抗抑郁药物
Antidepressants抗抑郁药物
Hope from a pill
从药品中获得希望
Disagreements over whether drugs to combat depression are worth taking
对是否应当使用抗抑郁药物的不同观点
ANTIDEPRESSANTS have long been the source of controversy. Amphetamines were widely used as an antidote to neurotic depression into the 1960s, until such “pep pills” came to be seen as doing more harm than good. Similar worries are now engulfing today's antidepressants, like Prozac and Paxil, which are among the most widely prescribed drugs in the world.
关于抗抑郁药物一直以来就存在争议. 安非他明在1960年代曾经被广泛应用于治疗精神性抑郁症直到后来这种精神类药品被认为对人的伤害要大于它的疗效.相似的争议在今天的抗抑郁药物中也存在,例如百忧解和Paxil这两种目前在世界上使用的最广泛的两种抗抑郁处方药.
Two new studies have stirred things up: one warning that antidepressants do not help most people very much, and the other gushing that they are a marvellously cheap way to save lives.
两项新公布的研究成果又使这个问题成为焦点：一种警告患者：抗抑郁药物对大多数人作用不大，另一种却认为它们是花很少钱就可以拯救生命的好办法。
Most antidepression pills prescribed today are selective serotonin reuptake inhibitors (SSRIs), a type of drug that boosts the amount of serotonin hanging around in the brain. Serotonin is a brain chemical closely associated with mood. Boosting its level this way might therefore improve a person's mood. Earlier versions were less effective than modern pills, which have fewer side effects and are less toxic in overdose. The use of SSRIs worldwide has shot up from below 3 billion doses in 1995 to over 10 billion in 2004.
今天大多数抗抑郁处方药都是选择性5羟色胺再摄取抑制剂(SSRIs),这种药物的作用原理是增加大脑中5羟色胺的含量。5羟色胺是一种存在于大脑内的与人的情绪关系密切的化学品。药品通过增加它的数量来改善人的情绪。早期的选择性5羟色胺再摄取抑制剂的效果没有现在的好但是负作用和服用过量后的毒性也没有现在的药品大。选择性5羟色胺再摄取抑制剂的使用剂量从1995年的30亿快速增长到2004年的100亿。
Is all the pill popping doing any good? There is recent evidence that it can lead young people to act on suicidal thoughts, prompting America's Food and Drug Administration (FDA) to insist on warnings. SSRIs have generally been seen as a way to ease depression in adults without killing them. Derek Summerfield argued in the Journal of the Royal Society of Medicine that, although there is no epidemic of depression,“the case for an epidemic of antidepressant prescribing is now cast iron.”
是不是所有的这类药物都有突出的疗效呢?最近有证据表明服用这类药物会使年轻人产生自杀的想法,这促使FDA发出有关此类药品的警告. 选择性5羟色胺再摄取抑制剂一般被认为是一种成人服用有助于减轻抑郁的药品(也没有导致其自杀的负作用) Derek Summerfield在《英国皇家医学会期刊》上发表的文章认为：抑郁症本身并没有传染性“目前抗抑郁类药品的流行应当被严格控制。”
A study published in this week's Public Library of Science (PLoS) Medicine, an open-access scientific journal, raises doubts about dispensing such drugs so freely. Irving Kirsch, of the University of Hull, and his colleagues scrutinised the clinical trials for several new antidepressants, taking care to include those never published (but which, by law, have to be reported to the FDA).
本周在《公共科学图书馆杂志（医学版）》（一种开放存取的科学杂志）公布的一篇研究报告增加了人们对自由使用这类药品的怀疑。赫尔大学的Irving Kirsch先生和他的同事们对几种新型抗抑郁药物的临床试验情况进行了分析，其中包括对一些从未公布的试验结果的分析（虽然不能对外公布但是根据法律这些时局必须报告给FDA
They found that SSRIs did not help the vast majority of depressed people much more than placebos did. The net benefits over placebos did not usually reach the level considered big enough to be of clinical significance by Britain's National Institute for Health and Clinical Excellence (NICE).
他们发现对大多数患抑郁症的患者而言选择性5羟色胺再摄取抑制剂的疗效并不比安慰剂更明显.这类抗抑郁药物与安慰剂相比的净疗效一般达不到英国国立医疗技术研究所认可的有显著疗效的水平.
This study points to two factors that bedevil proponents of SSRIs: publication bias and the power of placebos. Dr Kirsch believes published data “give an exaggerated view of a drug's benefit.”
研究者认为有两点可以来解释这种让人感到困惑的现象:已公布数据的误导和安慰剂的作用. Kirsch博士相信已经对外公布的数据”夸大了药品的疗效.”
People with very severe depression did see benefits above the NICE threshold, but even that was not a ringing endorsement. Dr Kirsch explains that this was not because SSRIs worked much better in the very seriously depressed, but rather that the effectiveness of placebos dropped off sharply in such people,making the drug look better.
那些患有严重抑郁症的患者服药的效果在英国国立医疗技术研究所认可的有显著疗效的水平之上,但即使如此也不能说其疗效就是绝对可靠的. Kirsch博士对此的解释是这并不能说明选择性5羟色胺再摄取抑制剂对严重抑郁的患者效果要好的多,而是由于安慰剂对这类患者的效果大大减少,所以使药物的疗效看起来更好.
