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Ukudakumba

Ukudakumba okanye ukuphazamiseka okungamandla kokudakumba (MDD) ligama eli banzi elisetyenziselwa ukucacisa inani elikhulu lokuphazamiseka okubonakalisa isimo sokudakumba nokuphelelwa ngumdla kwimisebenzi eliqela yemihla ngemihla.

Ukudakumba okanye ukuphazamiseka okungamandla kokudakumba (MDD) ligama eli banzi elisetyenziselwa ukucacisa inani elikhulu lokuphazamiseka okubonakalisa isimo sokudakumba nokuphelelwa ngumdla kwimisebenzi eliqela yemihla ngemihla.1

ISIMO SOKUDAKUMBA

Isimo sokudakumba sesinye seempawu ezimbini ezifunekayo ekufumaneni ziphumo zoxilongo lwe-MDD. Lolona phawu lwaziwa kakhulu ngokubanzi kwaye ilelona kusoloko kugxilwe kulo lunyango.8
I-serotonini ne-noradrenalin ziphembelelela isimo. Izithomalalisi-kudakumba ezisebenza kwi-serotonin, noradrenaline okanye kuzo zombini zinxulunyaniswa nokuphiliswa kwale mijikeliso.
Oku kungacacisa kakuhle ukuba izithomalalisi-kudakumba zingaziphucula njani iimvakalelo zokuva kakubi nesimo sokudakumba.8

UKUDAKUMBA KUWUCHAPHAZELA NJANI UMGANGATHO WOBOMI

UMbutho wezeMpilo weHlabathi (WHO) ukubeka ukudakumba njengesifo esinye esisesona sifo singumthwalo ehlabathini. Luphazamiseko olunganyangekiyo kwaye lungachaphazela kabuhlungu nayiphi na inkalo yobomi bomntu namandla okusebenza.4 Nkqu nokudakumba okuzolileyo nje kungawuchaphazela umgangatho wobomi. Iinkcukacha-manani zibonakalisa ukuba izinga lokuzibulala kwizigulana ezidakumbileyo kuyanda.9

INGABA KUYANYANGEKA NA UKUDAKUMBA?

Uninzi lwezigulana zibuyela ekusebenzeni kwesiqhelo emva kokuba sekudlule isehlo esingaqhelekanga kodwa, benganyangekanga, malunga nama-50% ukuya kuma-85% wabo banesisigulo ekugqibeleni bazophinda behlelwe zezinye izehlo ezingaqhelekanga.3,9 Ezona njongo ziphambili zonyango kukudamba (akukho zimpawu zakudakumba), ukuze abo banesisigulo bakwazi ukuzuza amandla wabo okusebenza kakuhle kwakhona kuze kuphucuke umgangatho wabo wobomi. Unyango lungakwazi nokunciphisa iimpawu zokudakumba luze lunciphise namathuba okuphinda kwehle izehlo ezingaqhelekanga zokudakumba kwixesha elizayo.9

IINDLELA ZONYANGO

Unyango lukanquka:

  • Amayeza azizithomalalisi-kudakumba okanye
  • Unyango lwengqondo ngaphandle kwamayeza olugxile kukudakumba, okanye
  • Indibanisela yoku kubini.

Zikhona nezinye iindlela zonyango ezifana nonyango lokuxhuzula ngombane (ECT), isivuseleli sesitsalane se-transcranial (TMS), kunye nesivuseleli i-vagal nerve, kodwa ezi zisetyenziswa kwiimeko ezixhathisa kakhulu zokudakumba okubukhali.3,9

ZISEBENZA KANGAKANANI IZITHOMALALISI-KUDAKUMBA

Izithomalalisi-kudakumba ziyohluka ngendlela ezisebenza ngayo, nendlela sisebenzisana ngayo namanye amayeza, imiphumela yawo nokuthi kulula kangakanani ukulungelelanisa umthamo. Ukuba awuhambelani kakuhle nohlobo oluthile lwesithomalalisi-kudakumba, oko akuthethi ukuba awuzokuhambelana kakuhle nolunye uhlobo.10
Xa uqala ukusebenzisa isithomalalisi-kudakumba, ugqirha wakho ngokwesiqhelo uza kumisela owona mthamo mncinci isithuba esingangeeveki ezine phambi kokuba awandise okanye atshintshe unyango lwakho. Kuza kuthatha iiveki ezintandathu ukuya kwezisibhozo ukuze umzimba wakho ubonakalise ukusebenza konyango okokuqala, nangona ukuphucuka okuthile kudla ngokubonakala kwakwiveki yesibini ukuya phambili kona.3,12
Ngokwesiqhelo kucetyiswa ukuba unyango lwezithomalalisi-kudakumba maluqhutywe isithuba:

  • Sonyaka emva kokuzibonakalisa kweempawu emva kwesehlo esingaqhelekanga sokuqala
  • Seminyaka emibini ubuncinane ukuba uneemeko ezongezelelweyo zemingcipheko

Iimeko zemingcipheko eyongezelelweyo ziquka ukudakumba (okunzima ukukunyanga) okubukhali kungekho kuphucuka, kubantu abadala nabantu abanezinye izigulo ezihambelanayo.12

YINTONI UNYANGO LWENGQONDO NGAPHANDLE KOKUSEBENZISA AMAYEZA?

