depresiis marTva pirvelad · 2017-06-05 · 2 depresiis marTva pirvelad jandacvaSi 1. daavadebis...

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danarTi 1

depresiis marTva pirvelad

jandacvaSi

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

damtkicebulia saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2010 wlis 11 oqtombris

# 330/o brZanebiT

miRebulia “klinikuri praqtikis erovnuli rekomendaciebis (gaidlainebi) da daavadebaTa marTvis saxelmwifo

standartebis (protokolebi) SemuSavebis, Sefasebisa da danergvis erovnuli sabWos"

2009 wlis 30 dekembris #2 sxdomis gadawyvetilebis Sesabamisad

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depresiis marTva pirvelad jandacvaSi

1. daavadebis ganmarteba, sinonimebi, klasifikacia da

terminologia

ganmarteba

depresia ganixileba rogorc guneb-ganwyobis, interesis, xalisis progresirebadi daqveiTeba sul mcire ori kviris ganmavlobaSi, rasac Tan axlavs individis socialuri (maT Soris samsaxurebrivi/ profesiuli) da fizikuri aqtivobis mniSvnelovani daqveiTeba.

sinonimebi

jandacvis profesionalebi iyeneben terminebs: depresia, klinikuri depresia, depresiuli daavadeba, depresiuli sindromi, melanqolia.

klasifikacia

depresiis klasifikacia efuZneba amerikis fsiqiatrTa asociaciis mentaluri daavadebebis diagnostikis da statistikis meoTxe gadaxedvas (DSM-IV-TR) da janmos daavadebaTa da janmrelobis problemebis saerTaSoriso statistikur klasifikacias (ICD-10).

guneb-ganwyobis darRvevis ZiriTadi klasifikaciebi

DSM-IV-TR guneb-ganwyobis darRvevebi didi depresiuli aSliloba

msubuqi

saSualo

mZime

melanqoliuri niSnebiT

fsiqozuri niSnebiT

ICD-10 G guneb-ganwyobis (afeqturi) darRvevebi Ddepresiuli epizodi

msubuqi

saSualo

mZime

somaturi niSnebiT

fsiqozuri niSnebiT

erTi epizodi

ganmeorebiTi

ganmeorebiTi depresiuli darRveva

bipolaruli darRveva

axali epizodi depresiis, maniis an orivesi erTad

bipolaruli afeqturi darRveva

mimdinare epizodi depresiis, maniis an orivesi erTad

disTimia (qronikuli depresia) cikloTimia

disTimia cikloTimia

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Tanmxlebi darRvevebi

depresiuli guneb-ganwyobiT

depresiis da SfoTvis erTobliobiT

Tanmxlebi darRvevebi

xanmokle depresiuli reaqcia

gaxangrZlivebuli depresiuli reaqcia

depresiis da SfoTvis erToblioba

guneb-ganwyobis darRveva gamowveuli specifikuri samedicino mdgomareobiT

organuli guneb-ganwyobis (afeqturi) darRveva

2. epidemiologia

msoflioSi mosaxleobis 5% daavadebulia depresiiT; imavdroulad sicocxlis manZilze depresiiT daavadebis riski daaxloebiT 20%-s Seadgens;

yoveli merve adamiani, anu saerTo populaciis 15%, cxovrebaSi erTxel mainc saWiroebs antidepresantebiT mkurnalobas depresiis gamo;

depresiis prevalensi ganviTarebul qveynebSi Seadgens 2.3-3..2% -s kacebs Soris da 4.5-9.3 %-s qalebs Soris;.

depresia, mosaxleobis dainvalidebis TvalsazrisiT, 2020 wels daikavebs meore adgils gul-sisxlZarRvTa daavadebebis Semdeg;

depresiis insidensi pirvelad jandacvaSi 10 dan 14 %-mdea im pacientebs Soris, romlebic raime mizeziT mimarTaven eqims;

antidepresantebis gamoyenebis sixSire mniSvnelovnad gaizarda. aSS-Si antidepresantebis gamoyeneba orjer gaizarda 1995 - 2002 wlebSi;

saqarTveloSi depresiis Taobaze zusti statistikuri monacemebi ar arsebobs. daavadebaTa kontrolis centris monacemebiT, romelic eyrdnoba fsiqonevrologiur dispanserebis monacemebs, guneb-ganwyobis aSlilobebis prevalensi 2007 wlisTvis Seadgenda 5160 SemTxvevas, aqedan 1948 qali iyo; insidensi – 189;

pacientTa mxolod 1/3 akiTxavs fsiqiatrs;

SemTxvevebis mxolod 1/4¼-Si xdeba swori diagnostireba da iniSneba adekvaturi mkurnaloba; aqedan 50% ama Tu im mizeziT wyvets mkurnalobas;

didi depresiuli epizodis dros dasrulebuli suicidis sixSire 15-20%-ia, rac 20-jer ufro maRalia vidre mTlian populaciaSi da 3-4-jer ufro maRali, vidre sxva fsiqikuri aSlilobebis dros;

SemTxvevaTa 60%-Si daavadeba iZens qronikul xasiaTs;

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pirveli depresiuli epizodis Semdeg avadmyofebis 5-10%-s uviTardeba maniakaluri mdgomareoba;

genderuli Tanafardoba: SemTxvevaTa 2/3 qalia;

depresias Tan axlavs SfoTva SemTxvevaTa 60_70%-Si;

depresiuli epizodi cxovrebaSi erTxel mainc gadaitana qalebis 20-25%-ma, mamakacebis 7-12%-ma;

atipuri depresiis gavrceleba populaciaSi 0,7%-ia da misi manifestaciis saSualo asaki 35 welia;

sicocxlis manZilze disTimiis ganviTarebis riski 3_6%-s Seadgens, avadoba 2_jer metia qalebSi.

3. etiologia

radgan depresias aqvs mravali mizezi, zogjer depresiis gamomwvev mizezebs yofen sam jgufad: fsiqologiuri, neiroendokrinuli da socialuri faqtorebi. F

fsiqologiuri faqtori: stresi iwvevs guneb-ganwyobis progresirebad daqveiTebas, sakuTari Tavisadmi pativiscemis daqveiTebas da momavlisadmi uimedobas. sakuTari Tavisadmi negatiuri damokidebuleba ,,saqmeebi cudad midis” “imitom, rom me var `cudi”, ,,yovelTvis yvelaferi cudad iqneba”, momavlis pesimisturi xedva _ marcxis molodini;

neiroendokrinuli faqtori: depresias iwvevs qimiuri nivTierebebis donis cvlileba Tavis tvinSi. Mmag.: menstrualuri ciklis, orsulobis, mSobiarobis, menopauzis periodSi organizmSi hormonebis donis cvalebadoba ganapirobebs guneb-ganwyobis cvalebadobas. kvlevebiT dadasturebulia, rom Ddepresiul pirebs aqvT neirotransmistebis, kerZod serotoninis, noradrenalinis da dopaminis dabali done;

socialuri faqtori: mZime Sroma, siRaribe, socialuri izolacia, axloblebis gardacvaleba, mozardobis asakSi stresuli SemTxvevebi;

memkvidreoba: dadasturebulia, rom adamianebis daaxloebiT 20%

-s aqvs 5-HTT geni; es is adamianebi arian, romlebic ganwyobilni arian depresiisadmi stresul mdgomareobis Sedegad. Mmeore mxriv, depresiis ojaxuri anamnezis mqone bevr pirs ar uviTrdebaT depresiuli mdgomareoba, maSin, roca araojaxuri anamnezis mqone pirebi avaddebian depresiiT.

depresiis sxva mizezebi: alkoholis Warbad miReba, narkotikebis moxmareba, zogierTi medikamentis gamoyeneba.

komorbiduli daavadebebi: qronikuli daavadebebi zrdian depresiis ganviTarebis risks. depresiis Sefasebisas pirveladi jandacvis profesionalebis mier unda dadgindes: depresia

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pirveladi procesia Tu qvemoT CamoTvlili daavadebebis simptomi: gulis iSemiuri daavadeba, Saqriani diabeti, avTvisebiani simsivneebi, cerebrovaskularuli daavadebebi, hipoTireoidizmi, hiperTireoidizmi.

asakobrivi Taviseburebebi:

prepubertatuli periodi _ somaturi Civilebi, aJitacia, SfoTva, fobiebi;

pubertatuli periodi _ fsiqoaqtiuri nivTierebebis Warbi moxmareba, opoziciuri da antisocialuri qceva, daudevroba, siZneleebi swavlaSi, skolis gacdena, SemTxveviTi nacnoboba, negatiuri Sefasebisadmi mometebuli mgrZnobeloba;

sibere _ inteleqtualuri darRvevebi, yuradRebis ioli gadanacvleba, mexsierebis daqveiTeba, dezorientireba, cnobierebis abneva, fsevdodemencia an demencia Serwymuli depresiasTan, apaTia.

depresiis gamomwvevi medikamentebi

depresiis gamomwvevi medikamentebi alternativebi

klonidini, meTildofa, rezerpini sxva antihipertenziuli saSualebebi (sadiurezo, ACE-I,

CCB, ARB da sxva) lipofiluri betablokerebi (propranololi)

atenololi an metoprololi

kortikosteroidebi dozis Semcireba sedaciuri da hipnozuri saSualebebi dozis Semcireba benzodiazepinebi gamoyenebis Semcireba

estrogenebi, progesteroni vitaminiBB 6-is damateba, progesteronis dozis Semcireba

parkinsonis sawinaaRmdego medikamentebi alternativa ar arsebobs

antikonvulsantebi Seafase diagnozi da ganixile alternativebi

indometacini sxva arasteroidebi

interferoni (HepC, MS) alternativa ar arsebobs

4. klinikuri simptomatika

garegnoba _ depresiuli pacienti gamoirCeva tipuri garegnobiT; mouwesrigebelia, mouvlelia, Secvlili aqvs gamometyveleba: daSvebulia tuCis kuTxeebi, Subli SeWmuxnulia, mzera Camqrali, quTuToebi damZimebuli, iSviaTad axamxamebs Tvalebs. Mmxrebi Camovardnilia, TavCaqindruli da Tvalebdaxrilia, Jestikulacia minimumamdea dayvanili, zogjer ki sruli amimiaa. miuxedavad Rrma depresiisa, zogi avadyofi saxeze Rimils inarCunebs _ momRimari anu ironiuli depresia.

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guneba-ganwyoba _ dominirebadia melanqoliuri afeqti, romelic SeiZleba gamovlindes naRvliani, daTrguli, melanqoliuri gunebaganwyobiT.

vitaluri komponenti SeiZleba sxvadasxva siZlieriT iyos gamoxatuli, msubuqi modunebidan da sicocxlis tonusis daqveiTebidan gaqvavebamde da sruli umweobis gancdamde. vitaluri gancda _ ,,sulieri tkivilis”, ,,gulze lodis”, ,,simZimis”, ,,sulis marwuxebSi moqcevis” SegrZnebiT, romelsac zogjer Tan axlavs mosalodneli ubedurebis dauZleveli gancda. vitaluri naRvelis gancdas ufro xSirad Tan axlavs SfoTva da yalibdeba SfoTviT-naRvliani afeqti, xolo emociuri gancdebis ukmarisobis, ganurCevlobis arsebobis dros yalibdeba apaTiuri afeqti.

depresiis simptomebi:

guneb-ganwyobis darRveva – depresiuli guneb-ganwyoba (mwuxareba, naRvlianoba).

anhedonia - interesis an siamovnebis gancdis unaris dakargva.

depresiuli fiqrebi – Cafiqreba, pesimizmi, dabali TviTSefaseba an danaSaulis SegrZneba, morcxvoba, uimedoba, sikvdilze fiqri an suiciduri azrebi. G

fizikuri da biologiuri cvlilebebi – Zilis darRvevebi, wonis daqveiTeba an piriqiT, momateba (madis daqveiTeba an momateba), daRliloba, energiis daqveiTeba, fsiqomotoruli cvlilebebi – azrovnebis Seneleba, koncentrirebis unaris daqveiTeba, moZraobis Seneleba, aJitireba, libidos daqveiTeba.

depresiis klinikuri suraTi simZimis xarisxis mixedviT

depresiuli epizodi SeiZleba iyos msubuqi, saSualo (zomieri) da mZime.

msubuqi depresiis dros avadmyofi garegnulad ar gamoiyureba daTrgunulad. uCivis guneba-ganwyobis daqveiTebas, uRonobas, siamovnebis miRebis unaris dakargvas, momatebul gaRizianebadobas, Zilis darRvevas – uWirs CaZineba, RamiT utydeba Zili da mxolod gamTeniisas iZinebs. ,,biologiuri” niSnebi, rogorc wesi, ar vlindeba, Tumca guneba-ganwyoba SeiZleba icvlebodes dRis ganmavlobaSi, saRamos Cveulebriv uaresia, vidre diliT. msubuqi depresiis dros ufro xSirad gvxvdeba e. w. ,,nevrozuli” simptomebi: fobia, SfoTva obsesiuri da isteriuli simptomebi, ris gamoc zogi avtori msubuq depresias nevrozul depresias uwodebs. fsiqo-socialuri funqcionireba gaZnelebulia.

saSualo depresia xasiaTdeba simptomebis zomierebiT da harmoniuli depresiuli triadiT _ guneba-ganwyobis daqveiTeba, sixarulis gancdis unaris dakargva, pesimisturi azrovneba, energiis daqveiTeba, rac fsiqosocialuri funqcionirebis gauaresebas da Sromis unaris daqveiTebas iwvevs.

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mZime depresiis dros klinikur suraTSi dominirebs daTrgunuli melanqoliuri guneb-ganwyoba (dardi, SfoTva, naRveli), interesebis dakargva, ganurCevloba, anhedonia. darRveulia interpersonuli urTierTobebi da fsiqo-socialuri funqcionireba. gamoxatulia ideatoruli da motoruli Sekaveba. viTardeba adinamiuri, anu Sekavebuli depresia an zogjer fsiqikuri anesTezia.

depresiis tipebi

didi depresia – depresiis xuTi an meti simptomis arseboba sul mcire 2 kviris ganmavlobaSi. Ddid depresias axasiaTebs sul mcire 6-Tviani mimdinareoba. didi depresiiT daavadebuli pirebi midrekilni arian suicidisadmi.

mcire depresiisTvis damaxasiaTebelia xuTze naklebi depresiuli simptomis arseboba sul mcire 2 kviris ganmavlobaSi. mcire depresia msgavsia didi depresiisa, gansxvavdeba misgan mxolod simptomebis raodenobiT).

bipolaruli depresia (adre iwodeboda depresiul maniakalur darRvevad) – didi depresiis epizodebis da aranormalurad aweuli guneb-ganwyobis – maniis monacvleoba.

unipolaruli depresia – igive didi depresia: es aris guneb-ganwyobis darRveva, romelsac axasiaTebs depresiuli guneb-ganwyoba, interesis an siamovnebis gancdis unaris dakargva, Zilis darRveva, wonis cvalebadoba, koncentrirebis da yuradRebis unaris daqveiTeba, sikvdilze fiqri an suiciduri azrebi. maSin, rodesac adamianebis umravlesoba periodulad ganicdis mwuxarebas, unipolaruli depresiiT daavadebuli pirebi ganicdian ukiduresad Rrma mwuxarebas, romelic grZeldeba kvireebis da Tveebis gamnavlobaSi. Uunipolaruli depresiuli darRvevebi moicavs did depresias, disTimias, sezonur depresias da sxva msgavs depresiul darRvevebs.

disTimia – qronikuli depresia mcire depresiis simptomebiT, grZeldeba sul mcire 2 weli. disTimia warmoadgens qronikul depresiul aSlilobas, romlis klinikuri mimdinareoba naklebad mZimea, vidre didi depresiisa. gamoyofen pirvelad da meorad disTimiebs, aseve disTimiebs adreuli da mogvianebiTi dasawyisiT. pirveladi anu ,,sufTa” disTimia Cveulebriv viTardeba TandaTanobiT, bavSvobis an pubertatul asakSi, swrafad iRebs qronikul xasiaTs (21 w-mde) da ar aris dakavSirebuli raime winamorbed fsiqikur aSlilobasTan. meoradi disTimia iwyeba mogvianebiT, ukve arsebuli

fsiqikuri an somaturi daavadebis fonze.

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mSobiarobis Semdgomi depresia – vlindeba mSobiare qalTa 10-15 %-Si. mSobiarobis Semdgomi depresia simptomebiT ar gansxvavdeba unipolaruli an bipolaruli depresiisgan mSobiarobis Semdgomi pirveli oTxi kviris ganmavlobaSi. Ddepresiis simZime SesaZloa iyos saSualodan mZimemde da gagrZeldes ori kviridan erT Tvemde, SesaZloa erT wlamdec.

atipuri depresia – vlindeba depresiiT daavadebul pacientTa erT mesamedSi. damaxasiaTebelia paradoqsuli anhedonia, aRiniSneba gaZlierebul mada da Zilianoba (hipersomnia).Aatipuri depresiiT ZiriTadad avaddebian axalgazrda qalebi. maT depresiis simptomebi ufro mZimed aqvT gamoxatuli.

