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【drug-news】抗抑郁药：天使还是魔鬼？
Feb 28th 2008 | NEW YORK
From The Economist
“Disagreements over whether drugs to combat depression are worth taking” 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Antidepressants：Hope from a pill
抗抑郁药：小药片带来的希望
Feb 28th 2008 | NEW YORK
From The Economist
“Disagreements over whether drugs to combat depression are worth taking”
对于抗抑郁药物是否值得使用，一直存在争议。
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. 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.
抗抑郁药一直是争议的来源。在60年代抗抑郁药被广泛用于神经症性忧郁病，直到如“兴奋丸”类药物被发现其带来的伤害大于利处。今天同样的担心在抗抑郁药使用上，比如白忧解、帕罗西汀这两种世界最广泛使用的抗抑郁药。两项新的研究使事情变得混乱，一项警告说对于大多数人抗抑郁药无明显作用，另一项却表明抗抑郁药能廉价有效的改善生活。
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.
现在，大多数抗抑郁症药物处方为选择性5羟色胺再吸收抑制剂(SSRIs),是一类提高脑内5羟色胺量的药物，5羟色胺是脑类和情绪最相关的物质。提高它的含量水平能改善人的情绪，最先的观点认为这类药物比其他现代药物的影响更小，就是超剂量服用也没有太大的毒副作用，所以临床大量广泛使用，从1995年的每年30亿剂量以下到2004年已超过100亿剂量。
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.”
那么说抗抑郁药全是益处吗？最近的证据表明，服用抗抑郁药能够导致青少年产生自杀倾向，FDA主张要强调这个警告。SSRIs类抗抑郁药广泛的用于成年人消除抑郁，而不是谋杀他们，Derek Summerfield 在皇家医药学会杂志上争辩说，尽管抑郁症没有传染性，“抗抑郁症药物处方具有传染性是确切的”
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). 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).
本周一项研究发表在公共科学图书馆(PLoS）药物学杂志，一家公共性的科学杂志上，对调剂此类药物过于容易提出了怀疑，来自于Hull大学的Irving Kirsch，和他的同事们详细调查了几个新的抗抑郁药物临床试验资料，包括未出版的报告（但在法律程序上必须向FDA提交的），他们发现对大多数抑郁症患者，SSRIs类药物并不比安慰剂更有效。英国国家健康和优秀临床机构(NICE).认为，此类药物对比安慰剂所达到的治疗作用不足以认定为有显著的临床意义。
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.” 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.
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作者:admin@医学,生命科学 2010-10-30 05:11
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