There are two sorts of criticism of the idea that SSRIs are mostly a waste of money. One comes from those who say the study itself is rubbish. David Nutt, of the University of Bristol, says failed drug trials often remain unpublished because their design is shoddy or their results uninteresting.
对这种认为选择性5羟色胺再摄取抑制剂毫无价值的观点有两种反对意见.一种意见认为这项研究本身就毫无价值. 布里斯托大学的David Nutt认为那些失败了的药物临床试验往往是不对外公布的因为这些试验或者设计本身就存在问题或者试验结果毫无价值.
He criticises the PLoS paper as a “mishmash of quality trials and lousy trials leading to a false criticism of these drugs”, which he maintains do help those with depression even if their effectiveness falls below the NICE's “arbitrary” threshold. Dr Nutt thinks it is misleading to compare these drugs with placebos, since what matters is that they work when compared with some alternatives, such as “talk therapy”, for which he believes there is even less evidence of effectiveness.
他对《公共科学图书馆杂志（医学版）》的批评是“将各种质量水平的临床试验混为一谈，根据那些失败的临床试验的结果对抗抑郁的药物提出了错误的批评。”他认为即使这些药品的疗效达不到英国国立医疗技术研究所认可的水平，它们对抑郁症患者而言依然是有帮助的。Nutt博士认为用安慰剂进行对照容易引起误解。他认为应当将这些药品与治疗抑郁症的其他替代疗法（例如心理医生的谈话疗法）进行对比，他认为那些方法更难证明是有效的。
Good-news potions
针对抗抑郁药物的好消息
Yet there is reason to think that unpublished studies do reveal some important and rather unflattering details about antidepressants.
公众认为那些未对外公布的研究数据暴露出一些很重要但对抗抑郁药物很不利的信息是有道理的。
A well-designed study published in January in the New England Journal of Medicine looked at a larger group of antidepressants and concluded there was indeed “a bias toward the publication of positive results”: 94% of the published trials were positive, whereas only about half of the unpublished ones were.
一份构思极佳的研究报告发表在08年1月份的《新英格兰医学杂志》上，报告对更多数量的抗抑郁药物进行了分析，它的结论是仅根据已经公布出来的临床试验数据来判断抗抑郁药物的疗效是有偏差的。因为已经对外公布的临床试验结果中有94%是证明药品有效的，而未公布的试验结果中说明药品有积极效果的只有一半。
That bolsters the PLoS paper, but there is another sort of critique that challenges its conclusions. A recent study published by America's National Bureau of Economic Research (NBER) analysed data from 26 countries over several decades to determine what effect SSRIs have had on suicides.
这份报告显然是对《公共科学图书馆杂志（医学版）》观点的支持，但是又有另一项研究对这一观点发起了挑战，它就是由美国国家经济研究局公布的对26个国家进行的几十年来选择性5羟色胺再摄取抑制剂对预防自杀的效果的研究。
Its authors argue that antidepressants are in fact “a very cost-effective means for saving lives”.
这份报告的作者认为实际上抗抑郁药物是“一种非常划算的保护生命的方法。”
Countries with both high and low initial rates of antidepressant use saw similar trends in suicides until SSRIs were introduced. Jens Ludwig, of the University of Chicago, argues that countries that took to the new drugs saw a relative decline in suicides.
这些国家无论最初抗抑郁药物的使用率是高是低在使用选择性5羟色胺再摄取抑制剂后自杀率都呈现相似的趋势。芝加哥大学的Jens Ludwig认为这些国家使用新型抗抑郁药物后导致了自杀率的相对下降。
After controlling for many variables, his NBER team reaches the cheerful conclusion that an increase in sales of one pill per person per year (about a 12% increase over the level in 2000) leads to a decline in suicide mortality of about 5%.
在对很多变量加以控制后，他在经济研究局的团队得出了一个令人鼓舞的结论：随着人均每年消费抗抑郁药物数量的增长（与2000年的水平相比增长速度是12%）导致自杀死亡率有5%的下降。
So are SSRIs to be shunned or saluted? The controversy will rage on, but Erick Turner, of the Portland VA Medical Centre in Oregon, suggests a third way. As one of the authors of the New England Journal ofMedicine paper, he says the study confirms that most antidepressants do not work as well as published reports claim. That suggests many people, especially children, should be more careful about using them.
我们到底应该拿选择性5羟色胺再摄取抑制剂怎么办呢？欢迎还是拒绝？有关这个问题的争论估计还会继续下去，在俄勒冈的波特兰鉴定医学中心的Erick Turner先生却提出了对抗抑郁药物的第三种观点，作为《新英格兰医学杂志》的作者之一，他认为这项研究证实大多数抗抑郁药物的疗效并不像它们公布出的临床试验报告中说的那么好。所以一些人特别是孩子在使用抗抑郁药物方面要更加慎重。
But that does not mean they are pointless. He speculates that, if other therapies fail, “maybe all you need is a minor or mediocre effect in order to reduce suicides overall.” That may be particularly true for those who are closest to the edge of darkness.
但是这也不能说明那些抗抑郁药物就毫无价值。他认为如果其他治疗方法不起作用，也许患者所需要的只是通过服用这类疗效一般的抗抑郁药物来降低自杀的风险。通过服用抗抑郁药物来治疗抑郁症对于那些患严重抑郁的人也许更加适合。
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