SfoTviTi depresia. klinikuri suraTi gamoirCeva foriaqis, aJitaciis, somato_vegetatiuri simptomebis siWarbiT. saRamoobiT mdgomareoba SeiZleba damZimdes. xSiria TviTdanaSaulis, TviTbraldebis ideeebi, aseve ipoqondriuli gancdebi da fobiebi.

cikloTimia bipolaruli depresiis msgavsi mdgomareobaa. maSin, rodesac bipolaruli depresiis mimdinareoba SesaZloa gaumjobesdes wlebis ganmavlobaSi, cikloTimia qronikuli mdgomareobaa, romelic grZeldeba xangrZlivi periodis ganmavlobaSi.

cikloTimia xasiaTdeba qronikuli fluqtuirebadi mimdinareobiT da mravlobiTi hipomaniakaluri da msubuqad an zomierad gamoxatuli depresiuli epizodebiT. cikloTimiis klinikaSi ar gvxvdeba fsiqozuri simptomebi. qalebSi da mamakacebSi Tanabari sixSiriT viTardeba, rogorc wesi, mozardobis an ymawvilobis asakSi iwyeba da Tan axlavs alkoholis da fsiqoaqtiuri nivTierebebis Warbi gamoyeneba. depresiuli aSliloba ufro xSiria pirdapir naTesavebSi, vidre populaciaSi. emociuri aSlilobis rekurentulobam SeiZleba gamoiwvios fsiqo-socialuri funqcionirebis gauareseba.

sezonuri depresia unipolaruli depresiis erT-erTi saxea, romelic vlindeba upiratesad CrdiloeTis qveynebis axalgazrda qalebSi, upiratesad zamTarSi., rodesac mzis sinaTlis periodi xanmoklea.

guneb-ganwyobis sxva darRvevebi: am darRvevebSi moiazreba medikamentebiT an sxva nivTierebebiT gamowveuli guneb-ganwyobis darRvevebi. Oorive SemTxvevaSi SesaZloa saxeze iyos mania, depresia an Sereuli guneb-ganwyobis darRveva.

fsiqozuri darRvevis, igive Sizoafeqturi darRvevis diagnozi ismeba, rodesac SizofreniiT daavadebul pirovnebas uviTardeba maniis, depresiis epizodebi an Sereuli formiT orive erTad.

rezistentuli depresia – depresiis am formis dros simptomebi - sevda, imedgacrueba, interesis dakargva – persistirebs mkurnalobis miuxedavad.

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garTulebebi

depresiiT daavadebul pacientebs Soris 20 - jer ufro maRalia suicidis riski. suicidis riski izrdeba antidepresantebiT mkurnalobis sawyis periodSi, amitom pacientebi, romlebic mkurnaloben antidepresantebiT, gansakuTrebul meTvalyureobas saWiroeben. suicidis maRal riskze miuTiTebs:

pacientis mier sikvdilze an suicidze saubari. frazebi: “Cemi ocnebaa mkvdari viyo” an “me vfiqrob, gardacvlilebi Cvenze bednierebi arian”, an “kargi iqneboda dameZina da arasodes gamRviZeboda”;

TviTdazianebebi: xelebis da fexebis daserva, sigaretiT miyenebuli damwvroba;

guneb-ganwyobis uecari aweva (depresiis mimdinareobisas an antidepresantebiT mkurnalobis adreul etapze uecrad amaRlebuli guneba-ganwyoba). es SesaZloa miuTiTebdes, rom pirovnebam gadawyvita suicidis ganxorcieleba da am gadawyvetilebis gamo Tavs ukeT grZnobs.

5. daavadebis diagnozi

DSM IV - s mixedviT depresiis diagnozi marTlzomieria, Tu pacients qvemoT CamoTvlili cxra simptomidan aqvs xuTi an meti simptomi. simptomebi SesaZloa gamovlindes orkviriani periodiT, an yoveldRiurad da gamoixatos pirvandeli funqcionirebis cvlilebiT. saxeze unda iyos sul mcire erTi_erTi am or simptomTagan: 1) depresiuli guneb-ganwyoba an 2) interesis an siamovnebis gancdis dakargva.

sul mcire xuTi simptomi qvemoT CamoTvlilTagan:

1. depresiuli guneb-ganwyoba;

2. interesis an siamovnebis gancdis unaris dakargva;

3. wonis daqveiTeba an piriqiT momateba (madis daqveiTeba an momateba);

4. Zilis darRvevebi;

5. daRliloba, energiis daqveiTeba;

6. fsiqomotoruli aJitireba an Seneleba;

7. koncentrirebis an gadawyvetilebis miRebis SiSi;

8. dabali TviTSefaseba an danaSaulis SegrZneba;

9. sikvdilze fiqri an suiciduri azrebi. G

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gamovlenili simptomebis mixedviT depresia SesaZloa iyos:

msubuqi – xuTi an eqvsi depresiuli simptomi funqcionirebis daqveiTebiT;

saSualo – simptomebi da funqcionirebis daqveiTeba msubuqsa da saSualos Soris;

mZime – saxezea simptomebis umravlesoba funqcionirebis gamoxatuli daqveiTebiT.

ICD-10 iyenebs depresiis 10 simptoms:

depresiuli guneb-ganwyoba;

interesis, siamovnebis miRebis unaris daqveiTeba;

momavlisadmi pesimisturi ganwyoba;

madis darRveva (madis daqveiTeba an momateba);

Zilis darRvevebi;

fsiqomotoruli aJitireba an piriqiT Seneleba;

daRliloba, energiis daqveiTeba;

dabali TviTSefaseba an danaSaulis SegrZneba;

koncentrirebis da yuradRebis unaris daqveiTeba;

sikvdilze fiqri an suiciduri azrebi.

ICD-10 –is mixedviT simptomebi iyofa 4 ZiriTad jgufad:

depresia ar aris (4 simptomze naklebi);

msubuqi depresia (4 simptomi);

saSualo simZimis depresia (5-6 simptomi);

mZime depresia (7 da meti simptomi). simptomebi saxeze unda iyos sul mcire 2 kvira.

gamokvlevis sqema _ laboratoriuli da fsiqologiuri

gamokvleva

testi deqsametazoniT - hipoTalamo_hipofizur-adrenaluri sistemis hiperaqtivobiT gamowveuli kortizolis hipersekreciis daTrgunva ar xdeba deqsametazonis Seyvanis Sedegad testi dadebiTad iTvleba. misi klinikuri gamoyeneba SezRudulia sirTulisa da maRali cdomilebis gamo;

fsiqologiuri testebi: depresiis sakvlevi unificirebuli Skalebi:

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o bekis depresiis kiTxvari; o hamiltonis depresiis Sefasebis Skala.

bekis depresiis kiTxvari mocemulia danarTSi.

orsulebSi da mSobiarobis Semdgomi depresiis skriningisaTvis gamoiyeneba edinburgis postnataluri depresiis skala.

6. mkurnaloba

klinikuri rekomendaciebi:

antidepresantebi mniSvnelovnad aumjobeseben depresiul mdgomareobas placebosTan SedarebiT. antidepresantebs Soris efeqturobis TvalsazrisiT mniSvnelovani gansxvaveba ar aris (A).

pacientebi, romlebic mkurnaloben antidepresantebiT saWiroeben monitorings medikamentebis efeqturobis, gverdiTi efeqtebis da suicidis TvalsazrisiT (C).

antidepresantebiT mkurnalobis dawyebidan oTxi-Tormeti kviris ganmavlobaSi mkurnalobis uefeqtobis SemTxvevaSi saWiroa mkurnalobis sakiTxis gadaxedva (B).

antidepresantebiT mkurnalobis warumateblobis SemTxvevaSi Semdgomi gadawyvetileba SesaZloa iyos imave jgufis sxva preparatiT mkurnaloba, sxva jgufis medikamentiT mkurnaloba an damatebiTi meTodebis gamoyeneba (B).

antidepresantebi ar aris rekomendebuli msubuqi xarisxis depresiis sawyisi mkurnalobisTvis, radgan riski aWarbebs sargebels (C).

antidepresantebiT mkurnaloba unda gagrZeldes sul mcire eqvsi kviris ganmavlobaSi depresiis epizodis remisiis Semdeg, radgan es mniSvnelovnad amcirebs recidivis risks (A).

pacienti, romelsac uaxloes warsulSi hqonda ori an meti depresiuli epizodi mniSvnelovani funqciuri darRvevebiT, saWiroebs antidepresantebiT mkurnalobas ori wlis ganmavlobaSi (B).

depresiis mkurnaloba moicavs sxvadasxva meTodebs:

farmakoTerapias;

fsiqoTerapias;

SemecnebiT qceviT Terapias;

12

msubuqi xarisxis depresiis mkurnaloba pirvelad jandacvaSi

msubuqi depresiis dros, Tu pacienti uars acxadebs mkurnalobaze an SesaZloa misi gamojanmrTeleba yovelgvari Carevis gareSe, saWiroa monitoringi mdgomareobis Sefasebis mizniT - Cveulebriv ori kviris ganmavlobaSi (C);

msubuqi depresiis dros rekomendebulia rCevebi fizikuri aqtivobis, Zilis higienis, qceviTi Terapiis, fsiqoTerapiis Sesaxeb (C);

antidepresantebi ar aris rekomendebuli msubuqi xarisxis depresiis sawyisi mkurnalobisTvis, radgan riski aWarbebs sargebels (C);

Tu msubuqi depresia persistirebs, sxvadasxva Carevebis miuxedavad, an mas safuZvlad udevs fsiqo-socialuri an samedicino problemebi, naCvenebia antidepresantebis daniSvna (C);

Tu msubuqi depresiis mqone pacients anamnezSi aqvs saSualo an mZime depresiis epizodebi, naCvenebia antidepresantebis daniSvna (C);

rekomendebulia msubuqi depresiiT daavadebuli yvela pacientis uwyveti monitoringi (C).

saSualo da mZime depresiis mkurnaloba pirvelad jandacvaSi

saSualo depresiis mqone yvela pacients rutinulad unda daeniSnos antidepresantebi fsiqologiuri intervenciebis Catarebamde (B);

aucilebelia pacientis informireba medikamentebis SesaZlo gverdiTi efeqtebis, mkurnalobis xangrZlivobis, mkurnalobis Sewyvetis Sedegad ganviTarebuli moxsnis sindromis, daniSnulebis sworad Sesrulebis Sesaxeb (C);

sucidiis maRali riskis SemTxvevaSi iniSneba antidepresantebis SezRuduli doza. aucilebelia pacientis mudmivi monitoringi (C);

saSualo da mZime depresiis dros saWiroa antidepresantebiT mkurnalobis gagrZeleba remisiis dadgomidan sul mcire eqvsi Tvis ganmavlobaSi (A);

rutinuli mkurnalobisTvis gamoiyeneba serotoninis ukumitacebis seleqciuri inhibitorebi (fluoqsetini, paroqsetini, citaloprami), romlebsac axasiaTebT tricikluri antidepresantebis msgavsi efeqturoba da naklebad gamoxatuli toqsikuroba, vidre pirveli Taobis antidepresantebs (A);

13

dozulepiniT, fenelziniT, kombinirebuli antidepresantebiT, liTiumis preparatebiT mkurnaloba unda dainiSnos mxolod specialistis mier (C);

Tu serotoninis ukumitacebis seleqciuri inhibitorebiT mkurnalobis daswyisSi gamovlinda gaZlierebuli aJitireba, SecvaleT sxva antidepresantiT an xanmokle periodis ganmavlobaSi damatebiT daniSneT benzodiazepinebi (C).

mkurnalobis xangrZlivoba

pacientebi, romlebic ar ganekuTvnebian suicidis maRali riskis jgufs, saWiroeben monitorings mkurnalobis dawyebidan ori kviris Semdeg da regularulad yovel 2-4 kviraSi pirveli sami Tvis ganmavlobaSi (C);

saSualo da mZime depresiis depresiis mqone pacientebs antidepresantebiT mkurnaloba unda gaugrZeldeT sul mcire eqvsi Tve remisiis dadgomis Semdeg (A);

Tu pacienti itarebs mkurnalobas antidepresantebiT eqvsi Tvis ganmavlobaSi remisiis dadgomidan, saWiroa antidepresantebiT mkurnalobis gagrZelebis sakiTxis ganxilva wina epizodebis raodenobis, depresiis arsebuli narCeni simptomebis da Tanmxlebi fsiqo socialuri garemoebebis gaTvaliswinebiT (C);

pacienti, romelsac uaxloes warsulSi hqonda ori an meti depresiuli epizodi mniSvnelovani funqciuri darRvevebiT, saWiroebs antidepresantebiT mkurnalobas ori wlis ganmavlobaSi. (B).

antidepresantis arCeva

amerikis ojaxis eqimTa akademiis 2009 wlis gaidlainis mixedviT, depresiis mkurnalobaSi upiratesoba eniWeba meore Taobis antidepresantebs (mag: serotoninis ukumitacebis seleqciur inhibitorebs, serotonin-norepinefrinis ukumitacebis inhibitorebs da serotonin-norepinefrinis ukumitacebis seleqciur inhibitorebs);

rutinuli mkurnalobisTvis gamoiyeneba serotoninis ukumitacebis seleqciuri inhibitorebi, romlebsac aqvT Tanabari efeqturoba triciklur antidepresantebTan da naklebad gamoxatuli toqsikuroba dozis gadaWarbebisas, vidre pirveli Taobis antidepresantebs (mag., tricikluri antidepresantebi, monoaminooqsidazas inhibitorebi) (A);

dozulepiniT, fenelziniT, kombinirebuli antidepresantebiT, liTiumis preparatebiT mkurnaloba unda dainiSnos mxolod specialistis mier (C);

antidepresantebis maRali doziT mkurnalobisas aucilebelia maTi toqsikurobis gaTvaliswineba suicidis maRali riskis mqone pacientebSi. mxedvelobaSia misaRebi tricikluri antidepresantebis gamoyenebis maRali riski (lofepraminis

14

garda); magram venlafaqsinic iseve safrTxiloa, rogorc sxva msgavsi efeqturobis medikamentebi, romlebic rekomendebulia rutinuli gamoyenebisaTvis pirveladi jandacvis doneze (C).

antidepresantebiT mkurnalobisas aucileblad unda iyos gaTvaliswinebuli sxva medikamentebTan urTierTqmedeba (gansakuTrebiT, rodesac daniSnulia fluoqsetini, fluvoqsamini, paroqsetini, tricikluri antidepresantebi an venlafaqsini) (C);

antidepresantebis didi doziT gamoyenebisas an ori medikamentis kombinaciisas, SesaZloa ganviTardes serotoninuli sindromi.A

serotoninuli sindromi

kuWnawlavis mxriv _ muclis kolika da buybuyi, meteorizmi, gulisreva, iSviaTad - Rebineba, diarea;

cns-is mxriv: tremori, dizarTria, akatizia, hiperrefleqsia, kunTovani hipertonusi, mioklonuri SekrTomebi (iwyeba terfSi da vrceldeba mTel sxeulSi), SesaZloa ataqsia da kordinaciis darRveva;

gul-sisxlZarRvTa sistema: arteriuli wnevis momateba, taqikardia (serotononergiuli antidepresantebi, Cveulebriv, bradikardias iwveven);

mdg-is damZimebisas: fsevdomaniakaluri sindromi, metyvelebis gaZneleba, ideaTa rbola, Zilis darRveva, hiperaqtiuroba, abneva da dezorientacia;.

terminaluri stadia Zalian waagavs avTvisebian neirolefsiur sindroms _ maRali temperatura, profuzuli ofli, niRbiseburi, gapoxili saxe;

simptomebi qreba sumsi-s dozis Semcirebis an moxsnis Semdeg. mkurnaloba mZime SemTxvevebSi _ ciproheptadini 16-32 mg dReSi; beta-blokerebi; detoqsikacia, simptomuri Terapia;

sikvdili viTardeba mwvave kardio_vaskuluri ukmarisobis gamo.

antidepresantebis moxsna an dozis Semcireba

antidepresantebis moxsnis, dozis Semcirebis an dozis gamotovebis dros SesaZloa ganviTardes e.w. moxsnis simptomebi. es simptomebi, Cveulebrivad, sustad gamoxatulia, magram SesaZloa hqondes mZime gamovlineba, gansakuTrebiT Tu medikamentebis moxsna moxda uecrad. pacienti aucileblad unda iyos informirebuli amis Sesaxeb (C);

urCieT pacients, medikamenti miiRos eqimis daniSnulebis Sesabamisad, gansakuTrebiT naxevardaSlis xanmokle periodis mqone medikamentebi (paroqsetini da venlafaqsini) (C);

15

antidepresantebis doza SeamcireT TandaTanobiT, oTxi kviris ganmavlobaSi; fluoqsetinis SemTxvevaSi dozis Semcireba SeiZleba ufro mokle periodis ganmavlobaSi (C).

antidepresantebis ,,moxsnis sindromi”

maoi tca sumsi

simptomebi

aJitacia, ataqsia gamRizianebloba, aSlilobis gamwvaveba, insomnia, somnolencia, koSmaruli sizmrebi, kognituri darRvevebi, gaugebari metyveleba, iSviaTad _ halucinacia, bodva

gripismagvari simptomebi _ Semcivneba, mialgia, hiperhidrozi, Tavis tkivili, gulisreva,D uZiloba an mZafri sizmrebi. iSviaTad viTardeba mania da kardialuri ariTmia

gripismagvari simptomebi, ,,eleqtro Sokismagvari” SegrZnebebi, insomnia an uzomo Zilianoba, Tavbruxveva, gaRizianebuloba, wamoyvirebebi. iSviaTad _aSlilobis gamwvaveba, yuradRebis koncentraciis da mexsierebis problemebi

xSirad iwvevs xanmokle naxevardaSllis periodis mqone antidepresanti

tranilcipromini amitriptilini imipramini

paroqsetini venlafaqsini

saSualo da mZime depresiis sawyisi mkurnalobis uefeqtobis

SemTxvevaSi:

daazusteT, itarebda Tu ara pacienti medikamentur mkurnalobas regularulad da daniSnuli dozis mixedviT;

Tu antidepresantebis standartuli doziT miRebisas ara gvaqvs adekvaturi Sedegi da ar aris gamoxatuli gverdiTi efeqtebi, gazardeT doza TandaTanobiT, sqemis mixedviT (C);

SecvaleT antidepresanti, Tu mkurnalobis dawyebidan erTi Tvis Semdeg adevaturi Sedegi ara gvaqvs (C);

rodesac erTi antidepresanti meore antidepresantiT icvleba, mizanSewonilia araefeqturi an dabali tolerantobis mqone antidepresantis dozebis TandaTanobiT Semcireba da axali preparatiT TandaTanobiTi Canacvleba (C);

erTi antidepresantis meoriT Secvlis SemTxvevaSi gaiTvaliswineT wamalTSorisi urTierTqmedeba da serotoninuli sindromis ganviTarebis riski, rodesac daniSnulia serotonergiuli antidepresantebis kombinacia (C);

16

depresiis rezistentuli, atipuri da fsiqozuri formebis SemTxvevaSi saWiroa referali specialistTan.

sxvadasxva tipis depresiis mkurnaloba

atipuri depresia

atipuri depresiis samkurnalod gamoiyeneba serotoninis ukumitacebis seleqciuri inhibitorebi. maTi uefeqtobis SemTvevaSi rekomendebulia fenelzinis daniSvna (C);

Tu mkurnalobis Sedegi ar aris adekvaturi da gamoxatulia funqcionirebis mniSvnelovani darRveva, saWiroa referali specialistTan (C);

yvela pacienti, romelic itarebs mkurnalobas fenelziniT, saWiroebs mkacr monitorings, arteriuli wnevis kontrols da wamalTSorisi urTierTqmedebebis gaTvaliswinebas (C).

qronikuli depresia—disTimia

rekomendebulia antidepresantebis da fsiqoTerapiis kombinacia (C);

qronikuli depresiiT daavadebuli mamakacebisTvis, romelTa mkurnaloba uefeqtoa serotoninis ukumitacebis seleqciuri inhibitorebiT, rekomendebulia tricikluri antidepresantebiT mkurnaloba (C);

mamakacebSi maTi gverdiTi efeqtebi naklebad aris gamoxatuli (C);

aseTi pacientebisaTvis rekomendebulia `klinikebis” mowyoba (yovelkvireuli Sexvedrebi 2-6 Tvis ganmavlobaSi), rogorc damatebiTi RonisZieba farmakologiur da fsiqoTerapiul

mkurnalobasTan erTad. rekomendebulia reabilitaciuri

mkurnaloba umuSevari pacientebisaTvis da maTTvis, vinc didi xania CamoSorda socialurad aqtiur cxovrebas (C).

rezistentuli depresia

rezistentuli depresiis mqone yvela pacientisTvis rekomendebulia antidepresantebiT mkurnalobis da fsiqoTerapiis kombinacia (fsiqoTerapiis 16-20 seansi yovel 6-9 TveSi) (B);

rekomendebulia rezistentuli depresiis mqone pacientebis referali specialisTTan.

fsiqozuri depresia

fsiqozuri depresiiT daavaebuli pacientebisaTvis naCvenebia damatebiTi mkurnaloba antifsiqozuri medikamentebiT. rekomendebulia referali specialistTan.

