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Sezvo matambudziko ebasa, matambudziko ehukama, uye dzvinyiriro dzenzanga zvichiwedzera, kuora mwoyo kunogona kuramba kuripo. Kune varwere vanorapwa nemishonga inodzvinyirira kekutanga, vashoma pane hafu vanowana kuregererwa kwakasimba. Nhungamiro pamusoro pekusarudza mushonga mushure mekurapa kwechipiri kunoderedza kushungurudzika kunosiyana, zvichiratidza kuti kunyange kune mishonga yakawanda iripo, pane musiyano muduku pakati pavo. Pamishonga iyi, pane humbowo hunotsigira zvakanyanya hwekuwedzera atypical antipsychotics.

Muchiyedzo chechangobva kuitika, data yeESCAPE-TRD yekuyedza inonzi. Muedzo wacho waisanganisira varwere ve676 vane kuora mwoyo vasina kupindura zvakanyanya kune kanenge maviri antidepressants uye vakanga vachiri kutora serotonin reuptake inhibitors kana serotonin-norepinephrine reuptake inhibitors, yakadai sevenlafaxine kana duloxetine; Chinangwa chemuyedzo chaive chekuenzanisa kushanda kweesketamine nasal spray nequetiapine kuburitswa. Mhedziso yekutanga yaive kuregererwa pamasvondo e8 mushure mekuita randomisation (mhinduro yenguva pfupi), uye chikamu chechipiri chekupedzisira chakanga chisina kudzoka pamavhiki e32 mushure mekuregererwa pamasvondo e8.

Zvigumisiro zvakaratidza kuti hapana mushonga wakaratidza kunyanya kushanda kwakanaka, asi esketamine nasal spray yakanga inobudirira zvishoma (27.1% vs. 17.6%) (Mufananidzo 1) uye yakanga ine migumisiro yakaipa shoma yakaita kuti kuregedze kurapwa kwekuedza. Kushanda kwemishonga miviri yakawedzera nekufamba kwenguva: nevhiki 32, 49% uye 33% yevarwere muEsketamine nasal spray uye mapoka e-quetiapine anoramba achisunungurwa akanga awana kuregererwa, uye 66% ne47% vakanga vapindura kurapwa, maererano (Mufananidzo 2). Paiva nekudzoka zvishomanana pakati pevhiki 8 ne32 mumapoka maviri ekurapa

Chinhu chinoshamisa chekudzidza ndechekuti varwere vakasiya muyedzo vakaongororwa sevane mhedzisiro yakaipa (kureva, kuunganidzwa nevarwere vane chirwere chisina kuregererwa kana kudzokazve). Chiyero chepamusoro chevarwere vakarega kurapwa muboka re quetiapine kupfuura muboka re esketamine (40% vs. 23%), chigumisiro chinogona kuratidza nguva shoma yedzungu uye kuparadzana kwemigumisiro inobatanidza neEsketamine nasal spray uye nguva yakareba ye sedation uye kuwedzera kwehuremu kunobatanidza ne quetiapine yakaramba ichisunungurwa.

Waive muyedzo wakavhurika, zvichireva kuti varwere vaiziva rudzi rwemushonga wavaitora. Vaongorori vakaita bvunzurudzo dzekiriniki kuti vaone Montgomery-Eisenberg Depression Rating Scale zvibodzwa vaive varapi venzvimbo, kwete vashandi vekure. Pane kushaikwa kwemhinduro dzakakwana kune zvakakomba kupofumadza uye kutarisira kusarura kunogona kuitika mukuedzwa kwemishonga ine pfupi-pfupi psychoactive mhedzisiro. Nokudaro, zvakakosha kubudisa data pamusoro pemigumisiro yemishonga pakushanda kwemuviri uye hupenyu hwehupenyu kuti uone kuti mutsauko wakaonekwa mukubudirira hausi kungoita placebo, asiwo kuti mutsauko unoreva kliniki.

