Txhua lub hlwb tsis yog tib yam
Feem ntau kuv tau thov kom qhia seb kuv xav tias qhov twg yog qhov zoo tshaj plaws ntawm kev noj qab haus huv. Kuv cov lus teb? Qhov uas ua haujlwm rau koj. Txhua tus neeg yog tshwj xeeb thiab tsis tuaj yeem teb rau tib cov tshuaj.
Txhua chav kawm ntawm kev kho antidepressant ua haujlwm rau koj lub hlwb tsis hais lwm yam. Dr. Abbott Lee Granoff, tus kws tshaj lij ntawm kev tsis sib haum xeeb thiab kev nyuaj siab, hais li nram no: "Muaj tam sim no 23 antidepressants ntawm lub khw.
(Cov Lus Cim: Daim duab no tau nce ntxiv txij thaum Dr. Granoff tau txais kev xam phaj rau hauv tsab xov xwm no.) Tsuas yog ua rau cov neurotransmitters hauv hlwb thiab txhua tus tuaj yeem ua qhov sib txawv me ntsis ntawm lub hlwb. "Li ntawd, thaum ib tus neeg tau txais kev pab cuam los ntawm kev muaj Cov neeg mob yuav tsum tau noj tshuaj kom txhob muaj ntshav qab zib thiab lwm tus neeg mob yuav tsum tau noj tshuaj, xws li tshuaj anticonvulsant los yog ib qho kev nyab xeeb xws li lithium. Zoloft yuav tsis ua zoo li ntawm Prozac, txawm tias ob leeg muaj rau tib lub class.2 Txhua tus neeg yuav txawv hauv lawv cov kev xav tau noj tshuaj.
Cia li zoo li ntau lub paj hlwb, muaj ntau yam tshuaj antidepressants. Hais lus dav dav, cov caij nplooj ntoos zeeg rau cov chav kawm nram no: monoamine oxidase inhibitors (MAOIs), tricyclics (TCAs) thiab cov tshuaj serotonin reuptake inhibitors (SSRIs).
Kuj tseem muaj ntau yam tshuaj tshiab uas muaj nyob rau hauv lawv txoj kev ua haujlwm.
Cov tshuaj Monoamine Oxidase
Cov tshuaj tiv thaiv monoamine oxidase (MAOIs) yog cov tshuaj thawj zaug tshuaj antidepressant. Cov neurotransmitters lub luag haujlwm rau cov paib, feem ntau yog norepinephrine thiab serotonin, kuj yog hu ua monoamines. Monoamine oxidase yog ib qho enzyme uas lov cov tshuaj no. Cov tshuaj tiv thaiv Monoamine oxidase, raws li lub npe siv, inhibits no enzyme, yog li cia lub zog ntawm cov tshuaj no kom nyob twj ywm ntxiv.
MAOIs tau poob ntawm kev nyiam ua thawj kab-tshuaj antidepressants vim lawv muaj ntau qhov tsis zoo rau cov neeg mob piv rau cov tshuaj tshiab. Kev sib kis ntawm kev siv tshuaj yeeb-tshuaj muaj peev xwm tshwm sim nrog MAOIs thaum ua ke nrog ntau hom tshuaj uas muaj serotonin agonists ("serotonin syndrome") lossis cov neeg tsis muaj zog los ntawm cov tshuaj no. Cov neeg ntawm cov tshuaj no yuav tsum ua raws li cov kev txwv tsis pub noj zaub mov ntawm cov zaub mov hauv tyramine4 kom tsis txhob muaj tej zaum hypertensive (ntshav siab) ntsoog. Ib qho teeb meem nyhav loj uas tshwm sim hauv MAOIs yog hypotension (tsis tshua muaj ntshav siab), uas tuaj yeem tshwm sim tau qaug zog thiab muaj peev xwm ua kom mob siab ntxiv ntawm qhov kev nyuaj siab ploj. Vim li no, cov ntshav siab yuav tsum tau saib xyuas thaum siv cov tshuaj tua kabmob no
Tricyclics
Tricyclics, tseem hu ua heterocyclics, tuaj rau sab siv 1950's. Cov tshuaj no ua rau cov kab mob qog muaj peev xwm rov qab txais cov kab mob serotonin thiab norepinephrine, yog li cia qhov ntau dua ntawm ob yam tshuaj no yuav tsum muaj rau kev siv paj hlwb.
Tsis tas li ntawd, kuj ua rau cov neeg tsis muaj zog nyob hauv cov neeg tsis paub qab hau thiab serotonin, tricyclics zoo li cov teebmeem ntawm histamine thiab acetylcholine. Qhov no yog lub luag hauj lwm rau cov kev phiv cov nyom peb feem ntau nyob nrog cov tshuaj no, xws li lub qhov ncauj qhuav, qhov muag tsis pom kev, hnyav nce thiab sedation.6
Nrog tricyclics, ib tus neeg mob keeb kwm kev kho mob yuav tsum tau raug xam pom.
Cov tshuaj noj no yuav ua rau cov neeg tsis muaj zog txaus siab (kiv taub hau thaum lub plawv dhia ceev ceev, qee zaus nrog kev mob plawv, thiab ua rau lub plawv dhia ceev nrooj.
Kev Xaiv Tsa Tshuaj Txhaj Tshuaj Serotonin Rov Qab
Cov kev thov kom tsis muaj kev phiv los sis tsis zoo los ntawm kev siv tshuaj rau cov laus thaum ub tau ua rau cov lus qhia ntawm antidepressant nrov heev rau xyoo tas los no. Cov tshuaj hauv cov chav kawm no muaj xws li fluoxetine (Prozac), citalopram (Celexa) escitalopram (Lexapro), fluvoxamine (Luvox), sertraline (Zoloft) thiab paroxetine (Paxil).