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orsulTa depresia

depresiis insidensi orsulebSi naklebia depresiis insidensze mSobiarobis Semdgom periodSi. Ddepresiis diagnostika orsulebSi rTulia, radgan orsulobas xSirad axlavs depresiisTvis damaxasiaTebeli simptomebi, Mmag., cvlilebebi madis, Zilis, libidos mxriv, energiis daqveiTeba. orsulTa depresia ar gansxvavdeba cxovrebis sxva periodSi ganviTarebuli depresiisgan.

orsulobis periodSi msubuqi da saSualo simZimis depresiiis samkurnalod rekomendebulia fsiqoTerapia. zogierT SemTxvevaSi orsuli saWiroebs farmakologiur mkurnalobas. paroqsetini ar gamoiyeneba orsulobis pirvel trimestrSi an im SemTxvevaSi, Tu qali gegmavs orsulobas. orsulobis mesame trimestrSi depresiis samkurnalod serotoninis ukumitacebis seleqciuri inhibitorebis da serotonin-noradrenalinis ukumitacebis inhibitorebis gamoyenebisas unda Sefasdes mkurnalobis riski da sargebeli, radgan axalSobilebSi, romelTa dedebi orsulobis mesame trimestrSi iyenebdnen antidepresantebs, SesaZloa ganviTardes iseTi garTulebebi rogoricaa dispnoe, cianozi, respiraciuli distresi, kvebis gaZneleba, Rebineba, hipoglikemia, gaRizianebadoba, tremori.

mSobiarobis Semdgomi depresia

mSobiarobis Semdgomi depresia uviTardeba qalebis 8—10%-s skriningisaTvis gamoiyeneba edinburgis postnataluri depresiis

skala (ix. `daavadebis diagnozi”) mkurnalobisTvis ZiriTadad rekomendebulia fsiqoTerapia, xolo mZime depresiis, suiciduri azrebis da fsiqozuri simptomebis arsebobisas - medikamenturi mkurnaloba. Uupiratesoba eniWeba serotoninis ukumitacebis inhibitorebis gamoyenebas. laqtaciis periodSi serotoninis ukumitacebis inhibitorebi iTvlebian arCevis preparatebad. arCevis preparatebad iTvleba sertralini da paroqsetini. Ffluoqsetini ar aris rekomendebuli pirveli rigis samkurnalo saSualebad laqtaciis periodSi. axalSobilebSi is iwvevs kolikas, wonis matebis Seferxebas, gaRizianebadobas. Aar aris monacemebi laqtaciis periodSi bupropionis da venlafaqsinis gamoyenebis Sesaxeb.

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antidepresantebis klasifikacia da dozireba

saxelwodeba sawyisi doza

mg/dRe

Terapiuli doza

mg/dRe

maqsimaluri

doza mg/dRe

tricikluri antidepresantebi

amitriptilini 25 75 – 150 300

klomipramini 25 100 – 200 250

doqsepini 25 75 – 150 300

imipramini 25 50 – 150 300

trimipramini 25 50 – 150 200 – 300

dezipramini 25 100 – 200 300

nortriftilini 10-25 75 – 150 300

Taneptini 25 37,5 50

prtriftilini 15 15 – 40 60

serotoninis ukumitacebis seleqciuri inhibitorebi

citaloprami 20 20 – 40 60

fluoqsetini 20 20 – 40 80

fluvoqsamini 50 50 – 200 300

paroqsetini 20 20 – 40 50

sertralini 50 50 – 150 200

sxva qimiuri struqturis antidepresantebi

bupropioni 150 150 - 300 450

venlafaqsini 37,5 75 – 225 375

serotoninis modulatorebi

nefazadoni 200 300 – 500 600

trazodoni 150 300 – 400 400 – 600

mao-s Seuqcevadi inhibitorebi

nialamidi 300 300 – 400 500

fenelzini 45 45 – 75 90

tranilcipromini 30 30 – 40 60

mao-s Seqcevadi inhibitorebi

moklobemidi 150 300 – 600 600

pirazidoli 100 150 – 400 500

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antidepresantebis gverdiTi efeqtebi


(tca)

mao-s

inhibitorebi

(maoi)

serotoninis

ukumitacebis

seleqciuri

inhibitorebi

(sumsi) qolinerguli:

piris simSrale, yabzoba, Sardis Sekaveba, peristaltikis da eakulaciis daTrgunva, akomodaciis darRveva, deliriumi_xSirad moxucebSi kupireba: dozebis Semcireba an moxsna, detoqsikacia. simptomuri Terapia _ prozerini an galantamini 1_4mg kanqveS; fizostigmini 0,5_2mg yovel saaTSi, I/M an kanqveS; pilokarpini 1_2% (Tvalis wveTebi);

igive, rc tca-s dros

kardio-vaskuluri:

• taqikardia, orTostatikuri hipotenzia; saWiroa: dozis Semcireba; kordiamini 2% _1,0mlI/M

• ekg-s darRveva: T kbilis daTrgunva an inversia, QRS segmentis gaxangrZliveba, ariTmia, gamtareblobis darRveva. (xangrZlivi miRebisas _ miokardiumis infarqti da kardiomiopaTia); saWiroa: mk-is Sewyveta; simptomuri Terapia;

taqikardia, orTostatiuri hipotenzia; kupireba: dozebis Semcireba

taqikardia, TA-s momateba saWiroa: dozebis Semcireba

gastro-enterologiuri:

• gulisreva, Rebineba, pirSi mware gemo, nawlavebis peristaltikis darRveva; saWiroa: dozebis Semcireba; _medikamentis ufro danawevrebuli miReba;

siyviTle, hepatiti; kupireba: mkurnalobis Sewyveta

gulisreva, kuWis gadavsebis grZnoba, Rebineba, buybuyi, muclis kolika, diarea, meteorizmi;

hematologiuri:

leikocitozi, leikopenia, eozinofilia, Trombocitopenia; saWiroa: mkurnalobis Sewyveta

centraluri:

sedacia, Zilianoba, sisuste, Tavbrusxveva, nistagmi, ataqsia, dizarTria, paroqsizmuli movlenebi, eqstrapiramiduli simptomebi, wvrilamplitudiani tremori, romelic ar reagirebs qolinolizur preparatebze); saWiroa: _ dozis Semcireba an mkurnalobis Sewyveta; dozis Semcireba+beta blokerebi; fenobarbitali; maniakaluri mdg-is ganviTarebisas saWiroa: mk-is Sewyveta+liTiumi+neiroleptikebi

hipertonuli krizi; koma, sxva preparatebTan. interaqtivobis gamo. smenis da optikuri nervis dazianeba saWiroa: mk-is moxsna

alergiuli:

* qolestatikuri siyviTle, agranulocitozi, (mk-is dawyebidan 1-2 TveSi), dermatovaskuliti, WinWris cieba; saWiroa: mkurnalobis moxsna

dermatovaskuliti arTropaTia, arTriti, limfadenopaTia saWiroa: mk-is moxsna

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sxvadasxva:

• ,,moxsnis sindromi” _ saWiroa medikamentis moxsna 4-6kviris ganmavlobaSi (ix. dafa 6.)

• wonis momateba, libidos daqveiTeba, prolaqtinemia, hipoglikemia

priapizmi, libidos daqveiTeba, anorgazmia, ,,moxsnis sindromi”

prolaqtinemia ,,serotoninuli sindromi”.

7. depresia bavSvebsa da mozardebSi

gaidlainis es nawili exeba exeba bavSvTa da mozardTa asakSi (5-dan 18 wlamde asakobrivi jgufi) pirvelad jandacvaSi depresiis identificirebas, mkurnalobasa da marTvas. gaidlaini ganixilavs daavadebaTa da masTan dakavSirebul mdgomareobaTa saerTaSoriso klasifikaciis meaTe gadaxedvis (ICD-10 World Health Organization 1992)

mixedviT Semdeg mdgomareobebs: depresiuli epizodi (F32), rekurentuli depresiuli epizodi (F33). Ggaidlainis udidesi nawili efuZneba kvlevebs, romlebSic gamoyenebulia msgavsi, Tumca araidenturi klasifikacia (DSM-IV 1994.) - amerikis fsiqiatriuli asiciaciis gonebrivi aSlilobebis diagnistikuri da statistikuri saxelmZRvanelos klasifikacia.

ganmarteba, simptomebi

klinikurad depresia warmoadgens qcevis tipis cvlilebebs, romelic SeiZleba gaerTiandes simptomebis sam did jgufad: cvlileba xasiaTSi, azrovnebasa da aqtivobaSi, romelic pirovnul da /an socialur funqcionirebaze axdens uaryofiT gavlenas.

xasiaTis cvlilebebi Cveulebriv warmodgenilia naRvlianobiT da/an gaRizianebadobiT, rasac Tan axlavs adre sasiamovno da saintereso aqtivobebis mimarT siamovnebis SegrZnebis dakargva.

kognituri cvlilebebi iwveven pacientisaTvis uxerxul azrebs, romlebic ZiriTadad TviTkritikul xasiaTs atareben.

fizikurad depresiis mqone pacientebi naklebad aqtiurebi xdebian, Tumca pasiuroba SeiZleba SeniRbuli iyos SfoTviTa da mRelvarebiT. Mmiuxedavad imisa, rom arsebobs bavSvTa da mozrdilTa depresias Soris bevri msgavseba, arsebobs mniSvnelovani gansxvavebani bavSvebsa da mozardebSi am sami sferos cvlilebebis ganviTarebaSi.

iseve, rogorc mozrdilebSi, bavSvebSic aRiniSneba cvlilebebi xasiaTSi, rac sxvadasxva garemo pirobebSi gansxvavebuli drois ganmavlobaSi persistirebs da gavlenas axdens bavSvis yoveldRiur aqtivobaze. zigierTma bavSvma SeiZleba uaryos, rom is mowyenilia, Tumca zogi aRniSnavs, rom “raRac ar aris xasiaTze”, an gabrazebulia, gabutulia, gaRizianebulia. mozardi gogonebis 15-20% aRniSnavs cxovrebisadmi xalisis SegrZnebis dakargvas.

depresiuli bavSvebis da mozardebis umetesobas aqvs:

TviTSefasebis dabali done;

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socialuri Tu sazogadoebrivi problemebisadmi sakuTari braleulobis SegrZneba;

momavlis uperspeqtivobis SegrZneba;

Civilebi koncentraciis unaris da yuradRebis daqveiTebaze ;

gadawyvetilebis miRebis uunaroba (sakuTar TavSi daurwmuneblobisa da logikurad azrovnebis unaris Sesustebis gamo) ;

TviTbraldebis, sakuTari Tavis dasjis saWiroebis SegrZneba;

mSoblebis ganSorebaSi TviTdanaSaulis SegrZneba;

suiciduri azrebi;

deluziebi da halucinaciebi (Zalze iSviaTad);

fizikuri daRlilobis SegrZneba, apaTia;

motivaciis arqona;

umadoba an piriqiT - gaZlierebuli mada;

Zilis normaluri ritmis darRveva: uZiloba RamiT, momatebuli Zilianoba dRis ganZilze;

“endogenuri daavadebis” simptomebi: daRlilobis SegrZneba diliT, cudi mada, apaTia. fizikuri retardacia da cudi emociuri pasuxi;

Civilebi muclis, Tavis an fexis tkivilze. (bavSvebis 2-10%-Si).

depresiasTan dakavSirebul somatur simptomatikaSi SeimCneva genderuli gansxvaveba. Ggaurkveveli genezis Tavis tkivilis SemTxvevaSi gogonebSi SeiZleba adgili hqondes depresias, xolo gaurkveveli Zval-saxsrovani sistemis mxrivi Civilebis dros depresia orive sqesis bavSvebsa da mozardebSia mosalodneli.

somaturi xasiaTis Civilebi ufro xSiria bavSvTa asakSi, xolo kognituri cvlilebebi, araraobis SegrZneba, TviTSefasebis dabali done da Civilebi koncentraciis unaris daqveiTebaze sWarbobs mozardebSi.

daavadebis mimdinareoba da prognozi

depresiis mqone bavSvTa da mozardTa daaxloebiT 10% pirveli sami Tvis ganmavlobaSi spontanurad ikurneba. danarCen 40% -Si adgili aqvs erTi wlis manZilze spontanur gamojanmrTelebas. depresiis pirveli epizodidan erTi wlis Tavze bavSvTa da mozardTa 50% kvlav klinikurad depresirebuli rCeba, xolo depresiuli epizodidan 24 TvisTvis 20-30%-Si klinikurad vlindeba depresia (Harrington and Dubicka

2001.Goodyer et.al 2003). ar aris cnobili, Tu ramdenad moqmedebs depresiis mkurnaloba misi mimdinareobis xangrZlivobaze, magram arsebobs monacemebi, rom mkurnaloba amcirebs 12 Tveze meti xangrZlivobis depresiis simZimesa da xangrZlivobas.

depresiis yvelaze seriozuli garTuleba suicidia. riski daaxloebiT 3%-ia. aseve aRsaniSnavia dabali akademiuri moswreba da mudmivi sirTule megobrebis SeZenasa da SenarCunebaSi. persistenTuli

22

depresia did daRs asvams pirovnebis fsiqikur sferos. arsebobs mosazrebebi, rom is cvlis Tavis tvinis funqciebs, Tumca damadasturebeli sistemuri kvlevebi ar moipoveba. Gganmeorebadi depresiuli epizodebi zrdis depresiis mimRebobis risks.

pirveli 5 wlis ganmavlobaSi depresiis recidivis riski daaxloebiT 30%-ia. bevr maTgans recidivi mozrdilobis asakSi aReniSneba. ucnobia mkurnalobis gavlena grZelvadian prognozul gamosavalze.

gavrceleba

depresiis gavrceleba (prevalensi) prepubertul asakSi 12 Tvis ganmavlobaSi 1%-s Seadgens, xolo postpubertul mozadrebSi, Sesabamisad, 3%-a. prepubertul asakSi sxvadasxva sqesis warmomadgenlebs Soris Tanafardoba ar gansxvavdeba erTmaneTisagan maSin roca postpubertul mozardebSi prevalentoba sWarbobs gogonebSi.

depresias bavSvTa da mozardTa asakSi xSirad mentaluri sferos sxva problemebic axlavs Tan.

depresiis prevalentoba maRalia specifikur jgufebSi:

skolaSi adaptirebis problema (ufro xSiria mozard gogonebSi);

udisciplinobiT gamowveuli qceviTi sirTuleebi;

Zaladobis, maT Soris gaupatiurebis, msxverpli bavSvebi da mozardebi;

bavSvebi da mozardebi, romlebic regularulad zians ayeneben sakuTar Tavs;

bavSvebi da mozardebi gamudmebuli kamaTiT ojaxSi;

bavSvebi da mozardebi alkoholizmiT da toqsikomaniiT.

etiologia

didi depresiuli aSlilobis mqone bavSvTa da mozardTa 95-%-s aReniSneba xangrZlivi fsiqo-socialuri problemebi:

mudmivi kamaTi da Cxubi ojaxSi, mSoblebis daSoreba-ganqorwineba, ojaxuri Zaladoba, fizikuri Tu seqsualuri Zaladoba; problemebi skolaSi: cudi akademiuri moswreba, gamocdaze CaWra, Tanatolebis mier abuCad agdeba, socialuri izolacia. bavSvTa da mozardTa Zalian mcire nawilSi depresia aRmocendeba uecrad, Zlieri stresoris zemoqmedebis Sedegad.

depresiis etiologiuri faqtorebidan aRsaniSnavia genetikuri, bioqimiuri da endokrinuli, fsiqologiuri, socialuri Dda socioekonomiuri Teoriebi, Tumca sakmarisi mtkicebulebebis ararsebobis gamo vercerTma Teoriam ver moipova popularoba.

