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лекция

наука

00:00:00

[applause]

00:00:03

if we are talking about

00:00:05

drugs and dependence on them, well, we

00:00:08

probably first need to understand what

00:00:10

addiction is as such, the

00:00:12

definition actually

00:00:14

varies quite a lot, but

00:00:16

in general, this is a situation when a

00:00:20

person takes a drug

00:00:22

in order to achieve some pleasant he has

00:00:26

effects and takes it, let’s say

00:00:29

compulsive,

00:00:30

he has an acute need for this, an

00:00:33

acute desire that is difficult for him

00:00:35

to control, or a person does the

00:00:38

same but to prevent any unpleasant

00:00:42

sensations,

00:00:43

this will be just a situation of

00:00:46

dependence, an

00:00:48

important element compulsive, as I already

00:00:50

said, when under with this desire to take a

00:00:53

conditional pill or make the nation

00:00:55

impossible to fight or difficult to fight,

00:00:57

it violates the quality of life,

00:01:01

then we need to introduce two more terms, or

00:01:04

I would like to introduce two terms into our

00:01:06

circulation: abstinence and tolerance,

00:01:10

by abstinence we understand the situation

00:01:13

when

00:01:14

failure to take the next dose of the drug

00:01:17

leads to deterioration of

00:01:19

a person’s well-being, unpleasant symptoms arise

00:01:22

that disappear if the dose

00:01:27

is nevertheless taken and

00:01:29

the end of tolerance is a

00:01:33

phenomenon in which the

00:01:36

effect of the drug decreases over

00:01:40

time, its use,

00:01:42

for example, the

00:01:44

drug is used for three

00:01:47

weeks, everything is fine and in the fourth week the

00:01:50

same dose suddenly stops

00:01:52

working or at least sects

00:01:53

turn out to be much lower, this is precisely

00:01:56

tolerance, the development of tolerance

00:01:58

when we talk about addiction, it is customary to

00:02:01

distinguish between physical and mental, but

00:02:03

here in fact there is a lot of debate about

00:02:05

whether these are different things, whether they need to be separated so clearly,

