Thuoc dieu tri tram cam: huong dan day du ve thuoc chong tram cam

Roi loan tram cam nang (MDD) la mot trong nhung benh suc khoe tam than pho bien nhat va gay tan phe nhat tren the gioi, anh huong den khoang 280 trieu nguoi. Benh dac trung boi tam trang tram buon keo dai, mat hung thu hoac niem vui (anhedonia), thay doi giac ngu va su them an, met moi va cam giac vo gia tri. Tram cam khong phai la khuyet diem tinh cach — ma la mot benh ly lien quan den nhung thay doi phuc tap trong hoa hoc nao.

Voi tram cam nhe, lieu phap tam ly (CBT) thuong du. Thuoc duoc khuyen cao la lua chon dau tien cho tram cam trung binh den nang. Phuong phap hieu qua nhat la dieu tri ket hop — thuoc cong voi tam ly tri lieu.

Sertralin (50–200 mg/ngay) — thuong la lua chon dau tien. Escitalopram (10–20 mg/ngay) — chon loc nhat. Fluoxetin (20–60 mg/ngay) — uu tien o thanh thieu nien. Citalopram (20–40 mg/ngay). Paroxetin (20–50 mg/ngay) — nguy co hoi chung ngung thuoc cao nhat. Tac dung phu thuong gap: buon non, roi loan chuc nang tinh duc (30–70%), thay doi can nang.

Venlafaxin (75–375 mg/ngay) — theo doi huyet ap. Duloxetin (60–120 mg/ngay) — cung duoc chap thuan cho dau than kinh va dau co xuong man tinh.

Thuoc chong tram cam ba vong (TCA): amitriptylin, nortriptylin, clomipramin — hieu qua nhung nhieu tac dung phu. Chi so dieu tri hep — qua lieu co the gay tu vong. MAOI: phenelzin, tranylcypromin — rat hieu qua nhung can kieng an (thuc pham chua tyramin). Danh cho tram cam khang tri.

Bupropion (150–450 mg/ngay) — khong gay roi loan chuc nang tinh duc; chong chi dinh khi co co giat. Mirtazapin (15–45 mg/ngay) — gay buon ngu va kich thich su them an. Trazodon — thuong dung lam thuoc ngu hon. Vortioxetin (10–20 mg/ngay) — loi ich nhan thuc. Agomelatine (25–50 mg/ngay) — can theo doi chuc nang gan.

Voi mat ngu — mirtazapin, trazodon. Voi met moi — bupropion, venlafaxin. Voi lo au — sertralin, escitalopram. Voi dau man tinh — duloxetin, amitriptylin. Tat ca can 2–4 tuan de bat dau co hieu qua va 6–8 tuan cho dap ung day du.

Ngung thuoc dot ngot — dac biet paroxetin va venlafaxin — co the gay chong mat, buon non, "soc nao" va kho chiu. Phong ngua: giam lieu dan trong it nhat 4 tuan. Cho tram cam khang tri (~30% benh nhan): tang cuong bang lithium, thuoc chong loan than khong dien hinh (aripiprazol, quetiapin), esketamin (xit mui), ECT hoac TMS.

Cac thuoc chinh: sertralin, escitalopram, fluoxetin, venlafaxin, duloxetin, bupropion, mirtazapin, amitriptylin, trazodon, vortioxetin va agomelatine. Tim hieu cac tinh trang lien quan tren PillsCard: roi loan lo au, mat ngu, dau man tinh, dau nua dau.