D

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depresiis ganviTarebis risk faqtorebi: faqtorTa tipologia

pirovnuli maxasiaTeblebi (ubeduri SemTxveva, postinfeqciuri periodi, finansuri problemebi);

latenturi fsiqologiuri procesebi (imedgacrueba, safrTxe);

personaluri fokusireba (sakuTar Tavze, megobarze, mSobelze);

warmoSoba (TviTinducirebuli, damoukidebeli);

warmoSobis dro da xangrZlivoba;

kontrolirebis xarisxi (TviTkontrolirebadi., arakontrolirebadi);

risk faqtorebis zemoqmedebis asaki (Cvilobis asaki, bavSvobis, pre da postpubertuli periodi).

socialuri riskis faqtorebi: yoveldRiuri movlenebi rac bavSvis kontrolis gareSea da rasac depresiis gamowveva SeuZlia.

ojaxuri riskis faqtorebi: konfliqti bavSvsa da romelime mSobels Soris, Sida konfliqti ojaxSi, mSoblebis ganSoreba, ojaxuri Zaladoba, ojaxis romelime wevris avadmyofoba an gardacvaleba. alkoholizmiT an toqsikomaniiT daavadebuli mSobeli.

megobroba: megobrebis aryola, an maTTan iSviaTi kontaqti. Ralati megobris mxridan (imedgacrueba, Seusabamoba molodinsa da Sedegs Soris).

individualuri riski: depresiisadmi genetikuri winaswarganwyobis arseboba sabolood dadasturebuli ar aris.

temperamenti: emociuri,aqtiuri, mgZnobiare, mtirala bavSvebi ufro midrekilni arian depresiisadmi.

TviTSefasebis dabali done: bavSvi, romelic fiqrobs, rom is arasasurvelia, ar uyvarT mSoblebs. bavSvi araraobis da zedmetobis SegrZnebiT.

fiziologiuri riski: arsebobs ramodenime uaxlesi kvleva depresiis sxvadasxva monoaminebTan (serotnonini) da glukokortikoidebTan (kortizoli) kavSiris Taobaze.

gansakuTrebuli riskis gjufi: fizikuri naklis da SezRuduli gonebrivi SesaZleblobebis, aseve Rrma endokrinuli darRvevebis mqone bavSvebi. autizmisa da aspergeris sindromis mqone bavSvebi.

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riskis klasifikacia

savaraudo xelSemwyobi faqtorebi

serotoninis genis defeqti;

momatebuli dilis kortizolis done;

SeZenili fetaluri infeqciebi;

bavSvisadmi Cvilobis asakSi cudad mopyroba;

dedis postnataluri depresia;

anamnezSi mSoblebis depresia (riski maRalia);

Tavis tvinis daavadeba, maT Soris travma da infeqcia bavSvobis asakSi;

mdedrobiTi sqesi (riski maRalia);

postpubertuli periodi (riski maRalia);

ganqorwinebuli mSoblebis hyola;

mSoblebis qronikuli fsiqikuri daavadeba. savaraudo aqtivatorebi

arasasurveli piradi cxovrebiseuli movlenebi, rac ojaxis wevrebsa da megobrebs Soris porovnebaTaSorisi urTierTobis permanentul Secvlas iwvevs (riski maRalia);

Tavis tvinis mwvave infeqcia;

omi, SimSili, infqcia;

pirovnuli Seuracxyofa;

depresiuli epizodi anamnezSi (riski maRalia);

nevrozuli da emociuri xasiaTis Strixebi (riski maRalia).

sxvadasxva faqtorebi, romelTa roli bolomde garkveuli ar aris:

TviTdamamcirebeli azrebi;

cudi akademiuri moswreba skolaSi;

Tanatolebis mier abuCad agdeba;

Tanxlebi samedicino problemebi;

axlo naTesavis sikvdili;

sayvareli cxovelis sikvdili;

simsuqne.

damcavi faqtorebi:

kargi iumoris grZnoba;

kargi megobrebis qseli;

kargi urTierToba minimum erT ojaxis wevrTan;

TvalsaCino socialuri aqtivoba;

inteleqtis normaluri an maRali done.


pirveladi jandacvis specialistebi momzadebuli unda iyvnen depresiis simptomebis amosacnobad da depresiis ganviTarebis riskis mqone bavSvebisa da mozardebis Sesafaseblad. eqimma unda moaxerxos

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warsuli Tu arsebuli riskis faqtorebis Sefaseba rogoricaa: asaki, sqesi, ojaxuri disharmonia, Tanatolebis mxriv daCagvra, seqsualuri, fizikuri Tu emociuri Zaladoba, Tanxlebi paTologiebi, maT Soris alkoholis moxmareba da toqsikomania, mSoblebis depresia, ramodenime risk faqtoris erTdroulad arseboba, eTnikur-kulturuli Taviseburebebi; aseve, depresiis ganviTerebis maRal riskTan asocirebuli faqtorebi (usaxlkaroba, devniloba, saerTo sacxovrebelSi cxovreba) (C).

pirveladi jandacvis specialistebi unda flobdnen iseTi komunikaciur unar-Cvevebs, rogoricaa aqtiuri mosmena da dialogis warmoebis teqnika, raTa SeZlon mwave danaRvlebisa Tu stresis fazaSi myof bavSvTan (mozardTan) konfidencialuri dialogis warmarTva (kargi klinikuri praqtika).

pirveladi jandacvis specialistebma unda Seafason uaryofiTi garemo da/an socialuri faqtorebis arseboba mwvave danaRvlianebisa Tu stresis fazaSi myofi bavSvebisa da mozardebisaTvis (kargi klinikuri praqtika).

rodesac bavSvi an mozardi aris iseTi uaryofiTi emociuri faqtoris gavlenis qveS, rogoricaa mSoblebis ganSoreba an sxva mwvave, imedis gamacruebeli negatiuri movlena, eqimma unda Sefasos, Tu ramdenad maRalia depresiis ganviTarebis riski am SemTxvevaSi da Sedegi Seatyobinos bavSvis mSobels (meurves) Semdgomi TanamSromlobisaTvis. Sefasebis Sedegi dokumentirebuli unda iyos bavSvis (mozardis) samedicino ruqaSi (C).

rodesac bavSvi an mozardi aris iseTi uaryofiTi emociuri faqtoris gavlenis qveS, rogoricaa danaklisi, mSoblebis ganSoreba an sxva mwvave, imedis gamacruebeli negatiuri movlena da Tu depresiis ganviTarebis riski dabalia, eqimma unda gamoxatos mxardaWera da SesTavazos bavSvs (mozards) am uaryofiT sakiTxze saubari (kargi klinikuri praqtika).

erTi xanmokle uaryofiTi cxovrebiseuli epizodis (danaklisi, mSoblebis ganSoreba an sxva mwvave, imedis gamacruebeli negatiuri movlena) Semdeg bavSvis gadagzavna specialistTan Semdgomi Sefaseba –mkurnalobis mizniT ar aris rekomendebuli, radgan erTi xanmokle uaryofiTi epizodis gavleniT depresiis ganviTarebis albaToba dabalia (C).

rodesac bavSvi an mozardi aris iseTi uaryofiTi emociuri faqtoris gavlenis qveS, rogoricaa danaklisi, mSoblebis ganSoreba an sxva mwvave, imedis gamacruebeli negatiuri movlena da depresiis ganviTarebis riskis Sefasebisas igi maRalia (arsebobs depresiis ganviTerebis 2-ze meti riskis faqtori), mas unda mieces profesionalTan am Temaze saubris SesaZlebloba. depresiis da TviTdazianebis arsebobisas droulad unda ganxorcieldes referali specialistTan (kargi klinikuri praqtika).

rodesac bavSvi an mozardi aris iseTi uaryofiTi emociuri faqtoris gavlenis qveS, rogoricaa danaklisi, mSoblebis ganSoreba an sxva

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mwvave, imedis gamacruebeli negatiuri movlena da ojaxis minimum erT wevrs aReniSneba depresiis mravlobiTi riskis faqtori, maT unda SeeTavazoT aRniSnul uaryofiT movlenaze profesionalTan saubari, unda Sefasdes depresiis arseboba. depresiis da TviTdazianebis SemTxvevaSi saWiroa referali adreul etapze (kargi klinikuri praqtika).

diagnostika

depresia warmoadgens heterogenul diagnostikur kategorias cvalebadi klinikuri sazRvrebiTa Tu klasifikaciis meTodebiT. ICD-

10-is klasifikaciiT depresiis dayofa msubuq, saSualo da mZime xarisxis depresiad klinikuri Rirebulebisaa.

depresiis simptomatika Tavs iCens dilis saaTebSi gaRviZebisas, dRis manZilze simptomatika SeiZleba gaumjobesdes.

depresiuli epizodis doagnostirebis aucilebeli pirobaa:

depresiuli mdgomareobis xangrZlivoba unda iyos ara naklebi ori kvirisa;

anamnezSi ar unda iyos maniakaluri an hipomaniakaluri epizodebi;

epizodi ar unda ukavSirdbodes fsiqoaqtiuri nivTierebis miRebas, sxva fsiqikur an somatur aSlilobas.

ZiriTadi kriteriumebia:

guneb-ganwyobis daqveiTeba;

interesebis da siamovnebis miRebis unaris dakargva;

energiis daqveiTeba aqtivobis daqveiTebiT da daRlilobis SegrZneba.

damatebiTi kriteriumebia:

yuradRebis koncentrirebis unaris daqveiTeba;

sakuTar TavSi rwmenis da TviTSefasebis daqveiTeba;

TviTbraldebis da TviTdamcirebis dausabuTebeli ideebi;

momavlis bundovani da pesimisturi xedva;

xSiri, ganmeorebadi azri an qmedeba TviTdazianebisa da TviTmkvlelobis mizniT;

Zilis darRveva;

madis daqveiTeba. depresiis tipiuri simptomebi:

daqveiebuli guneb-ganwyoba naklebad icvleba garegani faqtorebis zegavleniT da ikavebs dRis umetes nawils;

xasiaTdeba cirkadulobiT;

SesaZlebelia SfoTva, uimedoba da aJitacia ufro metad iyos gamoxatuli, vidre depresia.

27

guneb-ganwyobis daqveiTeba SesaZlebelia SeniRbuli iyos damatebiTi simptomebiT:

gaRizianebebadobiT;

alkoholis Warbi moxmarebiT;

isteriulobiT;

obsesiur-kompulsiuri simptomebiT;

somato-vegetatiuri simptomebiT.

F 32.0 msubuqi depresiuli epizodi klinikur suraTSi warmodgenili unda iyos:

depresiis minimum ori ZiriTadi kriteriumi da

ori damatebiTi kriteriumi mainc;

arc erTi simptomi ar unda iyos gamoxatuli Rrma xarisxSi;

depresiuli epizodis xangrZlivoba unda iyos aranakleb 2 kvirisa. tipuri simptomebia:

guneb-ganwyobis daqveiTeba;

interesebis dakargva da anhedonia;

ioli daRla. me-5 niSnis gamoyeneba SesaZlebelia somaturi sindromis aRsaniSnavad: FXX. X0 _ somaturi simptomebis gareSe; FXX. X1 _ somaturi simptomebiT

akmayofilebs msubuqi depresiuli epizodis kriteriumebs;

da Tan axlavs 4 an meti somaturi simtomi an

Tan axlavs 2 an sami mZime somaturi simptomi. msubuqi depresiuli epizodis dros, miuxedavad siZneleebisa, fsiqosocialuri funqcionireba SenarCunebulia. F32. 1 _ zomierad gamoxatuli depresiuli epizodi

ZiriTadi kriteriumebidan minimum oris arseboba;

ZiriTad kriteriumebTan erTad 4-5 damatebiTi kriteriumis arseboba. me-5 niSanis gamoyeneba SesaZlebelia somaturi sindromis aRsaniSnavad: FXX. X0 _ somaturi simptomebis gareSe; FXX. X1 _ somaturi simptomebiT

akmayofilebs zomieri depresiuli epizodis kriteriumebs;

da Tan axlavs 4 an meti somaturi simtomi an

Tan axlavs 2 an 3 mZime somaturi simptomi. fsiqo-socialuri funqcionireba zomieri depresiuli epizodis dros mniSvnelovnad gaZnelebulia. F32. 2 mZime depresiuli epizodi fsiqozuri simptomebis gareSe mniSvnelovnadaa gamoxatuli:

mousvenroba da aJitacia an SesaZlebelia Sekaveba;

sakuTari arasrulfasovnebis, TviTdanaSaulis da TviTbraldebis azrebi;

maRalia suiciduri riski;

mudmivia somato-vegetatiuri simptomebi.

D

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diagnostikuri kriteriumebi:

saerTo sami ZiriTadi kriteriumidan samive saxezea;

ZiriTad kriteriumebTan erTdroulad arsebobs aranaklebi 4 damatebiTi kriteriumi, romelTagan nawili mZime xarisxiT aris warmodgenili;

depresiuli epizodi grZeldeba aranakleb 2 kvirisa;

mwvave dasawyisis da simptomebis gansakuTrebuli simZimisas, dasaSvebia mZime depresiuli epizodis diagnostireba 2 kviraze adre.

mZime depresiuli epizodis dros avadmyofis fsiqo-socialuri funqcionireba mkveTrad SezRudulia.

F32. 3 mZime depresiuli epizodi fsiqozuri simptomebiT

Seesabameba mZime depresiuli epizodis (F32. 2), kriteriumebs, romelsac Tan erTvis:

bodviTi ideebi, ufro xSirad TviTbraldebis, TviTdanaSaulis codvianobis, danaklisis Sinaarsis;

smeniTi an ynosviTi halucinaciebi _ xmebi, romlebic adanaSauleben da Seuracxyofas ayeneben an gaxrwnili xorcis da sibinZuris suni;

depresiuli stupori _ mZime motoruli Sekaveba SeiZleba stuporSi gadaizardos.

Tu arsebobs amis saWiroeba, bodva da halucianacia SeiZleba ganisazRvros, rogorc F

F32. 30 _ wamyvani afeqtis kongruentuli an F32. 31 wamyvani afeqtis arakongruentuli

fsiqozuri depresia (didi depresiuli aSliloba asocirebuli halucinaciebTan an deluziebTan) SeiZleba Segvxvdes bavSvebsa da mozardebSic. prepubertuli asakis bavSvebSi ZiriTadad xSiria smeniTi halucinaciebi, Tumca mozardebSi SeiZleba Segvxvdes rogorc deluziebi, aseve halucinaciebi. fsiqozuri depresia asocirebulia ufro mwvave depresiasTan, xangrZliv avadobasTan, recidivis warmoqmnis maRal albaTobasTan, bipolarul aSlilobasTan da suicidTan. fsiqozuri simptomebis arseboba antidepresantebiT adreul etapze mkurnalobis saWiroebis indikatoria, Tumca aseve antidepresantebiT monoTerapiis resiztentobis indokatoric SeiZleba iyos.

29

didi depresiuli aSlilobis diagnostikuri kriteriumebi (DSM-IV 1994.)

amerikis fsiqiatriuli asociaciis gonebrivi aSlilobebis diagnostikuri da statistikuri saxelmZRvanelos mixedviT

mozrdilebi bavSvebi da mozardebi

a) qvemoT mocemuli simptomebidan 5 an meti aRiniSneba minimum 2 kviris manZilze da pirovnebis funqcionireba adrindel mdgomareobasTan SedarebiT, Secvlilia. am simptomTagan minimum erTi mainc aris 1) depresiuli ganwyoba an 2) interesis an siamovnebis SegrZnebis dakargva 1) depresiuli ganwyoba TiTqmis mTeli dRis manZilze, TiTqmis yoveldRe, rac aRiniSneba subieqturad pacientis (Tavs grZnobs mowyenilad, an dacarielebulad) an garSemomyofTa mier (xSirad SeumCneviaT acremlebuli)

Gganwyoba SeiZleba iyos depresiuli an aRiniSnebodes gaRizianebadoba. M moumwifebeli kognitur-lingvisturi SesaZleblobebis mqone bavSvebisaTvis rTulia Sinagani ganwyobis gadmocema, amitom Civilebi SeiZleba warmodgenil iyos gaurkveveli xasiaTis fizikuri SegrZnebebiT. naRvliani saxis gamometyveleba, susti TvalebiT kontaqti. gaRizianebadoba SeiZleba gamoxatuli iyos mousvenrobiT an mtruli, agresiuli qmedebebiT. mozardebSi SeiZleba aRiniSnos mozrdilebis msgavsi ganwyobis cvlilebebi.

2)yvelafrisadmi an TiTqmis yvelafrisadmi daqveiTebuli interesi an siamovnebis SegrZnebis dakargva yoveldRe an TiTqmis yoveldRe, rac SeigrZnoba rogorc subieqturad, aseve garSemo myofTa mier.

TanatolebTan TamaSis an saskolo aqtivobebSi monawileobis miRebis interesis dakargva.

3)wonaSi mniSvnelovani kleba dietis dacvis gareSe an mniSvnelovani mateba (sxeulis masis 5%-is cvlileba erTi Tvis ganmavlobaSi), an madis mniSvnelovani momateba/umadoba yoveldRe an TiTqmis yoveldRe.

bavSvebSi ufro xSiria wonaSi matebis SeCereba, vidre wonaSi dakleba

4) insomnia-uZiloba an hipersomnia TiTqmis yovelDdRe

Mmsgavsad mozrdilebisa

F5) fsiqomotoruli aJitireba an Sekaveba TiTqmis yoveldRe (sxvebis dakvirvebis safuZvelze da ara ubralod subieqturi mousvebrobisa an Senelebulobis SegrZneba )

guneb-ganwyobis cvlilebebTan erTad SeiZleba aRiniSnos hiperaqtiuri qceva.

6) daRliloba an energiis arqona TiTqmis yoveldRe

daRlilobaze mimaniSnebel simptomebad SeiZleba CaiTvalos TanatolebTan TamaSisagan gamoTiSva, skolaSi siarulze uaris Tqma da skolis gacdena.

30

mozrdilebi bavSvebi da mozardebi

7) sakuTari araraobis SegrZneba an gadametebuli da Seusabamo TviTdadanaSauleba yvelaferSi (deluziis CaTvliT). TviTdadanaSauleba cudad yofnaSi.

bavSvebSi vlindeba sakuTari Tavis damcirebis tendenciebi: ”me suleli var,” “me araferi vici” da a.S. deluziebi Cveulebriv ar aRiniSneba.