00:02:08

or whether it is always some kind of

00:02:11

complex but nevertheless, without going into

00:02:14

formalities, when we talk about

00:02:16

physical dependence, it’s understandable that

00:02:22

nausea, pain,

00:02:25

general weakness arises, and a person wants to

00:02:28

take more medicine,

00:02:32

when we talk about mental dependence, it would

00:02:36

seem physically that nothing unpleasant

00:02:38

happens, but

00:02:40

we are sad, we are burdened anxious

00:02:45

without the drug, we want to take it so

00:02:49

that it becomes calmer and more joyful, more

00:02:52

fun, so that communication develops better,

00:02:55

so that we can work faster, this is more likely,

00:03:00

yes, mental dependence occurs

00:03:02

when we talk about

00:03:04

specific examples of addiction instead of

00:03:07

starting with a conversation in

00:03:09

morphine

00:03:10

classic, which is known to many

00:03:13

including from lectures and within the framework of the

00:03:16

post-science project, I would like to start

00:03:19

depending on such a

00:03:21

seemingly harmless remedy as

00:03:23

vasoconstrictor drops from the forecast, how does

00:03:27

this dependence develop and what is the problem here? The

00:03:31

fact is that in our body,

00:03:34

in the words of Boris Nikolaev, the price

00:03:37

exists a very complex subtle system of

00:03:39

checks and balances, all processes, all

00:03:42

elements in the body are

00:03:44

controlled from several sides, a

00:03:45

fairly fine system has been worked out

00:03:49

that

00:03:50

controls the

00:03:52

condition of the nasal mucosa,

00:03:55

in particular, control without loops

00:03:58

is ensured by controlling the tone of the

00:04:00

vessels of the mucous membrane, if these vessels

00:04:03

expand, then swelling of the mucous membrane occurs,

00:04:07

if they narrow, swelling becomes

00:04:09

less and nasal breathing is facilitated on the

00:04:13

vascular cells there are receptors, the

00:04:17

same signal receivers, receptors for

00:04:20

adrenaline and

00:04:23

adrenaline binding to these receptors

00:04:26

constricts the blood vessels,

00:04:28

nasal breathing is facilitated

00:04:30

accordingly, it was logical to completely

00:04:33

develop a medicine that is reminiscent in

00:04:36

its action in its structure of the

00:04:38

same adrenaline that will

00:04:40

bind to the same the receptors themselves

00:04:42

and provides vasoconstriction, a

00:04:45

wonderful solution in a situation of acute

00:04:47

rhinitis, for example, or chronic rhinitis,

00:04:49

it would seem,

00:04:51

however, as I already said, there is a system of

00:04:53

checks and balances

00:04:55

when these receptors for adrenaline in

00:04:58

the vessels of the mucous membrane

00:05:00

are bombarded with an extreme amount of

00:05:03

stimulus by our medicine,

00:05:06

the body urgently tries to do something to

00:05:08

lead the situation to the original one, in

00:05:12

particular, it reduces the sensitivity of

00:05:13

these receptors; the

00:05:16

receptors have become less sensitive; we

00:05:20

forgot the spray at home; we went to work; and

00:05:25

normally, the compass continues

00:05:28

to circulate; our own adrenaline

00:05:30

in the blood; it continues to act on the

00:05:32

receptors, squeezing the blood vessels so that they do not

00:05:34

relax, but the sensitivity

00:05:36

has decreased these receptors need more

00:05:39

stimulation because we have been pumping for a week

00:05:42

in a row with a

00:05:43

vasoconstrictor drug and all of our

00:05:46

own adrenaline

00:05:48

is no longer

00:05:49

enough, the problem of the problem, what is interesting

00:05:54

here is

00:05:55

that such a change, a decrease in the

00:05:57

sensitivity of receptors in the vessels of the

00:05:59

mucous membrane, develops already on the third

00:06:01

day, the use of vasoconstrictors is

00:06:05

precisely why this 3-day

00:06:07

restriction has now been introduced in many

00:06:10

countries of the world very clearly no more than 3 days

00:06:12

before and even three days only on the condition that

00:06:15

nothing else helps and it is very

00:06:17

difficult for you, therapy for

00:06:19

drug dependence on these

00:06:21

drugs can be quite complicated and

00:06:23

take several months therefore

00:06:27

This problem is now receiving a lot of

00:06:29

attention and the

00:06:31

ministries of health, for example, of many countries and the

00:06:34

United States of Norway are releasing

00:06:36

special information materials

00:06:38

to warn patients about this

00:06:40

danger. Yes, it is an effective drug; it is

00:06:43

extremely undesirable to use it for more than three days.

