupropion ha e utloisisoe hantle, empa ho nahanoa hore e sebelisoa ka tsela ea noradrenergic kapa ea dopaminergic kapa mabeli a mabeli. Meriana ena ha e na litla-morao tsa thobalano tse tloaelehileng ho SSRI 'me li ratoa ho bakuli ba bontšang ho hloka matla , ho lieha kelellong le boroko bo feteletseng.
Nefazodone le moelelo-pele oa eona oa trazodone ka bobeli ba thibela ho khutlisetsoa ha neuro ea serotonin le, ho isa tekanyong, norepinephrine. Li boetse li thibela li-receptor tsa 5-HT2 tsa postsynaptic. Nefazodone e na le kamano e fokolang ea li-cholingeric le a1-adrenergic receptors, ka hona, e amahanngoa le sedation e nyenyane le orthostasis ho feta trazodone.11
Venlafaxine ke motsoako o sa amaneng le o mong le o mong oa khatello ea kelello.12 Joaloka li-TCA, venlafaxine e thibela phetoho ea neuronal ea serotonin le ea norepinepherine. Venlafaxine e itšetlehile ka meno, liphetoho tse lekaneng lipampong tsa ho tsuba bakeng sa serotonin 'me joale norepinephrine .. Ka 75 mg / letsatsi, venlafaxine ke boholo ba serotonin reuptake inhibitor (SRI) joaloka SSRIs.
Ka 375 mg / letsatsi, e hlahisa mofuta o tšoanang oa norepinephrine ho thibela NSRI e kang desipramine.13
Mirtazapine ke eona e sa tsoa lokolloa ho bana ba bane 'me ke oa pele oa li-antagonist ea rekisoang e le mohatelli oa khatello ea kelello.14 Mekhoa e ikhethang ea ketso ea Mirtazapine ha e akarelletse ho thibela tšebetso ea enzyme kapa ho thibela phetoho ea li-neurotransmitter reuptake. Mirtazapine e eketsa ho lokolloa ha norepinepherine ho tswa ho li-neuronergic neurons tse bohareng ka ho thibela li-autoreceptor tsa alpha-2 tse sa thibeloeng ke presynaptic. E fana ka tumello ea alpha-1 ea postsynaptic receptor 'me kahoo e hlahisa phetoho e ncha ea noradrenergic. E le mosebetsi oa bobeli oa ho thibela ho amohela li-presynaptic, mirtazapine e thibela li-alpha-2 heteroreceptor tse thibelang li-neuron, e leng se etsang hore ho be le ho eketseha ha serotonin. Ka morao-rao, mirtazapine e na le bonngoe bo tlase boemong ba 5-HT1A, ka hona ho lumella serotonin hore e lokolloe ho synapse ho tlama le ho susumetsa mokelikeli ona.
Leha ho le joalo, e thibela li-receptor postsynaptic 5-HT2 le 5-HT3. Ho khothaletsoa ho amoheloa ha 5-HT2 ho nahanoa hore ke eona e ikarabellang bakeng sa litla-morao tsa serotonergic tsa ho hlobaela, ho ferekanya le ho se sebetse ka thobalano ho bonngoeng ka ts'ebetso ea SSRI le ea 5-HT3 ea ho amoheloa ha maikutlo ho nahanngoa hore ho na le ho nyefoloa ho bonoang le mahlahana ana.15, 16, 17 Ka lebaka leo, sephiri se sireletsang li-mirtazapine se thibela liphello tse lehlakoreng tse nang le ts'ebetso ea ho ntsalective ea serotonin receptors e hlahang ka li-blockers tse hloekileng.