8) fiqrisa da koncentrirebis, aseve gadawyvetilebis miRebis daqveiTebuli unari TiTqmis yoveldRe (aRiqmeba subieqturad an fiqsirdeba garSemo myofTa mier)

yuradRebis da koncentraciis problemebi SeiZleba gamoixatos skolaSi cudi daswrebisa da cudi yofaqcevis saxiT.

9) mudmivi fiqri sikvdilze (ara ubralod sikvdilis SiSi), mudmivi suiciduri ideebi raime konkretuli gegmiT an mis gareSe an suicidis mcdeloba.

SeiZleba arsebobdes potenciuri suicidis mimaniSnebeli specifikuri araverbaluri qcevebi: mag. sayvareli nivTis, koleqciis gaCuqeba.

b) simptomebi ar akmayofilebs Sereuli bipolaruli aSlilobis kriteriumebs

msgavsad mozrdilebisa simptomebi ar akmayofilebs Sereuli bipolaruli aSlilobis kriteriumebs

g) simptomebi mniSvnelovan gavlenas axdenen pacientis socialur, samsaxureobriv Tu sxva mniSvnelovan funqciur aqtivobaze

klinikurad saxezea mniSvnelovani socialuri Tu saskolo aqtivobis moSla. momuSave mozardebSi aRiniSneba samsaxureobrivi problemebi

d) simptomebi ar aris gamowveuli pirdapiri fsiqozuri moqmedebis mqone nivTierebebiT (sxvadasxva medikamenti, toqsikomania) an samedicino mdgomareobiT (mag., hipoTireozi)

Mmsgavsad mozrdilebisa

e)simptomebi ar aris gamowveuli mZime danaklisiT (mag., sayvareli adamianis dakargviT). simptomebi persistirebs 2 Tveze meti da xasiaTdeba mniSvnelovani funqciuri darRveviT:Lgadametebuli araraobis da ususurobis SegrZnebiT, suiciduri ideebiT, fsiqozuri simptomebiT an fsiqomotoruli retardaciiT.

mwvaved gamoxatuli didi depresiuli epizodis dros SeiZleba arsebobdes fsiqozuri simptomebic, romlebic ufro metad smeniTi halucinaciebis saxes atareben da TviTkritikuli Sinaarsisani arian.

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depresiis sadiagnozo taqtika eqimebisaTvis

SekiTxva qmedeba

xom ar aris aRniSnuli mdgomareoba gamowveuli bavSvis (mozardis) zogadi janmrTelobis mgdomareobiT, medikamentebiT an orive faqtoriT erTad?

gamoricxe depresiuli qceviTi aSlilobis sxva mizezebi

xom ar aris aRniSnuli mdgomareoba dakavSirebuli alkoholis an aralegaluri medikamentis (toqsikomania) gamoyenebasTan?

gansazRvre konkretul SemTxvevaSi depresia meoradia, Tu TviT pirveladi depresia aris garTulebuli toqsikomaniiTa da/an alkoholis gamoyenebiT

dakavSirebulia Tu ara depresia cxovrebiseul stresTan?

moiazre adaptaciuri aSliloba

xom ar aris aRniSnuli qronikuli, msubuqi xarisxis depresia?

moiazre disTimia

aris Tu ara es sxva tipis depresia? moiazre bipolaruli aSliloba, sezonuri afeqturi aSliloba an atipuri depresia

aris es didi depresia? ixile DSM-IV klasifikaciis Skala, Seafase fsiqoturi simptomebi

aris Tu ara sxva Tanmxlebi mentaluri daavadeba?

ტოქსიკომანია, moiazre disTimia, afeqturi aSliloba, yuradRebis deficitisa da hiperaqtivobis sindromi, opoziciur-demonstratiuli aSliloba, disTimia

saxifaToa depresia? Seafase suicidis riski

suicidis riskis Sefaseba

pirvelive vizitis dros eqimma unda Seafasos suicidis riski depresiis mqone yvela pacientSi da SeimuSavos mkurnalobis yvelaze Sesaferisi strategia. depresiuli aSliloba warmoadgens suicidebis yvelaze xSir mizezs. aSS-Si Tineijerebis (13-19 wlis mozardebi) 20% fiqrobs suicidze da 8%-s aqvs suicidis mcdeloba. 2000 wlis aSS-is statistikiT suicidi 10-19 wlis mozardebSi sikvdilobis mesame mizezi iyo.

pacientis mxridan sucidze nebismieri saxis saubari seriozulad unda iyos miCneuli.

pacientis Sefasebisas gaTvaliswinebuli unda iyos sucidis maRali riskis da piriqiT, misgan damcavi faqtorebi. suicidis maRali riskis mqone pacientebis referali unda moxdes bavSvTa da mozardTa fsiqikuri janmrTelobis specialistTan.

dasaSvebia dabali riskis da suicidisagan damcavi faqtorebis (Tbili, Sekruli, mosiyvarule ojaxi, pacientis maRalreligiuroba, pozitiuri

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samomavlo perspeqtivebi) mqone pacientebis ambulatoriulad mkurnaloba.

mSobeli (meurve), Tu ojaxis danarCeni wevri gafrTxilebul unda iqnen, bavSvisaTvis (mozardisTvis) misi cxovrebis aseT kritikul periodSi sxvadasxva saxis medikamentebis, asafeTqebeli nivTierebebis, mWreli sagnebis Tu cecxlsasroli iaraRis miuwvdomlobis Taobaze.

bavSvis mSobeli (meurve) aseve informirebuli unda iyos antidepresantebiT mkurnalobis dawyebis dros suicidis maRali riskis arsebobis Taobaze.

suicidis riskisa da damcavi faqtorebis sqema bavSvebsa da mozardebSi.

maRali riski dabali riski an damcavi faqtori

biodemografiuli monacemebi: asaki: gviani mozardobis periodi 20 wlis CaTvliT (20% fiqrobs suicidze, 8% cdilobs Caidinos suicidi) sqesi: suicidis mcdeloba da ideebi maRalia gogonebSi, Tumca ganxorcielebuli suicidi xuTjer metia vaJebSi. eTnikuri warmomavloba: riski maRalia TeTrkanianebSi da laTinoamerikuli warmoSobis pirebSi, SedarebiT naklebia SavkanianebSi da yvelaze mcirea yviTelkanianebSi

Savkaniani, mdedrobiTi sqesis bavSvi (mozardi)

anamnezuri monacemebi: didi depresia: suicidis riski 12-jer maRalia orive sqesis bavSvsa da mozardSi, gansakuTrebiT Tu erT-erTi simptomia uimedoba toqsikomania: riski matulobs 2-jer ქცევითი აშლილიბა qceviTi aSliloba vaJebSi suicidis 1/3 qceviT aSlilobasTan aris dakavSirebuli.suicidis riski izrdeba daaxloebiT 2-jer stresorebis arseboba an danaklisi (problemebi skolaSi, romatikuli urTierTobis gawyveta, arasasurveli orsuloba, problemebi samarTaldamcavebTan Zlieri xangrZlivi damcireba sxvebis mier) fizikuri da seqsualuri Zaladoba minimaluri komunikacia mSoblebTan

amJamad ar aRiniSneba depresia toqsikomania da alkoholis Warbad moxmareba amJamad ar aRiniSneba. saxezea garemosTan adaptaciiisa da problemebis gadawyvetis kargi unari stresorebisa Tu danaklisis arseboba amJamad ar aRiniSneba Sekruli da damxmare ojaxi da Tbili pozitiuri damokidebuleba mSoblebTan mSoblebis unari mxarSi amoudgnen da Tan zedamxedveloba moaxdinon bavSvze (mozardze) misTvis kritikul momentebSi anamnezSi fizikuri Tu seqsualuri Zaladobis ararseboba Rrma religiuri rwmena.

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suicidis riskisa da damcavi faqtorebis sqema bavSvebsa da mozardebSi.

maRali riski dabali riski an damcavi faqtori

pozitiuri Sexeduleba momavalze, konkretuli pozitiuri gegmebiT garkveviT ayalibebs im mizezebs, ratomac unda icocxlos, suicidisadmi ambivalenturoba.

suiciduri qceva anamnezSi suiciduri azrebi suiciduri gegmiT: sityvierad saubrobs specialuri gegmis arsebobaze, aseve saxezea suicidis savaraudo gegmis araverbaluri ekvivalentebi (mag. sayvareli nivTebis gaCuqeba) sucidis mcdeloba anamnezSi: suicidis erT-erTi udidesi prediqtoria suicidis ojaxuri anamnezi cecxlsasrol iaraRisa da toqsinebis xelmisawvdomoba

suiciduri Sinaaris azrebi ar aRiniSneba. ar aris suicidze mimaniSnebeli araverbaluri ekvivalentebi. ar aris suicidis mcdeloba anamnezSi.

ar aris suicidis ojaxuri anamnezi cecxlsasroli iaraRi da toqsinebi ar aris xelmisawvdomi

mavne gavlena: televizorSi, internetSi, cnobili porovnebis “varskvlavis” TviTmkvlelobis ambavi suiciduri qcevis imitaciuri TamaSebi suicidi skolaSi, sacxovrebel ubanSi

mocemuli momentisaTvis mediaSi da bavSvis irgvliv socialur garemoSi ar moipoveba suicidis Semcveli informacia.

D

diferenciuli diagnozi

pirveladi depresiuli aSlilobis diagnozi eqimisagan yuradRebas da daxelovnebas moiTxovs, radgan diferenciuli diagnozi unda gatardes sxvadasxva mentalur Tu organul daavadebebTan. Aaseve aRsaniSnavia informaciis mopovebis sirTule bavSvebSi. maT uWirT simptomebis gadmocema rogorc eqimisTvis aseve sakuTari mSoblebisTvis. amasTan, Tvalcremlianoba da mtiraloba yovelTvis ar warmoadgens depresiaze mimaniSnebel simptoms.

depresiis sadifereniciacio sxvadasxva samedicino mdgomareobebia:

endokrinopaTiebi (hipoTireozi);

avTvisebiani simsivneebi;

qronikuli daavadebebi;

infeqciuri mononukleozi;

anemia;

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vitaminebis deficiti (gansakuTrebiT folis mJava);

samedicino daniSnulebiT miRebuli medikamentiT gamowveuli depresia (mag, izotretinioni).

Tu saxezea CamoTvlili mizezidan romelime, maSin ismeba meoradi depresiuli aSlilobis an samedicino mdgomareobiT gamowveuli depresiuli qceviTi aSlilobis diagnozi.Tu mdgomareobis mkurnalobis an gamomwvevi medikamentis moxsnis Semdeg depresia mainc rCeba, pacienti Semdgom kvlevas saWiroebs.

Tu saxezea toqsikomania, maSin depresiis diagnozis dasma xdeba preparatis moxmarebis remisiis fazaSi.

depresiis diferenciuli diagnozi unda gatardes sxvadasxva mentalur problemebTanac:

adaptacuri aSliloba;

atipuri depresia (hipersomnia, momatebuli mada da naxSirwylebis didi raodenobiT moxmareba, wonaSi mateba, mgrZnobiaroba pirovnebaTaSoris urTierTobebSi, simZimis SegrZneba xel-fexSi, reaqtiuli, mtruli ganwyoba);

sezonuri afeqturi aSliloba;

bipolaruli aSliloba;

obsesiur kompulsiuri aSliloba;

kvebiTi aSliloba.

sxvadasxva kvlevebis mixedviT depresias Tan axlavs sxva mentaluri problemac.

klinikuri rekomendaciebi

eqimebma, romelTac aqvT Sexeba depresiis mqone pacientis gamovlena, Sefasebasa da mkurnalobasTan, unda moaxerxon pacientisTvis, misi mSoblis (mSoblebisTvis) an meurvisaTvis Sesabamisi informaciis Sesaferis dros miwodeba. informacia unda iyos asakis Sesaferisi da unda Seexebodes depresiis bunebas, mis mimdinareobas, mkurnalobas da medikamentis daniSvnisas, mis SesaZlo gverdiT efeqtebs. (kargi klinikuri praqtika)

depresiis mkurnalobaSi monawile eqimma dro unda dauTmos pacientTan da mis mSobelTan (meurvesTan) damxmare, megobruli urTierTobis Camoyalibebas. (kargi klinikuri praqtika)

mkurnalobis dawyebamde eqimma unda moaxerxos aqtiurad CarTos pacienti da misi mSobeli (meurve) mkurnalobis meTodis amorCevaSi, gaarkvios ra molodinebi aqvs Tavad pacients da mis mSobels (meurves) da maTgan gaazrebuli informirebuli Tanxmoba moipovos (kargi klinikuri praqtika).

sxvadasxva eTnikuri warmoSobis pacientTan da mSoblebTan urTierTobisas, eqimma unda gaiTvaliswinos eTnikuri Taviseburebebi. enobrivi barieris dros sasurvelia pacients da mis mSoblebs

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(meurves) informacia mSobliur enaze miewodos. (kargi klinikuri praqtika)

depresiis sadiagnozo kiTxvarebi

specialuri kiTxvaris Sevseba bavSvebSi (mozardebSi) depresiis sadiagnozod gamoyenebadi yvelaze gavrcelebuli meTodia. bavSvs Txoven upasuxos SekiTxvebs da gadmosces Tu rogor grZnobs Tavs da raze fiqrobs bolo ori kviris ganmavlobaSi. kiTxvarebSi gansakuTrebuli aqcenti gakeTebulia didi depresiis gamomJRavnebaze.

mozrdilebSi depresiis sadiagnozod gamoyenebadi bekis kiTxvari ar gamodgeba bavSvebSi am ukanasknelTa arasakmarisi leqsikuri mzaobis gamo. Ddabalia kiTxvaris mgrZnobeloba da specifikuroba ufrosi asakis mozrdilebSic.

bavSvTa depresiis kiTxvari Childrens depression Inventory CDI gamiyeneba 12 wlamde asakis bavSvebSi sadiagnozod, Tumca monacemebi kiTxvaris mgrZnobeloba specifikurobaze aradamakmayofilebelia. zogierTi kvlevis mixedviT kiTxvari safuZvlianad ver ansxvavebs depresiis mqone da armqone bavSvebs da SesaZloa disforiuli aSlilobis sadiagnozod ufro gamodgebodes.

ganwyobisa da SegrZnebebis kiTxvari Mood and feeling Questionnaire (MFQ) gamoiyeneba 8-17 wlis asakis bavSvebsa da mozardebSi depresiis sadiagnozod. mas gaaCnia bavSvisa da mSoblis forma da kargi diagnostikuri validurobiT xasiaTdeba. kiTxvari Seswavlilia klinikuri epidemiologiuri kvlevebiTac, Tumca igi ver afasebs suiciduri ideebis arsebobas.

reinoldsis mozardTa depresiis Skala Reynolds Adolescent Depression Scale

(RADS) gankuTvnilia 13-18 wlis mozardTaTvis.Skala xasiaTdeba sandoobiTa da validurobiT, Tumca zogierTi kvlevis mixedviT SemTxvevaTa 30%-Si Skala cru uaryofiT Sedegs iZleva.

epidemiologiuri kvlevebis centris depresiis Skala (CES-D) Seqmnili iyo mozrdilebSi da nawilobriv mozardebSi depresiis sadiagnozod. kvlevemba aCvena, mozardebSi Skalis gamoyenebis bevri susti mxare. CES-D warmatebiT gamoiyeneba Sinagani SfoTvis sadiagnozod.

kuCeris mozardTa depresiis Skala Kutcher Adolescent Depression Scale(KADS)

xasiaTdeba kargi sandoobiTA da maRali mgrZnobeloba specifikurobiT. Skala eqvs punqtiania da warmoadgens depresiis gamosaricx advilad sawarmoebel kiTxvars.

arsebobs depresiis sadiagnozo sxva kiTxvarebic, Tumca zemoT moxseniebuli maTganni yvelaze meti sandoobiT xasiaTdebian. bavSvTa naxatebiT depresiis diagnostika porveladi jandacvis sferoSi depresiis pirveladi diagnostikisaTvis naklebad gamoyenebadi meTodia. misi gamoyeneba moizreba bavSvTa da mozardTa depresiis marTvis Semdgom etapze mgdomareobis Sesafaseblad.

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mkurnaloba

fsiqologiuri mkurnaloba

arsebobs bavSvTa da mozardTa asakSi depresiis mkurnalobis fsiqologiuri meTodebi. maTi klinikuri efeqturoba meTodisa da kvlevebis mixedviT gansxvavebulia. yvelaze farTod gamoyenebadi meTodebia:

kognitur-bihevioruli Terapia;

kognitur-bihevioruli Terapia calke mSoblis seansiT;

interpersonaluri fsiqoTerapia;

fsiqoanalizur/fsiqodinamiuri bavSvTa fsiqoTerapia;

TviT-modelireba;

TviT relaqsacia;

socialuri unarebis treningi;

marTuli TviT Terapia;

kontrolis gamaZlierebeli Terapia;

kontrolis jgufebi (ara direqtuli TanadgomiTi Terapia, Terapiuli Tanadgomis jgufi, standartuli mzrunveloba, klinikuri menejmenti, bihevioruli problemis gadawyveta, cxovrebiseuli unarebis gamomuSaveba).