SSRI txhais tau hais tias yog Kev Xiam Siv Xeev Serotonin Reuptake Inhibitor. Cov tshuaj no ua hauj lwm, raws li lub npe siv, los ntawm kev txwv cov tshuaj mob presynaptic serotonin transporter receptor.8 Cov tshuaj no txawv ntawm qhov tricyclics hauv nws qhov kev txiav txim tshwj xeeb rau serotonin nkaus xwb. Cov nyhuv rau cov kev tsis tuaj yeem los ntawm tus neeg tsis muaj zog yog tsis ncaj, los ntawm qhov tseeb tias qhov kev poob rau serotonin "permits" norepinephrine kom poob thiaj li khaws cia serotonin preserves norepinephrine.9 SSRIs, los ntawm lawv qhov tseem ceeb, muaj qhov kom zoo dua tsis cuam tshuam txog cov tshuaj histamine thiab acetylcholine. Qhov kev cuam tshuam yog tias txawm tias lawv tsis yog tsis muaj teebmeem tshwm sim, lawv tsis tsim tib yam kev phom sij zoo li qhov xwm txheej hauv seem.
Newer Mechanisms
Tsib dua tshiab cov tshuaj uas tsis haum rau cov kab saum toj no yog: bupropion (Wellbutrin), nefazodone (Serzone), trazodone (Desyrel), venlafaxine (Effexor), thiab mirtazapine (Remeron). Lub tswv yim ntawm cov lus qhia ntawm cov tshuaj tua kab mob hauv siab no tsis yog to taub zoo, tab sis nws xav tias yuav tsum muaj kev sib haum xeeb los ntawm txoj kev tsis tuaj los ntawm cov chaw kho mob los yog cov dopaminergic los yog ob qho tib si.10 Qhov kev siv tshuaj no tsis muaj kev sib deev nrog rau SSRIs thiab yog rau cov neeg mob uas tsis muaj lub zog , psychomotor slowness thiab ntau pw tsaug zog.
Nefazodone thiab nws cov precursor trazodone ob leeg inhibit neuronal reuptake ntawm serotonin thiab, kom tsawg dua, norepinephrine. Lawv kuj thaiv postsynaptic 5-HT2 receptors. Nefazodone muaj qhov tsis muaj zog rau cholingeric thiab a1- adrenergic receptors thiab, yog li ntawd, yog muaj kev sib daj sib deev thiab orthostasis tsawg dua trazodone.11
Venlafaxine yog ib qho tseem ceeb uas yog ua tsis ncaj rau lwm yam tshuaj tua kabmob (antidepressants) ..12 Zoo li cov TCAs, venlafaxine inhibits tus neuronal uptake ntawm ob leeg serotonin thiab norepinepherine. Venlafaxine muaj dose-dependent, tshwm sim los ntawm cov twj tso kua tshuaj rau serotonin thiab ces norepinephrine. Thaum 75 mg / hnub, venlafaxine feem ntau yog ib tug serotonin reuptake inhibitor (SRI) zoo li cov SSRIs.
Ntawm 375 mg / hnub, nws ua rau cov tsis muaj peev xwm ua kev tsis zoo los ntawm tus NSRI xws li desipramine.13
Mirtazapine yog qhov nyuam qhuav tso tawm ntawm cov plaub thiab yog thawj a2-antagonist kev ua lag luam raws li cov tshuaj tua kabmob.14 Mirtazapine lub cim kev cai ntawm kev ua haujlwm tsis koom nrog kev ntseeg hauv lub cev lossis qhov blockage ntawm neurotransmitter reuptake. Mirtazapine ua rau kev tso tawm ntawm norepinepherine los ntawm central noradrenergic neurons los thaiv qhov muag cov tawv nqaij uas tsis muaj zog nyob rau hauv alpha-2 autoreceptors. Nws muab cov duab resonator alpha-1 tso rau qhov no thiab thiaj li ua rau cov nqa nce hauv noradrenergic kis. Raws li ib tug neeg ua haujlwm presynaptic reset tus thib ob, cov tshuaj mirtazapine ua rau lub cev tsis haum alpha-2 heteroreceptors nyob rau ntawm cov neuron serotonergic, ua rau kom kev tso tawm ntawm serotonin. Postsynaptically, mirtazapine muaj tsawg affinity rau 5-HT1A reseptor, yog li qhov tso cai rau serotonin tso rau hauv lub zais zis mus khi rau thiab hnia no tus txais tos.
Txawm li cas los, nws blocks postsynaptic 5-HT2 thiab 5-HT3 receptors. Kev ntseeg siab ntawm 5-HT2 tus neeg txais kev kho yog xav tias yuav tsum muaj lub luag haujlwm rau cov kev mob ntsws ntawm lub ntsws, kev ntxhov siab, thiab kev sib deev uas pom tau tias SSRI thiab 5-HT3 reseptors stimulation yog xav kom sib haum xeeb pom nrog cov neeg sawv cev no.15, 16, 17 Yog li no, mirtazapine tus receptor thaiv cov ntaub ntawv tiv thaiv cov kev phiv nrog pom tsis ua haujlwm ntawm serotonin receptors uas tshwm sim los ntawm cov neeg ua hauj lwm dawb huv.