健康择药:百忧解带来的未解之忧

When it came to pharmacological solutions to life's despairs, Aldous Huxley was ahead of the curve. In Huxley's 1932 novel about a dystopian future, the Alphas, Betas and others populating his "Brave New World" have at their disposal a drug called soma. A little bit of it chases the blues away: "A gramme" — Huxley was English, remember, spelling included — "is better than a damn." With a swallow, negative feelings are dispelled.
说到以药物手段来医治生活中的绝望，奥尔德斯·赫胥黎(Aldous Huxley)可谓走在了时代的前面。在赫胥黎1932年的小说《美丽新世界》(Brave New World)中，生活在那个反乌托邦未来世界中的阿尔法、贝塔和其他种姓的人类手头常备一种名叫“苏麻”的万能灵药，只要一点点就可以驱散生活中的阴霾。“服药胜过受煎熬。”只要吞下药丸，负面情绪也随之烟消云散。

Prozac, the subject of this week's video documentary from Retro Report, is hardly soma. But its guiding spirit is not dissimilar: A few milligrams of this drug are preferable to the many damns that lie at the core of some people's lives. Looking back at Prozac's introduction by Eli Lilly and Company in 1988, and hopscotching to today, the documentary explores the enormous influence, both chemical and cultural, that Prozac and its brethren have had in treating depression, a concern that gained new resonance with the recent suicide of the comedian Robin Williams.
本周（指9月22日那周）的"Retro Report"（以重新审视历史上的重大事件为主题的系列纪录片）的主题百忧解(Prozac)和“苏麻”当然不是一码事，但其宗旨却并无不同：对某些人而言，服用几毫克这种药物总比应付生活中的大堆烦恼合算多了。继回顾了1988年美国礼来制药(Eli Lilly and Company)推出百忧解的经过之后，这部纪录片又将视角转回当下，从化学和文化的双重角度探讨了百忧解及其同类产品在抑郁症的治疗领域造成的巨大影响。由于喜剧演员罗宾·威廉姆斯(Robin Williams)不久前自杀，抑郁症又成为当今人们关注的热点。

In the late 1980s and the 90s, Prozac was widely viewed as a miracle pill, a life preserver thrown to those who felt themselves drowning in the high waters of mental anguish. It was the star in a class of new pharmaceuticals known as S.S.R.I.s — selective serotonin reuptake inhibitors. Underlying their use is a belief that depression is caused by a shortage of the neurotransmitter serotonin. Pump up the levels of this brain chemical and, voilà, the mood lifts. Indeed, millions have embraced Prozac, and swear by it. Depression left them emotionally paralyzed, they say. Now, for the first time in years, they think clearly and can embrace life.
在20世纪80年代末和90年代，人们普遍将百忧解看作是一种“神奇药丸”，是那些觉得自己快要没顶于精神痛苦中的人们眼里的救生圈。百忧解是一类名为选择性血清素再摄取抑制剂(SSRI)的新型药物中的明星产品。其作用基于的观念为，抑郁症是由一种名叫血清素的神经递质不足引起的。只要能提高这种脑化学物质的浓度，好啦，精神一下子就振奋起来了。事实上，已经有成百上千万人接受了百忧解，并对它的作用深信不疑。抑郁症导致他们情感麻痹，他们说。而今，他们终于可以清楚地思考并热情地拥抱生活了——多年来，这样的感觉还是第一次。

Pharmacological merits aside, the green-and-cream pill was also a marvel of commercial branding, down to its market-tested name. Its chemical name is fluoxetine hydrochloride, not the most felicitous of terms. A company called Interbrand went to work for Eli Lilly and came up with Prozac. "Pro" sounds positive. Professional, too. "Ac"? That could signify action. As for the Z, it suggests a certain strength, perhaps with a faint high-techy quality.
除去其药理学价值，这种半截绿色半截奶油色的胶囊丸也堪称商业品牌推广中的奇迹，而这尤其要感谢它经过市场考验的商品名。它的化学名称为盐酸氟西汀，这显然不够朗朗上口。一家名为Interbrand的公司为礼来出谋划策，想出了Prozac这个名字。"Pro"听起来就给人胸有成竹、十分专业(professional)的感觉。"Ac"呢，可以认为它表示“行动”(action)。至于Z，这个字母代表了某种力量，可能还有一点点高科技的感觉。