Tu msubuqi xarisxis depresiis mqone bavSvs an mozards ar surs raime samedicino Careva da Tu eqimis daskvniT misi gankurneba Carevis gareSec SesaZlebelia, Semdgomi Sefaseba unda moxdes ori kviris ganmavlobaSi e.w. “fxizeli lodini” (C);

Tu depresiis mqone bavSvi an mozadi ar gamocxaddeba ganmeorebiT vizitze mgdomareobis Sesafaseblad, eqimi Tavad unda daukavSirdes mas (C);

4 kviramde “fxizeli lodinis” Semdeg yvela msubuqi xarisxis depresiis da Tanmxlebi daavadebebis ar mqone bavSvs da mozards romelTac ar aReniSnebaT suiciduri ideebi, unda SesTavazon xanmokle (daaxloebiT 2-3 Tve) ara direqtiuli TanadgomiTi Terapia, jgufuri kognitur-bihevioruli Terapia an marTuli TviT daxmareba. Yyvela meTodi unda ganaxorcielos am sferoSi kvalificirebulma specialistma (B);

msubuqi xarisxis depresiis mqone bavSvebi da mozardebi romlebic ar daemorCilebian ara direqtiul TanadgomiT Terapias, jgufur kognitur-biheviorul Terapias an marTul TviT daxmarebas gadagzavnili unda iyvnen bavSvTa da mozardTa fsiqiuri janmrTelobis specialistTan Sesafaseblad (kargi klinikuri praqtika);

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saSualo da mZime xarisxis depresiis mqone bavSvebi da mozardebi gadagzavnili unda iyvnen bavSvTa da mozardTa fsiqiuri janmrTelobis specialistTan Sesafaseblad (B);

saSualo da mZime xarisxis depresiis mqone bavSvebs da mozardebs unda SesTavazon pirveli rigis mkurnaloba, specifiuri fsiqoligiuri Terapia (individualuri kognitur bihevioruli Terapia, interpersonaluri Terapia an xanmokle kursiT ojaxuri Terapia). mkurnaloba savaraudod 3 Tve unda gagrZeldes (B);

bavSvebisaTvis da mozardebisaTvis fsiqologiuri Terapiis mimwodebeli unda iyos bavSvTa da mozardTa fsiqikuri janmTelobis sferoSi kvalificirebuli specialisti (B);

fsiqologiuri mkurnalobis warmmarTveli specialisti unda TanamSromlobdes bavSvisa Tu mozardis ojaxis wevrebTan. Tu amis ganxorcieleba ver xerxdeba, ojaxis wevrebTan sxva secialistma unda imuSavos (C);

bavSvisa Tu mozardis sxva Tanmxlebi daavadebebi, socialuri Tu ganaTlebismxrivi problemebi Sefasebuli da marTuli unda iyos am saqmeSi kompetenturi specialistebis mier (B);

yuradRebiT unda Sefasdes bavSvis (mozardis) mSoblebis fsiqikuri janmrTelobis mdgomareoba (gansakuTrebiT depresia) da saWiroebis SemTxvevaSi daigegmos paralelurad mSoblebis Sesabamisi mkurnalobis strategiac rac bavSvis (mozardis) mgdomareobis gaumjobesebas moemsaxureba (B).

farmakologiuri mkurnaloba

bavSvebsa da mozardebSi depresis farmakologiuri mkurnalobis Sesaxeb sistemuri kvlevebis arsebobamde, xdeboda mozrdilebSi Catarebuli igive saxis kvlevebis eqstrapolireba, rac Tavis mxriv araswori midgoma iyo. amJamad bavSvebsa da mozardebSi sxvadasxva antidepresantis gamoyenebis efeqturobis Sesaxeb sxvadasxva sistemuri kvleva da Sedegebis gadaxedva warmoebs.

did britaneTSi Aantidepresanti preparatebis mwarmoeblebi ar iZlevian maT 18 wlamde asakis pirebSi gamoyenebis rekomendacias da preparatebi ar aris licenzirebuli am asakobriv jgufSi gamosayeneblad. miuxedavad amisa britaneTis pediatriisa da bavSvTa janmrTelobis samefo kolejma 2000 wels gamosca maregulirebeli uwyeba zogierTi aralicenzirebuli medikamentis an zogierTi licenzirebuli medikamentis aralicenzirebuli daniSnulebiT gamoyenebis Taobaze, rac pediatriis sferoSi am medikamentebis gamoyenebis saWiroebiT iyo nakarnaxevi.

medikamentebis usafrTxoebis komitetis eqspertebis muSa jgufis mier (Expert Working Group of the Committee on Safety of Medicines (CSM, 2003) 2003 wels gamoica rekomendacia rom citaloprami, escitaloprami, fluvoqsamini,

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paroqsetini, sertralini da venlafaqsini ar unda iyos gamoyenebuli 18 wlamde asakis pirebSi depresiis axali SemTxvevis samkurnalod. maTive rekomendaciiT mxolod fluoqsetinis riskisa da efeqturobis balansi iyo pozitiuri.

evropis Mmedikamentebis Sefasebis saagentos adamianis samedicino produqtebis komitetis (Committee on Human Medicinal Products (CHMP) of the

European Medicines Evaluation Agency13 (EMEA) 2005 wlis aprilis rekomendaciiT SesaZlebelia serotoninis seleqciuri ukuSTanTqmis inhibitorebisa da serotonin noradrenalinis seleqciuri ukuSTanTqmis inhibitorebis bavSvTa da mozardTa asakSi gamoyeneba.

amerikis wamlisa da sakvebi produqtebis administraciis 2004 wlis rekomendaciiT The Food and Drug Administration (FDA) arsaebobs sucidisa da suciduri azrebis momatebuli riski bavSvebisa da mozardebis antidepresantebiT mkurnalobis periodSi. amitom FDA-m urCia wamlis mwarmoeblebs, e.w. Savi gamafrTxilebeli abris mikvra yvela aseT preparatze, raTa bavSvis mSobeli, meurve da eqimi kidev erTxel gafrTxilebul iyos riskis da bavSvis (mozardis) intensiuri monitoringis auciloblobis Taobaze.

fluoqsetini amerikis wamlisa da sakvebi produqtebis administraciis (FDA) mier bavSvTaAda mozardTa asakSi depresiis samkurnalo erTaderT nebadarTul preparats warmoadgens.


tricikluri antidepresantebi araefeqturia bavSvebSi. igi placebosTan SedarebiT umniSvnelo efeqturobiT xasiaTdeba mozardebSi depresiis mkurnalobisas remiisiis miRwevis, mkurnalobaze pasuxis Tu simptomebis reduqciis TvalsazrisiT.

placebosTan SedarebiT am jgufis medikamentebi ufro meti gamoxatuli gverdiTi efeqtebiT xasiaTdebian, rac medikamentis moxsnis mizezi xdeba. tricikluri antidepresantebi (lofepraminis garda) gadametdozirebis SemTxvevaSi maRaltoqsiurobiT xasiaTdebian

fluoqsetini (serotoninis seleqciuri ukuSTanTqmis inhibitori)

fluoqsetini (40 mg-mde dReSi 7-dan 12 kviris ganmavlobaSi) 7-18 wlis asakis bavSvebsa da mozardebSi depresiis samkurnalo efeqturi preparatia. placebosTan SedarebiT adgili aqvs simptomatikis mniSvnelovan gaumjobesebas, xangrZliv remisiasa da mkurnalobaze dadebiT pasuxs. aseve aRniSneba mniSvnelovani klinikuri gaumjobeseba da depresiis simwvavis Semcireba. bundovania mtkicebulebebi fluoqsetiniT mkurnalobis dros funqciuri statusis gaumjobesebis Taobaze.

seriozuli gverdiTi efeqtebis da suiciduri qcevebis riskis interpretacia garTulebulia, Tumca aRniSnuli SedarebiT maRalia fluoqsetinis jgufSi (Sedareba xdeboda placebosTan). muxedavad amisa arsebobs mtkicebulebebi, rom fluoqsetiniT mkurnalobis

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jgufSi placebo jgufze naklebad xdeboda nebismieri mizeziT mkurnalobis Sewyvetis aucilebloba.

mkurnalobasTan dakavSirebuli gverdiTi efeqtebi msgavsia fluqsetinisa da placebo jgufSi, garda hiperkinezis, Tavis tkivilis da kanze gamonayrisa, rac fluoqsetinis jgufSi ufro metad aRiniSna.

paroqsetini (serotoninis seleqciuri ukuSTanTqmis inhibitori)

erTi kvlevis mixedviT paroqsetiniT mkurnalobam (40 mg-mde dReSi 8-12 kviris manZilze) gaaumjobesa remisiis xangrZlivoba. Tumca SedarebiT axali kvlevebis safuZvelze miRebuli mtkicebulebebiT paroqsetiniT mkurnalobisas miiRweva susti pasuxi, aseve umniSvneloa klinikuri da funqciuri gaumjobeseba.

paroqsetinis jgufSi mniSvnelovnad maRalia seriozuli gverdiTi efeqtebis albaToba (xdeboda placebosTan Sedareba). Aarasakmarisia mtkicebulebebi suiciduri qcevebis riskis da nebismieri mizeziT mkurnalobis Sewyvetis Taobaze.

mkurnalobasTan dakavSirebuli gverdiTi efeqtebi rogoricaa uZiloba, Zilianoba, mtruli, agresiuli qmedebebi, Tavbruxveva da tremori paroqsetinis jgufSi ufro metad aRiniSna (xdeboda placebosTan Sedareba)

sertralini (serotoninis seleqciuri ukuSTanTqmis inhibitori)

sertralinma (200mg-mde dReSi 10 kviris ganmavlobaSi) placebosTan SedarebiT depresiuli simptomebis umniSvnelo gaumjobeseba gamoiwvia 6-17 wlis bavSvebsa da mozardebSi. Tumca mtkicebulebebi remisiis, mkurnalobaze pasuxis da klinikuri gaumjobesebis Taobaze aradamarwmunebelia. Mmtkicebulebebis mixedviT ar aRiniSneba aranairi gavlena funqciur statusze.

arsebobs mtkicebulebebi imis Taobaze, rom 6-11 wlis bavSvebis sertraliniT mkurnalobisas didia mkurnalobis Sewyvetis, preparatis moxsnis albaToba misi gverdiTi efeqtebis gamo. mtkicebulebebi medikamentis miRebis dros suiciduri ideebisa da qmedebebis Taobaze arasakmarisia.

6-11 wlis bavSvebis sertraliniT mkurnalobisas SedarebiT maRalia iseTi gverdiTi efeqtebi ,rogoricaa gulisreva, diarea da anoreqcia, aseve SesaZloa gaizardos Rebinebis, aJitirebis, Sardvis Seukaveblobis da purpuris riski (xdeboda placebosTan Sedareba).

12-17 wlis mozardebSi sertraliniT mkurnalobam placebosTan SedarebiT ufro metad SeiZleba gamoiwvios Rebineba da diarea.

citaloprami (serotoninis seleqciuri ukuSTanTqmis inhibitori)

ar aris sakmarisi mtkicebulebebi imis Taobaze ,rom citaloprami (40 mg-mde dReSi 8-12 kviris ganmavlobaSi) 7-18 wlis bavSvebsa da mozardebSi placebosTan SedarebiT axangrZlivebs remisias, mkurnalobisadmi pasuxs da aumjobesebs simptomatikas.

40

ar moipoveba sakmarisi mtkicebulebebi citalopramiT mkurnalobis dros mkurnalobasTan dakavSirebuli gverdiTi efeqtebis, suiciduri azrebisa da qmedebebis riskis zrdis Taobaze aseve monacemebi gverdiTi efeqtebis gamo wamlis adreul etapze moxsnis aucileblobis Sesaxeb.

placebosTan SedarebiT cotaloprami ufro metad iwvevs mkurnalobasTan dakavSirebul Semdeg gverdiT efeqtebs: rinits, gulisrevas, gripismagvar simptomebs, daRlilobas, diareas da faringits.

venlafaqsini (serotoninis da noradrenalinis seleqciuri ukuSTanTqmis inhibitori)

arsebobs arasakmarisi mtkicebulebebi, 6-17 wlis bavSvebsa da mozardebSi venlafaqsiniT (225 mg-mde dReSi 8 kviris manZilze) mkurnalobisas depresiuli simptomebis umniSvnelo gaumjobesebis Taobaze (xdeboda placebosTan Sedareba). ar arsebobs mtkicebulebebi venlafaqsiniT mkurnalobis dros remisiis miRwevis sixSiris, mkurnalobisadmi pasuxis Tu funqciuri statusis gazrdis Taobaze.

arsebuli mtkicebulebebiT venlafaqsiniT mkurnalobisas izrdeba suiciduri qcevebisa da ideebis riski rac preparatis ardeul etapze moxsnis mizezi xdeba.

arsebobs arasakmarisi mtkicebulebebi imis Taobaze, rom venlafaqsini placeboze metad iwvevs mkurnalobasTan dakavSirebul gverdiT efeqtebs: gulisrevas, anoreqsias da Tavbruxvevas.

mirtazapini (presinapsuri a2 antagonisti)

mtkicebulebebi mirtazapinis (15-45 mg/dReSi 8 kviris ganmavlobaSi) efeqturobis Taobaze 7-17 wlis bavSvebsa da mozardebSi da misi placebosTan Sedarebis Sedegebi urTiereTgamomricxavia. ar arsebobs mtkicebulebebi mirtazapiniT mkurnalobis dros remisiis miRwevis albaTobis, mkurnalobisadmi pasuxis Tu funqciuri statusis Taobaze. arasarwmunoa mtkicebulebebi mkurnalobis dros suiciduri qcevebisa Tu ideebis gazrdili riskis Taobaze. mirtazapiniT mkurnalobis dros placebosTan SedarebiT maRalia Semdegi gverdiTi efeqtebi wonaSi mateba, somnolencia, Tavis tkivili da madis momateba.

ar arsebobs sakmarisi mtkicebulebebi serotoninis seleqciuri ukuSTanTqmis inhibitorebisa da atipuri antidepresantebis bavSvTa da mozardTa asakSi depresiis samkurnalod gamoyenebis efeqturobis Taobaze. arsebobs monacemebi maTi gamoyenebisas suiciduri ideebisa da qmedebebis matebis da gverdiTi efeqtebis gamo mkurnalobis Sewyvetis maRali riskis Taobaze.

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serotoninis ukuSTanTqmis seleqciuri ukumitacebis inhibitorebis (sumsi) yvelaze xSiri gverdiTi efeqtebi

ssui-is gamoyenebasTan dakavSirebuli ssui-is dozis daklebasTan an

moxsnasTan dakavSirebuli

akaTizia an motoruli mousvenroba Tavbru

Tavbru Zilianoba

Zilianoba daRliloba

gastrointestinuri simptomebi koncentraciis darRvevebi

Tavis tkivili Tavis tkivili

mkurnalobasTan dakavSirebuli aJitireba da mtruli qmedebebi

gabrueba

tremori gulisreva

serotoninis seleqciuri ukumitacebis inhibitoris da tricikluri anditdepresantis Sedareba

arsebuli mtkicebulebebiT serotoninis seleqciuri ukuSTanTqmis inhibitorebma (paroqsetini 40 mg-mde dReSi 8 kviris ganmavlobaSi) triciklur antidepresantebTan (imipramini 200 mg-mde dReSi 8 kviris ganmavlobaSi) SedarebiT SeiZleba gazardon depresiis remisiis xangrZlivoba 12-18 wlis mozardebSi. mtkicebulebebi urTierTgamomricxavia mkurnalobaze pasuxisa da depresiuli simptomebis gaumjobesebis Taobaze.

aseve urTierTgamomricxavia mtkicebulebebi klinikuri gaumjobesebis Taobaze serotoninis seleqciuri ukuSTanTqmis inhibitoriT (paroqsetini 40 mg-mde dReSi 8 kviris ganmavlobaSi) tricikluri antidepresantebiT (imipramini 200 mg-mde dReSi 8 kviris ganmavlobaSi) an klomipraminiT (150mg-mde dReSi) 12-20 wlis pirebis mkurnalobis Sedarebisas.

arasakmarisia monacemebi gverdiTi efeqtebis Sedarebis Taobaze, Tumca paroqsetinis SemTxvevaSi preparatis gverdiTi efeqtebis gamo adreul etapze moxsnis riski ticiklur antidepresantebTan SedarebiT dabalia.

krazana

ar arsebobs mtkicebulebebi krazanas bavSvTa da mozardTa asakSi depresiis samkurnalod gamoyenebis Taobaze. amasTan erTad problematuria krazanas sxva medikamentebTan erTad gamoyeneba.

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daskvna

fluoqsetini erTaderTi serotoninis seleqciuri ukuSTanTqmis inhibitori/atipiuri antidepresantia romlis efeqturobaze arsebuli mtkicebulebebi aRemateba risks. A

arsebuli mtkicebulebebiT tricikluri antidepresantebi ar unda iyos gamoyenebuli bavSvebsa da mozardTa asakSi depresiis samkurnalod.

krazana ar aris licenzirebuli medikamenti, ar arsebobs am asakobriv jgufSi misi gamoyenebis aseve sxva preparatebTan urTierTqmedebis Sesaxeb informacia. igi ar unda iyos gamoyenebuli bavSvebsa da mozardTa asakSi depresiis samkurnalod.

antidepresantebi fsiqologiur mkurnalobasTan erTad

fluoqsetinis kognitur biheviorul TerapiasTan kombinacia ufro efeqturia depresiuli simptomebis Semcirebisa da saerTo klinikuri gamosavlis TvalsazrisiT. efeqturoba placebosTan SedarebiT sakmaod maRalia, xolo mxolod fluoqsetiniT mkurnalobasTan SedarebiT umniSvnelo.

arsebobs arasakmarisi monacemebi fluoqsetiniT mkurnalobisas suiciduri ideebisa Tu qcevebis riskis matebis Taobaze, Tumca kognitur-biheviorul TerapiaTan erTad, es riski SesaZloa mcirea.

sxva medikamentebi

arsebobs mxolod erTi randomizebul kontrolorebadi kvleva romelic bavSvTa da mozardTa asakSi depresiis liTiumiT mkurnalobas adarebs placebos. A

ar arsebobs mtkicebulebebi liTiumiT mkurnalobis dros placebosTan SedarebiT depresiuli simptomebis an saerTo funqciuri mdgomareobis gaumjobesebis Taobaze. Mmtkicebulelebis safuZvelze liTiumiT mkurnalobis dros SeiZleba gaizardos Rebineba da dadges gverdiTi efeqtebis gamo adreul etapze preparatis moxsnis aucilobloba.

relafsis prevencia

sistemuri kvlevebis mimoxilviT ar gamovlinda randomizebul kontrolirebuli kvleva bavSvTa da mozardTa asakSi depresiis relafsis prevenciis Taobaze. ar aris kvlevebi da Sesabamisad mtkicebulebebi mkurnalobis strategiis (Tu ramden xans gagrZeldes mkurnaloba, masze dadebiTi pasuxis miRebis Semdeg, da rogor aviciloT Tavidan recidivi) Taobaze. ZiriTadad xdeba mozrdilTaTvis gankuTvnili rekomendaciebis gamoyeneba: Tu bavSvi an mozardi pasuxobs antidepresantiT mkurnalobas, is unda gagrZeldes 6-12Tve. Ddepresiis meore epizodis dros mkurnaloba sul mcire 1 wlis ganmavlobaSi grZeldeba. Ddepresiis ori sami relafsis epizodis SemTxvevaSi mkurnalobis xangrZlivoba 1-3 wlis ganmavlobaSi SeiZleba gagrZeldes.Aaseve rekomendirebulia

43

TandaTanobiT 4-6 kviris ganmavlobaSi preparatis dozis SemcirebiT antidepresantis moxsna, Tumca mtkicebulebebi arasakmarisia.

elqtro konvulsiuri Terapia

elqtrulad producirebuli gulyra. did britaneTSi meTodi Zalze iSviaTad gamoiyeneba bavSvTa da mozardTa asakSi depresiis samkurnalod. is SeiZleba gamoyenebul iqnes, roca yvela sxva danarCeni meTodi uSedegoa da saxezea pacientis sicocxlisaTvis saSiSi mdgomareoba. meTodis yvelaze seriozuli gverdiTi efeqti aris amnezia. ar arsebobs monacemebi Tu ra gavlenas axdens elqtrulad producirebuli gulyra mozardis tvinze.

fsiqozuri depresiis marTva

sistemuri kvlevebis Catareba fsiqozur depresiaze SezRudulia radgan aRniSnuli aSliloba ar aris mkafiod gamoyofili rogorc calke diagnistikuri subtipi. aseve rTulia aseTi pacietebis kvlevaSi CarTva. aqedan gamomdinare ar moipoveba kargi xarisxis sando epidemiologiuri da kontrolorebadi kvlevebi fsiqozuri depresiis mwvave Tu xangrZlivi mkurnalobis Taobaze. sistemuri kvlevebis eleqtronuli bazis mimoxliviT napovni iqna erTi kvleva (Geller et al.,

1985), sadac mozardebSi fsiqozuri depresiis antidepresantebiTa da antifsiqozuri medikamentebiT kombinirebuli mkurnaloba SedarebiT efeqturad CaiTvala, Tumca kvleva fokusirebuli iyo plazmaSi medikamentis doneze vidre gamosavalze.

klinikuri rekomendaciebi

antidepresantebi ar unda iyos gamoyenebuli bavSvebsa da mozardebSi msubuqi xarisxis depresiis sawyis mkurnalobad (B).