00:06:46

I will not

00:06:48

spend a lot of time talking about Marfa and

00:06:51

morphine-like drugs. substances and dad

00:06:54

atah everyone knows that an addiction can arise to them, a

00:06:58

dependence may arise, let’s not say that it can

00:07:01

arise unfortunately with long-term

00:07:03

use, in general, it is inevitable,

00:07:06

what are our problems and the mechanism here is in the

00:07:10

body in the brain in particular,

00:07:12

but not only there are receptors to

00:07:15

morphine and morphine-like substances,

00:07:17

why not because evolution, when creating

00:07:21

us, foresaw what would appear in bin imac, but

00:07:25

because the body has its own

00:07:28

pain-relieving system that

00:07:30

produces substances similar to morphine

00:07:32

in structure and they bind to these

00:07:34

receptors and suppress minimal

00:07:37

minor pain impulses with so

00:07:39

that we do not live in a constant background of pain,

00:07:43

microscopic damage in the body

00:07:45

occurs constantly if every

00:07:48

minimal stimulus causes us

00:07:50

pain, well, this is not how we can live, and not

00:07:54

only for humans, for any

00:07:56

living organism, this reduces

00:08:00

functioning in a complex environment; this is why it

00:08:05

exists This is our internal

00:08:10

pain-relieving system, developed by nature, but

00:08:12

morphine also acts through these same receptors, and what we

00:08:15

get after some time all over the

00:08:17

world gul arnova morphine use,

00:08:20

receptors, just like in the case of

00:08:22

vasoconstrictor drugs, lose their

00:08:25

activity, lose their sensitivity

00:08:26

and

00:08:27

assume that we removed morphine,

00:08:31

our own pain-relieving system

00:08:33

continues to secrete a certain amount, the

00:08:35

same amount of

00:08:37

pain-relieving molecules means but the

00:08:39

receptors have lost sensitivity and,

00:08:42

accordingly, those pain impulses

00:08:45

that would not have even developed in our

00:08:48

body before now they bypass this

00:08:52

filter and,

00:08:53

well, let’s say life becomes a pain

00:08:56

in fact, the smile here was not entirely

00:08:59

appropriate because speaking of withdrawal,

00:09:02

this is a very terrible condition and people

00:09:05

dependent on morphine and similar

00:09:07

energy drinks experience extremely

00:09:10

pronounced pain in a situation

00:09:13

when they do not receive the next dose and

00:09:15

this is of course a tragic catastrophe,

00:09:18

therefore

00:09:19

[music]