Unyango lwengqondo okungasetyenziswa mayeza kulo “lunyango lokuthetha” ukunceda abanesisigulo ukuba bakhulelwe yindlela esempilweni yokumelana neemeko ukusebenza ngoxinizelelo lwemihla ngemihla. Xa lusetyenziswa kunye nelinye iyeza elimiselweyo, singanyanga side sisombulule neengxaki ze-MDD.9

UNGAYA PHI UKUFUMANA UNCEDO

Kuninzi lwabantu abanokudakumba unyango lusebenza kakuhle. Inyathelo lokuqala ekunyangeni ukudakumba kukuxoxa ngeempawu zakho nogqirha wakho okanye igosa lenkathalelo yezonyango kwikliniki yendawo ohlala kuyo okanye esibhedlele.

Ingenzenga njengesehlo esinye okanye ngokuphinda-phindanayo.2 Isimo sokudakumba nokuphelelwa ngumdla okanye ukuphelelwa bubumnandi phantse kuyo yonke imisebenzi kufuneka kubekhona ukuze kukwazi ukufumaneka iziphumo esichanekileyo kuxilongo kunye ezinye okanye ngaphezulu kwezi mpawu zilandelayo:3

  • Ukulahleka okanye ukongezeka kobunzima bomzimba okungamandla okanye ukwanda komdla wokutya okanye ukuphelelwa ngumdla wokutya
  • Ukuphazamiseka kokulala okufana nokuphuthelwa okanye ukulala ngokugqithisileyo kunesiqhelo
  • Ukudinwa okanye ukuphelelwa ngamandla
  • Ubunzima ekucingeni nokuzikisa ingqondo okanye ukungabi nasigqibo
  • Ukudineka
  • Ukuziva ungaxabisekanga, ukuphelelwa lithemba okanye ukuziva unobutyala ngokugqithisileyo/ngokungafanelekanga
  • Ingcinga zokufa eziphinda phandanayo – uloyiko lokufa okanye ukuzibulala

NGUBANI OSEMNGCIPHEKWENI?

Ukudakumba kokunye kokona kuphazamiseka kuthanda ukuba ziziphumo zoxilongo.4 Kunokwenzeka nokuba mingaphi na iminyaka yomntu, nkqu nasebuntwaneni okanye kumntu ofikisayo, kodwa iminyaka ephaya kumashumi amabini nengamashumi amathathu bobona budala buqhelekileyo.3 Imiba yemingcipheko iquka iminyaka nesini apho abasetyhini iba ingabona basemngciphekweni omkhulu kunamadoda.

YINTONI EBANGELA UKUDAKUMBA?

Mininzi imiba enegalelo kwiimpawu zokudakumba nokuphazamiseka. Oku kuquka ufuzo (imbali yosapho), uxinizelelo, imiba yezokusingqongileyo neyezentlalo, kodwa oyena nobangela akakacaci.5 Kodwa esikwaziyo kukuba kukho izigqithiseli eziyintloko ezigqithisela ukuphazamiseka engqondweni ezibizwa i-serotonin, i-noradrenalin ne- dopamine, ezinxulumeneyo nokudakumba.

Medical References

Iimbekiselo
1. Soleimani L, Lapidus K, Iosifescu DV. Diagnosis and Treatment of Major Depressive Disorder. Neurol Clin 2011;29:177–193.
2. Akiskal AS. Mood Disorders. Clinical Features. In: Kaplan and Sadock’s Comprehensive Book of Psychiatry. Sadock BJ, Sadock VA, Pedro R editors. 9th ed. Philadelphia. Wolters Kluwer Health/Lippincott Williams & Wilkins 2009. Chapter 13.7.
3. Grobler G. Major Depressive Disorder. The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders. SAJP 2013;19(3):130-196.
4. Richards D. Prevalence and clinical course of depression: A review. Clinical Psychology Review 2011;31:1117–1125.
5. Coryell W. Depressive Disorders. The Merck Manual. [online] 2013, December. [cited 2014, August 18] Available at http://www.merckmanuals.com/professional/psychiatric_disorders/mood_disorders/depressive_disorders.html?qt=Depressive%20Disorder&alt=sh 
6. Stahl SM. Circuits in Psychopharmacology. In: Stahl’s Essential Psychopharmacology. Neuroscientific Basis and Practical Application. Cambridge University Press, Cambridge. Third Edition 2008.Chapter 7:195-222.
7. http://www.drugs.com/health-guide/major-depression.html 
8. Stahl SM, Zhang L, Damatarca C, Grady M. Brain Circuits Determine Destiny in Depression: A Novel Approach to the Psychopharmacology of Wakefulness, Fatigue, and Executive Dysfunction in Major Depressive Disorder J Clin Psychiatry 2003;64 [suppl 14]:6–17.
9. Gelenberg AJ, Freeman MP, Markowitz JC, Rosenbaum JF, Thase ME, Trivedi MH, et al. Practice Guideline For The Treatment of Patients With Major Depressive Disorder. Third Edition. American Psychiatric Association. 2010:11-152.
10. Rush AJ, Nierenberg AA. Mood Disorders: Treatment of Depression. In: Kaplan and Sadock’s Comprehensive Book of Psychiatry. Sadock BJ, Sadock VA, Pedro R editors. 9th ed. Philadelphia. Wolters Kluwer Health/Lippincott Williams & Wilkins 2009. Chapter 13.8.
11. Choe CJ, Emslie GJ, Mayes TL. Depression. Child Adolesc Psychiatric Clin N Am 2012;21:807–829
12. Mahli GS, Hitching R, Berk M, Boyce P, Porter R, Fritz K. Pharmacological management of unipolar Depression. Acta Psychiatr Scand 2013: 127 (Suppl. 443): 6–23.