Tu msubuqi xarisxis depresia ar pasuxobs mkurnalobas, maSin eqimma unda ixelmZRvanelos saSualo-mZime xarisxis depresiis marTvis rekomendaciebiT (kargi klinikuri praqtika).

antidepresantebiT mkurnaloba ar unda SesTavazoT saSualo-mZime xarisxis depresiis mqone bavSvebsa da mozardebs, gamonaklisia fsiqologiur mkurnalobasTan kombinacia. specialuri Sexvedrebi unda daigegmos mentaluri statusis da saerTo progresis Sesamowmeblad aseve wamlismieri gverdiTi efeqtebis monitoringis mizniT. magaliTad, yovel kvireuli kontaqti bavSvTan (mozardTan) da mis mSobelTan (meurvesTan) mkurnalobidan pirveli 4 kviris ganmavlobaSi. Sexvedrebis sixSire individualuria da Sexvedris Sedegebi dokomentirebuli unda iyos. Tu bavSvi an mozardi ar aris Tanaxma fsiqologiur mkurnalobaze, maSin antidepresantebi mainc unda dainiSnos da medikamentis gamomwerma eqimma xSiri monitoringi unda awarmoos rogorc bavSvis (mozardis) progresze aseve medikamentebis gverdiT efeqtebze (B).

antidepresantis daniSvnis saWiroeba mxolod bavSvTa da mozardTa fsiqiatris Sefasebisa da diagnostirebis Semdeg unda moxdes (C)

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saSualo-mZime xarisxis depresiis dros antidepresantis daniSvisas, arCevani fluoqsetinze unda gakeTdes, radganac is erTaderTi antidepresantia, romelzec Catarebulma sistemurma kvlevebma preparatis sargeblianobis, riskze upiratesoba aCvena (A).

bavSvis (mozardis) antidepresantebiT mkurnalobis dawyebis win bavSvi (mozardi), misi mSoblebi (meurve) informirebuli unda iyos mkurnalobis Taviseburebebis (xangriZlivoba, gverdiTi efeqtebi, efeqturoba) da medikamentis daniSnulebisamebr miRebis Taobaze. aRniSnuli informacia werilobiTi saxiT maTTvis gasageb enaze miwodebul unda iyos rogorc bavSvisaTvis (mozardisaTvis) aseve misi mSoblebisaTvis (meurvisaTvis). Aaseve miwodebuli unda iyos bolo informacia bavSvis (mozardis) mdgomareobis Taobaze. (kargi klinikuri praqtika)

Tu bavSvisTvis (mozardisTvis) daniSnulia antidepresanti, mkurnalma eqimma an fsiqologuri mkurnalobis mimwodebelma specialistma unda Seafasos bavSvis (mozardis) siuciduri ideebis, TviT zianis miyenebis, mtruli qmedebebis arseboba, gansakuTrebiT mkurnalobis adreul etapze. Tu ar aris medikamentis dauyovnebliv dawyebis aucilebloba, medikamentis gamoweramde 7 dRis ganmavlobaSi unda moxdes simptomebis monitorireba, romlebic SemdgomSi SeiZleba interpretirebul iqnes rogorc gverdiTi efeqtebi. medikamentis gamoweris Semdeg, mkurnalma eqimma unda gaafrTxilos pacienti da misi mSoblebi (meurve), am saxis nebismieri axali simptomis gamoCenisTanave daukavSirdnen mas. (kargi klinikuri praqtika)

bavSvebsa da mozardebSi fluoqsetinis daniSvnis SemTxvevaSi sawyisi doza unda iyos 10mg /dReSi. klinikuri saWiroebebidan gamomdinare mkurnalobidanDerTi kviris Semdeg SesaZlebelia dozis gazrda 20 mg-mde dReSi, Tumca mcire wonis, umcrosi asakis bavSvebSi SedarebiT dabali dozebiT mkurnaloba unda iyos moazrebuli. ar arsebobs sakmarisi mtkicebulebebi dReSi 20mg-ze maRali dozebiT mkurnalobis efeqturobis Taobaze. Tumca maRali dozebiT mkurnaloba SeiZleba moazrebul iqnes SedarebiT ufrosi asakis, didi wonis mqone mozardebSi romelTac daavadebis mZime forma aReniSnebaT da prioritetulia adreul etapze klinikuri Sedegis miRweva (kargi klinikuri praqtika).

rodesac bavSvi an mozardi pasuxobs fluoqsetiniT mkurnalobas, remisiis (8 kviriani mkurnalobis Semdeg ar aRiniSneba simptomebi da saxezea sruli funqcionireba) miRwevis Semdeg mkurnaloba kidev 6 Tves unda gagrZeldes. (C)

im SemTxvevaSi Tu fluoqsetiniT mkurnaloba warumatebelia an Tu ver xdeba medikamentis misi gverdiTi efeqtebis gamo atana, sxva antidepresantis daniSvna unda iyos moazrebuli. am SemTxvevaSi sertralini da citaloprami aris rekomendirebuli meore rigis mkurnaloba (B)

45

sertralini da citaloprami unda dainiSnos mxolod Semdeg SemTxvevebSi:

bavSvi (mozardi) da misi mSoblebi (meurve) sruliad informirebulia da CarTulia medikamentis daniSvnis diskusiaSi. axsnili da ganmartebulia medikamentis savaraudo pozitiuri mxareebi da riskebi, informacia miwodebulia werilobiTi formiT. informacia unda Seexebodes medikamentiT mkurnalobis Taviseburebebs (mkurnalobis xangriZlivoba, gverdiTi efeqtebi, efeqturoba, mosalodneli Sedegebi da medikamentis daniSnulebisamebr miRebis aucilebloba) (C);

bavSvis (mozardis) depresia imdenad mZimea da/an iwvevs seriozul simptomebs rogoricaa wonaSi kleba da suiciduri qcevebi, rom gamarTlebulia sxva antidepresantiT mkurnalobis mcdeloba (C);

arsebobs utyuari monacemebi yvela rekomendirebuli mkurnalobis Catarebis mcdelobisa. (uSedegod nacadi iyo fluoqsetiniTa da fsiqologiuri meTodebiT kombinirebuli mkurnaloba) (C);

xelaxla iqna Sefasebuli depresiisa da mkurnalobis rezistentobis savaraudo mizezebi (gamoricxul iqna iseTi diagnozebi, rogoricaa bipolaruli aSliloba da toqsikomania) (C);

arsebobs bavSvTa da mozardTa fsiqiatris rekomendacia (C);

bavSvma an mozardma an misma mSoblebma (meurvem), an 16 wels gadacilebulma mozardma Tavad (Tu is miCneulia kompetenturad) Seafasa mkurnalobis riskebi da pozitiuri mxareebi da ganacxada informirebuli Tanxmoba (C);

rodesac bavSvisTvis an mozardisTvis iniSneba fluoqsetinisagan gansxvavebuli antidepresanti, sawyisi doza mozardebis sawyisi dozis naxevari unda iyos. Tu klinikuri saWiroeba moiTxovs, SesaZlebelia dozis TandaTanobiTi (momdevno 2-4 kviris ganmavlobaSi) mozrdilebis dRiur dozamde gazrda. Tumca mcire wonis mqone bavSvebSi upiratesoba mainc dabal dozebs unda mieniWos. miuxedavad monacemebis simwirisa mozrdilebsa da bavSvebSi maRali dRiuri dozebiT mkurnalobis efeqturobis Taobaze, maRali dozebiT mkurnaloba SeiZleba moazrebul iqnes SedarebiT ufrosi asakis didi wonis mqone mozardebSi, romelTac depresiis mZime forma aReniSnebaT da prioritetulia adreul etapze klinikuri Sedegis miRweva (kargi klinikuri praqtika).

rodesac bavSvi an mozardi pasuxobs citalopramiT an sertraliniT mkurnalobas, remisiis (8 kviriani mkurnalobis Semdeg ar aRiniSneba simptomebi da saxezea sruli funqcionireba) miRwevis Semdeg mkurnaloba kidev 6 Tves unda gagrZeldes (C).

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paroqsetini da venlafaqsini ar unda iyos gamoyenebuli bavSvebsa da mozardebSi depresiis samkurnalod (A).

tricikluri antidepresantebi ar unda iyos gamoyenebuli bavSvebsa da mozardebSi depresiis samkurnalod (C).

antidepresantis moxsna unda moxdes etapobrivad 6-12 kviris ganmavlobaSi dozis titraciiT (C).

bavSvebisa da mozardebis antidepresantiT mkurnalobis dros gansakuTrebuli yuradReba unda daeTmos sxva danarCen medikamentebTan mis urTierTqmedebas. unda gairkves pacientis mier sxvadasxva alternatiuli medikamentebisa Tu biodanamatebis, aseve alkoholis moxmarebis faqti (kargi klinikuri praqtika).

miuxedavad imisa, rom arsebobs monacemebi mozrdlilebSi msubuqi da saSualo xarisxis depresiis dros, krazanas gamoyenebis efeqturobis Sesaxeb, Sedegebis bavSvebsa da mozardebSi eqstrapolireba ar aris rekomendirebuli. amasTan ucnobia misi gverdiTi efeqtebi da igi urTierTqmedebs mTel rig medikamentebTan, maT Soris kontraceptivebTan. yovelives gaTvaliswinebiT, krazana ar unda iyos gamoyenebuli bavSvTa da mozardTa asakSi depresiis samkurnalod (C).

Tu depresiis mqone bavSvi an mozardi damatebiT Rebulobs krazanas, mas unda ganemartos riski da erCios medikamentis miRebis Sewyveta da SesTavazon arsebuli gaidlainis Sedabamisi alternatiuli mkurnaloba (C).

Tu bavSvis (mozardis) saSualo an mZime xarisxis depresia ar emorCileba fsiqologiur mkurnalobas mkurnalobis 4-6 kursis Semdeg, unda moxdes mdgomareobis multidisciplinuri gadaxedva (kargi klinikuri praqtika).

TuMmultidisciplinuri ganxilvis Semdeg bavSvis an mozardis depresia ar emorCileba fsiqologiur mkurnalobas,sxva Tanmxlebi faqtorebis (ojaxuri konfliqti, sxva Tanmxlebi daavadeba, mSoblebis fsiqiuri daavadeba) Tanaarsebobis gamo, SesaZloa moazrebul iqnes alternatiuli fsiqologiuri mkurnaloba bavSvisTvis an damatebiTi fsiqologiuri mkurnalobis Catareba mSoblebisaTvis an ojaxis sxva wevrebisaTvis (C).

TuMmultidisciplinuri ganxilvis Semdeg bavSvis an mozardis (12-18 wlis) saSualo-mZime xarisxis depresia ar emorCileba fsiqologiuri mkurnalobis 4-6 kurss, fluoqsetiniT mkurnaloba unda iyos SeTavazebuli (B).

TuMmultidisciplinuri ganxilvis Semdeg bavSvis (5-11 wlis) saSualo-mZime xarisxis depresia ar emorCileba fsiqologiuri mkurnalobis 4-6 kurss. fluoqsetiniT mkurnaloba sifrTxiliT unda iyos moazrebuli. Tumca am asakobriv jgufSi fluoqsetinis efeqturoba Seswavlili ar aris (C).

Tu saSualo an mZime xarisxis depresia ar emorCileba specifiuri fsiqologiuri mkurnalobis 6 kursiT da fluoqsetiniT kombinirebul

47

mkurnalobas, an Tu pacienti da/ an misi mSobeli (mSoblebi), meurve uars acxadebs fluoqsetiniT mkurnalobaze, multidisciplinurma gundma unda Seafasos preparatis saWiroeba da riski. Sefaseba unda moicavdes diagnozis xelaxla gadaxedvas, savaraudo Tanmxlebi diagnozebis aRmoCenas, depresiis savaraudo individualur, ojaxur Tu sazogadoebriv mizezTa xelaxla Sefasebas. aseve unda Sefasdes ramdenad gamarTlebuli iyo Catarebuli mkurnaloba da gadawydes Semdgomi fsiqologiuri Terapiis saWiroeba pacientisTvis da/an damatebiTi daxmareba ojaxisTvis (kargi klinikuri praqtika).

maRali riskis jgufSi (mag. individebSi romelTac ukve aReniSnaT depresiis 2 epizodi, romelTac aqvT subsindromuli simptomebi an romlebic kvlav rCebian depresiis xelSemwyobi mravali risk faqtorebis zemoqmedebis qveS) moazrebul iqnes savaraudo recidivis albaToba an Catardes specifiuri fsiqologiuri mkurnalobis kursi recidivis albaTobis Sesamcireblad (B).

remisiis fazaSi myofi rekurentuli depresiis mqone bavSvi an mozardi (2 simptomze naklebi da sruli funqcionireba sul mcire 8 kviris ganmavlobaSi) regularulad unda Semowmdes Semdgomi 24 Tvis ganmavlobaSi gamocdili bavSvTa da mozardTa fsiqiuri janmrTelobis specialistis mier. Sexvedrebis sixSire da intervali individualurad unda SeTanxmdes specialists, bavSvsa da mis mSoblebs (meurves) Soris da Sedegebi werilobiT unda iyos dokumentirebuli. Tu aRniSnuli periodis Semdeg remisia SenarCunebulia, bavSvi (mozardi) pirveladi jandacvis specialistis meTvalyoreobis qveS rCeba (C).

warmatebulad namkurnalevi rekurentuli depresiis mqone bavSvis (mozardis) ganmeorebiTi depresiuli epizodis dros is dauyovnebliv unda iyos gadagzavnili bavSvTa da mozardTa fsiqiuri janmrTelobis specialistTan (kargi klinikuri praqtika).

elqtro konvulsiuri Terapia moazrebul unda iyos Zalze mZime xarisxis depresiis dros ,roca arsebobs sicocxlisaTvis saSiSi simptomebi (magaliTad suiciduri qcevebi) an roca mZime xarisxis depresia arcerT sxva samkurnalo meTods ar daemorCila (C).

elqtro konvulsiuri Terapia bavSvebsa da mozardebSi gamoyenebul unda iqnes Zalze iSviaTad, mxolod am sferoSi gamocdili specialistis guldasmiT Sefasebis da gaidlainis rekomendaciebis gaTvaliswinebis Semdeg (C).

eleqtro konvulsiuri Terapia ar aris rekomendirebuli 5-11 wlis bavSvebis samkurnalod (C).

fsiqozuri depresiis mqone bavSvebisa da mozardebis depresiis mkurnalobis sqemaSi moazrebuli unda iyos atipuri antifsiqozuri medikamentiebis CarTva, Tumca ucnobia optimaluri doza da mkurnalobis xangrZlivoba (C).

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antifsiqozuri medikametebiT mkurnalobisas unda moxdes bavSvebisa da mozardebis guldasmiTi monitoringi, gverdiTi efeqtebis gamosavlenad (C).

8. gaidlainis gadasinjvis da ganaxlebis vada

gaidlainis gadasinjvis da ganaxlebis vadaa 2 weli;

9. gaidlainis miRebis xerxi/wyaro:

winamdebare gaidlaini warmoadgens adaptirebul gaidlains. gaidlainebis miRebis xerxi/wyaro aris sxvadasxva gaidlainebis Sejereba da adaptacia. (ix. literatura).

mtkicebulebis done, rekomendaciebis xarisxi

done

mtkicebulebis done xaris-

xi rekomendaciis xarisxi

I

Zlieri mtkicebuleba, eyrdnoba minimum erT sistemur mimoxilvas, romelic efuZneba swori dizainis mqone randomizebul kontrolirebad kvlevas

A

eyrdnoba I donis mtkicebulebas da Sesabamisad mtkiced rekomendebulia

II

Zlieri mtkicebuleba, eyrdnoba minimum erT swori dizainis mqone randomizebul kontrolirebad kvlevas

B

eyrdnoba II donis mtkicebulebas da Sesabamisad rekomendebulia

III klinikuri kvleva randomizaciis gareSe, kohortuli da SemTxveva-kontrolis kvlevebi

C

eyrdnoba III donis mtkicebulebas, SeiZleba CaiTvalos Sesabamisad

IV araeqsperimentuli multicentruli kvlevebi D

eyrdnoba IV da V donis mtkicebulebas, saWiroebs konsesuss

Vა avtoritetul profesionalTa mosazreba

Vბ klinikuri gamocdileba, aRwerilobiTi kvlevebi an eqspertTa angariSi

10. alternatiuli gaidlaini ar arsebobs

49

11. gamoyenebuli literatura:

1. Depression: NICE guideline (amended) 25 April 2007

2. guneba-ganwyobis (afeqturi) aSliloba . saqarTvelos fsiqikuri janmrTelobis asociacia 2008

3. Practice Guidelines ACP Guideline on Second-Generation Antidepressants for Depression

Treatment August 1, 2009

4. Identification of common mental disorders and management of depression in primary care.

New Zealand Guidelines Group; 2008 Jul.