00:09:21

the desire to receive the next dose is

00:09:23

connected not only with the fact that you want to

00:09:25

get, speaking of drug addicts or

00:09:29

drug users, not only this desire is

00:09:31

connected with the fact that you want to get

00:09:33

the joy and euphoria from taking the drug,

00:09:35

but also simply in order to avoid these

00:09:37

severe symptoms of withdrawal symptoms,

00:09:40

addiction can develop a little

00:09:42

differently another mechanism, not so much

00:09:46

because a person wants to get euphoria,

00:09:48

but because a person wants to

00:09:50

escape from

00:09:52

disability and anxiety, so you can

00:09:55

say because a severe real

00:09:58

anxiety disorder is generalized,

00:10:00

that is a serious illness and it is

00:10:02

very difficult for a person to constantly live in serious

00:10:06

anxiety, this is torture and it is

00:10:08

clear that sometimes a person can go

00:10:12

for

00:10:13

excessive use of

00:10:15

medications and in particular this may be

00:10:18

due to not entirely correct therapy

00:10:20

prescribed by a doctor and drugs

00:10:23

from which dependence can easily develop,

00:10:24

these so-called benzodiazepines are

00:10:26

drugs that suppress our central

00:10:29

nervous system, suppress anxiety,

00:10:32

create such a calm, but there

00:10:36

is an interesting point of

00:10:37

interest

00:10:40

so to speak, the interest or desire to receive

00:10:44

benzodiazepines in an addicted person is

00:10:47

formed not only due to the search for a

00:10:51

remedy for anxiety, but also because

00:10:55

benzodiazepines have the effect of causing

00:10:59

mild euphoria; this effect is

00:11:01

formed in a very interesting way; benzodiazepines themselves are

00:11:05

not capable of giving euphoria; however, we

00:11:09

have this biologically in our brains an active

00:11:11

substance called dopamine, it is

00:11:14

associated with reward with the world

00:11:17

biological phenomenon of reward with

00:11:20

joy with a feeling of warmth of

00:11:22

pleasure and the

00:11:25

release of dopamine in the brain

00:11:28

is under strict control because

00:11:31

if we are constantly in a

00:11:32

state of pleasure, from the

00:11:34

point of view of neurobiology, nothing

00:11:37

good will come of it although it

00:11:38

would seem that someone would probably want this,

00:11:42

so the neurons that release dopamine

00:11:45

above them are a kind of controllers that

00:11:49

control nirvana that do not

00:11:52

allow the release of dopamine constantly

00:11:55

benzodiazepines suppress the central

00:11:57

nervous system and in particular suppress

00:11:59

those same controllers the watchman fell asleep and the

00:12:03

release of dopamine continues to a

00:12:05

greater extent, a person receives

00:12:07

pleasant emotions, so here the reason for

00:12:10

addiction is not only in the desire to

00:12:14

suppress anxiety, but also for some

00:12:18

people in the desire to get that very

00:12:21

pleasant feeling

00:12:23

associated with dopamine, phenobarbital is a

00:12:25

very old, widely known, well-

00:12:28

known drug

00:12:30

that has, in particular, hypnotic

00:12:33

effect

00:12:34

sedative effect

00:12:35

anticonvulsant effects phenobarbital

00:12:38

is part of such super popular

00:12:40

drugs as phena, valocordin and

00:12:44

corvalol,

00:12:45

people think that they smell somehow pleasant

00:12:48

and there is probably some kind of valerian in there,

00:12:50

something like that, but in fact there is

00:12:52

quite a rude substance in there and hard-

00:12:55

working drugs phenobarbital,

00:12:57

which is perfectly capable of causing

00:12:59

addiction, which is why in most

00:13:02

developed countries this substance is

00:13:05

under strict control,

00:13:06

so the

00:13:09

body adapts to the entry of

00:13:13

phenobarbital into the system and the liver learns to

00:13:15

process it faster, so

00:13:18

we start with 10 drops and this gives its

00:13:22

calming effect but after some

00:13:25

time you need to take 50 drops

00:13:27

because the liver has adapted and

00:13:29

quickly processes this medicine and

00:13:31

then even a teaspoon.

00:13:34

Unfortunately, I have seen especially elderly

00:13:36

patients who take

00:13:39

catastrophically large quantities of

00:13:40

Corvalol and

00:13:42

Valocordin and are not able to sleep without them

00:13:44

and in principle, to function is

00:13:47

of course a big problem. Very often

00:13:49

patients and colleagues ask the question whether there is an

00:13:52

addiction to antidepressants and the

00:13:55

answer to this question is not very simple, on the

00:13:58

one hand, if we are talking about

00:13:59

addictions such as dependence on

00:14:01

vasoconstrictors or on morphine,

00:14:05

similar drugs for opiates, then there

00:14:08

is no such dependence here, however, there is another

00:14:11

situation that for the patient may

00:14:14

look like an addiction, namely, let’s

00:14:16

assume that a person has a

00:14:19

well, classically expressed, good,

00:14:22

unfortunately, in quotation marks, of course, but also a

00:14:25

classically expressed depressive

00:14:27

disorder,

00:14:29

therapy is prescribed and the therapy

00:14:32

turns out to be effective, the mood

00:14:34

improves, more strength is more or less

00:14:37

not bad after some time, as if

00:14:39

after a year, either the patient or the doctor may

00:14:43

want to try to stop the drug

00:14:44

or reduce the dose, let’s assume canceling

00:14:47

if the drug is stopped abruptly, what

00:14:51

situation do we find ourselves in? After all, depression

00:14:54

during this time with a high probability has

00:14:55

not disappeared anywhere, for

00:14:58

some it may be persistent improvement yes,

00:15:00

but for some the

00:15:02

disease is still there, we just kept it

00:15:05

in check with the help of treatment and

00:15:09

naturally the condition improves the person

00:15:13

feels significantly worse and

00:15:14

returns to therapy of course it is

00:15:16

perceived as an addiction but in

00:15:19

fact I would not call it an

00:15:20

addiction I would just saying that,

00:15:22

unfortunately, someone’s disease is too

00:15:25

severe and without therapy it is

00:15:31

not possible to maintain a fairly good quality of life and therefore it is very

00:15:34

important if you try to reduce the dose and this is

00:15:36

acceptable and normal in many cases, then

00:15:38

do it very slowly very

00:15:41

carefully so as not to cause such

00:15:43

dips in well-being, there are also

00:15:45

interesting interesting group of questions:

