amakuru

Mugihe ibibazo byakazi, ibibazo byimibanire, hamwe nigitutu cyimibereho bigenda byiyongera, kwiheba birashobora gukomeza. Ku barwayi bavuwe na antidepressants ku nshuro yabo ya mbere, munsi ya kimwe cya kabiri bagera ku buryo burambye. Amabwiriza yuburyo bwo guhitamo ibiyobyabwenge nyuma yubuvuzi bwa kabiri bwo kurwanya antidepressant binaniwe gutandukana, byerekana ko mugihe hariho imiti myinshi ihari, nta tandukaniro rito hagati yabo. Muri iyi miti, hari ibimenyetso bifatika byerekana ko wongera antipsychotics idasanzwe.

Mubushakashatsi buheruka, amakuru yubushakashatsi bwa ESCAPE-TRD aratangazwa. Muri urwo rubanza harimo abarwayi 676 bafite ikibazo cyo kwiheba batitabiriye cyane imiti igabanya ubukana nibura kandi bagifata imiti igabanya ubukana bwa serotonine cyangwa se serotonin-norepinephrine reuptake inhibitor, nka venlafaxine cyangwa duloxetine; Icyari kigamijwe mu igeragezwa kwari ukugereranya efficacy ya esketamine nasal spray na quetiapine irekurwa rirambye. Iherezo ryibanze kwari ukurekurwa mubyumweru 8 nyuma yo gutoranya (igisubizo cyigihe gito), kandi urufunguzo rwibanze rwa kabiri ntirwigeze rusubira mubyumweru 32 nyuma yo koherezwa mubyumweru 8.

Ibisubizo byerekanye ko nta muti wagaragaje imikorere myiza cyane, ariko gutera esketamine yamazuru byagize ingaruka nziza (27.1% na 17,6%) (Ishusho 1) kandi byagize ingaruka nke zituma bahagarika kwivuza. Ingaruka z’ibi biyobyabwenge byombi ziyongereye igihe: mu cyumweru cya 32, 49% na 33% by’abarwayi bo mu bwoko bwa Esketamine spray na quetiapine bakomeza kurekura bari barangije gukira, naho 66% na 47% bitabiriye kwivuza (Ishusho 2). Habayeho gusubiramo bike cyane hagati yicyumweru 8 na 32 mumatsinda yombi yo kuvura

Ikintu cyagaragaye cyane muri ubwo bushakashatsi ni uko abarwayi bavuye mu igeragezwa basuzumwe ko batagize ingaruka mbi (ni ukuvuga, bahujwe n’abarwayi indwara zabo zitari zisubizwa cyangwa ngo zisubiremo). Umubare munini w'abarwayi bahagaritse kwivuza mu itsinda rya quetiapine kuruta mu itsinda rya esketamine (40% na 23%), igisubizo gishobora kwerekana igihe gito cyo kuzunguruka no gutandukana n'ingaruka ziterwa na Esketamine izuru ryamazuru hamwe nigihe kirekire cyo kwikinisha no kwiyongera ibiro bifitanye isano no kurekurwa kwa quetiapine.

Byari ikigeragezo gifunguye, bivuze ko abarwayi bari bazi ubwoko bw'ibiyobyabwenge banywa. Abasesenguzi bakoze ibiganiro byubuvuzi kugirango bamenye amanota ya Montgomery-Eisenberg amanota yo kwiheba ni abaganga baho, ntabwo ari abakozi ba kure. Hano harabuze ibisubizo byuzuye kubibazo bikomeye byo guhuma no gutegereza bishobora kugaragara mugupima ibiyobyabwenge bifite ingaruka zigihe gito zo mumutwe. Niyo mpamvu, birakenewe gutangaza amakuru yingaruka zibiyobyabwenge kumikorere yumubiri nubuzima bwiza kugirango harebwe niba itandukaniro ryagaragaye mubikorwa ridafite ingaruka gusa, ahubwo nanone itandukaniro rifite ireme mubuvuzi.