5. UW Health: 2008 – Diagnosing and Treating Depression in Adults in Primary Care

6. Pharmacologic Management of Adult Depression - March 15, 2008 -- American Family Physician

7. Depression in Women . American academy of Family Physicians 2008

8. Treatment-Resistant Depression2009 American Academy of Family Physicians

9. Major depressive disorder From Wikipedia, the free encyclopedia

10. Mood Disorders Merck Manuals online medical library

11. Beck-Depression-Inventory _ BDI http:/www.minddisorders.com/A-Br/Beck-Depression-

Inventory.html;

12. American Psychiatric Association Diagnostic and Statistical Manual of Mental disorders (DSM-

IV) Fourth Edition

13. UW Health: 2008 – Diagnosing and Treating Depression in Adults in Primary Care – 10 UM-

20787-08 7. Postpartum

14. UW Health: 2008 – Diagnosing and Treating Depression in Adults in Primary Care – 12 UM-

20787-08 SQARTULI GAIDLAINI

15. UW Health: 2008 – Diagnosing and Treating Depression in Adults in Primary Care 11 UM-

20787-08

16. საქართველოს შრომის, ჯანმრთელობისა და სოციალური დაცვის სამინისტრო

დაავადებათა კონტროლის და სამედიცინო სტატისტიკის ეროვნული ცენტრი

ჯანმრთელობის დაცვა საქართველო, 2007 სტატისტიკური ცნობარი

17. The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization 23

January 2009

18. British National Formulary 16 Sep 2009: New BNF published

19. General Practice Psychiatry edited by Grant Blashki, Fiona Judd, Leon piterman 2007

20. Physician PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

21. Childhood and Adolescent Depression SHASHI K. BHATIA, M.D., and SUBHASH C.

BHATIA, M.D., Creighton University,Department of Psychiatry, Omaha, Nebraska 2008

22. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification,

Assessment, and Initial Management PEDIATRICS (ISSN 1098-4275). ©2007 by the

American Academy of Pediatrics

23. The National Collaborating Centre for Mental Health (NICE) Depression in Children and Young

People.

24. hildhood and Adolescent depression. American Academy of Family Physician 2007y.

25. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment,

and Initial Management 2007.American Academy of Pedicatics

26. Screening for Child and Adolescent Depression In Primary Care Setting: A Systematic Evidence

Review for the US Preventive Service Task Force. 2009.april. American Academy of

Pedicatics

http://www.nice.org.uk/nicemedia/pdf/CG23NICEguidelineamended.pdf

http://www.merck.com/mmhe/sec07/ch101/ch101a.html

http://bnf.org/bnf/extra/current/450034.htm#77

mhtml:file://C:/Documents%20and%20Settings/user/Desktop/depresia%201/Guidelines%20for%20Adolescent%20Depression%20in%20Primary%20Care%20(GLAD-PC)_%20I.%20Identification,%20Assessment,%20and%20Initial%20Management%20--%20Zuckerbrot%20et%20al.%20120%20(5)_%20e1299%20--%20Pediatrics.mht!/misc/terms.shtml

mhtml:file://C:/Documents%20and%20Settings/misha/Desktop/depresia%201/Guidelines%20for%20Adolescent%20Depression%20in%20Primary%20Care%20(GLAD-PC)_%20I.%20Identification,%20Assessment,%20and%20Initial%20Management%20--%20Zuckerbrot%20et%20al.%20120%20(5)_%20e1299%20--%20Pediatrics.mht!/misc/terms.shtml



50

27. Tiet, Q.Q., Bird, H.R. Davies, M., et al. (1998) Adverse life events and resilience. Journal of

theAmerican Academy of Child and Adolescent Psychiatry, 37, 1191–1200.

28. United Nations (UN) Population Division (November 2004) Replacement migration. Age-

sexstructures by scenario for 2000.

http://www.un.org/esa/population/publications/migration/uk.pdf.

29. US Department of Health and Human Services (1996) Physical Activity and Health: A Report

ofthe Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic

Disease Prevention and Health Promotion, Atlanta, USA.

30. Walter, G., Rey, J.M., & Mitchell, P.B. (1999a) Practitioner review: Electroconvulsive therapy in

adolescents. Journal of Child Psychology and Psychiatry, 40, 325–33

12. avtorTa jgufi

klinikuri praqtikis erovnuli rekomendacia (gaidlaini) momzadda saqarTvelos ojaxis eqimTa asociaciis mier

avtorebi:

rusudan CitaiSvili (ojaxis eqimi), magda simonia (ojaxis eqimi), daviT zurabiSvili (fsiqiatri), givi javaSvili (redaqtori), guram kiknaZe (redaqtori).

eqspertebi:

saqarTvelos saojaxo medicinis profesionalTa kavSiri;

lela woworia _ saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros janmrTelobis dacvis departamenti;

Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros janmrTelobis dacvis departamenti.

http://www.un.org/esa/population/publications/migration/uk.pdf

51

13. danarTebi

bekis depresiis kiTxvari (Beck Depression Inventory _ BDI)

A. 0. me ar var sevdiani. 1. me sevdiani var. 2. me mudam sevdiani var da unari ar Semwevs moviSoro es gancda. 3. me imdenad sevdiani da ubeduri var, rom amis atana aRar SemiZlia.

B. 0. me, Cveulebriv, uimedod ar vuyureb Cems momavals. 1. me uimedoba meufleba Cemi momavlis gamo. 2. me vgrZnob, rom momavalSi araferi maqvs saimedo. 3. me vgrZnob, rom Cemi momavali sruliad uimedoa da amas araferi

eSveleba

C. 0. me ar vTvli Tavs warumatebel adamianad. 1. me vgrZnob, rom sxva adamianebTan SedarebiT naklebad warmatebuli var. 2. me cxovrebaSi uamravi warumatebloba mqonda. 3. me vgrZnob, rom sruliad warumatebeli adamiani var.

D. 0. me iseTive siamovnebas viReb cxovrebidan, rogorc adre. 1. me cxovrebidan iseT siamovnebas veRar viReb, rogorc adre. 2. me Zalian miWirs raime siamovnebis miReba cxovrebidan. 3. me saerTod veranair siamovnebas veRar viReb cxovrebidan.

E. 0. me ara maqvs danaSaulis gancda. 1. me zogjer maqvs danaSaulis gancda. 2. me TiTqmis yovelTvis mawuxebs danaSaulis gancda. 3. me mudmivad maqvs danaSaulis gancda.

F. 0. me ar mawuxebs gancda, rom davisjebi. 1. me vfiqrob, rom SeiZleba davisajo. 2. me velodebi dasjas. 3. me aucileblad davisjebi.

G. 0. me ar var ukmayofilo sakuTari TaviT. 1. me guli gamityda sakuTar Tavze. 2. me mgonia, rom autaneli var. 3. me mezizReba sakuTari Tavi.

H. 0. me skuTari Tavi sxvebze nakleb adamianad ar mimaCnia. 1. me Secdomebis gamo sakuTar Tavs xSirad vakritikeb. 2. me mudmivad vsayvedurob sakuTar Tavs mravali naklis gamo. 3. me yvelaferSi sakuTar Tavs vadanaSauleb.

52

I. 0. me ara maqvs TviTmkvlelobis azrebi. 1. me zogjer miCndeba TviTmkvlelobis azri, magram me mas ar vyvebi. 2. me Tavis mokvla minda. 3. me Tavs moviklav, rogorc ki amisi SesaZlebloba meqneba.

J. 0. me ar vtiri Cveulebrivze ufro mets. 1. amJamad gacilebiT mets vtiri, vidre saerTod mCvevia. 2. me axla sul vtiri. 3. adre SemeZlo metira, axla ki tirilis unaric davkarge.

K. 0. me ar vRiziandebi Cveulebrivze ufro metad.. 1. me gacilebiT advilad vRiziandebi, Cveulebrivze ufro advilad vgrZnob Tavs Suracxyofilad. 2. mudmivad gaRizianebuli var. 3. sul aRar maRizianebs is ambebi, rac adre maRizianebda.

L. 0. sxva adamianebis mimarT interesi ar maqvs dakarguli. 1. adrindelTan SedarebiT sxva adamianebi axla naklebad Mmainteresebs. 2. sxva adamianebis mimarT interesi umetesad dakarguli maqvs. 3. absoluturad davkarge yovelgvari interesi adamianebis mimarT.

M. 0. me, Cveulebisamebr, advilad viReb gadawyvetilebebs. 1. me xSirad varideb Tavs raime gadawyvetilebis miRebas. 2. me Zalian miWirs gadawyvetilebis miReba. 3. me saerTod ver viReb veranair gadawyvetilebas.

N. 0. me ara maqvs imis gancda, rom adrindelze uaresad gamoviyurebi. 1. me ganvicdi rom moberebulad da dauZlurebulad gamoviyurebi. 2. me vgrZnob, rom garegnoba Semecvala, Seuxedavi gavxdi. 3. me vTvli, rom saSinlad gamoviyurebi.

O. 0. me iseTive Sromisunariani var, rogorc adre. 1. me zogjer Tavs Zalas vatan, rom Sevasrulo samuSao. 2. me mudmivad mWirdeba Zaldataneba sakuTar Tavze, rom samuSao Sevasrulo. 3. me saerTod veRarafers vakeTeb.

P. 0. me, Cveulebisamebr, kargad mZinavs 1. me ise kargad aRar mZinavs, rogorc adre. 2. me Cveulebrivze 1-2 saaTiT adre meRviZeba, Semdeg miWirs daZineba. 3. me Cveulebrivze ramdenime saaTiT adre meRviZeba da veRar viZineb.

53

Q. 0. me ar viRlebi adrindelze metad. 1. me adrindelTan SedarebiT ufro advilad viRlebi. 2. me yvelaferi mRlis. 3. me iseTi daqanculi var, rom arafris gakeTeba SemiZlia.

R. 0. me Cveulebriv cudi mada ar maqvs. 1. me iseTi kargi mada aRar maqvs, rogorc adre. 2. axla gacilebiT uaresi mada maqvs, vidre adre. 3. saerTod ar maqvs mada.

S. 0. wonaSi ar damiklia mniSvnelovnad. 1. wonaSi davikeli 2,5 kiloramze meti. 2. wonaSi davikeli 5 kg-ze meti. 3. wonaSi davikeli 7,5 kg-ze meti. (daazusteT, icavs Tu ara dietas: diax /ara)

T. 0. Cemi janmrTeloba ar mawuxebs Cveulebrivze metad. 1. zogjer me mawuxebs sakuTari janmrTelobis mdgomareoba. 2. mawuxebs sakuTari janmrTeloba da miWirs sxva rameze fiqri. 3. imdenad var Sewuxebuli sakuTari janmrTelobiT, rom ar SemiZlia sxva rameze fiqri.

U. 0. bolo xanebSi ar SeminiSnavs raime cvlileba Cems seqsualur SesaZleblobebSi. 1. adrindelTan SedarebiT, seqsiT naklebad var dainteresebuli. 2. gacilebiT naklebad var dainteresebuli seqsiT. 3. seqsis mimarT interesi sruliad davkarge.

54

bekis kiTxvaris interpretacia A. sevda.

B. uimedoba.

C. warumatebloba.

D. daukmayofileba.

E. danaSaulis gancda.

F. sasjelis molodini.

G. sakuTari pirovnebis miuRebloba.

H. TviTdanaSauli.

I. suiciduri azrebi.

J. tirilis epizodebi.

K. gaRizianebuloba.

L. socialuri gariyva.

M. sakuTar TavSi daurwmunebloba.

N. sxeulis xatis Secvla.

O. Seneleba, Sekaveba.

P. uZiloba.

Q. daRliloba.

R. madis daqveiTeba.

S. wonis dakleba.

T. wuxili somaturi Civilebis gamo.

U. dabali energetikuli done.

55

BDI Sedegebis Sesafaseba

A_0 1 2 3 H_0 1 2 3 O_0 1 2 3

B_0 1 2 3 I_0 1 2 3 P_0 1 2 3

C_0 1 2 3 J_0 1 2 3 Q_0 1 2 3

D_0 1 2 3 K_0 1 2 3 R_0 1 2 3

E_0 1 2 3 L_0 1 2 3 S_0 1 2 3

F_0 1 2 3 M_0 1 2 3 T_0 1 2 3

G_0 1 2 3 N_0 1 2 3 U_0 1 2 3

eqsperimentis Sedegi BDI = depresiis simZimis xarisxi

BDI mowodebulia Aaron T. Beck_is mier 1961 wels;

warmoadgens depresiis TviTSefasebis Skalas 17-80 wlis asakis pirebSi;

BDI gamoiyeneba depresiis simptomebis gamovlenis, simZimis xarisxis gansazRvrisa da monitoringisaTvis klinikuri da eqsperimentuli mizniT;

eqsperimentatori SeiZleba iyos fsiqikuri janmrTelobis specialisti, romelic trenirebulia am Skalis gamoyenebasa da SefasebaSi;

BDI testSi mocemulia 21 punqti, TiToeulSi 4 debuleba, romelic dalagebulia simptomis simZimis xarisxis mixedviT _ 0, 1, 2, 3 _ neitraluridan maqsimalurad mZimemde;

gamosakvlevi piri yovel punqtSi moniSnavs mxolod erT debulebas, romelsac yvelaze metad eTanxmeba ,,amJamad“ da/an ,,bolo 7 dRis“ ganmavlobaSi;

kiTxvaris Sesavsebad eZleva 5-10 wuTi (ar aris mkacri SezRudva);

testis 1 _13 punqtiT fasdeba fsiqologiuri bunebis, xolo 14 _ 21 punqtiT upiratesad fizikuri simptomebi; fasdeba sakuTriv depresiuli simptomebi da depresiis specifikuri bihevioruli gamovlinebebi;

testis saboloo jamuri maCvenebeli gansazRvravs depresiis simZimis xarisxs.

testis totaluri maCvenebeli fasdeba: BDI = 0 _ 9 _ ar aqvs depresia (depresiis simptomebi minimaluria) 10 _ 16 _ msubuqi depresia 17 _ 29 _ saSualo depresia 30 _ 63 _ mZime depresia zogad populaciaSi depresiis maCvenebelia >21 jamuri maCvenebeli.B

56

edinburgis postnataluri depresiis skala

rogor grZnobdiT Tavs bolo erTi kviris, bolo 7 dRis ganmavlobaSi:

1 me mqonda sicilis unari da sasacilo mdgomareobis aRqmis unari:

rogorc yovelTvis.

arc imdenad sakmarisad amJamad.

amJamad gansakuTrebiT naklebad.

srulebiT ara. 2 me, Cveulebriv, interesiT vuyureb Cems momavals:

rogorc yovelTvis.

naklebad vidre adre.

mniSvnelovnad naklebad vidre adre.

uimedod Sevyureb momavals.

*3 me vadanaSauleb Cens Tavs, rodesac saqmeebi cudad midis:

diax, yovelTvis.

Xandaxan.

arc ise xSirad.

Arasodes.

4 me mqonda SfoTva da wuxili arasasurveli SedegisTvis:

srulebiTac ara.

zogjer msubuqi.

diax, zogjer.

diax, Zalian xSirad.

*5 me vardebi panikaSi da mipyrobs SiSi cudi azrebis gamo: diax, xSirad.

diax, zogjer.

arc ise xSirad.

Arasdros.

*6 saqmeebi zogjer CemTvis miuwvdomeli mwvervalia:

xSirad me ar SemeZlo Tavi gamerTva saqmeebisTvis.

diax, zogjer me arc ise kargad varTmevdi Tavs saqmeebs, rogorc mCvevia.

ara, ufro xSirad me kargad varTmevdi saqmebs Tavs.

ara, me, rogorc yovelTvis, kargad varTmevdi saqmebs Tavs.

* 7 me viyavi iseTi ubeduri, rom mqonda siZneleebi Zilis mxriv: dix. TiTqmis yovelTvis am periodSi.

diax, zogjer.

arc ise xSirad.

arasdros.

*8 me Tavs vgrZnob sevdianad da daucvelad:

diax, TiTqmis yovelTvis.

57

diax, zogjer.

arc ise xSirad.

Arasdros.

*9 me viyavi iseTi ubeduri, rom vtirodi: diax, Zalian xSirad.

sakmaod xSirad.

iSviaTad.

Arasodes.

*10 fiqrebi TviTdazianebis Sesaxeb:

sakmaod xSirad.

xandaxan.

iSviaTad.

arasodes. pasuxebi fasdeba 0 - dan 3 - mde quliT simptomebis simZimis zrdis mixedviT.

* moniSnuli kiTxvebi fasdeba SebrunebiTi qulebiT (mag: 3, 2, 1 da 0)

Tu kixvaris gamoyenebiT qali daagrovebs 9 dan 13 qulamde, testi dadebiTia. imavdroulad, Tu dagrovebuli qulebi cxra an metia, an miTiTebulia romelime suiciduri niSani, rac niSnavs, rom man miuTiTa erT-erT maRal qulaze #10 kiTxvidan, aseTi pacienti saWiroebs uwyvet meTvalyureobas. Tu dagrovili qulebi 9-ze naklebia, magram klinicistebis SefasebiT qals aqvs depresia, is saWiroebs referals specialistTan.

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