00:15:48

people who start taking medicine

00:15:51

for high blood pressure or

00:15:52

high cholesterol, statins,

00:15:54

people are afraid of becoming addicted and say

00:15:58

how can I no longer be able to

00:16:00

live normally without these drugs, and

00:16:02

this question, by the way, is about it

00:16:05

it must be treated with respect, it is

00:16:07

absolutely understandable and natural, but a

00:16:09

person is not required to know physiology,

00:16:11

biochemistry, pharmacology, but a

00:16:14

doctor must know these disciplines in the case of the same

00:16:18

antihypertensive drugs for high

00:16:20

blood pressure,

00:16:21

starting to take them, we do not

00:16:24

radically change the functioning of any

00:16:25

system in the body, we do not we do so that

00:16:28

without the drug, our blood pressure will suddenly begin

00:16:30

to increase to an even greater extent than

00:16:34

before the start of therapy, just like with

00:16:37

drugs for high cholesterol,

00:16:38

statins, we start taking them and

00:16:41

the oven does not react to this with some

00:16:44

incredible adaptation, which will lead

00:16:47

to the fact that we have removed the drug and

00:16:50

our blood turns into butter; there is

00:16:52

no such risk; there is no cancellation of drugs for

00:16:57

high blood pressure or the withdrawal of statins

00:16:59

does not lead to a person

00:17:01

becoming worse than he was before the start of

00:17:03

therapy; if he really wants to

00:17:05

stop taking pills, he can

00:17:07

do this; nothing worse than what happened to him

00:17:11

will not happen, but this idea is not the best in

00:17:13

principle, since high blood pressure

00:17:16

needs to be treated and high cholesterol

00:17:17

also needs to be regulated,

00:17:20

and finally, the question of dependence as

00:17:23

such on drugs, is it necessary to be afraid of it in a

00:17:26

panic before addiction is bad, it’s

00:17:29

unpleasant, it’s scary in many situations,

00:17:31

but it’s

00:17:34

important understand the context and take it into account,

00:17:37

and if we are talking, for example, about a terminal

00:17:40

patient with advanced cancer, an

00:17:43

obviously extremely

00:17:45

unfavorable prognosis for life when

00:17:47

we are talking about a conditional year, but at the same time the

00:17:50

person has a very pronounced pain

00:17:52

syndrome and he, excuse me, screams at night and

00:17:54

this happens every day on every

00:17:58

street of everyone In the city, unfortunately, this is a

00:18:00

very common problem.

00:18:03

What are we afraid of here, that a person will become

00:18:06

dependent for the remaining year of his life? It

00:18:08

seems to me that we need to be afraid of the fact that a

00:18:11

person suffers. In making a decision about

00:18:14

using these drugs, we

00:18:16

must take into account the specific

00:18:19

situation of a particular patient;

00:18:24

because of our personal

00:18:26

prejudices and again because of our personal

00:18:28

fears, to make the

00:18:30

patient not sleep at night and

00:18:34

scream, bite his lips and experience

00:18:37

inhuman suffering, this should not

00:18:39

happen

00:18:40

[music]

Description:

Насколько безопасны антидепрессанты и почему зависимые от морфина постоянно чувствуют боль – рассказывает фармаколог Юрий Киселев Читай расшифровку лекции здесь: https://postnauka.org/video/156749 Юрий Киселев (https://postnauka.org/themes/yury_kiselev) – Ph.D., доцент Oslo Metropolitan University Поддержи ПостНауку — https://postnauka.org/donate/

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UDL Lite is a really convenient way to access a website from your mobile device. With its help, you can easily download videos directly to your smartphone.

Which format of "От каких лекарств бывают зависимости? / Юрий Киселев на Постнауке" video should I choose?

The best quality formats are FullHD (1080p), 2K (1440p), 4K (2160p) and 8K (4320p). The higher the resolution of your screen, the higher the video quality should be. However, there are other factors to consider: download speed, amount of free space, and device performance during playback.

Why does my computer freeze when loading a "От каких лекарств бывают зависимости? / Юрий Киселев на Постнауке" video?

The browser/computer should not freeze completely! If this happens, please report it with a link to the video. Sometimes videos cannot be downloaded directly in a suitable format, so we have added the ability to convert the file to the desired format. In some cases, this process may actively use computer resources.

How can I download "От каких лекарств бывают зависимости? / Юрий Киселев на Постнауке" video to my phone?

You can download a video to your smartphone using the website or the PWA application UDL Lite. It is also possible to send a download link via QR code using the UDL Helper extension.

How can I download an audio track (music) to MP3 "От каких лекарств бывают зависимости? / Юрий Киселев на Постнауке"?

The most convenient way is to use the UDL Client program, which supports converting video to MP3 format. In some cases, MP3 can also be downloaded through the UDL Helper extension.

How can I save a frame from a video "От каких лекарств бывают зависимости? / Юрий Киселев на Постнауке"?

This feature is available in the UDL Helper extension. Make sure that "Show the video snapshot button" is checked in the settings. A camera icon should appear in the lower right corner of the player to the left of the "Settings" icon. When you click on it, the current frame from the video will be saved to your computer in JPEG format.

What's the price of all this stuff?

It costs nothing. Our services are absolutely free for all users. There are no PRO subscriptions, no restrictions on the number or maximum length of downloaded videos.