Chinhu chinokosha chinopikisana nemiedzo yakadaro ndechokuti mishonga inoderedza kuora mwoyo inoita seinongoerekana yachinja uye inowedzera kuda kuzviuraya munhamba duku yevarwere. SUSTAIN 3 ndeyekureba, yakavhurika-label yekuwedzera yekudzidza kweChikamu 3 kuyedza SUSTAIN, umo kuwedzera kwekutevera kwevarwere ve2,769 - 4.3% vakawanikwa vaine chiitiko chakakomba chepfungwa chakashata mushure memakore. Nekudaro, zvichibva pane data kubva kuESCAPE-TRD kuyedza, chikamu chakafanana chevarwere muesketamine nemapoka equetiapine vakawana zviitiko zvakakomba zvakashata zvepfungwa.

Chiitiko chinoshanda ne esketamine nasal spray zvakare chinokurudzira. Cystitis uye kukanganiswa kwekuziva kunoramba kuri dzidziso kwete njodzi chaidzo. Saizvozvowo, sezvo mishonga yemhino inofanira kupiwa kune imwe nzvimbo yekunze, kushandiswa kwepamusoro kunogona kudzivirirwa, izvo zvinovandudzawo mikana yekudzokorora nguva dzose. Kusvika iye zvino, kusanganiswa kweracemic ketamine kana zvimwe zvinodhaka zvinogona kushandiswa zvisina kunaka panguva yekushandiswa kwe esketamine nasal spray hazviwanzoitiki, asi zvichiri kuchenjera kunyatsocherechedza izvi zvinogona kuitika.

Ndezvipi zvinorehwa nechidzidzo ichi pakuita zvekiriniki? Mharidzo inonyanya kukosha ndeyokuti kana murwere asingapinduri kune maviri antidepressants, mukana wekuwana kuregererwa kwakakwana mukati memwedzi miviri nekuwedzerwa kwemishonga yekurapa inoramba yakaderera. Tichifunga nezvekupererwa nezano kwevamwe varwere uye kuramba kwavo zvinodhaka, kuvimba nekurapwa kunogona kuderedzwa nyore. Ko munhu ane hosha huru yokuora mwoyo anopindura nemishonga here? Murwere wacho haasi kufara here? Uyu muyedzo naReif et al. inosimbisa kukosha kwevarapi kuratidza tariro uye kusimba mukurapwa kwavo, pasina izvo varwere vazhinji vanonyanya kurapwa.

Kunyange zvazvo kushivirira kuchikosha, ndizvo zvakaitawo kukurumidza kunoitwa nechirwere chokuora mwoyo. Varwere nenzira yomuzvarirwo vanoda kupora nokukurumidza sezvinobvira. Sezvo mukana wemurwere wekubatsirwa uchidzikira zvishoma nezvishoma nekukundikana kwega kwega kwekurapa kweanodzvinyirira, kufunga kunofanira kupihwa kuedza kurapwa kunoshanda zvakanyanya kutanga. Kana izvo chete zvinotaridza kuti ndeipi antidepressant yekusarudza mushure mekutadza kurapwa kwemishonga miviri inoshanda uye chengetedzo, saka bvunzo yeESCAPE-TRD inogona kugumisa zvine musoro kuti esketamine nasal spray inofanira kusarudzwa semutsetse wechitatu wekurapa. Nekudaro, kurapwa kwekuchengetedza ne esketamine nasal spray kazhinji kunoda vhiki nevhiki kana kaviri-vhiki kushanya. Naizvozvo, mutengo uye kusagadzikana zvinogona kunge zviri zvinhu zvine chekuita nekushandiswa kwavo.

Esketamine nasal spray haizove iyo yega glutamate anopikisa kupinda mukiriniki maitiro. Imwe meta-analysis ichangoburwa inoratidza kuti intravenous racemic ketamine inogona kunyatsoshanda kupfuura esketamine, uye miviri mikuru-ku-musoro miedzo inotsigira kushandiswa kwe intravenous racemic ketamine gare gare munzira yekurapa sechisarudzo kune varwere vanoda electroconvulsive therapy. Zvinoita sezvinobatsira kudzivirira kumwe kuora mwoyo uye kutora kudzora hupenyu hwemurwere.