Ikintu gikomeye cyerekana ibigeragezo ni uko imiti igabanya ubukana isa naho itunguranye mu buryo butunguranye kandi ikongera ubushake bwo kwiyahura ku barwayi bake. SUSTAIN 3 nubushakashatsi bwigihe kirekire, bwuguruye-label yubushakashatsi bwicyiciro cya 3 SUSTAIN, aho ubushakashatsi bwakorewe abarwayi 2.769 - 4.3% wasangaga bahuye nibibazo bikomeye byuburwayi bwo mumutwe nyuma yimyaka. Nyamara, ukurikije imibare yavuye mu igeragezwa rya ESCAPE-TRD, umubare munini w'abarwayi bo mu matsinda ya esketamine na quetiapine bahuye n'ibibazo bikomeye byo mu mutwe.

Uburambe bufatika hamwe na esketamine nasal spray nayo irashimishije. Cystitis hamwe nubumuga bwo kutamenya bikomeza kuba theoretical aho kuba ingaruka zifatika. Mu buryo nk'ubwo, kubera ko izuru ryizuru rigomba gutangwa hashingiwe ku bitaro by’ubuvuzi, gukabya gukoreshwa birashobora gukumirwa, ibyo bikaba binongerera amahirwe yo kwisuzumisha buri gihe. Kugeza magingo aya, guhuza ketamine y'amoko cyangwa ibindi biyobyabwenge bishobora gukoreshwa nabi mugihe cyo gukoresha imiti ya esketamine yizuru ntibisanzwe, ariko biracyari byiza gukurikiranira hafi ibyo bishoboka.

Ni izihe ngaruka zubu bushakashatsi kubikorwa byubuvuzi? Ubutumwa bw'ingenzi ni uko iyo umurwayi atitabye byibuze imiti ibiri igabanya ubukana, birashoboka ko umuntu ashobora gukira burundu mu mezi abiri hiyongereyeho imiti ivura bikomeza kuba bike. Urebye kwiheba kw'abarwayi bamwe na bamwe no kurwanya ibiyobyabwenge, icyizere cyo kuvurwa kirashobora kwangirika byoroshye. Umuntu ufite ikibazo gikomeye cyo kwiheba yitabira imiti? Ese umurwayi ntiyishimye mubuvuzi? Uru rubanza na Reif n'abandi. yerekana ko hakenewe abaganga kwerekana ibyiringiro no gushikama mubuvuzi bwabo, bitabaye ibyo abarwayi benshi bakorerwa.

Nubwo kwihangana ari ngombwa, ni nako umuvuduko ukemura ikibazo cyo kwiheba. Abarwayi mubisanzwe bifuza gukira vuba bishoboka. Kubera ko amahirwe yumurwayi agabanuka gahoro gahoro hamwe na buri muti wo kuvura imiti igabanya ubukana, hakwiye kwitabwaho kubanza kugerageza kuvura neza. Niba gusa imiti igabanya ubukana bwa antidepressant guhitamo nyuma yo kunanirwa kuvura imiti ibiri ari efficacy numutekano, noneho igeragezwa rya ESCAPE-TRD ryanzura ryumvikana ko esketamine yamazuru igomba guhitamo nkumuti wa gatatu. Ariko, kuvura kubungabunga hamwe na esketamine nasal spray mubisanzwe bisaba gusurwa buri cyumweru cyangwa kabiri-buri cyumweru. Kubwibyo, ibiciro nibitagenda neza birashoboka kuba ibintu byingenzi bigira ingaruka kumikoreshereze yabyo.

Esketamine nasal spray ntabwo izaba glutamate antagonist yonyine yinjira mubikorwa byubuvuzi. Isesengura ryakozwe vuba aha ryerekana ko ketamine yo mu bwoko bwa ketamine ishobora gukora neza kuruta esketamine, kandi ibigeragezo bibiri binini ku mutwe bishyigikira ikoreshwa rya ketamine yo mu bwoko bwa ketamine nyuma yo mu nzira yo kuvura nk'uburyo bwo kuvura abarwayi bakeneye ubuvuzi bwa electroconvulsive. Birasa nkaho bifasha kwirinda kwiheba no gufata ubuzima bwumurwayi.