(X is a pharmacological cousin to Z. Both letters are somewhat unusual, worth many points in Scrabble. It is surely not a coincidence that a striking number of modern medications contain either Z or X, or both, in their names, like Luvox, Paxil, Celexa, Effexor, Zantac, Xanax, Zoloft, Lexapro and Zocor, to name but a few. Not surprisingly, confusion can set in. Zantac or Xanax — remind me which one is for heartburn and which for panic disorder?)
（在制药领域，X与Z的地位近似。这两个字母在取名这种拼字游戏中享有异乎寻常的地位和价值。绝大多数现代药物的商品名都包含Z或X，或两者兼而有之。随便举几个例子，Luvox[兰释，亦称无郁宁]、Paxil[百可舒]、Celexa[喜普妙]、Effexor[郁复伸]、Zantac[善胃得]、Xanax[赞安诺]、Zoloft[左洛复]、Lexapro[来士普]和Zocor[舒降之]等等。这肯定不是用巧合可以解释的。由此产生困扰也就不足为奇了。Zantac和Xanax，哪个能治胃灼热，哪个又是用以治疗惊恐障碍的？看名字可真分不清。）

Pendulums, by definition, swing, and the one on which Prozac rides is no exception. After the early talk about it as a wonder pill — a rather chic one at that — a backlash developed, perhaps unsurprisingly. Grave questions arose among some psychiatrists about whether the S.S.R.I.s increased chances that some people, notably teenagers, would commit suicide or at least contemplate it. No definite link was confirmed, but that did not end the concern of some prominent skeptics, like a British psychiatrist, Dr. David Healy. He has dismissed the notion of S.S.R.I.s as saviors as "bio-babble."
但凡事都是三十年河东三十年河西，百忧解也不例外。起初它被尊为灵丹妙药，还是种十分时髦的灵丹妙药，后来人们却又开始强烈地抵制它（或许这种反应不足为奇）。关于SSRI是否会增加某些人，特别是青少年的自杀事件或自杀倾向，精神科医生提出了严厉的质问。目前尚无研究证实两者之间存在必然的关联，但是这并没有打消某些著名的怀疑论者的疑虑，英国的精神病学家戴维·希利博士(David Healy)正是其中之一。他将那些把SSRI类药物当成救世主的说法贬斥为“生物噪音”。

If some users deem Prozac lifesaving, others consider it sensory-depriving. A loss of libido is a common side effect. Some writers and artists, while often relieved to be liberated from depression's tightest grip, also say that Prozac leaves them mentally hazy. In his 2012 book, "Antifragile: Things That Gain From Disorder," Nassim Nicholas Taleb offered this: "Had Prozac been available last century, Baudelaire's ‘spleen,' Edgar Allan Poe's moods, the poetry of Sylvia Plath, the lamentations of so many other poets, everything with a soul would have been silenced."
有人觉得百忧解可以救命，其他使用者则认为它剥夺了人正常的生理感觉。百忧解的一个常见的副作用是丧失性欲。还有一些作家和艺术家声称，虽然百忧解将他们从抑郁症的魔爪之下解脱了出来，却也让他们精神恍惚。纳齐姆·尼古拉斯·塔利布(Nassim Nicholas Taleb)在他2012年的著作《反脆弱：从无序中受益》("Antifragile: Things That Gain From Disorder")中提出：“如果百忧解早在上个世纪就问世的话，那么波德莱尔(Baudelaire)的“忧郁”、埃德加·爱伦·坡(Edgar Allan Poe)的浪漫主义情怀、西尔维亚·普拉斯(Sylvia Plath)的诗歌、以及那么多其他诗人的哀叹，所有那些有灵魂的作品都将遭到扼杀。”

Then, too, S.S.R.I. critics express doubts that these drugs have proved themselves significantly more effective than placebos. Some among them question the very concept that serotonin levels, on their own, cause depression or prevent it. One psychotherapist in that camp is Gary Greenberg, an author of several books on mood disorders. Writing in The New Yorker last year, Dr. Greenberg said that scientists had "concluded that serotonin was only a finger pointing at one's mood — that the causes of depression and the effects of the drugs were far more complex than the chemical-imbalance theory implied."
此外，SSRI的批判者们还怀疑这些药物的效果是否显著优于安慰剂。其中一些人质疑单凭血清素水平是否就足以导致或防止抑郁症。心理治疗师加里·格林伯格(Gary Greenberg)就属于这一阵营，他撰写过若干本关于情绪障碍的著作。在去年的《纽约客》(The New Yorker)上，格林伯格博士写道：科学家们认为，“血清素只是影响个人情绪的一个因素，抑郁症的成因以及药物的效应远比化学失衡理论所描述的更加复杂。”